The White Noise Podcast: Recent Episodes
The White Noise Podcast
The aim of this sleep medicine podcast is to provide health care professionals who deal with sleep related issues with the most up to date clinical information when. We use expert interviews with leaders in the field of sleep medicine to help guide learning and grow clinical practice. We also try to have some fun along the way.
In this months episodes we speak with Dr. Dana Busch, an aviation medical examiner, about sleep disorders and FAA regulations
We welcome back Dr. Andy Berkowski to discuss more restless legs, including updated guidelines, and also get into a brief discussion of concierge sleep Medicine. Show Notes Thing of the month 4:00-The investiGATORS, Mouse, The Watchmen , 48 Laws of Power, Cloud Cuckooland, The last of UsRLS recap of previous RLS episode 8:422021 Mayo Clinic Proceedings RLS 10:00Alcoholism induced by dopamine agonist 14:30Think/check Iron first 15:30Parkinson’s patients 16:15Initial management & Serum Iron Brain Iron mismatch and iron dosing 21:30Iron supplementation: 23:5026:00 Transferrin Saturation28:30 HepcidinOral iron approaches 29:30Gabapentin side effects 30:45When symptoms continue despite iron repletion 32:15Gabapentin Encarbil 33:30 Clonazepam and…
In this months episode we will be discussing all things Inspire with Dr. Paul Hoff, an ENT at Michigan Medicine. What is Hypoglossal Nerve Stimulation? Who can get it? Does it Even work? Listen as we answer all your burning questions. Show Notes3:00 get to know you questions9:20 Favorite BookBest Advice 10:00The Inspire Case 11:00What type of sleep study? 18:20AHI Cutofffs: 18:55Goals of Care? 21:50What is considered effective therapy? 24:30Star Trial link: Upper-Airway Stimulation for Obstructive Sleep Apnea | NEJMAdhere Registry Link: Results of the ADHERE upper airway stimulation registry and predictors of therapyefficacy - Thaler - 2020 - The Laryngoscope - Wiley Online LibraryDefine CPAP failure? 26:00Nasal obstruction causing CPAP failure 28:00Floppy Epiglottis causing Aerophagia? 28:30Surgery for Aerophagia 29:30Risks and medical contraindications 33:00MRI compatibility? 33:30Surgery description/length 34:30ICD compatibility? 35:00Avg Voltage ranges? 37:00Removing devices 39:00Recovery time 39:40Incision size 40:45Back to the case, parameters for referral 43:00Drug Induced Sleep Endoscopy (DISE) 43:45What percentage of patients fail DISE? 47:00Management after Inspire placement 48:15Inspire sync: 49:15Battery life 11 years: 51:00Explant 51:30Surgical options other than Inspire 53:15Does UPPP work? 56:00What can we expect from surgery? 57:00When to refer for large tonsils 59:00Closing comments 1:01:00
In this months episode we chat with Dr. Miranda Lim of OHSU about Trauma Associated Sleep Disorder. Is it a new disorder? Does it always evolve into REM sleep Behavior Disorder? Are there any treatments? Listen to find out!
In this months episode we discuss narcolepsy with Matthew Horsnell. Matt is a narcolepsy patient and advocate, and we discuss his journey of living with narcolepsy.
SHOW NOTES
- Introduction of Guest: (5:00)
- Matt’s Best Advice (11:00)
- Matt’s Role in the sleep community (12:40)
- Matt’s symptoms onset (15:00)
- Matt’s additional symptoms (19:00)
- Matt’s onset of cataplexy (23:00)
- Cataplexy triggers (24:45)
- Delayed diagnosis: (27:00)
- Nightmares and sleep paralysis onset (31:30)
- One more question about sleep paralysis (34:15)
- Partial cataplexy (37:50)
- Diagnosis and Management: (39:00)
- Pitolisant (43:45)
- Strategic Napping (44:15)
- Bitter Pills (45:15)
- AASM revised Guidelines (47:22)
- Sodium Oxybate and Cataplexy (49:00)
- Finding a sleep physician to manage narcolepsy (55:00)
- Sleep apnea (60:30)
- MSLT (62:15)
- Treat Clinically (65:00)
- 4 pillars of management (66:00)
- Patient request/feedback (68:00)
- Academic vs private practice (71:30)
Links to articles and guidelines referenced in this episode are included
Trotti LM. Central Disorders of Hypersomnolence. Continuum (Minneap Minn). 2020 Aug;26(4):890-907.
Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline
Join us this month as we discuss OSA and cardiovascular disease with Dr. Peter Farrehi, a cardiologist at the University of Michigan. We focus on arrhythmias, but do delve into other topics as well. We hope you enjoy!
Time Stamps
00:45 intro
3:00 best advice
6:50 pick of the month
12:12 discussion begins
12:30 What should we be looking for on a sleep ECG?
14:00 See the patient or do the sleep study first?
16:38 should every patient with afib get a sleep study?
17:15 STOP BANG screening and afib
19:30 arrhythmia and auto-cpap
21:30 heart failure and preserved EF
22:50 why does OSA predispose to atrial fibrillation
26:00 anti arrhythmic drugs for afib with co-morbid sleep apnea
29:00 minutes coughing can be edited if you want
29:30 rate or rhythm control for afib?
31:00 fatigue or sleepiness?
32:20 Other sleep related arrhythmias
32:36 Non sustained ventricular tachycardia
33:00 Sustained ventricular tachycardia
36:00 arrhythmia and management on the sleep end
37:40 Long QT
38:00 Chronic afib
38:30 sinus pause
39:30 AV block
42:00 2 Lead ECG problems
43:00 medicare games
44:30 positional therapy
47:15 virtual visits discussed vs face to face
48:30 screening afib for OSA
50:33 compliance and non compliance - sleep heart health study
51:00 Meta –review JAMA
52:40 arrhythmia and cpap, when will my arrhythmia improve?
54:30 treat sleep apnea prior to cardioversion?
58:50 PVC’s
1:01:00 7 pvc/minute
1:02:00 PACs?
1:03:00 bigeminy or trigemini?
1:04:20 oxygen nadir and oxygen desaturation index
1:12:30 using oxygen nadir to reach the patient
1:15 wrap up
Join us as we talk with Dr. Barbara Felt about the management of ADHD in children with sleep disorders,
37:14 – Second-line medications for ADHD
38:08 – How late in the day can stimulant medications be given without risk of sleep disruption?
38:28 – How to approach the evaluation of night terrors in the patient from our case
40:22 – What is a “normal” ferritin in children?
41:15 – What is average ferritin in pre-school children?
41:40 – How do you approach a vague history provided by children regarding RLS symptoms?
43:12 – What dose of iron should be used to treat children with RLS?
44:00 – If treatment of OSA improves ADHD symptoms, is it reasonable to wean stimulant medications?
45:57 – How frequently should one re-evaluate medication doses for children with ADHD?
47:23 – Can ADHD resolve over time? Is ADHD a life-long disease?
50:32 – How commonly do children with ADHD have difficulty falling asleep?
52:15 – Discussion about behavioral insomnia of childhood, limit-setting type and combined type
54:35 – What sort of behavioral treatments are useful for children with insomnia?
56:20 – Are children with ADHD more likely to have circadian rhythm disorders?
59:00 – On the importance of sleep routines for children with ADHD
59:47 – Opportunities for research in the field of ADHD and sleep
1:02:42 – What dose of melatonin should be recommended for children?
1:05:01 – Take-home points from Dr. Felt
Legs bothering you? Well join the The White Noise Podcast as we pick the brain of Dr. Andy Berkowski, clinical associate professor and restless leg expert at the University of Michigan. Learn all about the diagnosis and management of restless legs syndrome. There is also a guest appearance by hepcidin, the bouncer at Club Ferritin.
CME credit link will be here when available
Show Notes – Season 1, Episode 4 – Restless legs syndrome
Time stamps
0:30 – Introduction
2:30 – Interview starts
7:40 – Picks of the month
12:50 – Case
13:50 – Initial thoughts on case
14:00 – Diagnosis of restless legs syndrome
16:50 – Diagnostic criteria for restless legs syndrome
17:40 – Difficulties in diagnosis
22:20 – Key questions to ask in taking history
24:00 – Periodic limbs vs restless legs syndrome
28:30 – Pathogenesis of restless legs syndrome
31:00 – History of Willis-Ekbom disease
35:50 – Case
36:40 – Medications for restless legs syndrome
38:30 – Dopamine agonists
43:30 – Alpha-2-delta-ligands
45:00 – Iron therapy
50:10 – PO vs IV iron supplementation
58:45 – IV iron formulations
1:00:30 – Narcotics
1:05:03 – Augmentation
1:09:00 – Non pharmacologic therapies
1:11:10 – Medications that worsen restless leg syndrome
1:16:00 – Screening for restless legs syndrome
1:18:00 – Follow-up of restless legs syndrome patients
1:18:50 – Sleep apnea and restless legs syndrome
1:20:10 – Take home points
1:22:00 – Interview end
Definitions
Augmentation: The process by which the symptoms of restless legs syndrome occur earlier in the day, become more severe, are less responsive to treatment, and spread to other parts of the body (e.g. arms and trunk), usually due to treatment with escalating doses of dopaminergic medications.
Restless legs syndrome: A condition characterized by an urge to move one’s legs (often accompanied by unpleasant sensations in the legs) that is most prominent at rest, partially or totally relieved by movement, and classically worse in the evening. The symptoms must not be better explained by another condition such as peripheral neuropathy.
Periodic limb movements of sleep: Periodic, repetitive, stereotyped limb movements that occur during sleep. American Academy of Sleep Medicine (AASM) scoring criteria require a minimum of 4 limb movements in series with 5-90 seconds between movements. Periodic limb movements of sleep are seen in the majority of patients with restless legs syndrome who undergo polysomnography.
Periodic limb movement disorder: A disorder characterized by more than 15 periodic limb movements per hour of sleep in adults (greater than 5 in children) that cause a significant sleep disturbance and/or functional impairment not better explained by a different disease entity.
Akathisia: An inner sense of restlessness and desire to move that is often caused by dopamine antagonist medications, is usually generalized (not limited to the legs), and is unlikely to be totally relieved by movement.
Clinical Pearls
- Restless legs is a clinical diagnosis
- The hallmark of the disease is a SENSATION of the need to move.
- There must be a circadian component to make a diagnosis.
- Augmentation will almost inevitably occur
Episode written and produced by John Barkham, MD, Mohan Dutt, MD, and Alok Sachdeva MD.
The White Noise Podcast discusses the medical management of nightmare disorders with our very own Dr. John Barkham, who is a clinical lecturer at the Ann Arbor VA. This is part one of our two part series on nightmare disorders.
Show Notes Season 1-Episode 2- Nightmare Disorder Part 1
Time Stamps
0:00 – Introduction
4:51 – Guest Introduction
8:10 – Picks of the month
- Maps of Meaning by Jordan Peterson
- 12 Rules for Life by Jordan Peterson
- The Big Fella by Jane Leavy
- Star Trek: Discovery
11:29 – Clinical case begins
11:40 – Evaluation of nightmares
- The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA).
22:00 – Nightmares in the veteran population
25:30 – Prazosin use for nightmare disorder
- Clinical case series: the use of Prazosin for combat-related recurrent nightmares among Operation Iraqi Freedom combat veterans.
28:00 – Diagnostic criteria for nightmare disorder
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper
32:05 – Disturbing dreams and nightmare severity index (DDNSI)
- Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: diagnostic and treatment implications.
34:00 – Resumption of case
37:45 – Prazosin dosing
41:50 – Problems with the DDNSI
47:18 – Pharmacologic alternatives to prazosin
51:00 – Alternatives to pharmacotherapy
- Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial.
Additional Information
From: Callen et al, Nightmare Disorders in Adults
From: Callen et al, Nightmare Disorders in Adults
Disclosures
The authors of The White Noise Podcast have no financial disclosures
This episode was written and produced by John Barkham, MD, Mohan Dutt, MD, and Alok Sachdeva MD.
Join The White Noise Podcast in part II of their discussion on nightmare disorder. In this episode we speak with Dr. Todd Favorite, an expert in the treatment of PTSD and nightmare disorders.
Show Notes Season 1-Episode 3- Nightmare Disorder Part 2
Time Stamps
0:00 – Introduction
0:30 – Get to know Dr. Favorite
2:45 – Pick of the Month
- Paths of Glory by Jeffery Archer
5:00 – Clinical Case
6:45 – Initial Evaluation
8:00 – Nightmares in the setting of post-traumatic stress disorder
16:00 – Dream rescripting
22:00 – How to evaluate success
28:00 – Choosing the right patient
30:00 – How to address nightmares with patients
38:00 – Scoring systems
39:45 – More information on dream rescripting
42:00 – Co-therapy with medication
45:00 – How to be successful
47:00 – Medication vs nightmare reduction therapy
Dr. Favorites Recommended Reading List
- Davis, J.L., Treating Post-Trauma Nightmares : A Cognitive Behavioral Approach. Springer Publishing Co. NY
- Favorite, T.K., Conroy, D. (2018). Psychosocial Treatments for Trauma-Based Nightmares. Psychiatric Times, Sept 2018
- Swanson, L., Favorite, T.K, Arnedt, T., Horin, E. (2009).A Combined Treatment for Nightmares and Insomnia in Combat Veterans: A Pilot Study. Journal of Traumatic Stress, 22(6): 639-642.
- Krakow,.B. , et.al. (2001). Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder A Randomized Controlled Trial. JAMA, August 1, 2001—Vol 286, No. 5
- Mysliwiec, V., O’Reilly, B., Polchinski, J., et.al. (2014). Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors.Journal of Clinical Sleep Medicine, Vol. 10, No. 10
Disclosures
The authors of The White Noise Podcast do not have any financial disclosures.
Join The White Noise Podcast in a discussion of the diagnosis and management of Delayed Sleep Wake Phase Disorder (DSWPD) with special guest Dr. Cathy Goldstein, an expert in circadian rhythm disorders in Ann Arbor, Michigan and Chair of the Artificial Intelligence in Sleep Medicine subcommittee of the American Academy of Sleep Medicine (AASM).
``` www.thewhitenoisepodcast.com
```