The sleep department of the University Hospital of Toulouse receives 24 patients a week at Pierre-Paul Riquet. For the most part, these are serious pathologies, with insufficient quality and quality of sleep for at least 3 months and consequences during the day. This results in tests that can sometimes lead to the withdrawal of the driver’s license.
It’s not always easy to be on time in the morning when getting up is complicated. But this week, Bertrand (1) showed up at the sleep ward of Pierre-Paul Riquet Hospital at 8:30 sharp, in a hurry to overcome the last obstacle that separated him from his return to work. Today’s exam is a maintenance test.
Véronique, nurse at the University Hospital of Toulouse since 1991, welcomes her with a smile. She takes an anamnesis, in particular notes that there is a syndrome of restless legs. And soon presents him with the comfortable chair in which he will have to spend four times 40 minutes until 5 p.m. Objectively, to gauge his vigilance once the room’s blackout curtain is all the way down.
To do this, she needs to install 17 electrodes. Two are placed on either side of the eyebrows to measure eye movements. Sensors have also been installed on his skull and chin, while an abdominal belt goes around his chest. The cables connected to the repeater make Bertrand look like a porcupine, who doesn’t seem stressed.
Dr. Rachel Debs in a room testing patients’ sleep.
Véronique checks if everything works. And here we go for the first three electrooculograms, electroencephalograms, and electromyograms of the day. A night vision camera focuses its round, cold eye on Bertrand, who doesn’t look at her once. He is already busy fighting the drowsiness that overtakes him. The proof, the eye movements that were relatively fast for the first few minutes, are slowing down. The muscles in his face relax. Immediate result, the coil waves – hitherto narrowed – draw more and more waves on the screen, a sign of the first delta waves. At the very bottom of the screen, no sign of snoring. But after 18 minutes, Bertrand switches to theta rhythm.
“He fell asleep,” translates Véronique, gesturing to Dr. Rachel Debs. “He struggles, he opens his eyes every now and then. But he is sleepy. You’ll have to see him,” the nurse slips to the head of the ward. It’s hard to be in the oven and in the mill when you’re the only doctor on duty. But Rachel promises to find a moment in the afternoon. We must first check whether the other three tests of the day confirm the impression of the first or not.
A medico-legal problem
Twenty-two minutes later, Véronique returns to the room, opens the blackout curtain and asks Bertrand about his impressions. “I dozed off, but I wasn’t asleep.” Surprise when Véronique tells him otherwise. “And if you were on a bike, what would happen,” asks the nurse, as so often to patients who deny. “I’d fall,” replies the sheepish Bertrand, not unhappy to be rescued from the machine.
Dr. Rachel Debs under screens monitoring patients during tests.
He takes advantage of the break to stretch his legs and smoke a cigarette, which may help him to resist better during the second trial. Like a number of patients in his case, he might as well be declared unfit to drive if the tests are not good. “There is a medico-legal problem with driving, for specific sleep pathologies such as narcolepsy, idiopathic hypersomnia or Klein-Levin syndrome,” explains Dr. Debs.
Bertrand may not be here yet. But with her DU “sleep technician”, Véronique still plans to send messages of good practice to the patients she accompanies for several hours during these day hospitalizations. “Sleep isn’t just about rest. People who work at night often suffer from weight problems and a weakened immune system.”
Therefore, unless there is a serious genetic problem, it is better to listen to it in order to sleep well.
Attention for children who also suffer from sleeping problems
Of the five beds in the sleeping unit of the Pierre-Paul Riquet hospital, two are regularly occupied by children under the age of five. “The youngest patient we received at 6 weeks,” says Dr. Rachel Debs, the head of the department, who works in connection with pediatric endocrinology. “They send us obese children for whom we look for sleep apnea.”
Here too, a Covid effect was noticed in toddlers. There is a before and an after health crisis. “We had children who weighed up to 20 kg during the first delivery. It is complicated, because it is the translation of a malaise and it accentuates vulnerabilities.” The care of children was done punctually by the University Hospital of Toulouse in Rangueil, “but it was especially developed when we arrived at the Purpan site, Dr. Debs specifies. The problem in children was previously little addressed”.
And it got worse with the evolution of society. “In 90% of cases, insomnia problems arise because people do not slow down their brain activity before going to sleep. They do not change their behavior, so the brain does not go into automatic mode. His attention is often taken by the screens. The films are later in the evening when they start. But in fact, if you’re a heavy sleeper and you need to sleep 9 to 10 hours, it doesn’t fit in the allotted time relative to the supposed wake-up time.”