Talking Sleep

Patient Advocacy in Sleep Medicine Sep 11, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes three patient advocates who are reshaping how sleep medicine is practiced and funded. Matt Horsnell, living with two sleep disorders and active as an author and panelist; Emma Cooksey, a patient-advocate and host of the Sleep Apnea Stories podcast; and Julie Flygare, a lawyer, author, and founder of Project Sleep, share their transformative advocacy work.

While clinicians often think of advocacy as writing letters or making donations, these three demonstrate that patient advocacy encompasses far more complexity and impact. They explain the multiple dimensions of advocacy work: legislative advocacy that influences policy and funding, educational advocacy that raises awareness and understanding, and research advocacy that shapes the scientific agenda.

The conversation begins with personal stories—what brought each advocate to this work and how living with sleep disorders motivated their commitment to systemic change. Matt shares insights as someone navigating two sleep conditions, while Emma and Julie discuss how legal training informed their approaches to advocacy and systems change.

Legislative advocacy receives detailed exploration. The guests explain how patient voices influence congressional action, regulatory decisions, and funding priorities. They discuss educational advocacy—raising public awareness, changing misconceptions, and helping people recognize sleep disorders they might otherwise dismiss or normalize.

Project Sleep, Julie's organization, serves as a centerpiece for discussion. While Project Sleep doesn't fund research directly, the conversation addresses which organizations do fund sleep medicine research and how clinicians and patients can access federal funding mechanisms. The guests provide insights into how disease-specific organizations like Wake-up Narcolepsy secure funding and the lessons applicable to sleep medicine more broadly.

Project Sleep's helpline receives attention—what it offers, who it serves, and the critical challenge of sustainability when grant funding ends. The guests discuss Rising Voices, an initiative amplifying patient narratives and lived experience in policy and clinical discussions.

A particularly valuable discussion addresses how clinicians can meaningfully engage with patient advocacy. Is this space exclusively for people living with sleep disorders, or can healthcare providers contribute? The conversation explores collaboration opportunities without appropriating patient voices or experiences.

The guests address practical questions: How do you sustain advocacy work without becoming discouraged? What does advocacy look like at local versus federal levels? What's on the wish list for sleep medicine advocacy? A recurring theme emerges: sustained funding remains elusive despite growing recognition of sleep disorders' impact on public health.

The episode acknowledges that patients bring irreplaceable perspectives to clinical practice, research prioritization, and policy development. Their lived experience of navigating diagnoses, treatments, and healthcare systems provides insights clinicians cannot access through clinical practice alone.

Whether you're interested in supporting patient-led advocacy, seeking to collaborate with patient organizations, curious about how to engage in legislative efforts, or simply wanting to understand the power of patient voices in healthcare transformation, this episode provides essential perspectives and practical guidance.

Join us for this important conversation with patient advocates who are leading meaningful change in sleep medicine.

Episode Correction: During the audio recording, federal funding for circadian research was misspoken as $60 Million. The correct amount is $600 Million.

Project Sleep Links

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Residual AHI vs Objective Testing: Which is Accurate? Aug 28, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Sahil Chopra to discuss research challenging a fundamental assumption: that residual AHI measurements from PAP device downloads accurately reflect whether patients' sleep apnea is adequately treated.

Sleep medicine clinicians routinely rely on residual AHI from PAP downloads to determine treatment success, typically targeting an AHI under 5. But what if this metric significantly underestimates untreated sleep apnea? Dr. Chopra's study comparing PAP-determined residual AHIs to cardiopulmonary coupling (CPC)-derived AHIs reveals striking discrepancies: mean residual AHI was 2.4 via PAP download versus 12.1 via objective testing. Even more concerning, 85% of nights showing residual AHI under 5 on PAP downloads had elevated AHI based on objective CPC measurement.

Dr. Chopra explains why he chose cardiopulmonary coupling as the comparator metric, using a PPG-based wearable ring worn for 7-10 nights. He clarifies why PAP devices may systematically underestimate residual disease through mask leak, unstable breathing, and periodic breathing patterns.

A particularly concerning finding involves residual hypoxia. Dr. Chopra discovered significant hypoxic burden in many patients considered "well-treated" by PAP standards—important since hypoxic burden, not just AHI, drives cardiovascular risk.

Dr. Chopra's conclusion isn't that PAP-derived AHI is "bad"—rather, that it shouldn't be the sole metric for assessing treatment efficacy. Even patients with good symptoms may have significant residual respiratory events and hypoxia that PAP downloads fail to detect.

Clinical applications are discussed, including when to pursue objective testing and what interventions to consider when objective testing reveals inadequate control despite acceptable AHI.

Whether you rely on PAP downloads to assess treatment efficacy, manage patients with residual symptoms, or seek emerging objective metrics, this episode provides essential perspectives on optimizing PAP therapy.

Join us for this important discussion that challenges current assumptions about measuring treatment success in sleep apnea.

Sleep and Perimenopause Aug 14, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Andrea Matsumura, a sleep physician with specialized certification in menopause medicine and national advisor for Monarch MD, to discuss how sleep clinicians can better support patients struggling with perimenopausal sleep disturbances.

Since the FDA removed the black box warning on hormone replacement therapy, more patients are inquiring about medications to treat perimenopausal sleep symptoms. Dr. Matsumura, who left traditional practice to pursue menopause certification and now works at the intersection of sleep medicine, mental health, and women's midlife health, provides practical guidance on this increasingly important clinical area.

The conversation begins with Dr. Matsumura's career evolution. After training as an internist with a leadership role at Kaiser Permanente and practicing sleep medicine in a group setting, she pursued specialized menopause certification—a credentialing process explained in detail. Dr. Matsumura discusses what menopause certification encompasses, who can pursue it, and her own path into this specialty. She also discusses her work developing specialized supplements for perimenopausal sleep support.

The episode systematically addresses how perimenopause disrupts sleep. Rather than focusing solely on hot flashes, Dr. Matsumura explains the full spectrum of sleep-related changes. She clarifies the timeline of perimenopause—when it starts and ends—and discusses less commonly recognized phenomena like menstrual hypersomnia that clinicians may not immediately associate with menopause.

A critical discussion addresses patient expectations around hormone replacement therapy. Many patients expect sleep clinicians to prescribe HRT, which raises legitimate concerns for providers unfamiliar with menopause management. Dr. Matsumura provides practical guidance on these conversations and clarifies the role of hormone level testing—addressing the debate between treating symptoms versus checking levels before initiating therapy.

The conversation explores the complex relationship between sleep apnea and menopause. Dr. Matsumura explains why and how obstructive sleep apnea may worsen during perimenopause, how to have these conversations with patients, and when referral to OBGYN colleagues is appropriate for collaborative care.

Additional topics include the role of hypnotics in perimenopausal sleep disorders, absolute contraindications to hormone replacement therapy, how to initiate HRT when appropriate, and whether restless leg syndrome worsens with perimenopause.

Dr. Matsumura addresses common misconceptions about menopause and sleep, helping clinicians understand what practitioners and patients frequently get wrong about this life stage. The episode emphasizes that sleep medicine clinicians don't need to become menopause specialists, but understanding these connections enables better patient care and appropriate referrals.

Join us for this important conversation about supporting women's sleep health through midlife transitions.

Sleep Medicine's Environmental Footprint and Impact Jul 31, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Laura Donahue, an assistant professor of sleep medicine at Vanderbilt University with a background in internal medicine and a researcher in sustainable healthcare, to discuss the environmental impact of sleep medicine practice and practical strategies for reducing carbon footprint and medical waste.

Recent environmental challenges—heat waves exacerbating insomnia, wildfires affecting respiratory and sleep health—highlight how climate directly impacts patient wellbeing. But do sleep medicine clinicians have an obligation to reduce their own environmental footprint? Dr. Donahue explores this question, examining the waste generated by sleep testing, PAP therapy, and ongoing supplies.

The conversation begins with foundational concepts: How does climate change impact sleep health? What exactly constitutes medical waste, and how does it differ from carbon footprint? Dr. Donahue explains methods for calculating carbon footprint and how the US healthcare system compares globally. She introduces life cycle analysis—a comprehensive tool for understanding environmental impact across product lifecycles.

Sleep lab waste assessments receive detailed attention. Dr. Donahue walks through how to conduct a waste audit of sleep facilities and why examining both carbon footprint and waste matters, acknowledging that these metrics don't always move directionally. Her research on PAP device waste, conducted with Dr. Morgenthaler, revealed substantial environmental costs associated with standard OSA therapy—findings that prompted examination of alternatives.

Telemedicine emerges as a potential sustainability strategy. Dr. Donahue compares carbon footprints of virtual versus in-person sleep consultations, exploring how practice model choices affect environmental impact. However, the analysis doesn't focus solely on PAP therapy—hypoglossal nerve stimulators and other non-PAP treatment options receive consideration as alternatives with potentially different environmental profiles.

SHAPE, an organization dedicated to helping healthcare providers examine their carbon footprint and waste generation, receives discussion. Dr. Donahue explains SHAPE's mission and practical resources available to sleep medicine programs. She provides concrete guidance on reducing environmental impact: waste audits, supply chain evaluation, and transitioning to circular economy models where possible.

A particularly relevant discussion addresses plastic waste from CPAP devices and consumable supplies. Dr. Donahue explains how waste audits serve as the first step toward identifying reduction opportunities and discusses strategies for minimizing single-use plastics in sleep medicine practice.

The episode acknowledges that sustainability requires institutional commitment and individual awareness. Dr. Donahue emphasizes that small changes—from supply selection to practice model design—accumulate to meaningful environmental impact.

Whether you're interested in sustainable healthcare, concerned about medical waste, seeking to reduce your sleep practice's carbon footprint, or wanting to better understand climate impacts on sleep health, this episode provides practical guidance and evidence-based approaches.

Join us for this important conversation about environmental responsibility in sleep medicine practice.

Daylight Saving Time: Advocating for Sleep Medicine Jul 17, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Karin Johnson, Professor of Neurology at UMass Chan School of Medicine–Baystate and expert on circadian rhythm policy, to discuss two competing legislative bills addressing permanent time change in the United States.

Two bills currently before Congress present starkly different solutions: the Sunshine Protection Act for permanent daylight saving time and the Sunshine for Our Kids Act for permanent standard time. Both campaigns use compelling language that makes their position sound obvious, complicating decisions for policymakers and clinicians alike.

Dr. Johnson reviews the AASM's official position on daylight saving time and what research reveals about time change effects—both short-term consequences of bi-annual clock transitions and long-term health impacts of permanent DST, particularly on adolescent mental health and circadian rhythm disruption. She explains what happened during the 1974 experiment with year-round daylight saving time and why that experience remains relevant today.

The conversation details both the Sunshine Protection Act and the Sunshine for Our Kids Act, including their legislative progress and specific provisions. Dr. Johnson clarifies which approach sleep medicine clinicians support and provides practical guidance on advocacy.

An intriguing discussion explores a proposed compromise to move clocks by 30 minutes and leave them there—why didn't this gain traction? Dr. Johnson also reveals how industry influence shapes policy, discussing candy companies' historical support for daylight saving time and other commercial interests that complicate what should be a health-based decision.

Dr. Johnson emphasizes that permanent standard time better aligns with human circadian biology, particularly for adolescents whose naturally delayed circadian rhythms suffer under permanent DST.

Whether you're seeking to understand these competing bills, advocate for science-based policy, or interested in how medical evidence influences legislation, this episode provides clarity on a complex issue with direct health implications.

Join us for this important conversation about how sleep medicine can influence public health policy.

Live from SLEEP 2026: The Future of Sleep Pharmacotherapy Jul 03, 2026

In this special live episode recorded from the SLEEP 2026 annual meeting in Baltimore, host Dr. Seema Khosla welcomes Dr. Sanjay Patel, director of the clinical sleep program at University of Pittsburgh Medical Center, to discuss groundbreaking medications for sleep disorders poised for FDA approval in 2026 and 2027.

The pharmaceutical landscape for sleep medicine is undergoing unprecedented transformation. Dr. Patel surveys the emerging drug pipeline that will fundamentally change how clinicians treat obstructive sleep apnea, narcolepsy, and idiopathic hypersomnia.

For obstructive sleep apnea, Dr. Patel discusses AD-109 (atomoxetine and R-oxybutynin), explaining the mechanistic rationale and practical considerations including use with tirzepatide. The Incannex drug combining dronabinol and acetazolamide receives analysis for different patient populations, and sultiame is discussed as a carbonic anhydrase inhibitor option. A critical framework emerges: Should treatment be symptom-based or airway-focused when PAP-intolerant patients present?

Tirzepatide, the GLP-1 agonist FDA-approved for moderate-to-severe OSA, receives comprehensive coverage including muscle loss concerns, long-term use, and emerging oral GLP-1 options. Retatrutide, the triple-hormone agent combining GLP-1, GIP, and glucagon, is also discussed.

The episode's most exciting segment focuses on orexin agonists for narcolepsy. Three pharmaceutical companies—Alkemeres, Centessa (purchased by Lilly), and Takeda—are developing these mechanistically novel agents. Dr. Patel clarifies how these medications differ, discusses why one medication disrupted nocturnal sleep (suggesting continued roles for oxybates), and addresses how clinicians will choose between similar medications.

Dr. Patel emphasizes a fundamental question: Should the field prioritize symptom management versus airway patency for OSA, and mechanistic approaches versus symptom management for narcolepsy?

Whether you're interested in emerging OSA treatments, narcolepsy innovations, or the future of pharmacological sleep medicine, this live episode provides essential updates on medications that will soon reshape clinical practice.

Join us for this exciting conversation about how sleep medicine will transform in the coming years.

Fixed PAP vs APAP: Impact on Blood Pressure and Autonomic Response Jun 05, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Abhishek Goyal, Professor and Head of Respiratory Medicine in Dehradoon, India, and Dr. Prakhar Agarwal, a pulmonologist in private practice in Bhopal, India, to discuss their research comparing fixed CPAP versus auto-titrating CPAP (APAP) on blood pressure control and autonomic nervous system response.

For years, difficult-to-treat hypertension has been recognized as an indication for sleep studies, reflecting the assumption that treating sleep apnea improves blood pressure. But does the method of PAP therapy matter? Beyond achieving a residual AHI under 5, are there treatment nuances that could optimize cardiovascular outcomes? Dr. Goyal and Dr. Agarwal's research addresses these questions, building on landmark work by Dr. Pepin examining fixed versus auto-titrating PAP therapy.

The motivation includes both clinical and economic considerations. A 2021 Portuguese study examined cost implications, and similar economic pressures exist in India where APAP is significantly more expensive than fixed CPAP. The study used a crossover design comparing fixed CPAP to APAP, measuring blood pressure dipping patterns and autonomic response to assess cardiovascular effects.

The results have prompted Dr. Goyal to reconsider his clinical practice regarding pressure selection, raising important questions: If fixed CPAP offers superior blood pressure outcomes, should the standard practice of prescribing APAP devices be reconsidered? This challenges assumptions about adaptive algorithms and raises questions about prioritizing cardiovascular outcomes beyond AHI reduction.

The episode contextualizes these findings within India's unique healthcare landscape, exploring surprising OSA incidence data and examining whether craniofacial anatomy or arousal patterns differ from Western populations. Dr. Agarwal discusses how pressures are typically determined and the practical differences between APAP 4-20 versus narrow-range settings.

Whether you're prescribing PAP therapy for hypertension, optimizing cardiovascular outcomes, or seeking evidence-based approaches to pressure selection, this episode provides important international perspectives.

Join us for this discussion that may prompt reconsideration of how we set PAP pressures and what outcomes we should prioritize.

Insomnia Combination Treatment: New AASM Guidelines May 22, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Daniel Buysse and Dr. Todd Arnedt, both members of the AASM clinical practice guideline committee, to discuss the newly released guidelines on combination treatment for chronic insomnia disorder in adults.

Unlike previous guidelines, this new guidance specifically addresses what happens in real-world clinical practice: patients often request both cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy, or arrive seeking medications while clinicians advocate for behavioral interventions. The guidelines provide evidence-based recommendations for navigating these combination treatment scenarios, incorporating patient preferences in ways previous guidelines did not.

The conversation explores the guideline development process, including how committee members were selected and how diverse professional backgrounds enriched the discussion. Dr. Buysse and Dr. Arnedt explain why patient preference wasn't adequately reflected in original practice guidelines and how this updated version addresses that gap.

The first recommendation receives detailed examination: In adults with chronic insomnia, the AASM suggests combination treatment with CBT-I plus medication over medication alone (conditional recommendation, low certainty of evidence). The experts clarify which medications were examined, including whether dual orexin receptor antagonists (DORAs) were included, and explain why evidence certainty is low despite numerous studies. Pharmaceutical sponsorship creates methodological differences—PSG outcomes, fixed time in bed requirements—that complicate interpretation. The high placebo response in insomnia trials adds another layer of complexity.

Critical implementation questions arise: What does "combination therapy" actually mean? Should both treatments start simultaneously, or should one precede the other? Can patients start medications while awaiting CBT-I appointments given typical access delays?

The second recommendation appears paradoxical: The AASM suggests against combination treatment over CBT-I alone, yet recommends combination over medication alone. Dr. Buysse and Dr. Arnedt explain this nuanced position—CBT-I alone remains superior, but for patients who prioritize rapid total sleep time improvement over daytime symptom reduction, combination therapy may be reasonable.

The conversation addresses whether treatment order matters and whether clinical (not just insurance-driven) logic suggests a medication hierarchy—zolpidem before eszopiclone, the role of trazodone, when to consider ramelteon. A crucial question emerges: What about patients who refuse or cannot access CBT-I? How do these guidelines apply when the preferred behavioral treatment is unavailable or unwanted?

Throughout, the experts emphasize that guidelines inform but don't dictate clinical decisions. Patient preferences, values, and individual circumstances must shape treatment plans. The guidelines provide evidence-based frameworks while acknowledging the complexity of real-world insomnia management.

Whether you're treating chronic insomnia, navigating patient requests for medications, addressing CBT-I access barriers, or seeking evidence-based approaches to combination therapy, this episode provides essential guidance.

Join us for this important conversation about balancing behavioral and pharmacological approaches to chronic insomnia in clinical practice.

OSA and Parkinson’s Risk: Can CPAP Change Outcomes? May 08, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Lee Neilson, Assistant Professor of Neurology at the University of Iowa and staff neurologist at the Iowa City VA specializing in movement disorders, to discuss his groundbreaking research examining whether obstructive sleep apnea represents a modifiable risk factor for Parkinson's disease.

Dr. Neilson's ambitious study analyzed records from 13 million patients within the VA system to investigate whether OSA is associated with higher risk of neurodegenerative disorders and whether treating sleep apnea might help delay the onset of dementia. The conversation traces the research design from initial hypothesis through methodology, explaining how he narrowed this massive dataset and defined both OSA diagnosis and Parkinson's disease progression.

Critical methodological details emerge: How was OSA diagnosed—through sleep testing, and using 4% or 3% hypopnea criteria? How did the study differentiate between mild and severe sleep apnea? How was Parkinson's disease identified—through clinical notes, medication records, or longitudinal follow-up? Dr. Neilson clarifies whether the analysis included only PD or extended to other neurodegenerative disorders like Alzheimer's disease.

The core findings receive extensive examination: Did CPAP therapy have a modifying effect on PD risk? After adjusting for confounding factors including BMI, diabetes, depression, and hypersomnia, which variables mattered most? What was the number needed to treat to prevent one case of Parkinson's disease? Could hypoxic burden be examined as a potential mechanism?

Intriguing tangential discussions explore whether idiopathic RBD can be distinguished from trauma-related RBD and whether these represent separate pathological processes. The conversation takes an unexpected turn into the neuroprotective effects of smoking in Parkinson's disease, with Dr. Neilson explaining proposed mechanisms and drawing parallels to ischemic preconditioning that might occur with OSA.

The episode addresses severity gradients—did OSA severity correlate with PD risk? It also tackles a fundamental question: Does treating sleep apnea delay dementia onset or actually prevent it? Dr. Neilson discusses whether non-PAP therapies were examined and addresses a critical ethical concern in sleep apnea research: Is it irresponsible to withhold treatment from symptomatic patients, and did this study focus on non-sleepy individuals or include all OSA patients regardless of symptoms?

This research has profound implications for how sleep medicine practitioners frame the importance of OSA treatment with patients and families. Beyond addressing immediate symptoms like sleepiness, treating sleep apnea may reduce long-term neurodegenerative risk—a compelling motivation for adherence that extends beyond quality of life to disease prevention.

Whether you're counseling patients about the importance of OSA treatment, interested in the sleep-neurodegeneration connection, or seeking evidence-based approaches to discussing long-term benefits of therapy, this episode provides essential insights.

Join us for this important conversation about how the work sleep medicine practitioners do every day may profoundly impact patients' neurological futures.

Community PAP Therapy: Engineering Better Sleep Apnea Care Apr 24, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes David Messerschmitt, a retired computer and signal processing engineer, and Stuart Crisp, a retired process control engineer and educator, to discuss patient-facing open-source PAP platforms and how informed users leverage detailed data to optimize their sleep apnea treatment.

This episode represents a departure from the typical clinical expert format. After eight seasons focusing on sleep medicine professionals, these engineer-patients reached out to share how platforms like Sleep HQ and OSCAR have transformed their understanding and management of sleep-disordered breathing. Both are power users who have helped thousands of fellow patients navigate complex PAP data, representing a patient empowerment movement that many clinicians may not fully appreciate.

David and Stuart explain what Sleep HQ and OSCAR are, how these platforms differ from standard clinical downloads, and what data visualization capabilities they offer. The platforms integrate multiple data streams—high-resolution flow rate data from PAP device SD cards, pulse oximetry from wearable rings, and sleep architecture from devices like Apple Watch—creating a comprehensive picture that goes far beyond what's typically reviewed in clinic appointments.

The conversation explores sophisticated analysis techniques these informed patients employ: identifying upper airway resistance syndrome through inspiratory flow limitation and heart rate spikes, distinguishing sleep onset versus wake onset events, detecting REM-related apneas, and recognizing positional apnea patterns. Stuart and David discuss "Somnopose," chin tuck events, and what they call "high-level waveform forensics"—detailed signal analysis that reveals subtle breathing pattern abnormalities.

A crucial discussion addresses whether these patient communities represent antagonism toward the medical establishment or an unmet need that sleep medicine should embrace. The guests emphasize their desire for collaboration, not confrontation, and offer insights into how clinicians can better partner with informed, data-driven patients who arrive with detailed self-analysis.

Whether you're encountering patients who bring detailed PAP data to appointments, curious about what these platforms reveal that standard reports don't, or seeking to better collaborate with informed patient communities, this episode provides essential perspectives from the patient side of sleep medicine.

Join us for this unique conversation that bridges the gap between clinical expertise and patient empowerment in sleep apnea management.

Comparing Hypoglossal Nerve Stimulators for OSA Apr 10, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. David Kent, Associate Professor and Director of Sleep Surgery in the Department of Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center, to discuss the evolving landscape of hypoglossal nerve stimulation for obstructive sleep apnea treatment.

With the recent FDA clearance of a new hypoglossal nerve stimulator, patients now have three device options available or coming soon. Dr. Kent, whose research explores upper airway neurophysiology and novel OSA treatments, helps clinicians understand the fundamental differences between these devices and how to select the most appropriate option for individual patients. He discloses his past consulting relationship with Inspire and current consulting role with Nyxoah to provide transparent context for the discussion.

The conversation begins with the foundational premise of hypoglossal nerve stimulation and why it effectively treats obstructive sleep apnea. Dr. Kent traces Inspire's evolution since its 2013 FDA approval, explaining the current implantation process and how the technology has advanced over the past decade.

A significant focus is placed on Genio, with Dr. Kent explaining how its design resembles a cochlear implant—breaking down this comparison for pulmonologists and other non-surgical specialists. Critical distinctions emerge: Genio uses bilateral stimulation versus Inspire's unilateral approach, lacks a respiratory sensor, and employs an external rechargeable battery. Dr. Kent clarifies the practical implications of these differences, including how pulse delivery is timed without respiratory synchronization, what external battery charging means for daily use, smartphone Bluetooth connectivity, and MRI compatibility considerations.

The episode tackles important clinical questions: Is bilateral hypoglossal nerve stimulation superior to unilateral stimulation? Does complete concentric collapse (CCC) matter as a contraindication, and if conflicting data exists about CCC exclusion criteria, how should this inform patient selection? Is drug-induced sleep endoscopy (DISE) necessary for all candidates? Dr. Kent discusses how the STAR trial differed from the DREAM trial and how pandemic timing affected patient outcomes and data interpretation.

Looking toward the future, Dr. Kent provides insights into Aura6000, expected to be available in 2027, and discusses his research on ansa cervicalis stimulation as a potential complementary approach, acknowledging that hypoglossal nerve stimulation alone may not be the complete solution for all patients.

A particularly valuable discussion addresses setting realistic patient expectations. Dr. Kent shares his experience with patients who arrive with preconceived notions about Inspire based on marketing or word-of-mouth, requiring significant time to align expectations with reality. He walks through his clinical conversations comparing Inspire versus Genio, helping clinicians develop frameworks for these nuanced discussions.

Whether you're counseling patients about device-based OSA treatment options, trying to distinguish between available technologies, or preparing for the expanding landscape of hypoglossal nerve stimulation, this episode provides essential comparative insights.

Join us for this comprehensive discussion about the past, present, and future of implantable OSA therapy.

Microplastics, PAP Therapy, and What the Science Shows Mar 27, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla explores growing concerns about microplastics in human health and what they may mean for patients using positive airway pressure (PAP) therapy. She is joined by Dr. Thais Mauad, a pathologist based in São Paulo, Brazil, and Dr. Michel Cahali, an otolaryngologist, whose recent research examines the presence of microplastics and inflammatory mediators in the nasal airway of PAP users and non‑users.

The conversation is framed by alarming findings from recent high‑profile studies showing microplastics in carotid artery plaque and even in the olfactory bulb of the human brain — discoveries that raise important questions about how these particles enter the body and their potential long‑term health effects. Dr. Mauad discusses her work on microplastics in neural tissue and explains how these particles may interact with inflammatory pathways, while Dr. Cahali describes their collaborative research evaluating microplastic deposition in the nasal airway.

A key focus of the discussion is whether PAP therapy itself contributes to microplastic exposure. The guests walk through their study design, control population, and findings, including the reassuring conclusion that PAP users did not demonstrate higher levels of microplastics in the nasal airway compared with controls. They also address important nuances, such as equipment age, material degradation, and how exposure may differ throughout the respiratory tract.

Beyond PAP therapy, the episode expands into a broader conversation about how plastics are manufactured, the role of additives and so‑called “forever chemicals,” and how responsibility for reducing plastic exposure has historically shifted to consumers rather than manufacturers. Drs. Mauad and Cahali reflect on what these findings mean for sleep medicine professionals and discuss practical steps the sleep community can take — from clinical practice to advocacy — to reduce plastic exposure in health care settings.

Whether you’re concerned about the safety of PAP devices, interested in emerging research on microplastics and inflammation, or looking to better understand how environmental exposures intersect with sleep health, this episode provides important scientific context and thoughtful perspective on an issue that extends far beyond the sleep clinic.

Inpatient Sleep Medicine: New AASM Guidelines Mar 13, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Reena Mehra, professor in the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Washington in Seattle, and Dr. Dennis Auckley, professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at MetroHealth Medical Center, Case Western Reserve University in Cleveland, to discuss the newly released AASM clinical practice guidelines for evaluating and managing obstructive sleep apnea in hospitalized adults.

The guidelines address a significant gap in inpatient care: how to systematically screen for sleep apnea in hospitalized patients, prioritize high-risk groups, determine when and where to perform testing, and ensure appropriate outpatient follow-up. Dr. Mehra and Dr. Auckley explain the impetus behind developing these guidelines and the PICO question process used to examine existing evidence, acknowledging the challenges of working with limited data in this emerging field.

The conversation systematically walks through the four key recommendations: in-hospital screening for OSA as part of an evaluation and management pathway, use of inpatient PAP treatment for newly diagnosed or untreated moderate-to-severe OSA, availability of sleep medicine consultation, and implementation of discharge management plans to ensure timely diagnosis and effective outpatient management.

Practical implementation receives extensive attention. How should patients be screened—using STOP-Bang or facility-specific methods? Should screening be built into the EMR? Which patient populations and hospital units should be prioritized? Who performs the screening—sleep navigators, nursing staff, or hospitalists? Can sleep consultations be conducted via telemedicine at the bedside? The experts emphasize the critical need for a program champion and comprehensive education initiatives.

Dr. Auckley shares invaluable lessons from his experience creating an inpatient sleep program, discussing what he wishes he'd known before starting and practical insights gained through implementation. A particularly frustrating issue receives attention: patients who bring their own PAP devices to the hospital but never have them set up or used during their stay. The guidelines address this common scenario and provide frameworks for ensuring treated patients continue therapy during hospitalization.

Legal liability considerations are explored: What responsibilities exist for untreated patients diagnosed with OSA during hospitalization? What about high-risk patients who haven't been formally diagnosed? The experts discuss strategies for ensuring outpatient follow-up, recognizing that effective discharge planning is essential for translating inpatient identification into long-term management.

Whether you're considering establishing an inpatient sleep program, frustrated by gaps in hospital-based sleep apnea care, or seeking evidence-based approaches to identifying and managing OSA in hospitalized patients, this episode provides essential guidance and practical implementation strategies.

Join us for this important discussion about bringing systematic sleep apnea evaluation and management into the inpatient setting.

High Altitude Central Sleep Apnea: Diagnosis and Treatment Feb 27, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. David McCarty, a sleep physician based in Colorado and Chief Medical Officer for REBIS HEALTH, to discuss the unique challenges of diagnosing and treating central sleep apnea at high altitude.

Living and practicing sleep medicine in Colorado has given Dr. McCarty extensive experience managing altitude-related central sleep apnea, a condition that affects many residents and visitors to elevated regions. The conversation begins with fundamental questions: Is central sleep apnea normal at altitude? What physiological mechanisms drive its development? Dr. McCarty explains the prevalence patterns across different elevations, from Denver's mile-high altitude to extreme elevations like 10,000 feet, and whether there's a threshold where everyone develops central events.

Practical diagnostic considerations receive detailed attention: Should patients be tested at their home altitude? How are titration studies conducted in high-altitude settings? What testing equipment best identifies central apneas, and should central hypopneas be scored? Dr. McCarty discusses the high prevalence of treatment-emergent central sleep apnea (TECSA) at altitude and how many patients present with mixed obstructive and central patterns, complicating treatment decisions.

The episode provides essential guidance for clinicians whose patients travel to high altitude destinations. What PAP adjustments should be made? How should EPR (expiratory pressure relief) settings be modified? Dr. McCarty walks through his decision-making framework for when to treat altitude-related central apnea, emphasizing the importance of patient education before ascension.

Treatment options are systematically reviewed: pressure adjustments, the role of BPAP therapy, when to consider ASV, acetazolamide use, and supplemental oxygen. Dr. McCarty discusses whether pre-emptive treatment is appropriate for patients planning high-altitude travel and provides practical protocols for managing both residents who live at altitude and visitors experiencing acute exposure.

The conversation emphasizes patient-centered approaches, considering not just the physiological aspects of altitude-related breathing disturbances but also the practical realities of treating patients in mountain communities and preparing lowland residents for high-altitude adventures.

Whether you practice in elevated regions, have patients who travel to altitude destinations, or simply want to understand the physiology behind altitude-related central sleep apnea, this episode provides essential clinical guidance.

Join us for this informative discussion about a condition that affects millions living at or traveling to high elevations.

Are Hypnotics Safe in Untreated OSA? Insights for Clinicians Feb 13, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Mark Boulos, Dr. Khullar, and Dr. Mak for an in‑depth discussion on a topic that has challenged clinicians for decades: Are hypnotics safe for patients with untreated obstructive sleep apnea (OSA)?

As new therapeutic options emerge and our understanding of comorbid insomnia and sleep apnea (COMISA) evolves, clinicians are increasingly confronted with nuanced decisions about when—and whether—to use hypnotic medications. The guests unpack the latest evidence and share insights from recent studies, including research evaluating dual orexin receptor antagonists (DORAs) such as lemborexant in individuals with sleep apnea.

The conversation begins with a review of hypnotic medication classes and explores which agents may be safer in untreated OSA, and which still raise concerns. The panel discusses a recent lemborexant study, its design, population characteristics (including BMI and OSA severity considerations), and whether industry sponsorship played a role. They clarify that while the study did not focus specifically on COMISA, it sheds light on how DORAs perform in people with sleep apnea—particularly in terms of respiratory metrics.

The experts tackle the practical clinical dilemma of treatment sequencing in COMISA: Should clinicians begin with cognitive behavioral therapy for insomnia (CBT‑I), initiate PAP therapy, or consider medications first? They walk through what is known about how different hypnotic classes—including z‑drugs, GABAergic agents, trazodone, and DORAs—affect respiratory drive and sleep architecture. The discussion extends to special circumstances such as REM‑related OSA, where increased REM sleep induced by certain medications may have unique implications.

The episode also considers broader emerging questions: Do DORAs improve apnea–hypopnea index (AHI) even without PAP? Can hypnotics be used strategically to improve sleep continuity without worsening respiratory parameters? And will future insomnia care rely on identifying phenotypes that respond differently to GABA‑based medications or wakefulness‑impairment targets?

Throughout the conversation, the guests emphasize evidence-based takeaways, including the central finding that DORAs do not appear to worsen OSA‑related metrics, offering reassurance for clinicians who might consider using a hypnotic in a patien with untreated OSA. .

Whether you regularly see patients with comorbid insomnia and untreated sleep apnea or simply want clarity on the evolving role of hypnotics in this population, this episode offers practical, research-grounded guidance for clinical decision making.

Join us for this important discussion on how hypnotics can be used safely and thoughtfully in patients with untreated OSA.

Wearable Sleep Tech: Clinical Use and Best Practices Jan 30, 2026

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes three members of the World Sleep Society's consumer health technology task force—Dr. Michael Chee, Professor and Director of the Center for Sleep and Cognition at the National University of Singapore who chaired the guideline-writing task force; Dr. Mathias Baumert, an associate professor leading the biomedical engineering discipline of the school of Electrical and Mechanical engineering at Adelaide University in Australia, and Dr. Cathy Goldstein, professor of neurology at the University of Michigan. to discuss their global recommendations for the use of consumer sleep technology and wearable health trackers.

Consumer wearables have become ubiquitous in clinical practice, with patients routinely sharing device data. While some clinicians have historically dismissed this information, attitudes are shifting as technology improves and rigorous research examines sensors, algorithms, and data quality. Dr. Chee explains that the recommendations are designed for multiple audiences: end-users, clinicians, researchers, and manufacturers, with specific guidance for each group.

The conversation addresses practical considerations: the assumption that users have good perfusion, how bed partners can influence movement detection, and the fundamental truth that the best device is one patients will actually wear properly. The panel discusses recent FDA regulatory changes and clarifies whether guidance applies only to non-FDA cleared wellness devices or has broader implications.

The experts systematically review various metrics from wearables. They introduce TATS (total attempted time in sleep) and explain what clinicians should know about sleep onset and offset detection.

The episode emphasizes the call for standardized Fundamental Sleep Measures and greater transparency about test populations used in device validation. Dr. Baumert discusses the need to co-create benchmarks for measurement accuracy across different contexts—from persons with normal sleep to shift workers to those with sleep disorders.

Whether you're skeptical about consumer wearables or seeking guidance on interpreting patient-generated data, this episode provides evidence-based recommendations for moving forward responsibly.

Join us for this important discussion about embracing consumer sleep technology while maintaining clinical rigor.

Central Sleep Apnea Treatment: New AASM Guidelines Jan 16, 2026

In this season 8 premiere of Talking Sleep, host Dr. Seema Khosla welcomes three members of the AASM guideline committee—Dr. Rami Khayat, Professor and Division Chief of Pulmonary, Allergy & Critical Care Medicine and Director of Penn State Health Sleep Services; Dr. Shirine Allam, Professor of Medicine at Emory University and Program Director for the Pulmonary and Critical Care Fellowship at the Atlanta VA Medical Center; and Dr. Christine Won, Medical Director of Yale Centers for Sleep Medicine and Professor of Medicine at Yale University—to discuss the newly released AASM clinical practice guidelines for central sleep apnea treatment.

The conversation begins with the rigorous process behind guideline development, clarifying the distinction between evidence-based recommendations and expert opinion. The panel systematically walks through each recommendation, addressing CPAP use across various CSA etiologies including primary CSA, heart failure-related CSA, medication-induced CSA, treatment-emergent CSA, and CSA due to medical conditions.

A surprising recommendation against BPAP without backup rate generates discussion about why backup rates matter and why heart failure patients are excluded from certain BPAP recommendations. The experts tackle the controversial topic of adaptive servo-ventilation (ASV), explaining why it's now conditionally recommended even for heart failure patients despite SERVE-HF trial concerns. They clarify that newer ASV algorithms differ from devices used in that study and emphasize the importance of patient-provider shared decision-making and treatment at experienced centers.

Practical implementation guidance covers oxygen therapy for heart failure and high-altitude CSA, including insurance coverage challenges. The panel discusses acetazolamide use across multiple CSA etiologies, providing concrete advice on prescribing and follow-up protocols. Transvenous phrenic nerve stimulation receives attention as an option for select patients, with candid discussion about its invasive nature, accessibility limitations, and high costs.

The episode addresses the shift toward viewing CSA treatment as chronic disease management, including billing code G211 implications. The experts emphasize that guidelines guide but don't constrain clinical judgment, stressing the importance of monitoring beyond AHI—including patient symptoms and quality of life improvements.

Whether you're treating patients with CSA, navigating insurance coverage, or seeking clarity on when ASV is appropriate, this review provides essential guidance for implementing evidence-based CSA treatment.

Join us for this season premiere that translates complex guidelines into practical clinical applications.

JCSM Year in Review: Top Sleep Research of 2025 Dec 12, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Safwan Badr, the newly appointed editor of the Journal of Clinical Sleep Medicine and sleep medicine physician at Wayne State University, for an in-depth review of the most impactful articles published in JCSM during 2025.

Dr. Badr discusses his vision for the journal and the editorial selection process, then guides listeners through key research findings shaping clinical practice. The conversation highlights both highly popular papers and important studies that deserve more attention from practicing clinicians.

A significant focus is placed on research confirming that traditional 4% hypopnea criteria and CMS definitions systematically underestimate sleep apnea in women, with expanded diagnostic criteria helping mitigate these gender disparities. The episode explores groundbreaking research on sleep architecture and Alzheimer's disease, examining how lower slow wave sleep and REM sleep correlate with brain atrophy in AD-vulnerable regions, particularly the inferior parietal lobe.

Consumer sleep technology receives critical examination through a meta-analysis comparing wrist-worn devices to polysomnography, revealing significant limitations in accuracy. Dr. Badr discusses implications for physicians and consumers who increasingly rely on these devices. Mental health intersects with sleep medicine through research showing that nightmares and insomnia in the acute aftermath of trauma predict suicidal ideation—nearly half of acute trauma patients with both conditions experience suicidal ideation within two months, highlighting urgent need for early interventions.

Additional topics include Canadian research on CBT-I effectiveness during pregnancy and findings from the TODAY study examining obstructive sleep apnea's relationship with glycemic control and cardiovascular risk in young adults with youth-onset type 2 diabetes.

Whether you're looking to stay current with evidence-based practice changes, interested in emerging research on sleep and neurodegeneration, or seeking to understand gender disparities in sleep medicine, this year-in-review provides essential updates.

Live from Disruptors: New Paths in Sleep Medicine Nov 28, 2025

In this special live episode recorded at Sleep Medicine Disruptors in Austin, Texas, host Dr. Seema Khosla sits down with two standout innovators whose technologies captured the spirit of disruptive innovation in sleep medicine. Dr. Jason McKeown from Neurovalens and Dr. Onur Kilic from Bairitone Health present groundbreaking approaches to treating insomnia and personalizing obstructive sleep apnea therapy.

Dr. McKeown, a neurologist, introduces his FDA-cleared non-pharmacological treatment for insomnia using vestibular nerve stimulation. He explains how the technology works, why stimulating nerves in this manner is safe, and how it differs from vagus nerve devices. The conversation explores the relationship with cognitive behavioral therapy for insomnia (CBT-I), addresses the placebo effect question, and clarifies whether this is a long-term solution or temporary intervention. Dr. McKeown discusses contraindications including pregnancy and Inspire therapy, potential side effects, and ideal patient populations.

Dr. Kilic presents his sensor technology that enables non-invasive assessment of airway collapse location and severity—what he calls an "anatomic PSG." This innovation addresses a critical challenge: predicting which patients will respond to specific treatments like oral appliances, Inspire, or PAP therapy based on individual anatomical collapse patterns. Using a cheek-mounted sensor, the device identifies obstruction levels, differentiates between primary and secondary collapse sites, and detects collapse at the velopharyngeal level.

The discussion explores whether this represents a scalable alternative to drug-induced sleep endoscopy (DISE), how it integrates with OSA endotyping, and practical applications during titration studies to identify optimal pressure ranges and guide combination therapies. Both innovators emphasize moving beyond one-size-fits-all approaches toward personalized, anatomy-based treatment selection.

Whether you're interested in non-pharmacological insomnia treatments, precision medicine approaches to OSA, or the future of sleep diagnostics, this episode showcases innovative thinking driving the next generation of sleep medicine.

Join us for this exciting live conversation from Sleep Medicine Disruptors.

Craniofacial Sleep Medicine Nov 14, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Dave Singh, a former Adjunct Professor in Sleep Medicine at Stanford University, with a PhD in craniofacial cleft palate development, and a third PhD in orthodontics, to explore the evolving field of craniofacial sleep medicine. As founder of REMA Sleep based in North Carolina, Dr. Singh introduces the concept of craniofacial sleep medicine—an etiology-based approach to treating obstructive sleep apnea guided by anthropomorphic features rather than solely AHI severity metrics.

Craniofacial sleep medicine represents a paradigm shift from license-based treatment allocation to collaborative, anatomy-driven care where dentists, surgeons, and sleep physicians work together to determine the most appropriate interventions based on individual structural characteristics. Dr. Singh explains why understanding craniofacial structures is crucial for personalizing OSA treatment, including why Asian populations show high OSA prevalence despite lower obesity rates.

The conversation provides a comprehensive crash course in assessing craniofacial anatomy: What is retrognathia and what causes it? How can clinicians alter jaw position by adjusting cranial base morphology? Dr. Singh explains the classification system for dental occlusion (Class I, II, and III bites), midface assessment techniques, and the palate evaluation method Dr. Guilleminault taught fellows. He discusses critical anatomical considerations including tongue positioning at rest and during sleep, lateral pharyngeal wall collapse, and cervical vertebrae influence on airway patency.

The episode explores both preventive approaches in children and interventions for adults, addressing whether craniofacial modifications require surgery or can be achieved through other means. Dr. Singh discusses palatal expansion, tongue traction techniques, and the physiological components that remain addressable even after skeletal maturity. He also explains age-related changes including loss of muscle tone, bone volume reduction, and maxillary drift that progressively narrow the airway.

Intriguing topics include the mechanisms behind why didgeridoo playing and conch shell blowing improve sleep apnea, the role of oromyofunctional therapy as a viable treatment option, evolutionary changes in human dentition that impact airway anatomy, and even the dental stem cell implications for regenerative approaches. Dr. Singh also clarifies surprising facts, such as why mouthguards in contact sports serve purposes beyond tooth protection.

Whether you're seeking to understand anatomical contributors to OSA beyond obesity, interested in multidisciplinary treatment approaches, or curious about how craniofacial structure influences treatment selection, this episode provides essential insights into personalized, anatomy-based sleep apnea management.

Join us for this fascinating exploration of how form determines function in the upper airway and how understanding craniofacial anatomy can revolutionize OSA treatment strategies.

Responsible AI Use in Sleep Medicine Oct 31, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes members of the AASM Artificial Intelligence in Sleep Medicine Committee—Dr. Margarita Oks, Dr. Subaila Zia, Dr. Ramesh Sachdeva, and Matt Anastasi—to discuss their recently published position statement on the responsible use of AI in sleep medicine practices.

Artificial intelligence is rapidly transforming healthcare, from AI-assisted sleep study scoring to clinical documentation tools and insurance claim processing. Yet AI is not a monolith—the technology encompasses various types with different capabilities, risks, and regulatory considerations. Matt Anastasi breaks down the different forms of AI clinicians encounter in practice, while the panel explains what "responsible use" actually means in practical terms.

The updated position statement, notably shorter and more accessible than previous versions, addresses four major pillars: data privacy, fairness and transparency, infrastructure requirements, and medical-legal considerations. The discussion explores critical questions facing sleep medicine practitioners: How do we understand and trust the AI systems we use? What happens when insurance payors deploy AI to deny claims—should we fight AI-generated denials with AI-generated appeals? Do patients need to be informed when AI is used in their care, and how specific must those disclosures be?

The conversation delves into liability concerns that keep practitioners awake at night: If your employer implements AI and it makes an error, who bears responsibility? What about ignoring AI prompts—does that create liability? Dr. Sachdeva explains the concept of vicarious responsibility and how it applies to AI implementation.

Practical implementation guidance is provided through discussion of governance checklists, equity considerations in AI deployment, and the limitations of FDA clearance for AI-assisted sleep study scoring. The experts introduce AASM Link and discuss how practitioners can evaluate AI tools beyond marketing claims, ensuring systems are trained on diverse, representative data sets.

The episode tackles a fundamental question: Is AI use inevitable in sleep medicine, or can practitioners opt out? The panel offers realistic perspectives on integrating AI responsibly while maintaining clinical judgment and patient-centered care.

Whether you're already using AI tools, considering implementation, or resistant to adoption, this episode provides essential guidance on navigating the AI transformation in sleep medicine while upholding professional and ethical standards.

Join us for this timely discussion about balancing innovation with responsibility in the AI era of sleep medicine.

PLATO: New Longitudinal Assessment Tool for Sleep Apnea Oct 17, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Doug Kirsch, Medical Director of Atrium Health Sleep Medicine and Clinical Professor in the Department of Neurology at Wake Forest School of Medicine, and Dr. Fariha Abbasi-Feinberg, president-elect of the AASM and private practice physician with Millennium Physician Group in Fort Myers, Florida, to introduce PLATO—a groundbreaking longitudinal assessment tool for obstructive sleep apnea.

The Epworth Sleepiness Scale has been a cornerstone of sleep medicine practice for decades, yet clinicians universally acknowledge its limitations in capturing the full patient experience. Similarly, PAP adherence—while important and part of Medicare's MIPS program—tells only part of the story about treatment success. During his AASM presidency, Dr. Kirsch recognized the need for a more comprehensive metric and convened an expert advisory panel to develop a better solution.

The conversation traces PLATO's development journey, which Dr. Rosen described as "Doug's baby with a prolonged gestation." Starting with 44 potential questions and utilizing the ICON methodology, the panel carefully refined the tool to capture domains beyond simple sleepiness—including quality of life, functional impairment, and symptom burden that the Epworth overlooks. Dr. Kirsch and Dr. Abbasi-Feinberg explain the validation process, how the tool discriminates between OSA severity levels, and why certain seemingly similar questions about sleepiness were all retained.

The episode addresses practical implementation questions: How is PLATO scored? Why do the first two sections use 5-point scales while the final section uses 10 points? Is it free to use, and how does one access it? Will it integrate into electronic health record systems like Epic? Most importantly, how should clinicians use this tool—will it replace the Epworth for Medicare requirements, or does it serve a different purpose?

The discussion also explores how PLATO relates to the recent AHRQ report on OSA treatment outcomes and why the tool focuses on patient-reported symptoms rather than solely cardiovascular endpoints. Dr. Kirsch shares his vision for PLATO's future, including hopes for foundation grants to further study the tool and demonstrate that treating OSA and its associated sleepiness meaningfully improves patient outcomes.

Whether you're frustrated with current assessment limitations, interested in value-based care metrics, or seeking better ways to document treatment efficacy beyond adherence data, this episode provides essential insights into a tool that may reshape how we measure success in sleep medicine.

Join us for this important discussion about moving beyond PAP adherence and Epworth scores to truly capture what matters to our patients.

Sleep Medicine Disruptors: Innovation Preview Oct 10, 2025

In this bonus episode of Talking Sleep, host Dr. Seema Khosla offers an exclusive preview of the upcoming SleepMedicine Disruptors course, taking place November 14-15 in Austin, Texas. She speaks with Steve Van Hout, executive director of the AASM, and Dr. David White, professor of medicine part time at Harvard Medical School, about the groundbreaking innovations reshaping sleep medicine.

Steve Van Hout explains what makes the Disruptors conference unique compared to other AASM meetings like Trends and the annual SLEEP conference. Designed to bring together clinicians, researchers, technology innovators,and venture capitalists, Disruptors aims to foster cross-industry collaboration and encourage investment in sleep medicine innovations. The conference features innovation award presentations similar to Shark Tank pitches with the audience voting on their favorites, keynote speakers, and discussions about emerging technologies that promise to transform how we diagnose and treat sleep disorders.

Dr. White provides an in-depth preview of his presentation on pharmacotherapy for obstructive sleep apnea, sharing exciting developments in multiple drug candidates. He discusses Apnimed’s AD-109, a combination of atomoxetine and R-oxybutynin, which has completed two phase three studies showing approximately 50% reduction in AHI across six-month and one-year trials involving over 650 patients each. With FDA submission planned for early 2026, this medication could reach the market by late 2026.

The conversation explores other promising agents including Incannex's combination of dronabinol and acetazolamide, carbonic anhydrase inhibitors like sulthiame (recently licensed by Apnimed), and innovative potassium channelantagonists that could be delivered via nasal spray for localized upper airway effects with minimal systemic absorption. Dr. White discusses the potential for poly therapy approaches, combining medications with devices like mandibular advancement devices or positional therapy, drawing parallels to how hypertension and diabetes are managed with multiple treatments.

The episode tackles important questions about the future of sleep medicine: Will pharmacotherapy replace PAP therapy, or will hybrid approaches become standard? What AHI reduction is clinically meaningful for cardiovascularprotection and symptom improvement? How will pricing and insurance coverage affect accessibility? They emphasize that while these medications may not replace CPAP entirely, they offer promising options for patients who struggle with existing therapies.

Whether you're a sleep medicine practitioner interested in emerging treatments, an entrepreneur exploring innovation opportunities, or simply curious about the future of sleep disorder management, this episode provides essential insights into the rapidly evolving landscape of sleep medicine.

Join us for this forward-looking conversation about innovation, investment, and the technologies poised to disrupt traditional sleep medicine practice.

How Sleep Medicine Guidelines Are Created Oct 03, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla sits down with Dr. Anita Shelgikar, current president of the American Academy of Sleep Medicine, neurologist, and sleep fellowship program director at the University of Michigan, for a transparent look at how the AASM makes critical decisions that shape the field of sleep medicine.

Ever wondered how clinical practice guidelines are developed and why updates take so long? Dr. Shelgikar pulls back the curtain on the comprehensive process behind guideline creation, from topic selection to evidence review to final publication. She explains how the AASM prioritizes which guidelines need updating and how members can influence these decisions.

The conversation addresses pressing concerns facing sleep medicine practitioners: the ongoing review of home sleep apnea testing codes, declining reimbursement rates, and the financial viability of sleep medicine practices. Dr. Shelgikar discusses the AASM's advocacy efforts, recent legislative wins and setbacks, and strategies for improving the value proposition of polysomnography in an evolving healthcare landscape.

Looking toward the future, the discussion explores emerging trends including the potential for inpatient sleep medicine services, the shift toward chronic disease management models, and new technologies like acoustic stimulation. Dr. Shelgikar shares insights on how the field might evolve beyond its traditional testing-focused approach and adapt to changing reimbursement structures.

The episode also demystifies AASM governance: How are committees formed and sunset? Why can't every volunteer serve? What happens during board meetings? Is board membership reserved for academics? Dr. Shelgikar provides practical guidance on how members can engage more meaningfully with the organization and influence its direction.

Whether you're a longtime AASM member curious about organizational decision-making or a newer member seeking to understand how to get involved, this episode offers valuable transparency into the processes that shape sleep medicine policy and practice.

Join us for this informative conversation that bridges organizational leadership with frontline clinical concerns in sleep medicine.

Beauty Sleep: How Skin Health and Sleep Are Connected Sep 19, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Faisal Ali, professor of dermatology at the University of Central Lancashire and consultant dermatologist specializing in Mohs micrographic and laser surgery, to explore the fascinating connections between sleep and skin health.

Drawing from recent research published in Clinical and Experimental Dermatology, Dr. Ali explains how sleep serves as a critical regulator of skin physiology, affecting everything from skin surface pH and transepidermal water loss to blood flow and temperature regulation. The conversation delves into the complex interplay of circadian rhythms, hormones, and inflammatory cytokines that govern both sleep patterns and skin homeostasis.

The discussion covers how sleep deprivation accelerates skin aging as an extrinsic factor alongside sun exposure and pollution, with compelling evidence from studies showing that good sleepers have significantly better skin aging scores and improved recovery from UV exposure. Dr. Ali explores the bidirectional nature of this relationship—while poor sleep worsens skin conditions, dermatological disorders like atopic dermatitis, psoriasis, and rosacea can severely disrupt sleep through mechanisms including the itch-scratch cycle and inflammatory processes.

The episode addresses practical clinical concerns including the higher prevalence of sleep disorders in patients with conditions like hidradenitis suppurativa and rosacea, the role of obstructive sleep apnea in various skin conditions, and evidence-based approaches to breaking the itch-scratch cycle that disrupts sleep in dermatological patients.

The conversation also tackles common sleep treatment-related skin issues, from CPAP mask irritation and "maskne" to headgear-induced hair loss, providing practical guidance for managing these complications. Dr. Ali discusses proper skincare routines for CPAP users, including the safety of retinol use under masks and strategies for preventing pressure-related skin breakdown.

Whether you're a sleep medicine practitioner encountering dermatological complaints, a dermatologist treating patients with sleep disruption, or simply interested in optimizing both sleep and skin health, this episode provides evidence-based insights into this often-overlooked connection.

Join us for this comprehensive discussion that bridges dermatology and sleep medicine to enhance patient care and understanding.

ASV Algorithms & Central Sleep Apnea Management Sep 05, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Imran Iftikhar and Dr. Rami Khayat to discuss groundbreaking research on adaptive servo-ventilation (ASV) and the newly released AASM clinical practice guidelines for central sleep apnea treatment. Dr. Iftikhar presents his innovative approach to analyzing ASV data through meta-analysis combined with trial sequential analysis, offering fresh insights into the statistical reliability of existing research beyond traditional systematic reviews. His work addresses lingering questions about ASV efficacy and safety that have persisted since the controversial SERVE-HF trial results challenged previous assumptions about this therapy. Meanwhile, Dr. Khayat, who served as vice-chair of the AASM task force, walks through the comprehensive evidence-based recommendations covering the full spectrum of central sleep apnea treatments. The guidelines address critical clinical decisions: When should CPAP be used over no treatment? Who requires BPAP with backup rates? Why does the task force recommend against BPAP without backup rates for central sleep apnea? What role do oxygen, acetazolamide, and transphrenic nerve stimulation play in treatment algorithms? The conversation delves into practical considerations including differences between ASV device algorithms from various manufacturers, the clinical impact of current device availability issues, and findings from Dr. Parthasarathy's bench study. The experts tackle the complex question of ASV use in patients with reduced ejection fraction and clarify important distinctions between primary central sleep apnea and treatment-emergent central sleep apnea (TECSA). This episode addresses the evolving landscape of central sleep apnea management, helping clinicians navigate evidence-based treatment decisions in an era of changing technology and updated safety considerations. Whether you're treating patients with heart failure, complex sleep-disordered breathing, or emerging central events during PAP therapy, this episode provides essential guidance for optimizing care. Join us for this comprehensive update that translates complex research findings into practical clinical applications.

Sleep Disorders in Military Veterans Aug 22, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Greg Burek, a psychiatrist and former Marine, and Dr. Dmitriy Kogan, associate professor of medicine at the Medical College of Wisconsin and program director for the sleep medicine fellowship program, to discuss the unique sleep challenges facing military veterans and first responders.

The conversation explores how military and first responder training fundamentally changes individuals, creating an "adrenaline-focused" mindset that profoundly impacts their relationship with sleep and health. Dr. Burek provides insider insights into the stages of military service and the concept of "sacrifice" as a unifying characteristic among veterans, while explaining why many veterans may minimize or dismiss their service experiences.

The guests introduce the BRAVE program, an innovative initiative designed specifically for military veterans and first responders to address the "invisible wounds of service"—PTSD and TBI—and their complex interactions with sleep disorders. Unlike traditional VA programs, BRAVE takes a specialized approach to understanding how military culture and experiences create unique sleep medicine challenges.

The discussion covers critical clinical topics including insomnia management in veterans, the frequent use of clonidine as a treatment option, REM behavior disorder presentations that may differ from civilian populations, and the intricate relationships between PTSD, TBI, sleep-disordered breathing, and nightmare disorders. The experts address whether these sleep disturbances stem from combat trauma, brain injury, or the military experience itself.

This episode provides essential insights for healthcare providers treating veterans, including practical approaches to asking about TBI history, understanding military culture's impact on patient care, and recognizing when specialized referrals may be beneficial.

Whether you're a sleep medicine practitioner, mental health professional, or healthcare provider serving veteran populations, this episode offers valuable perspectives on culturally competent care for those who have served.

Join us for this enlightening discussion that bridges military culture and sleep medicine to improve care for our veterans and first responders.

OSA and PLMD Aug 08, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment.

Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment.

The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes.

Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption.

Whether you're treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms.

Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice.

Predicting RBD Phenoconversion via Autonomic Reflex Testing Jul 25, 2025

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Luca Baldelli, a neurologist from the University of Bologna and Treasurer-Elect of the International REM Sleep Behavior Disorder Study Group, to discuss breakthrough research on predicting which RBD patients will develop neurodegenerative diseases.

Building on the AASM's updated RBD guidelines, Dr. Baldelli presents compelling evidence for using simple autonomic reflex testing to identify patients at highest risk for phenoconversion to conditions like Parkinson's disease and dementia with Lewy bodies. His research demonstrates that objective autonomic testing, particularly orthostatic assessments, can reveal early neurogenic orthostatic hypotension that precedes overt neurodegeneration by years.

The conversation explores practical clinical applications: How can sleep medicine practitioners implement these screening protocols? What constitutes abnormal autonomic function in RBD patients? How do we interpret changes over time, and when should patients be referred for neurological evaluation? Dr. Baldelli shares his longitudinal monitoring framework that could transform how we counsel RBD patients about their future risk.

This episode addresses critical questions about biomarker development in prodromal neurodegeneration, the timeline of autonomic changes, and evidence-based approaches to patient discussions about prognosis. Dr. Baldelli also discusses current research initiatives and potential therapeutic interventions for high-risk patients.

Whether you're a sleep medicine physician, neurologist, or researcher interested in neurodegenerative diseases, this episode provides essential insights into improving early detection and patient care in RBD.

Join us for this informative discussion that bridges sleep medicine and neurology to enhance clinical decision-making and patient outcomes.

Zolpidem and the Glymphatic System Jul 11, 2025

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

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

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

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

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

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

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

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

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

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.

Sleep Apnea Detection: Inside the Apple Watch Algorithm Jan 24, 2025

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.

Understanding Residual AHI: What Sleep Doctors Need to Know Jan 10, 2025

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.

Sleep’s Role in PTSD Dec 06, 2024

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.

A Guide to OSA Endotyping Nov 22, 2024

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 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).

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.

RLS Clinical Practice Guideline Update Nov 08, 2024

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.

Should PAP be a Tool for the Obstetrician? Oct 25, 2024

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.

A new era of AASM accreditation Oct 11, 2024

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.

Behavioral therapy for sleep disorders: CBT-I and beyond Sep 27, 2024

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.

Sleep-related anxiety and new onset insomnia Sep 13, 2024

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 SWOT Analysis Aug 30, 2024

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.

Silent and sleepy: The use of wake-promoting medications in well-treated OSA Aug 16, 2024

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.

Cutting Through the Haze - the Use of Cannabis for Sleep and Sleep Apnea Aug 02, 2024

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.

Sleep technology for insomnia Jul 19, 2024

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.

Key Considerations When Implementing an RPM program Jul 05, 2024

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.

Reimbursement and clinical use of actigraphy Jun 21, 2024

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.

Hiding in plain sight: The importance of a SOREMP on PSG May 31, 2024

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.

The Philips consent decree and the path forward May 17, 2024

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.

ADVENT-HF trial May 03, 2024

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.

OSA proteomics and metabolomics Apr 19, 2024

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.

Acoustic stimulation for improving sleep Apr 05, 2024

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.

NIV and other considerations for the Philips Respironics PAP device recall Mar 22, 2024

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.

Neurotransmitters, insomnia pharmacotherapy and mental health Mar 08, 2024

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.

Sleep, OSA and sickle cell disease Feb 23, 2024

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.

A Practical Approach to Treating RLS Feb 09, 2024

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.

Sleep and Alzheimer’s disease Jan 26, 2024

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.

Sleep as an Opportunity to Improve Maternal Mortality Jan 12, 2024

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.

Keeping Up with the Changes to the Scoring Manual Dec 15, 2023

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.

Sleep and ADHD in Adolescents Dec 01, 2023

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.

Medications To Manage Central Disorders Of Hypersomnolence Nov 17, 2023

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.

Legal Issues in a Sleep Medicine Practice Nov 03, 2023

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.

Medications to Treat Obstructive Sleep Apnea Oct 20, 2023

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.

Management of Obesity Hypoventilation Syndrome Oct 06, 2023

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.

Insufficient Sleep, Circadian Disruption and Cardiometabolic Health Sep 22, 2023

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.

DREAM-IT: Insomnia Management in Adolescents Sep 08, 2023

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.

Obesity Management for Sleep Clinicians Aug 25, 2023

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.

Embracing Alternative Practice Models Aug 11, 2023

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.

Navigating the Ethics of Disclosure in RBD Jul 28, 2023

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.

SleepHouse Rock: How a CPT Code is Made Jul 14, 2023

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.

Bringing Sleep to the Neighborhood- The Mobile Sleep Lab Model Jun 30, 2023

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.

More Than Chin Music: How a New Signal Can Assess Sleep-Disordered Breathing Jun 16, 2023

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.

Predicting HGNS Treatment Success May 19, 2023

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.

The Nose and OSA: Why the Nose Always Seems to Know May 05, 2023

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.

The Microbiome and Sleep Apnea– A Bidirectional Relationship Apr 21, 2023

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.

Clinical Considerations for Novel Sleep Technology Mar 24, 2023

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.

Permanent Standard Time Advocacy Mar 10, 2023

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.

Comorbid Insomnia and Sleep Apnea (COMISA) Feb 24, 2023

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.

New AASM Clinical Practice Guideline: Management of REM Sleep Behavior Disorder Feb 10, 2023

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.

Improving Patient Understanding of Sleep Apnea Jan 27, 2023

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.

Sleep Age with Dr. Mignot Jan 13, 2023

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.

College, Transgender Students and Sleep Nov 18, 2022

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.

Sleep Technologist Education Nov 04, 2022

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.

Melatonin Oct 21, 2022

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

Spotlighting Central Sleep Apnea Oct 07, 2022

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.

CPAP in Pediatric Patients Sep 23, 2022

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.

Mind After Midnight Sep 09, 2022

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.

Untreated OSA and Alzheimer’s Disease Aug 26, 2022

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

How to Survive a Medicare Audit Aug 12, 2022

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.

Sleep-Related Movement Disorders Jul 29, 2022

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

Sleep Disorders in Women Jul 15, 2022

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.

Updated Protocols for Evaluating Daytime Sleepiness and Alertness Jul 01, 2022

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

The Science of Smart Beds May 20, 2022

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

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