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The vast field of sleep medicine is always evolving. Listen to Talking Sleep, a podcast of the American Academy of Sleep Medicine (AASM), to keep up on the latest developments in clinical sleep medicine and sleep disorders. Our host, Dr. Seema Khosla, medical director of the North Dakota Center for Sleep in Fargo, will take an in-depth look at issues impacting the diagnosis and treatment of sleep disorders. Episodes will feature conversations with clinicians, researchers, sleep team members ...
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In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Jared Saletin, a sleep researcher investigating the complex relationship between sleep and Attention-Deficit/Hyperactivity Disorder (ADHD). While ADHD diagnostic criteria don't currently include sleep assessment, Dr. Saletin's groundbreaking research reveals how sleep quality and …
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In this episode, Dr. Seema Khosla examines the complexities of central sleep apnea (CSA) with sleep medicine experts Dr. Vaishnavi Kundel, Dr. Rami N. Khayat, and Dr. Aneesa Das. The discussion moves beyond basic definitions to explore the critical limitations of home sleep apnea testing in accurately detecting CSA and when in-lab polysomnography b…
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In this episode, Dr. Seema Khosla explores the critical issue of clinician burnout with Dr. Venktesh Ramnath, Associate Clinical Professor at UC San Diego. Moving beyond typical wellness advice, Dr. Ramnath offers practical strategies for addressing burnout at its systemic roots rather than treating it as an individual failure. The conversation exa…
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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 dur…
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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-Aco…
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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 ab…
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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 endp…
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In this episode, host Dr. Seema Khosla explores KPAP, a new 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 while still remaining effective for sleep apnea patients. Discover the sci…
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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 …
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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 …
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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 …
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In this episode, host Dr. Seema Khosla welcomes Dr. Danny J. Eckert, a sleep and respiratory physiologist and professor at Flinders University in Adelaide, Australia. Dr. Eckert is a leading expert in his field and the recipient of the 2023 European Respiratory Society Gold Medal in Sleep-Disordered Breathing. As the Director of the Adelaide Instit…
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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 sl…
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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 servi…
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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 …
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We have long known about the bi-directional relationship between anxiety and insomnia. When I was a fellow, we were taught that treating the anxiety would treat the insomnia. Since that time, more data has emerged on the importance of treating insomnia. More recently, our guests have noticed a pattern of anxiety about insomnia that doesn’t always r…
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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 committ…
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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 t…
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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 Pra…
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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 e…
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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 phys…
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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 Ra…
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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 s…
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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…
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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 bu…
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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? Dr. Laura Castillo is a chemist who has studied biological matrices to i…
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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 d…
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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 …
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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 modalit…
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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 complication…
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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 o…
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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 polyso…
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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,…
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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 fr…
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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 sle…
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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 formular…
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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 interes…
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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 accli…
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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 requ…
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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 contr…
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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…
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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…
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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.…
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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-…
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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. …
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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 implicati…
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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…
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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. Her…
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