Talking Sleep

In the last few years, more medications have been available to treat central disorders of hypersomnolence. While treatments for narcolepsy and idiopathic hypersomnia are similar, there are some specific considerations when trying to determine which combination of medications is most appropriate for a patient. Significant payor coverage and formulary variability add another layer to this conversation. Some are considered off-label and others are on-label but may be cost-prohibitive. Dr. Hrayr Attarian explains some of the nuances of these newer medications, how they perform for specific symptoms, and how to consider tailoring medication regimens with shared decision-making.

Drowsy driving accidents are just one of the many ways in which health care can interface with the legal system. Our guest for this episode is Dr. Ramesh Sachdeva, a sleep medicine and pediatric critical care physician who decided to go to law school several years ago and has previously served as an adjunct professor of law. He has a unique interest in the intersection of medicine, healthcare quality, and law and is here today to help us explore potential legal issues that can arise in a sleep medicine practice.    Please note that this is not legal advice. This discussion is for educational purposes only and should not be relied upon as legal advice or legal opinion. 

We have long known that CPAP therapy isn’t meant for everyone who has obstructive sleep apnea. There are plenty of non-PAP treatment options, including oral appliance therapy and hypoglossal nerve stimulation. Pharmacotherapy has been used as an adjunct therapy to treat persistent hypersomnolence despite well-treated OSA or to assist with PAP acclimatization. Now medications are being developed to treat OSA and its underlying obstruction. Here to help us understand more about these medications is Dr. Sanjay Patel.

Obesity hypoventilation syndrome can be challenging to manage. Obtaining the appropriate device for each patient is often complicated by insurance requirements and endless red tape. Previous guidelines have indicated that CPAP may be as effective as bi-level PAP; however, this doesn’t apply to all patients. How can we identify patients who may require more advanced treatment modalities while also ensuring that those treatments do not cause undue financial burden for them? Here to help us understand this better is Dr. Babak Mokhlesi. 

We frequently discuss how insufficient sleep may be harmful to cardiometabolic health, but is this the whole story? How does circadian rhythm misalignment contribute to this relationship? Could a behavioral sleep intervention possibly improve cardiometabolic health? Dr. Chris Depner investigates how insufficient sleep and circadian disruption contribute to the risk of metabolic disorders such as obesity and diabetes. His long-term goal is to develop sleep and circadian-based interventions that improve metabolic health. He is here to help us better understand the relationship between insufficient sleep, circadian disruption, and cardiometabolic health.

As students go back to school, many adolescents will have to advance their sleep phase in order to start classes early in the morning. While delayed sleep phase syndrome is common during adolescence, insomnia symptomatology may be underrecognized. It may be attributed to excessive screen time, social jet lag, or too much caffeine. We try to provide education around proper sleep hygiene techniques and often deploy cognitive behavioral therapy for insomnia, which was developed for adults. Are there other special considerations for adolescents? Does it make sense to utilize CBT-I in this age group? Is it appropriate to utilize sleep restriction therapy for teenagers? Should we adapt our current CBT-I algorithms to better suit the adolescent population? Here to help us answer these questions are Dr. Maureen Elizabeth McQuillan and Dr. Sarah Morsbach Honaker.   

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

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

In this episode of Talking Sleep our guest, Dr. Alon Avidan, helps us better understand the ethics of disclosure in REM sleep behavior disorder. A big part of this disorder's overall management includes disclosing potential neurodegenerative sequelae. While prescribing medications can be fairly straightforward, the discussion of a potentially life-altering diagnosis is more nuanced. It requires not only the explanation of Lewy Body dementia or Parkinson’s but also the ability to assess what a patient needs to hear and when it is appropriate to disclose this information. 

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