Talking Sleep

Latest Episodes:

Zolpidem and the Glymphatic System Jul 11, 2025

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In this episode of Talking Sleep, host Dr. Seema Khosla sits down with Dr. Natalie Hauglund to discuss a groundbreaking mouse study on how the popular sleep medication zolpidem affects the brain’s natural cleaning system during sleep.

Building on Dr. Maiken Nedergard's award-winning work on the glymphatic system, Dr. Hauglund's latest study published in Nature reveals surprising findings about how sleep medications may interfere with the brain's ability to clear waste products. Through innovative mouse studies using advanced imaging techniques, her research demonstrates that zolpidem reduces glymphatic clearance by 30%, raising important questions about long-term cognitive health.

The conversation explores fascinating discoveries about micro arousals during sleep—are these brief awakenings actually beneficial for brain clearance rather than disruptive? Dr. Hauglund explains the delicate balance between sleep quality and the brain's cleaning mechanisms, and how different neurotransmitters orchestrate these crucial overnight processes.

This episode addresses critical clinical questions: Should we reconsider our prescribing practices for sleep medications? How do we weigh the benefits of medicated sleep against potential impacts on brain health? What are the implications for patients using zolpidem long-term, particularly regarding neurodegenerative disease risk?

Whether you're a sleep medicine practitioner, researcher, or interested in understanding how sleep affects brain health, this episode provides essential insights into the complex relationship between sleep medications and neurological well-being.

Join us for this thought-provoking discussion that may reshape how we think about treating insomnia and protecting long-term brain health.

Teledentistry Jun 27, 2025

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In this episode of Talking Sleep, Drs. Michelle Cantwell and Aaron Glick discuss the updated American Academy of Dental Sleep Medicine (AADSM) Standards for Practice.

Dr. Michelle Cantwell received her DMD through the University of Pittsburgh's School of Dental Medicine, where she also completed a three-year residency in prosthodontics. Following dental school, she served as a lieutenant commander in the US Navy. She is a diplomate of the ABDSM and the president-elect of the AADSM. She works in the pulmonary and sleep medicine department of WellSpan Health.

Aaron Glick, DDS, FAGD, FICOI, D.ABDSM, is a dentist who has committed his practice to dental sleep medicine. He has been recognized as a “Top 10 Dentist to Watch” and works clinically utilizing teledentistry for efficient patient care. Dr. Glick educates fellow practitioners as the Mastery Program Director at the American Academy of Dental Sleep Medicine, focusing on mandibular advancement devices. Additionally, he is on the faculty at the University of Texas Health Science Center at Houston School of Dentistry. He actively lectures nationally and publishes on obstructive sleep apnea and technology. He enjoys all technologies and has a medical device and software programming background

Exploring the Connection Between Sleep and ADHD May 16, 2025

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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 timing may significantly impact attention, particularly in children. Through fMRI studies and clinical observations, he explores whether sleep loss exacerbates ADHD symptoms or might even present as ADHD-like behavior in some cases.

The conversation delves into fascinating questions: Are people with ADHD more sensitive to sleep deprivation? Can improving sleep habits reduce ADHD symptoms? How do common sleep disorders like obstructive sleep apnea intersect with attention disorders? Dr. Saletin shares practical strategies for protecting sleep in children with attention challenges, including potential educational accommodations.

Whether you're a healthcare provider, parent, educator, or simply interested in understanding the sleep-attention connection, this episode offers valuable insights into how addressing sleep might be a crucial component in managing ADHD effectively.

Join us for this enlightening discussion as we explore how sleep might be a modifiable risk factor in ADHD, providing new hope for better management strategies.

Central Sleep Apnea: Expert Insights & Treatment Priorities May 02, 2025

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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 becomes essential. The conversation addresses important clinical distinctions between post-arousal, transitional, and mixed apneas, challenging common assumptions about their significance and treatment approaches. The panel provides clarity on various CSA etiologies, including heart failure-related periodic breathing, medication-induced central apneas, treatment-emergent CSA, and neurological disorders. Discover evidence-based perspectives on treatment strategies, including updated views on adaptive servo-ventilation since the SERVE-HF trial, indications for phrenic nerve stimulation, and the potential of combination therapies. Learn when to consider alternative approaches like dead-space ventilation, supplemental oxygen, and acetazolamide, either alone or as part of hybrid treatment plans. The discussion also examines practical clinical questions: Does distinguishing between obstructive and central apnea matter if treatment approaches overlap? When should patients with suspected CSA undergo in-lab studies versus home testing? What guidance should clinicians follow for patients with ejection fractions below 45%? Whether you're managing complex sleep disorders or encountering CSA in primary care, this episode provides essential insights for optimizing patient outcomes through accurate diagnosis and appropriate treatment selection.

Real World Strategies for Clinician Burnout Apr 18, 2025

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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 examines how to recognize true burnout versus temporary fatigue and challenges the common rhetoric about "resilience" that shifts responsibility from broken systems to individuals. Dr. Ramnath shares his personal burnout experience and discusses whether dramatic career changes are necessary before making meaningful improvements to professional satisfaction.

Discover actionable steps for reducing burnout, including negotiating with leadership, establishing horizontal professional networks, and eliminating low-value work. Learn how coding efficiency relates to burnout and understand the emerging role of "health architects" in creating sustainable medical workplaces.

The discussion also addresses Dr. Ramnath's public response to demands for federal employee productivity reporting, techniques for constructive workplace conversations, and practical advice for saying "no" effectively—a crucial skill rarely taught in medical training. Whether considering a job change or trying to improve a current position, this episode provides essential guidance for creating a more sustainable medical career.

Decoding Women's Sleep Health Across the Lifespan Apr 04, 2025

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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 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.

Tirzepatide & OSA: Implementation for Sleep Clinics Mar 21, 2025

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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-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

Too Much of a Good Thing? Benefits of Lower Pap Settings Mar 07, 2025

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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 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

Defining Well Treated Obstructive Sleep Apnea Feb 21, 2025

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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 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.

KPAP: Exploring a Novel PAP Therapy Approach Feb 07, 2025

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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 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.

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