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Your opinion on sleep impacted by Covid-19?
Because of the change in people’s schedules because they’re not working, they’re at home, you know, sleep patterns of course have changed and they are because of it, besides the fact that they don’t go to work and sleep late and get up late, they don’t set alarms because they don’t have to rush to the office.
Other than that, I think the stress of the financial burden they might have to face, the stress of their family’s well-being, the stress of this fear of not getting Covid-19, all of those things have changed the world. quality and quantity of sleep in people. Another factor would be that by staying at home, those who drink may have increased the amount of alcohol because there is not much to do. The stress again financial burdens made them take more alcohol. Alcohol can put them to sleep, but the quality of sleep is not good, so the sleep always gets fragmented and ultimately leads to, you know, the aftereffects of anxiety, fear, of not being fresh the next morning, not to be physically fit, headaches and so on.
Impact on sleep medicine?
Sleep medicine has of course taken a hard hit because of this pandemic, as such emergency services and Covid services were carried out in most hospitals. The normal routine work had been stopped and sleep medicine was a subspecialty, which was most affected mainly because I think these patients snore and snoring produces a lot of aerosols, so the aerosol can transmit the coronavirus.
All the tests, all the sleep studies that were taking place in hospitals were stopped because it is a closed room, soundproof rooms, the labs, so it all took a bit of trouble because of the covid pandemic, so we had to stop working for a while for the peak of this covid-19 pandemic.
Co-morbidities and risk factor from an ENT point of view?
You see, the comorbidities in themselves would be, I would say primarily obesity. Obesity is the mother of all the other comorbidities, be it diabetes, hypertension, cardiovascular disease, everything. I would say the heart of the basic problem is obesity, which leads to all of these problems over and over again. Apart from these comorbidities, I think the decrease in the immunity level of the patients, again I would say maybe due to stress, maybe due to lack of sleep or inadequate sleep again led to decreased levels of immunity, which were, and the covid virus being so virulent that patients who had associated uncontrolled diabetes, patients who had taken steroids, especially high doses of steroids, more late in the second phase, the second wave of Covid developed an entity called mucormycosis which is an invasive fungal disease has also been shown to be quite morbid and fatal. From an ENT point of view, I think this is one of the most significant comorbidities we have seen during this Covid pandemic.
How do you see the increase in mucormycosis during the second wave?
Mucormycosis is not something that was new to us as ENT surgeons. Being a tertiary care referral center that I work in, so we were seeing around 40-45 mucosal yeast patients a year previously as well, but during this second wave of Covid the numbers were just huge. You know there has been so much mucormycosis all around and from my clinical experience I would say the two most important factors have been hyperglycemia which is uncontrolled diabetes and steroids given for the treatment of Covid, stated, not stated we won’t go into that, but, you know, large doses of steroids are given. So these two factors are the most important thing and the most, I would say the things scientifically proven at present which has led to such increase of mucormycosis in India.
From an ENT surgeon’s point of view, of course, it has to be, you know, you have to detect it as soon as possible and you have to start the treatment again as soon as possible and as soon as possible, I would say immediate we have to take, the sooner we start treatment, the better the prognosis because as such it is a very debilitating disease. It is a very morbid condition. Thus, the diagnosis and initiation of medical treatment and the most urgent surgical treatment combined with medical treatment would help us to increase the prognosis or improve the prognosis of this disease.
With the Covid in decline, how do you see the reopening of the sleep lab?
So now with the decline of covid as the number of covid patients decreases day by day, so we reopened our sleep lab, we started doing our sleep studies and you know, we even started doing our drug-induced sleep endoscopies in our operating rooms to find out the level of obstruction in patients who have been referred, such as those who have had CPAP therapy failure, medical management, or no ‘had not tolerated the medical management, which did not, which did not improve even after lifestyle changes and weight loss and everything, so for all these patients we started doing our drug-induced sleep endoscopy and we also operated on a patient or two so I’m seeing my sleep practice slowly and slowly picking up.
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