Talking Sleep – An AASM Podcast

Listen to Talking Sleep, a podcast of the American Academy of Sleep Medicine (AASM), for insightful discussions about the latest developments in the practice of clinical sleep medicine. Season five is now playing, and you can listen to the archived episodes from past seasons. Be sure to subscribe through your favorite podcast platform so you never miss a new episode.

We’d love to hear from you! Send your feedback and suggestions for Talking Sleep topics and guests to podcast@aasm.org.

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Season Seven

Episode 1:

Understanding Residual AHI: What Sleep Doctors Need to Know

Welcome to Season Seven of Talking Sleep! In this episode, host Dr. Seema Khosla examines a crucial clinical question: how reliable is the residual AHI measured by PAP devices? Experts Dr. Robert Thomas, Dr. Tavi Ioachimescu, and Dr. Imran Iftikhar analyze the accuracy of PAP downloads, brand differences in measurement, and implications for patient care. Through meta-analysis findings and clinical research, they explore stable versus unstable breathing patterns and how this data influences treatment decisions.

The discussion covers device-specific algorithms, historical development of AHI measurement, and the role of patient monitoring software like OSCAR and SleepHQ. Learn about therapeutic approaches for unstable breathing, including medication options and practical management strategies for complex sleep apnea cases. (50:56) Listen now

Episode 2:

Sleep Apnea Detection: Inside the Apple Watch Algorithm

In this episode, host Dr. Seema Khosla explores the new Apple Watch sleep apnea screening algorithm with Dr. Matt Bianchi, a research scientist from Apple’s Health Technologies team. Learn about the innovative technology that monitors sleep patterns and potentially identifies sleep apnea risk through advanced wearable device capabilities.

Discover how this algorithm uses accelerometry and breathing disturbance detection to screen for potential sleep apnea, its limitations, and implications for patient care. The conversation delves into the algorithm’s performance, its role in consumer health technology, and guidance for sleep medicine professionals navigating new diagnostic tools. Whether you’re a clinician or interested in sleep health technology, this episode offers critical insights into the future of sleep disorder screening. (36:44) Listen now

Episode 3:

KPAP: Exploring a Novel PAP Therapy Approach

In this episode, host Dr. Seema Khosla explores KPAP, a groundbreaking PAP therapy innovation with Dr. David White, former AASM president, and Dr. William Noah, inventor of the V-com device. Learn about this new technology that promises to make positive airway pressure more comfortable and potentially more effective for sleep apnea patients.

Discover the science behind KPAP, its potential advantages over traditional CPAP, and how it addresses issues like treatment-emergent central apneas and CO2 rebreathing. The discussion covers the device’s development, clinical trial results, and implications for sleep apnea treatment, offering insights for clinicians and patients alike. (44:24) Listen Now

Episode 4:

Defining Well Treated Obstructive Sleep Apnea

In this episode, host Dr. Seema Khosla tackles a critical question in sleep medicine: What defines “well-treated” obstructive sleep apnea? Joined by Dr. Barry Krakow, a pioneering sleep medicine physician, the discussion explores the nuanced approach to assessing sleep apnea treatment beyond traditional metrics.

Discover insights into clinical endpoints for evaluating OSA treatment, the complex relationship between upper airway collapsibility and anxiety, and innovative strategies for patients with challenging sleep disorders. Dr. Krakow shares his unique perspectives on PAP therapy, including approaches for patients with PTSD and the potential role of behavioral interventions. (45:44) Listen Now

Episode 5:

Too Much of a Good Thing? Benefits of Lower Pap Settings

In this episode, host Dr. Seema Khosla explores a provocative question in sleep medicine: Could high pressure PAP therapy have unexpected inflammatory effects? Joined by Dr. Sanja Jelic from Columbia University and Dr. Daniel Gottlieb from Brigham and Women’s Hospital, the discussion examines emerging research that challenges conventional wisdom about positive airway pressure (PAP) therapy.

Discover groundbreaking findings on how PAP settings may influence inflammatory biomarkers like angiopoietin-2 (AP2) and VEGF-A, potentially explaining why cardiovascular outcomes in clinical trials haven’t consistently shown improvement with PAP therapy. Learn about pressure optimization strategies, alternatives to high-pressure PAP therapy, and implications for treating obstructive sleep apnea (OSA) in non-sleepy patients versus those with daytime sleepiness. (42:11) Listen Now

Episode 6:

Tirzepatide & OSA: Implementation for Sleep Clinics

In this episode, host Dr. Seema Khosla explores a transformative development in sleep medicine: the FDA approval of tirzepatide for obstructive sleep apnea (OSA). Joined by an expert panel including Dr. Atul Malhotra, lead investigator of the SURMOUNT-OSA trial, and specialists Dr. Radhika Breaden, Dr. Jeremy McConnell, and Dr. Rafael Sepulveda-Acosta, the discussion examines how sleep clinicians can effectively incorporate this groundbreaking medication into their treatment protocols.

Discover key insights about the SURMOUNT-OSA trial results published in the New England Journal of Medicine, including the mechanisms behind AHI improvement beyond weight reduction alone. Learn practical implementation strategies for private practices, including documentation requirements for insurance approval, necessary baseline labs, and optimal patient follow-up protocols. The experts address crucial questions about Medicare coverage, long-term medication management, the need for retesting at goal weight, and considerations for transitioning patients already using GLP-1 medications like Ozempic or Wegovy.

This episode provides essential guidance for sleep medicine specialists considering expanding their treatment options beyond traditional PAP therapy, including collaborations with obesity medicine clinics and whether obtaining board certification in Obesity Medicine would benefit sleep clinicians. This timely discussion equips practitioners with the knowledge to navigate the intersection of sleep medicine and obesity treatment in managing OSA patients. (47:27) Listen Now

Episode 7:

Decoding Women’s Sleep Health Across the Lifespan

In this episode, Dr. Seema Khosla talks with women’s sleep expert Dr. Safia Khan about women’s unique sleep challenges. Dr. Khan is an editor for A Clinical Casebook of Sleep Disorders in Women and specializes in women’s sleep health at UT Southwestern. She explains how sleep disorders affect women differently across their lives, particularly during pregnancy and menopause, and how these transitions disrupt normal sleep patterns.

Discover Dr. Khan’s assessment strategies for insomnia in women, including decision-making frameworks for implementing CBT-I versus medication interventions. Learn about the underdiagnosis of sleep disorders in women, particularly during menopause, and strategies for changing this normalized narrative. The conversation explores the physiological differences in sleep-disordered breathing between men and women, explaining why sleep apnea incidence equalizes during menopause.

The discussion addresses managing hypersomnia during pregnancy, approaches to fatigue without diagnosed sleep disorders, connections between PCOS and sleep disruption, and guidance on Restless Legs Syndrome management, including the critical role of iron deficiency screening in adolescent girls.

This episode provides essential knowledge for practitioners seeking to better understand and treat the unique sleep health challenges women face across their lifespans. Listen Now

Season Six

Welcome to Season Six of Talking Sleep! We are starting the new year by examining that time in our lives when we welcome new lives into the world. We often think about pregnancy as a joyful time. But, for too many women in the U.S., pregnancy leads to significant morbidity and mortality. Our U.S. 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 out of 5 pregnancy-related deaths in the U.S. are preventable. Dr. Ghada Bourjeily is here to show us how maternal mortality intersects with sleep medicine. (47:47) Listen now

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. (41:40) Listen now

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 (47:26) Listen now

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. (34:10) Listen now

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. (55:15) Listen now

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. (42:19) Listen now

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. (39:00) Listen now

We know that there are a billion people in the world with undiagnosed obstructive sleep apnea (OSA) and that it simply isn’t practical to have every person undergo a sleep study. Are there other methods that might be more efficient identifying those at the highest risk of OSA? Laura Castillo is a chemist who has studied biological matrices to identify biomarkers for obstructive sleep apnea. Her research involves analyzing sweat and she has found that there are specific markers for those with severe OSA and those without any OSA. Dr. David Gozal has been working in this field for many years and has published extensively. He has also studied urine proteomics as a method to identify sleep disordered breathing in children. (43:13) Listen now

The world of sleep medicine has had several large recent disruptions with COVID-19 and the Philips Respironics recall. These haven’t been the only ones. If we look back almost a decade, sleep medicine was disrupted by the SERVE-HF results and field safety notice for ResMed ASV devices. Another trial was conducted around the same time as SERVE-HF but utilized Philips ASV devices. Those results have now been published and provide some insight into the use of peak-flow-triggered ASV for those with an ejection fraction of 45% or below. Dr. Douglas Bradley is here to share his results and to offer his thoughts on the use of ASV. (37:07) Listen now

After nearly three years, the Department of Justice and the Food and Drug Administration have finally agreed to the terms of a consent decree with Philips. It states that Philips Respironics cannot manufacture or distribute new sleep and respiratory care devices in the U.S. market until certain criteria are met, unless the devices are classified by the FDA as “medically necessary.” The scope of the recall is far larger than just consumer PAP devices. This impacts sleep diagnostics – including Alice polysomnography systems, home sleep apnea test platforms, and in-lab titration devices. Here to help us understand the specifics of the consent decree are Drs. Peter Gay, Aneesa Das, and Robert Owens. (53:34) Listen now

Despite having more treatment options than ever before, narcolepsy remains significantly underdiagnosed. Is there a potential clue on the polysomnogram (PSG) that we are overlooking? Dr. Alyssa Cairns and her team are exploring the biophysiological phenotypes of sleep disorders, specifically central disorders of hypersomnolence. She discussed how she combed through half-a-million sleep records and looked at the predictive value of a sleep-onset REM period (SOREMP) on PSG for a future diagnosis of narcolepsy. (49:43) Listen now

The Actiwatch is a popular actigraphy device that is no longer sold or supported by Philips. Its discontinuation coincided with the launch of the AASM’s “Act on Actigraphy” campaign, which highlights the importance of actigraphy testing for sleep disorders and urges payers to reimburse health care professionals for this medical service. Dr. Paul Raymond, vice chair of the AASM Coding and Reimbursement Advisory Committee, discusses reimbursement for actigraphy, its clinical use, and current and future options for device selection. (30:53) Listen now

Remote patient monitoring codes have been active for a number of years. These have largely been used to monitor blood glucose levels via a continuous glucose monitor or to adjust heart failure medications via a connected digital scale. Dr. Charles Bae and Dr. Gabriela de Bruin discuss whether sleep medicine professionals should also use remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) codes in the sleep clinic. (40:18) Listen now

As technology continues to permeate every aspect of our lives, the subset of sleep-related technology continues to expand. The AASM Emerging Technology committee continues to assess both clinical and consumer sleep technology. We have previously discussed consumer and clinical sleep technology that largely centered around snoring and OSA. In this episode, we talk with committee members Drs. Shalini Paruthi and Sachin Shah about the latest sleep technology for insomnia. (40:36) Listen now

There are currently 40 states with legalized medical marijuana. Twenty-four of these also have legalized recreational marijuana. Many people report using cannabis to help them to initiate and maintain sleep. Is there any data to support this? Is cannabis safer than prescription sleep aids? What should we know about cannabis and sleep? Dr. Bhanu Prakash Kolla discusses the impact of cannabis on sleep and its potential use to treat sleep disorders. (30:20) Listen now

Excessive daytime sleepiness is a significant problem for many people who have obstructive sleep apnea (OSA), and persistent sleepiness occurs in some patients despite effective treatment of OSA. Dr. Kingman Strohl and Dr. Lucas Donovan discuss this common clinical scenario, provide tips for the evaluation of persistent sleepiness, and talk about the wake-promoting medications that are available as treatment options. (54:46) Listen now

AI is popping up everywhere — when we open a PDF, use an AI scribe, or look something up with Chat GPT. We all interface with AI daily and may not even realize it. This can become very complex and somewhat mysterious. How can we use AI in a sleep medicine practice? Is it trustworthy? Will we all be replaced by AI someday? The AASM has an AI committee tasked with these questions. In this episode, we talk with committee members Dr. Margarita Oks and Matt Anastasi about a SWOT analysis on the use of AI-enabled technology in sleep medicine. (50:01) Listen now

We have long known about the bi-directional relationship between anxiety and insomnia, and traditionally we’ve been taught that treating anxiety will treat insomnia. Since that time, more data have emerged on the importance of treating insomnia in the context of anxiety. Dr. Leisha Cuddihy, Dr. Sara Nowakowski, and Dr. Michael Grandner discuss how they have noticed a pattern of anxiety about insomnia that doesn’t always respond to traditional cognitive behavioral therapy for insomnia (CBT-I) and other behavioral interventions. (50:28) Listen now

Dr. Richard Blackburn is a sleep psychologist who is attempting to improve access to cognitive behavioral therapy for insomnia (CBT-I) and other behavioral therapies for sleep disorders. He has a psychologist training program as well as a telemedicine practice, and he hopes to increase the availability of sleep behavioral therapy by increasing the pipeline and expanding access via telemedicine. He explains his model and discusses other behavioral interventions to consider for patients with sleep disorders. (53:29) Listen now

The AASM is introducing a new service-based accreditation model and updated Standards for Accreditation, which will take effect in January 2025. Based on feedback from members and accredited programs, this accreditation model provides greater flexibility to accommodate all practice types, making it easier to manage, add, and remove accredited services. Changes to the Standards for Accreditation were also made to remove barriers and promote administrative and operational efficiencies in sleep practice management. In this episode, AASM Accreditation Committee Chair Dr. Fady Jamous and AASM Director of Accreditation Ray Anthonijsz help explain some upcoming changes to AASM accreditation programs. (46:52) Listen now

There was a recent consensus statement from the Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology on the screening, diagnosis, and treatment of obstructive sleep apnea (OSA) in pregnancy. For too many, a sleep evaluation is deferred until the pregnancy is over, with the idea that pregnancy-related sleep disorders will resolve at the end of the pregnancy. This leaves so many with sleep disorders undiagnosed and untreated. Dr. Louise O’Brien has tried to bridge this gap. She works in the Division of Sleep Medicine in the Department of Neurology, as well as the Division of Maternal and Fetal Medicine in the Department of Obstetrics and Gynecology at the University of Michigan. She is here to share her experience locally, but also globally when it comes to sleep health during pregnancy. (45:43) Listen now

In this episode of Talking Sleep, Drs. John Winkelman and Andy Berkowski discuss the updated AASM clinical practice guideline for the treatment of restless legs syndrome and periodic limb movement disorder. (54:40) Listen now

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Danny J. Eckert, PhD, a sleep and respiratory physiologist and professor at Flinders University in Adelaide, Australia. As the director of the Adelaide Institute for Sleep Health, he discusses his groundbreaking work on OSA endotyping and the PALM classification system (Pcrit, Arousal threshold, Loop gain, and Muscle recovery). Dr. Eckert is a leading expert in his field and the recipient of the 2023 European Respiratory Society Gold Medal in Sleep-Disordered Breathing.

Discover why 70% of OSA patients have non-anatomical causes and how understanding these distinct endotypes can revolutionize treatment approaches. The conversation delves into practical applications for clinical settings, examining the roles of obesity and nasal obstruction in sleep apnea while discussing targeted therapeutic strategies, including GABAergic medications. (42:05) Listen Now

In this episode, host Dr. Seema Khosla welcomes Dr. Maya Schenker, a postdoctoral researcher from the University of Melbourne, who has dedicated her research to understanding the complex relationship between sleep and post-traumatic stress disorder (PTSD). With a focus on the bidirectional mechanisms linking sleep and trauma, Dr. Schenker explores how sleep can be a critical intervention point for managing and potentially preventing PTSD.

Discover the latest insights into how sleep impacts trauma response, including the role of REM sleep, fear conditioning, and the neurological processes that contribute to PTSD development. The conversation delves into why women are more susceptible to PTSD, the potential of sleep interventions, and breakthrough research on preventing trauma-related sleep disorders. Whether you’re a healthcare professional or interested in understanding the intricate connections between sleep and mental health, this episode offers valuable perspectives on trauma, sleep, and healing. (31:01) Listen Now

Season Five

Welcome to Season Five of Talking Sleep! In this 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. (45:27) Listen now

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. (43:06) Listen now

The AASM recently released a new clinical practice guideline that provides recommendations for the management of 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. (38:11) Listen now

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. (34:17) Listen now

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. (20:05) Listen now

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. (42:46) Listen now

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. (31:22) Listen now

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. (32:37) Listen now

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. (37:20) Listen now

Dr. Jean-Louis Pépin and Dr. Atul Malhotra 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. (28:55) Listen now

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. (35:29) Listen now

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. (48:01) Listen now

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. (44:56) Listen now

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. (46:27) Listen now

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. (42:26) Listen now

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. (36:25) Listen now

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. (37:57) Listen now

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. (47:54) Listen now

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. (33:12) Listen now

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. (46:02) Listen now

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. (37:21) Listen now

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. (34:09) Listen now

The AASM released an update to The AASM Manual for the Scoring of Sleep and Associated Events earlier this year. Some of the changes were minor and others more significant. Adhering to the AASM Scoring Manual is required for AASM 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 Scoring Manual Version 3. (32:07) Listen now

Season Four

Welcome to Season Four of Talking Sleep! In this episode we talk with Dr. Susan Redline about the American Heart Association’s recent scientific statement on the relationship between obstructive sleep apnea and heart disease and the need to collaborate with cardiologists to improve the diagnosis and treatment of OSA. Dr. Redline also gives a sneak peak of her SLEEP 2022 keynote address. Listen now.

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. Listen now.

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. Listen now.

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. Listen now.

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. Listen now.

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. Listen now.

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. Listen now.

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! Listen now.

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. Listen now.

In this episode, 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.  Listen now.

In this episode of Talking Sleep, we visit with Drs. Donna Arand and 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. Listen now.

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. Listen now.

In this 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. Listen now.

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. Listen now.

Welcome to the 50th episode of Talking Sleep! Today, 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. Listen now.

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. Listen now.

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. 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. Listen now.

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 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. Listen now.

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. Listen now.

Season Three

Join us for a conversation with Journal of Clinical Sleep Medicine Editor-in-Chief Dr. Nancy Collop on the 15th anniversary of the journal. A special anniversary collection highlights some of the most significant original research articles published in JCSM along with new commentaries from today’s experts on the lasting impact of the research. Review the complete collection and listen as Drs. Collop and Khosla discuss some of the papers and how they have impacted the practice of sleep medicine.

Telemedicine is changing the way sleep medicine is taught and practiced. In this episode, we talk with Dr. Barry Fields, a sleep physician at the Atlanta VA Health System and member of the AASM Telemedicine Presidential Committee. He shares AASM telemedicine resources and offers guidance on how to make the most of telemedicine in the clinic and the classroom.

In this episode, we explore how sleep modulates the immune system, affecting our ability to ward off infections and develop antibodies. Our guest is Dr. Aric Prather, a clinical health psychologist and associate professor of psychiatry at the University of California San Francisco, who has done extensive research on the relationship between sleep and immunity.

Cognitive behavioral therapy should be the first course of treatment in adults with chronic insomnia, according to a recently published AASM clinical practice guideline. This episode features Dr. Jennifer Martin, a clinical psychologist and co-author of the guideline, discussing the effectiveness of CBT-I, and why both physicians and patients should be aware that it’s an option. She also talks about the challenges of sleep during the pandemic, why melatonin isn’t the answer, and why consumer wearables may do more harm than good.

In this episode of Talking Sleep, we sit down with Loretta Colvin, APRN, to learn more about the role of advanced practice providers in the sleep medicine practice, how APPs collaborate with physicians to provide patient care, and how to incorporate these valuable team members into a practice to expand services and improve access to care.

Consumer-oriented sleep trackers are increasing in popularity and provide an opportunity to educate users about the importance of healthy sleep, says Dr. Logan Schneider, co-director of the Stanford/VA Alzheimer’s Research Center and a tech consultant. In this episode, Dr. Schneider discusses the benefits of sleep tech to consumers and clinicians and his involvement in developing Google’s new sleep tracking device.

From AI-assisted scoring to personalized sleep treatments, artificial intelligence has incredible potential in sleep medicine. In this episode, we talk to AASM AI committee members Dr. Anuja Bandyopadhyay and Sam Rusk to learn more about current and future applications of AI, the value to patients and plans for an AASM certification program to validate and standardize AI scoring software.

The apnea-hypopnea index is one of the most debated measures of the severity of obstructive sleep apnea. In this episode we talk with Drs. Daniel Gottlieb and Douglas Kirsch about a new research statement from the Sleep Research Society that explores the strengths and weaknesses of the AHI and considers other measures to determine OSA risk and treatment options.

Improving health outcomes and health systems requires new ways of thinking. In this episode, we talk with Dr. Azizi Seixas, an assistant professor in the Departments of Population Health and Psychiatry at NYU Langone and chair of the recent AASM Sleep Medicine Disruptors meeting, about leveraging disruption to be more efficient, develop new solutions and better engage with and care for people in our communities.

Obstructive sleep apnea affects 40-50% of children with Down syndrome; however, access to care, diagnosis, and treatment of OSA presents many challenges. In this episode, we talk with Dr. Ignacio Tapia, a pediatric sleep specialist whose research aims to increase access to sleep care for special needs’ patients, leverage home sleep apnea tests and improve PAP adherence through programs benefiting patients and their families.

In this episode, we review the CPAP technology assessment draft report released by the Agency for Healthcare Research and Quality and the AASM-led response. Our guest Dr. Susheel Patil highlights key findings of the report, where the Academy and its partners think it falls short, and how it could ultimately move the field forward by setting the stage for future research priorities.

Sleep medicine is a diverse profession and the AASM strives to be representative and inclusive of all backgrounds and perspectives. In this episode, we talk with Dr. Andrew Spector, chair of the AASM’s Diversity, Equity and Inclusion Committee, about the Academy’s efforts to identify and eliminate barriers to inclusion, support initiatives for better diversity, and work to reduce health care disparities.

In this episode, we review the recently released AASM clinical practice guideline for treatment of central disorders of hypersomnolence. We talk with Dr. Kiran Maski, chair of the AASM task force that developed the guideline, about the data-driven treatment recommendations as well as future research directions, the challenges of diagnosing hypersomnias, and the potential of sleep biomarkers.

With increased use of telemedicine, how reliable are video evaluations for obstructive sleep apnea? Today’s guest, Dr. Michael Yurcheshen, recently published a study in the Journal of Clinical Sleep Medicine comparing telemedicine to in-person assessments for sleep-disordered breathing. He discusses his findings, shares tips on how to conduct the best video exam and explores how telemedicine can be leveraged in the future.

The AASM’s inaugural Change Agents competition brought together teams from all areas of sleep medicine to think about innovative and creative ways to reimagine the diagnosis and treatment of obstructive sleep apnea. In today’s episode, we talk to the leader of the winning team, Dr. Amy Bender, about the proposal, “Let’s Put the Sleep Back into Sleep Medicine,” which recommends measuring sleep depth to predict CPAP adherence and offer more personalized sleep apnea treatment.

A clinical sleep health educator can help bridge the gaps between patients and providers, leading to improved diagnosis and treatment of sleep disorders and better coordination among the health care team. In today’s episode, we’ll learn about the Certification in Clinical Sleep Health credential with Andrea Ramberg, RPSGT, CCSH, president-elect of the Board of Registered Polysomnographic Technologists.

In this episode, we talk with Dr. Scott Kutscher, sleep fellowship director at Stanford and a member of the AASM’s Sleep Medicine Fellowship Directors Council. He discusses the Choose Sleep initiative to increase the knowledge and awareness of a career in sleep medicine, how sleep fellowship programs have responded and adapted to the pandemic, and a move for sleep medicine’s Match Day.

Are you overwhelmed by the constantly changing landscape of sleep technologies? Having trouble keeping up with your patient’s latest sleep tracker? The AASM Emerging Technology Committee is here to help. In this episode, we talk with committee members Drs. Maryann Deak, Sharon Schutte-Rodin and Ambrose Chiang about AASM resources to evaluate sleep-related clinical and consumer devices to help further your understanding of #SleepTechnology.

A new clinical practice guideline from the AASM advises when surgical consultation may be appropriate for patients struggling to use CPAP to treat their obstructive sleep apnea. In this episode, we talk with two of the guideline authors, Drs. David Kent and Jeff Stanley, both otolaryngologists and sleep specialists, about the recommendations for surgical consultation and how they can empower patients to make the best decision for their care.

New evidence-based principles co-published by the AASM and SRS are designed to help employers take a holistic view of setting work shift durations to positively impact employee health, safety, and productivity by reducing mental and physical fatigue. Lead author Dr. Indira Gurubhagavatula joins us to explain the guiding principles and how they can be used to develop effective, customized solutions for shift duration.

We wrap up season 3 of Talking Sleep with a discussion of the economic impact of sleep disorders. In a study recently published in the Journal of Clinical Sleep Medicine, Drs. Phil Huyett and Neil Bhattacharyya crunch the numbers to estimate the health care costs of diagnosing and treating sleep disorders and associated complications. We talk to them about their findings and the implications.

Season Two

In our season 2 debut, we talk with Dr. Nita Shattuck, professor at the Naval Postgraduate School and leader of the NPS Crew Endurance Team, which promotes sleep as a key element to naval readiness. Dr. Shattuck’s Virtual SLEEP 2020 presentation on sleep-related challenges in the military was one of the meeting’s most popular lectures. In this episode of Talking Sleep, Dr. Shattuck shares how evidence and data led to broad changes in naval policy.

Updated in early 2020, the AASM Manual for the Scoring of Sleep and Associated Events is the definitive resource for the evaluation of sleep tests. In this episode of Talking Sleep, our correspondent Dr. Robert Vorona talks with Drs. Richard Berry and Stuart Quan of the AASM Scoring Manual Committee for insight into some of the changes.

The AIRE program is a new approach to offering fellowships in sleep medicine using a competency-based curriculum and uniform evaluation tools. In this episode of Talking Sleep, we discuss the AIRE program with several guests, including program directors and fellows. Participants in the AIRE fellowship can complete their sleep training as part of a blended or part-time program, with the goal of increasing the number of sleep specialists.

Energy conservation and candy consumption are just two reasons the U.S. has implemented or extended daylight saving time. But evidence shows the twice-yearly time change has detrimental effects on our health and safety, especially when we “spring forward.” In this episode of Talking Sleep, we talk with Dr. M. Adeel Rishi, vice-chair of the AASM Public Safety Committee and lead author of the Academy’s position statement calling for the elimination of daylight saving time to learn why “falling back” to permanent standard time is best for optimal health.

Race and place have far-reaching consequences for sleep health. In this episode of Talking Sleep, Dr. Dayna Johnson, a sleep epidemiologist at Emory University, explains her research into the social and environmental factors that contribute to sleep health disparities as well as the disproportionate impact of COVID-19 on minorities. She also discusses how the sleep medicine community can take action to improve health equity, raise awareness of sleep benefits and improve access to care.

This episode of Talking Sleep features Dr. Rami Khayat, a leading research into central sleep apnea. Dr. Khayat discusses the challenges in scoring, diagnosing and treating CSA and why it’s important to test for it in heart failure patients. He also describes a current clinical trial studying the impact of low-flow oxygen on patients with CSA and heart failure.

In the year’s final episode of Talking Sleep, Dr. Asha Singh of the AASM Coding and Compliance Committee highlights changes to evaluation and management codes coming in 2021. Providers and office staff need to be aware of the updates, which include options to bill based on total time or medical decision-making. AASM members also can view this free E/M coding webinar for more information.

Season One

In the debut episode of Talking Sleep, we sit down with Dr. Chris Winter, a sleep physician in Charlottesville, Virginia, to discuss how the coronavirus pandemic is impacting his practice and what it could mean for the future of sleep medicine.

We’ll talk with Dr. John Winkelman, chief of the Sleep Disorders Clinical Research Program in the Department of Psychiatry at Massachusetts General Hospital and an expert in the epidemiology, physiology, cardiovascular consequences and treatment of restless legs syndrome.

Dr. Lisa Wolfe, a nationally recognized authority in non-invasive mechanical ventilation discusses the pros and cons of empiric and in-lab bilevel titration therapy.

Is there evidence that medical marijuana is an effective treatment for obstructive sleep apnea? Find out when we talk to Dr. Bhanu Kolla, an addiction psychiatrist and sleep physician who studies the interaction between sleep disturbances and addictive disorders.

In this episode of Talking Sleep we dig deep with Dr. Frances Chung, one of the authors of a landmark study examining the relationship between undiagnosed OSA and cardiovascular complications after non-cardiac surgery. Dr. Chung is a professor of anesthesiology and pain medicine at the University of Toronto and developer of the STOP-BANG questionnaire.

The pandemic has disrupted sleep and school schedules for children. In this episode, we talk with pediatric sleep specialist Dr. Dominic Gault about managing kids and sleep in the current environment and preparing for the return to school, whether it’s in-person or remote learning.

We’re encountering many patients who are having trouble sleeping during the pandemic. In this episode of Talking Sleep, we discuss some of the causes and treatments for insomnia. Psychologist Dr. Barbara McCann uses a variety of techniques to help her patients address their restless nights.

Dr. Seema Khosla sitting down.

Our Host

Seema Khosla, MD, is board certified in internal medicine, pulmonary disease, critical care medicine, and sleep medicine. She works in Fargo, North Dakota, where she is the medical director of the North Dakota Center for Sleep.

Dr. Khosla is chair of the AASM Public Awareness Advisory Committee. She previously served on the AASM Task Force on Sleep Telemedicine, which developed a position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders, and chaired the AASM Consumer and Clinical Technology Committee, which developed a position statement on the use of consumer sleep technology in clinical practice. Dr. Khosla also was co-chair of the AASM Sleep Medicine Trends course.

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