Talking Sleep

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 th...

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...

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. He...

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....

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 Philip...

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 embr...

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 lo...

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 impuls...

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...

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...

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 vers...

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 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 conversati...

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 qual...

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...

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...

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 o...

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...

We have long known that obesity is a risk factor for OSA, but most sleep clinicians don’t manage obesity. Is this something we should consider? How complicated is it? How should we navigate insurance hurdles? Do we need to employ a dietician? Is managing obesity feasible for a typical sleep medicine practice? Here to explore this further on today's episode of Talking Sleep is Dr. Rafael Sepulveda.

The practice of sleep medicine is extremely diverse. While there are many who are a part of academic institutions, others have chosen private practice. One option that is becoming more popular is a direct-to-consumer, self-pay model. Here to give us a better understanding of some of these practice models are Dr. Sahil Chopra and Dr. Andy Berkowski.

In this episode of Talking Sleep our guest, Dr. Alon Avidan, helps us better understand the ethics of disclosure in REM sleep behavior disorder. A big part of this disorder's overall management includes disclosing potential neurodegenerative sequelae. While prescribing medications can be fairly straightforward, the discussion of a potentially life-altering diagnosis is more nuanced. It requires no...

As sleep technology continues to advance, we are sometimes left to try to figure out which billing code to use. There are level 2 studies that have a g-code and some novel HSAT devices that are creating new metrics that don’t always fit into a current CPT code. Navigating this can be tricky. Here to help us understand how a CPT code is made is Dr. Vikas Jain.

A few years ago, the AASM held a competition challenging us to reimagine sleep care. The Mobile Sleep Lab was a model that was submitted as a contender in this challenge. Here to tell us more about this are Dr. Mark Boulos, Dr. Luqi Chi and Dr. Oleg Chernyshev.

In today’s episode of Talking Sleep, we are joined by Dr. Jean-Louis Pépin and Dr. Atul Malhotra, who talk about how the signal derived from mandibular jaw movements during sleep can be an alternative measurement of respiratory effort in patients being evaluated for suspected sleep apnea. We will focus on the scientific basis and clinical implications of this new signal.

In today’s episode of Talking Sleep, Dr. Raj Dedhia joins us to talk about hypoglossal nerve stimulation, which was first approved by the FDA in 2014 to treat a subset of patients with moderate to severe obstructive sleep apnea. Now, nearly a decade later, the treatment has evolved, and we have a better understanding of its nuances. Visualizing the airway during sleep endoscopy is a key element in...