Talking Sleep

There are a handful of direct-to-consumer devices that claim to improve the quality of our sleep by using acoustic stimulation. What is the science behind these devices? Dr. Roneil Malkani is an associate professor of neurology in the Feinberg School of Medicine at Northwestern University. He collaborates with others to study acoustic stimulation during sleep and its impact on sleep architecture. He describes how these devices work and how clinicians should approach them.

While CPAP devices are similar across manufacturers, there are more significant differences in the advanced modalities of ventilatory support. Dr. Lisa Wolfe is well known for her granular knowledge of mechanical ventilation, including noninvasive ventilation (NIV). She discusses some aspects of NIV that may become pertinent as both sleep labs and patients transition off devices recalled by Philips Respironics. She also addresses concerns related to patients who have complex conditions such as chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome, and neuromuscular disease.

We know that CBT-I is the gold standard treatment for insomnia, but it remains inaccessible for many due to cost or the limited availability of trained professionals. For patients with comorbid mental health disorders, insomnia treatment may improve their sleep and mental health, but sleep restriction therapy may not be the most appropriate modality. Dr. Chris Bojrab is a psychiatrist who has embraced sleep care as a vehicle to improve the mental health of his patients, and he has expertise in neurotransmitters. He discusses pharmacologic treatment of insomnia and some important considerations in those with mental health disorders.

While sleep disorders are associated with numerous health complications, one area that doesn’t receive much attention is the impact of sleep and sleep disorders on those with sickle cell anemia. A study published in Sleep and Breathing found that children with sickle cell disease and comorbid obstructive sleep apnea had 47% more health complications than those with sickle cell disease who had a lower risk for OSA due to negative OSA screenings or exams. These complications seemed to be related to nocturnal hypoxia. Pain from a sickle crisis also can lead to sleep fragmentation. Dr. Sonal Malhotra discusses the many ways in which she tries to optimize sleep for her patients with sickle cell anemia.

Johns Hopkins colleagues Dr. Rachel Salas and Dr. Sara Benjamin discuss the basics of treating restless legs syndrome (RLS), focusing on an updated algorithm published in the Mayo Clinic Proceedings in 2021 by the Scientific and Medical Advisory Board of the Restless Legs Syndrome Foundation. Topics of discussion include pharmacological treatment options, the risk of augmentation, potential impulsivity, and non-pharmacologic treatments.

We routinely see patients with dementia in our sleep clinics but often do not meet them until they present with a sleep complaint such as insomnia or obstructive sleep apnea. We know that sleep and dementia have a bidirectional relationship. Is there a way to identify those who are at higher risk of dementia and intervene earlier? Is there a polysomnographic fingerprint? Should polysomnography be performed in those who are felt to be at higher risk of dementia? How can we, as sleep clinicians, potentially impact the course of dementia? Are there special considerations for our patients who have dementia and a comorbid sleep disorder? Dr. Brendan Lucey help us explore these issues further.

We wanted to start the new year by examining that time in our lives when we welcome new lives into this world. We often think about pregnancy as a joyful time. But, for too many women in the US, pregnancy leads to significant morbidity and mortality. Our US maternal mortality rate increased from 20.1 per 100,000 live births in 2019 to 32.9 per 100,000 live births in 2021. For black women, this was 69.9 deaths per 100,000 live births. The causes are severe bleeding, infections, and preeclampsia/eclampsia. The CDC indicates that 4/5 pregnancy-related deaths in the US are preventable. Dr. Ghada Bourjeily is here to show us how maternal mortality intersects with sleep medicine.

The AASM released an update to the scoring manual earlier this year. Some of the changes were minor and others more significant. Adhering to the AASM scoring manual is a mandate of accreditation. Dr. Matt Troester, Dr. Alcibiades Rodriguez and Dr. Rich Berry are here to review these changes and highlight the most clinically pertinent information from the latest iteration of the scoring manual version 3.

We have seen data associating attention-deficit/hyperactivity disorder with sleep disorders, and many experts believe that a sleep assessment should be performed routinely in these patients. Is it all about insufficient sleep and sleep patterns? Or are there polysomnographic differences that may identify those who are at risk for ADHD? Can poor sleep in early childhood predict a diagnosis of ADHD in adolescence? Dr. Jessica Lunsford-Avery shares her research in this field and helps us understand the relationship between childhood sleep and adolescent ADHD.

In the last few years, more medications have been available to treat central disorders of hypersomnolence. While treatments for narcolepsy and idiopathic hypersomnia are similar, there are some specific considerations when trying to determine which combination of medications is most appropriate for a patient. Significant payor coverage and formulary variability add another layer to this conversation. Some are considered off-label and others are on-label but may be cost-prohibitive. Dr. Hrayr Attarian explains some of the nuances of these newer medications, how they perform for specific symptoms, and how to consider tailoring medication regimens with shared decision-making.

Drowsy driving accidents are just one of the many ways in which health care can interface with the legal system. Our guest for this episode is Dr. Ramesh Sachdeva, a sleep medicine and pediatric critical care physician who decided to go to law school several years ago and has previously served as an adjunct professor of law. He has a unique interest in the intersection of medicine, healthcare quality, and law and is here today to help us explore potential legal issues that can arise in a sleep medicine practice. Please note that this is not legal advice. This discussion is for educational purposes only and should not be relied upon as legal advice or legal opinion.

We have long known that CPAP therapy isn’t meant for everyone who has obstructive sleep apnea. There are plenty of non-PAP treatment options, including oral appliance therapy and hypoglossal nerve stimulation. Pharmacotherapy has been used as an adjunct therapy to treat persistent hypersomnolence despite well-treated OSA or to assist with PAP acclimatization. Now medications are being developed to treat OSA and its underlying obstruction. Here to help us understand more about these medications is Dr. Sanjay Patel.

Obesity hypoventilation syndrome can be challenging to manage. Obtaining the appropriate device for each patient is often complicated by insurance requirements and endless red tape. Previous guidelines have indicated that CPAP may be as effective as bi-level PAP; however, this doesn’t apply to all patients. How can we identify patients who may require more advanced treatment modalities while also ensuring that those treatments do not cause undue financial burden for them? Here to help us understand this better is Dr. Babak Mokhlesi.

We frequently discuss how insufficient sleep may be harmful to cardiometabolic health, but is this the whole story? How does circadian rhythm misalignment contribute to this relationship? Could a behavioral sleep intervention possibly improve cardiometabolic health? Dr. Chris Depner investigates how insufficient sleep and circadian disruption contribute to the risk of metabolic disorders such as obesity and diabetes. His long-term goal is to develop sleep and circadian-based interventions that improve metabolic health. He is here to help us better understand the relationship between insufficient sleep, circadian disruption, and cardiometabolic health.

As students go back to school, many adolescents will have to advance their sleep phase in order to start classes early in the morning. While delayed sleep phase syndrome is common during adolescence, insomnia symptomatology may be underrecognized. It may be attributed to excessive screen time, social jet lag, or too much caffeine. We try to provide education around proper sleep hygiene techniques and often deploy cognitive behavioral therapy for insomnia, which was developed for adults. Are there other special considerations for adolescents? Does it make sense to utilize CBT-I in this age group? Is it appropriate to utilize sleep restriction therapy for teenagers? Should we adapt our current CBT-I algorithms to better suit the adolescent population? Here to help us answer these questions are Dr. Maureen Elizabeth McQuillan and Dr. Sarah Morsbach Honaker.

We have long known that obesity is a risk factor for OSA, but most sleep clinicians don’t manage obesity. Is this something we should consider? How complicated is it? How should we navigate insurance hurdles? Do we need to employ a dietician? Is managing obesity feasible for a typical sleep medicine practice? Here to explore this further on today's episode of Talking Sleep is Dr. Rafael Sepulveda.

The practice of sleep medicine is extremely diverse. While there are many who are a part of academic institutions, others have chosen private practice. One option that is becoming more popular is a direct-to-consumer, self-pay model. Here to give us a better understanding of some of these practice models are Dr. Sahil Chopra and Dr. Andy Berkowski.

In this episode of Talking Sleep our guest, Dr. Alon Avidan, helps us better understand the ethics of disclosure in REM sleep behavior disorder. A big part of this disorder's overall management includes disclosing potential neurodegenerative sequelae. While prescribing medications can be fairly straightforward, the discussion of a potentially life-altering diagnosis is more nuanced. It requires not only the explanation of Lewy Body dementia or Parkinson’s but also the ability to assess what a patient needs to hear and when it is appropriate to disclose this information.

As sleep technology continues to advance, we are sometimes left to try to figure out which billing code to use. There are level 2 studies that have a g-code and some novel HSAT devices that are creating new metrics that don’t always fit into a current CPT code. Navigating this can be tricky. Here to help us understand how a CPT code is made is Dr. Vikas Jain.

A few years ago, the AASM held a competition challenging us to reimagine sleep care. The Mobile Sleep Lab was a model that was submitted as a contender in this challenge. Here to tell us more about this are Dr. Mark Boulos, Dr. Luqi Chi and Dr. Oleg Chernyshev.

In today’s episode of Talking Sleep, we are joined by Dr. Jean-Louis Pépin and Dr. Atul Malhotra, who talk about how the signal derived from mandibular jaw movements during sleep can be an alternative measurement of respiratory effort in patients being evaluated for suspected sleep apnea. We will focus on the scientific basis and clinical implications of this new signal.

In today’s episode of Talking Sleep, Dr. Raj Dedhia joins us to talk about hypoglossal nerve stimulation, which was first approved by the FDA in 2014 to treat a subset of patients with moderate to severe obstructive sleep apnea. Now, nearly a decade later, the treatment has evolved, and we have a better understanding of its nuances. Visualizing the airway during sleep endoscopy is a key element in patient selection; however, Dr. Dedhia explains that there are other ways to predict treatment success.

Obstructive sleep apnea is regularly linked to the posterior oropharynx and the tongue, but its relationship with the nose is often overlooked. Recent research suggests that the assessment of the nose plays an important role in the physiology of sleep. Nasal obstruction is common in sleep apnea and contributes greatly to the development of OSA. Here to talk to us about the role of the nose in OSA is Dr. Jolie Chang.

Recent evidence and data has highlighted important associations between obstructive sleep apnea and the microbiome. Here to help us learn more about how sleep and the gut microbiome impact our heath is Dr. Andrew Goldberg.

The sleep field is intertwined with technological advances. Innovative devices are being developed every day, some of which are crossing over into the clinical realm. In this episode of Talking Sleep, Dr. Scott Ryals and Dr. Steven Holfinger describe how some novel home sleep apnea test devices work and explain how clinicians should approach them.

It's that time of year again when we spring forward and set our clocks ahead one hour. Whether we should continue to change our clocks twice per year is an ongoing topic of debate, and legislation has been introduced in the U.S. Senate and House of Representatives to make daylight saving time permanent. Here to give more insight on the science of clock change and discuss the debate over daylight saving time and standard time is Dr. Karin Johnson.

An article was published in the ERJ demonstrating that CBT for Insomnia reduced the severity of obstructive sleep apnea. Our guest, Dr. Alexander Sweetman, is here to tell us more.

The AASM recently released a new clinical practice guideline which provides necessary recommendations for adults with REM Sleep Behavior disorder. The guideline provides clinicians with insight on how best to prevent sleep-related injury and how to provide patients with a risk assessment for neurological disease. Here to tell us more about this is Dr. Michael Howell.

In today’s episode of Talking Sleep, we talk about the importance of patient communication. Dr. Rebecca Robbins and Dr. Suzanne Bertisch of Harvard Medical School and Brigham and Women’s Hospital share their insights into existing patient education materials for obstructive sleep apnea and offer tips on how to make it easier to understand. Listen now.

In today’s episode of Talking Sleep our guest, Dr. Emmanuel Mignot, talks with us about sleep age and the importance of the EEG collected during polysomnography. As the interest in sleep grows, more attention is being paid to how sleep is related to morbidity and mortality. While there is much discussion about obstructive sleep apnea and cardiovascular health, the EEG may also hold clues about our future health.

In today’s episode of Talking Sleep, we discuss how insufficient sleep and other factors are negatively impacting college students’ health. Our guest, Dr. Shelley Hershner, is an associate professor of neurology at the University of Michigan. Through her research, she has found that there are certain populations of students, such as transgender students, who may be at higher risk of sleep disorders. She is here today to help us understand the significance of this issue and how we can better serve our college students.

In today’s episode of Talking Sleep, we discuss sleep technologist education. Our guests Karen Rowe, Debbie Guerrero and Dr. Brad Vaughn, who are part of the CoA PSG program, talk about the increasing demand for sleep technologist across the country and explain the pathway to becoming a certified sleep tech.

In today’s episode of Talking Sleep, we discuss the use of melatonin in both children and adults. Our guests Dr. Abby Strang and Dr. Gautam Ganguly, talk about the AASM’s recent health advisory for the appropriate use of melatonin in children and the importance of understanding how melatonin works. Listen now

In today’s episode of Talking Sleep, we discuss the complexities of central sleep apnea. Our guest, Dr. Safwan Badr, describes the multiple pathways that can cause different forms of central sleep apnea and how the disorder is more similar to obstructive sleep apnea than we think.

In today’s episode of Talking Sleep, we discuss safe and effective CPAP use in pediatric patients with obstructive sleep apnea. Drs. Louella Amos and Robin Lloyd join us to share information about the AASM’s recent position statement on age and weight requirements for PAP therapy in pediatric patients and the importance of appropriate management of younger, smaller children.

Today’s episode of Talking Sleep explores the “Mind After Midnight” hypothesis. Dr. Andrew Tubbs, a researcher in the department of psychiatry at the University of Arizona, explains sleep and circadian mechanisms that lead to a disproportionately increased risk of suicide between 2 and 3 a.m. The discussion may be troubling to some listeners. If you or someone you know is at risk for suicide, call 988 to reach the Suicide and Crisis Lifeline.

In today’s episode of Talking Sleep, we’re sitting down with Dr. Andrew Varga to discuss links between obstructive sleep apnea and neurodegenerative diseases. Dr. Varga is part of a research team from Mount Sinai that recently published findings showing just one night without using CPAP can increase the presence of biomarkers associated with Alzheimer’s disease.

In this episode of Talking Sleep, we highlight what to expect if your sleep practice is selected for a Medicare audit. AASM Coding and Compliance Committee Vice Chair Dr. Gabriela de Bruin discusses what auditors are often looking for, how to be prepared for an audit, the benefits of implementing a compliance program, and AASM resources available to help you.

In today’s episode of Talking Sleep, we look at sleep-related movement disorders. Dr. Afifa Uzzaman discusses when movements during sleep are incidental and when they are cause for concern. She also discusses common sleep-related movements in patients with Parkinson’s disease and post-traumatic stress disorder.

This episode of Talking Sleep focuses on sleep in women and highlights the role that gender plays in the diagnosis of sleep disorders. Dr. Andrea Matsumura, who focuses her practice on women, discusses how sleep is different in women throughout their lives and the various ways in which sleep disorders present in women. She also talks about the need for more research on sleep in women.

In this episode of Talking Sleep, we visit with Dr. Donna Arand and Dr. David Davila, members of the AASM task force that recently updated protocols for the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). The guidance provides detailed information on patient management, testing procedures, and reporting to ensure the tests provide high-quality, consistent data.

In the latest episode of Talking Sleep, we’re visiting with Raj Mills, a medical device engineer at Sleep Number. She talks about the technology behind smart beds, what they measure, how they compare to polysomnography, and how they might alert a sleeper that they’re getting sick

In this episode, we discuss the goals of the National Institutes of Health’s Sleep Research Plan with National Center on Sleep Disorders Research Director Dr. Marishka Brown. Learn more about how the plan is aimed at advancing sleep and circadian research to promote public health.

Get a sneak peek of the sessions and events taking place at SLEEP 2022, the 36th annual meeting of the Associated Professional Sleep Societies. Today’s guest is Dr. Shalini Paruthi, chair of the APSS Program Committee, and she’s excited to welcome everyone back to an in-person SLEEP meeting, June 4-8 in Charlotte, North Carolina. Register by Sunday, April 24 for early bird rates!

Researchers continue to explore links between sleep and cancer. In this episode, we talk with Dr. Jaspal Singh, medical director of pulmonary oncology at Atrium Health in Charlotte, North Carolina, to learn more about the role of sleep in cancer treatment and recovery. He describes associations between sleep and higher incidences of cancer in shift workers and flight personnel, and urges the sleep community to partner with their oncology colleagues to help cancer patients explore potential sleep problems.

Not all patients with obstructive sleep apnea experience daytime sleepiness. In this episode of Talking Sleep, we talk with researcher and clinician Dr. Allan Pack about phenotyping OSA patients to understand the differences in patient clusters based on physiology, symptoms, clinical presentations, and other factors. Phenotyping patients ultimately will allow clinicians to offer more personalized treatment.

As we prepare to “spring forward” an hour this Sunday, members of Congress are discussing the need to continue biannual time changes. In this episode of Talking Sleep, Dr. Erin Flynn-Evans, a circadian physiologist, explains why standard time puts our social, sun, and body clocks in the best alignment and supports overall health and safety.

Patients recovering from COVID or other critical illnesses often face additional health challenges after their hospitalization. In this episode of Talking Sleep, we talk to Dr. Carla Sevin, director of the ICU Recovery Center at Vanderbilt University, about the physical, cognitive and psychological issues, including sleep disturbances, that can trouble patients long after their initial illness.

As the 2022 Winter Olympics take place, we wondered, how do these elite athletes manage their sleep and adjust to travel across multiple time zones? We asked Dr. Jeff Durmer, a neuroscientist and sleep specialist who serves as the sleep performance director for the U.S. Olympic weightlifting team. Learn how he educates athletes about the importance of sleep duration, timing, and quality to help them feel and perform their best.

The pandemic has prompted many sleep physicians to consider alternate ways of testing for sleep apnea, and that’s led to greater use of home sleep apnea tests. But are HSATs effective in testing for children? In this episode, we talk with Dr. Shannon Sullivan, a pediatric sleep specialist, about developments in home sleep apnea testing for kids and adolescents.