Jean-Arthur MICOULAUD FRANCHI is a psychiatrist, neurophysiologist and sleep doctor. He works as a Associate Professor (research, teaching and clinical practice position) in the functional exploration of the nervous system service of the Sleep Clinic at Bordeaux Hospital. He works on the links between neurophysiological biomarkers and symptomatic aspects in neuropsychiatric disorders. He also studies the epistemological conditions delimiting the “normal” from the “pathological” in medicine and the role of physiology in such a process.
« Normal » sleep is an essential physiological function that maintains optimal homeostatic regulation in the human body. After Claude Bernard and his teacher François Magendie introduce physiological sciences, the study of body function was capital to predict, treat and cure pathologies in a unified way. Physiology is the condition of a true scientific medicine. But can we delimit normal and pathology in sleep medicine from the physiological perspective only? How a “normal sleep” can be distinguished from a pathological one? This presentation aims to bring the keys to answer these questions. We will show that more than neurophysiological alterations, somnological complaints contribute the most to the classification of sleep disorders. Moreover, the notion of etiology need to be rethought since the distinction between primary form (such as primary insomnia disorder) and secondary one (for instance, secondary insomnia related to a depressive disorder) does not stand in these classifications. Thus, this presentation will allow to rethink the notions of syndrome and clinical form, which are relevant from a physiological, prognostic or therapeutic point of view, the notion of comorbidity (associated or not), and finally the idea of a transversal approach, considering key components of clinical reasoning in somnology. Finally, we will emphasize the importance of sleep-related paraclinical examinations such as electro-clinical ones whose results have to be confronted with the clinic, which alone cannot lead to a diagnosis of sleep disorder. When confronted with clinical semiology, contexts and comorbidities, these examinations provide specific hints regarding the sleep physiology (independent from the notion of normal and pathological) to diagnose “pathological” sleep disorders.
American Academy of Sleep Medicine, Société Française de Recherche et Médecine du Sommeil. Classification Internationale des Pathologies du Sommeil, 3ème version2014.
Association of Sleep Disorders Centers, Association for the Psychophysiological Study of Sleep. Diagnostic classification of sleep and arousal disorders. Sleep 1979;2:1-154.
Micoulaud Franchi JA, Amad A, Geoffroy PA, et al. Les complaintes du carabin. Modèle pour un raisonnement clinique pratique. Annales Medico Psychologiques 2016;174:703-13.
Micoulaud Franchi JA, Dumas G, Quiles C, et al. De la clinique au « terrain fétide et palpitant de la vie » : une mise en perspective psychiatrique de la physiologie clinique. Annales Medico Psychologiques 2017;175:70-85.