Explore every episode of the podcast Talking Sleep

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.

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.

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.

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 respond to traditional CBT-I and behavioral intervention. Here today to explore this further are Dr. Leisha Cuddihy, Dr. Sara Nowakowski, and Dr. Michael Grandner. 

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.