comes to insomnia , and Dr . Perez-Guerra considers this a reasonable course of action — as long as the patient doesn ’ t delay too long .
“ As a general rule ,” he says , “ by the time they come to us they have had insomnia for several weeks , several months or , not infrequently , several years .” The team aims to identify the underlying cause and treat it appropriately . Treatments might include medications or cognitive behavioral therapy that is designed to minimize as much as possible the use of sleeping pills . While sleeping pills are useful and sometimes necessary , the team ’ s goal is to develop the best treatment plan for each patient .
Recruiting more staff To serve the influx of patients , Dr . Boethel expects to increase the size of the staff from 13 to about 20 . Besides adding sleep lab technicians , he plans to bring other specialists to the center as well . Like Dr . Boethel , most of the institute ’ s original physicians were pulmonologists . While Dr . Boethel believes the pulmonologists do an excellent job treating sleep apnea , he thinks that specialists from other areas of medicine could bring new insights to treating the whole range of sleep disorders , including insomnia , narcolepsy , restless legs syndrome and parasomnia , a disorder that involves abnormal movement during sleep .
“ Sleep medicine is multifaceted and there are multiple specialties that treat the various sleep disorders ,” Dr . Boethel says . This year the institute added Michael Abene , MD , a psychiatrist , and Patricia Ritch , MD , PhD , a pediatric neurologist . Psychiatrists are involved in caring for patients with insomnia . Because mood
Dr . Francisco Perez-Guerra and Dr . Carl D . Boethel in the monitoring room at the new Sleep Institute .
disorders such as anxiety and depression can be affected by poor sleep , their role is vital . “ In the long term we ’ re looking at developing a multidisciplinary , multispecialty sleep practice here that will not be based just on pulmonary disease .”
The institute will train new generations of sleep doctors by adding a postdoctoral fellowship position in sleep disorders .
Sleep research is a priority Another goal is to extend the institute ’ s ability to do research . “ It is the intention of Scott & White in general , and our division in particular , to increase our research efforts ,” says Dr . Perez-Guerra . “ We always kept up with the research that was going on in the world — still do — but now it ’ s our turn to start doing some of our own .”
Dr . Boethel says that one of his colleagues , Shirley Fong Jones , MD , a physician specializing in pulmonary , critical care and sleep medicine , is studying circadian rhythm disorders — malfunctions in a person ’ s “ brain clock ”— among patients who are in intensive care units . This research study , currently under way at Scott & White , has already received national recognition and is one of a kind .
Drs . Boethel and Perez-Guerra expect that Dr . Jones , who joined Scott & White in 2006 , will become the center ’ s main researcher .
“ We ’ re developing a budding area of research ,” says Dr . Boethel . “ This is an area of medicine that very little is known about , and it ’ s not always on the radar screen for most primary care doctors and for most people .” Rounding out the rest of the team are pulmonologists Peter Yau , MD , Christopher D . Spradley , MD and Nurse Practitioner Kim English . As Dr . Perez- Guerra contemplates retirement next year , he is pleased with the direction and mission of the institute that he founded . “ It is not just a place for sleep apnea ,” he says . “ We are capable of evaluating any known sleep-related disorder , and we are certainly interested in learning more about those that have not been discovered yet .” ■
Dr . Boethel also is an assistant professor of internal medicine , Texas A & M Health Science Center College of Medicine .
Dr . Perez-Guerra also is a professor of medicine , Texas A & M Health Science Center College of Medicine . sw . org | Fall 09 THE CATALYST 15