Talking Sleep

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. 

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. 

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. 

Dr. Safia Khan, a women's sleep expert and editor for "A Clinical Casebook of Sleep Disorders in Women," shares fascinating insights into the unique sleep challenges women face throughout their lives. She discusses how pregnancy and menopause disrupt sleep patterns differently in women compared to men. Dr. Khan emphasizes the underdiagnosis of sleep disorders and the importance of tailored assessments and treatments, including cognitive behavioral therapy and the management of conditions like sleep apnea and PCOS. She also explores the critical role of iron deficiency screening in adolescent girls.

Dr. Atul Malhotra, lead investigator of the SURMOUNT-OSA trial, joins specialists Dr. Radhika Breaden, Dr. Jeremy McConnell, and Dr. Rafael Sepulveda Acosta to discuss the groundbreaking FDA approval of tirzepatide for obstructive sleep apnea. They delve into its effectiveness beyond weight loss, practical implementation strategies for clinics, and the importance of managing associated conditions like obesity. The team addresses concerns about GLP-1 medications and emphasizes collaboration between sleep and obesity medicine to provide comprehensive care for patients.

Dr. Sanja Jelic, a prominent sleep medicine expert at Columbia University, and Dr. Daniel Gottlieb, an Associate Professor at Brigham and Women's Hospital, dive deep into the potential inflammatory effects of high-pressure PAP therapy for sleep apnea. They tackle eye-opening findings on how PAP settings might influence inflammatory markers and challenge existing beliefs about CPAP efficacy. Plus, they explore innovative alternatives like supplemental oxygen and advocate for personalized treatment to enhance cardiovascular health and overall outcomes in sleep medicine.

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. 

Dr. William Noah, founder of Sleep Centers of Middle Tennessee and KPAP inventor, joins Dr. David White, former AASM president and sleep research expert. They dive into KPAP therapy, a revolutionary approach to sleep apnea treatment that enhances comfort and efficacy over traditional CPAP. The duo discusses the innovative engineering behind the VECOM device, research studies on CO2 rebreathing, and how real-time pressure adjustments can significantly improve patient experience. Their insights offer a promising glimpse into the future of sleep therapy.

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. 

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.