Podcasts about cpap

Did you know you can fix sleep apnea without CPAP? Discover 3 sleep apnea exercises that can help stop sleep apnea naturally and even help with snoring for better sleep and better health.

What if better sleep starts with addressing what's happening inside your body? In this episode of The Healthy Sleep Revolution Podcast, Dr. Meghna Dassani sits down with dentist-turned-peptide coach Dr. Aimee Russo-Mounger to explore peptides, inflammation, cortisol, healing, and their potential role in supporting better sleep and overall wellness. After 28 years in dentistry, Dr. Aimee retired from clinical practice in 2026 and shifted her focus to peptide therapy and coaching for high-achieving women. She shares what led her down this path, how peptides work, and why she believes addressing the underlying causes of inflammation, stress, and poor sleep can be an important part of a broader health strategy. Together, Dr. Meghna and Dr. Aimee discuss: What peptides are and how they communicate with our cells The difference between natural and synthetic peptides How inflammation and cortisol can affect sleep, recovery, and overall health Peptides that may support relaxation, restorative sleep, and inflammation management Why peptides should not replace evidence-based treatment for sleep apnea, such as CPAP or oral appliance therapy The connection between chronic stress, the central nervous system, and restorative sleep Why high-achieving women and busy moms may be particularly vulnerable to chronic stress and burnout How Dr. Aimee approaches peptide therapy through personalized coaching The role of medical oversight when using peptide therapies Why addressing the foundation of health may be more effective than continually adding another "band-aid" Dr. Aimee also shares her own experience with stress, cortisol, weight changes, and the transition from practicing dentistry to helping women reclaim their energy, clarity, and vitality. Disclaimer: This episode is for educational purposes only and does not constitute medical advice. Peptide therapies may not be appropriate for everyone. Always consult an appropriately qualified healthcare professional before starting any new treatment. About Dr. Aimee Russo-Mounger Dr. Aimee Russo-Mounger has spent 28 years in medicine as a Doctor of Dental Surgery — and today she brings that same clinical rigor into an entirely different mission: helping high-achieving women reclaim their energy, clarity, and vitality from the inside out. Certified in Peptide Therapy through The Empowered Academy and an affiliate of MAKE Wellness, Dr. Aimee founded the Powerhouse Peptide Method, a science-backed, faith-rooted approach designed to help women feel like themselves again. As a speaker, coach, and host of The Dr. Aimee Podcast, she brings decades of clinical experience and a deeply personal conviction that true longevity starts with caring for the whole person — body, mind, and soul. Dr. Aimee's first book is set to release in December 2026. Connect with Dr. Aimee Russo-Mounger Website & Socials: https://linktr.ee/Dr.Aimeehealth Take the Free Assessment: https://boards.com/a/XesvKn.OZi0K0 About Meghna Dassani Dr. Meghna Dassani is passionate about promoting healthy sleep through dental practices. In following the ADA's 2017 guideline on sleep apnea screening and treatment, she has helped many children and adults improve their sleep, their breathing, and their lives. Her books and seminars help parents and practitioners understand the essential roles of the tongue, palate, and jaw in promoting healthy sleep.   Connect with Dr. Meghna Dassani Website: https://www.meghnadassani.com Facebook: https://www.facebook.com/healthysleeprevolution Instagram: https://www.instagram.com/healthysleeprevolution/ Youtube: https://www.youtube.com/channel/UC9Lh_n7xmbhQVPGQrSjBIrw Get a copy of Airway is Life: https://www.airwayislife.com

Real Bears football is less than two weeks away as the 53 is (basically) set. How confident are the boys of Zero Doinks that the Bears will return to the playoffs and how do they stack up against the rest of the NFC North? Is Josh Jacobs a proper representative of the Packers organization as a whole? Is Matt LaFleur still getting daily haircuts and if he isn't, what does it mean? The boys also lament (?) the end of an era in Chicago sports media and have a few CPAP updates. B1G football talk as well.

Send us Fan MailMost trials comparing CPAP and NIMV leave a lingering doubt about whether surfactant explained the difference. This one does not. Ben brings a multicenter noninferiority trial from JAMA Network Open in infants born between 24 and 29 weeks, randomized to nasal CPAP or NIMV with every baby receiving less invasive surfactant administration. The trial stopped early for futility after 312 infants. Noninvasive ventilation failure within 72 hours was 26 percent on CPAP versus 13 percent on NIMV. Ben and Daphna talk through what happens when surfactant is off the table, the unexpected NEC signal, and where the guidelines may need revisiting.----Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation in Preterm Infants With Respiratory Distress Syndrome: A Randomized Clinical Trial. Zhang H, Zhang Y, Zeng L, Tong X, Piao M, He H, Zhao C, Xie H, Zheng Z, Cui Q, Lai Y, Wang H, Wang L, Liu H, Tian X, Wu H, Kang L, Han T.JAMA Netw Open. 2026 Jun 1;9(6):e2619785. doi: 10.1001/jamanetworkopen.2026.19785.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Tova Noel, one of the two correctional officers assigned to the Metropolitan Correctional Center's Special Housing Unit on the night Jeffrey Epstein died, told the House Oversight Committee that she failed to conduct the required inmate checks and later signed records falsely indicating that the rounds had been completed. Noel described an understaffed, poorly managed facility in which she was exhausted, inadequately trained and assigned duties beyond her normal responsibilities. She maintained that she last saw Epstein alive during the evening medication round and observed nothing that made her believe he was preparing to harm himself. Noel also testified that Epstein received unusual accommodations, including extra bed linens, a CPAP machine and access to medication that appeared different from the treatment ordinarily given to other prisoners.Noel denied having any role in Epstein's death, receiving money in connection with him or knowing anything about an alleged payment to facilitate access to his cell. She also rejected claims that she was the unidentified orange-colored figure seen moving toward Epstein's tier at approximately 10:39 p.m., insisting that she never returned to the area and could not explain what—or who—the surveillance image showed. Although Noel said she believed Epstein died by suicide because he was supposedly alone inside the cell, her testimony did little to resolve the most important unanswered questions: why required checks were abandoned, why Epstein remained without a cellmate, who or what appeared near the tier, and how so many security procedures failed simultaneously. Instead, her account reinforced the picture of extraordinary negligence, special treatment and institutional dysfunction surrounding the death of the most consequential prisoner in federal custody.to contact me:bobbycapucci@protonmail.comsource:Tova-Noel-Transcript.pdf

Tova Noel, one of the two correctional officers assigned to the Metropolitan Correctional Center's Special Housing Unit on the night Jeffrey Epstein died, told the House Oversight Committee that she failed to conduct the required inmate checks and later signed records falsely indicating that the rounds had been completed. Noel described an understaffed, poorly managed facility in which she was exhausted, inadequately trained and assigned duties beyond her normal responsibilities. She maintained that she last saw Epstein alive during the evening medication round and observed nothing that made her believe he was preparing to harm himself. Noel also testified that Epstein received unusual accommodations, including extra bed linens, a CPAP machine and access to medication that appeared different from the treatment ordinarily given to other prisoners.Noel denied having any role in Epstein's death, receiving money in connection with him or knowing anything about an alleged payment to facilitate access to his cell. She also rejected claims that she was the unidentified orange-colored figure seen moving toward Epstein's tier at approximately 10:39 p.m., insisting that she never returned to the area and could not explain what—or who—the surveillance image showed. Although Noel said she believed Epstein died by suicide because he was supposedly alone inside the cell, her testimony did little to resolve the most important unanswered questions: why required checks were abandoned, why Epstein remained without a cellmate, who or what appeared near the tier, and how so many security procedures failed simultaneously. Instead, her account reinforced the picture of extraordinary negligence, special treatment and institutional dysfunction surrounding the death of the most consequential prisoner in federal custody.to contact me:bobbycapucci@protonmail.comsource:Tova-Noel-Transcript.pdf

Tova Noel, one of the two correctional officers assigned to the Metropolitan Correctional Center's Special Housing Unit on the night Jeffrey Epstein died, told the House Oversight Committee that she failed to conduct the required inmate checks and later signed records falsely indicating that the rounds had been completed. Noel described an understaffed, poorly managed facility in which she was exhausted, inadequately trained and assigned duties beyond her normal responsibilities. She maintained that she last saw Epstein alive during the evening medication round and observed nothing that made her believe he was preparing to harm himself. Noel also testified that Epstein received unusual accommodations, including extra bed linens, a CPAP machine and access to medication that appeared different from the treatment ordinarily given to other prisoners.Noel denied having any role in Epstein's death, receiving money in connection with him or knowing anything about an alleged payment to facilitate access to his cell. She also rejected claims that she was the unidentified orange-colored figure seen moving toward Epstein's tier at approximately 10:39 p.m., insisting that she never returned to the area and could not explain what—or who—the surveillance image showed. Although Noel said she believed Epstein died by suicide because he was supposedly alone inside the cell, her testimony did little to resolve the most important unanswered questions: why required checks were abandoned, why Epstein remained without a cellmate, who or what appeared near the tier, and how so many security procedures failed simultaneously. Instead, her account reinforced the picture of extraordinary negligence, special treatment and institutional dysfunction surrounding the death of the most consequential prisoner in federal custody.to contact me:bobbycapucci@protonmail.comsource:Tova-Noel-Transcript.pdf

Tova Noel was one of the two correctional officers assigned to the Special Housing Unit at the Metropolitan Correctional Center in Manhattan on the night Jeffrey Epstein died in August 2019. Along with fellow officer Michael Thomas, Noel was responsible for monitoring Epstein and the other inmates housed on the unit, including conducting required inmate counts and rounds. Federal investigators later charged Noel and Thomas with falsifying prison records after concluding that they had signed logs indicating checks had been completed when, in fact, required rounds had been missed for hours. Noel ultimately avoided trial through a deferred prosecution agreement that required her to cooperate with the Justice Department's investigation and complete community service, after which the charges were dismissed. She later became an important witness in congressional scrutiny of Epstein's death because she was among the last people known to have seen him alive, was present when his body was discovered and had firsthand knowledge of the conditions inside the MCC that night.When Noel finally testified before the House Oversight Committee in May 2026, she largely portrayed herself as an inexperienced, exhausted employee trapped inside a catastrophically understaffed prison rather than someone responsible for Epstein's death. She said her poor performance resulted from inadequate training, mandatory overtime and the crushing workload at the MCC, telling investigators that she had earned roughly a full year's base salary in about six months because she was working so much overtime. Noel denied sleeping during the shift, although she acknowledged browsing the internet, and said she could not remember specifically searching for news about Epstein shortly before his body was discovered. She also acknowledged that Epstein received treatment other inmates did not, including extra linens, a CPAP machine and other accommodations, describing exceptions as being made essentially because he was Jeffrey Epstein. Perhaps most strikingly, Noel insisted that her only connection to Epstein's death was that she happened to be forced into overtime that night, distancing herself from responsibility despite being one of the officers specifically assigned to monitor him and despite admitting that the system around him had broken down. She denied knowing anything about an unidentified orange-colored figure captured on surveillance footage, rejected allegations that she participated in any cover-up and maintained that years of suspicion surrounding her role had devastated her life.to contact me:bobbycapucci@protonmail.com

Dave makes his version of fideos and talks all things sleep with Chris Ying and his guests Jamie and Dustin. After a MOIF, they answer questions like: Do you sleep naked or with pajamas? What's your bedtime routine? Dustin uses WHAT as a pillow? Dave also pitches his idea for sleep clinics where they give you a good night's sleep...and tries to bring up Ying's CPAP machine as much as possible.For your chance to sit at our counter in Los Angeles, write us at tickets@majordomomedia.com with your name, social media handle, and a little about yourself. With Vrbo, what you book is what you get. Learn more about your ad choices. Visit podcastchoices.com/adchoices

On today's 8.27.26 show we talked about the Yerba Buena Tunnel lights, CPAP baddies, new research on CTE, Doja Cat shaded Nicki Minaj, changes to the NFL, the amount of money Justin Baldoni will have to pay to Blake Lively, a new Costco record and more!See omnystudio.com/listener for privacy information.

Central sleep apnea is a complex and often underrecognized sleep-related breathing disorder that differs from obstructive sleep apnea by involving reduced respiratory drive rather than upper airway obstruction. In this episode, Dr. Ran Liu reviews the underlying mechanisms of central sleep apnea, including the role of ventilatory control instability, discusses its association with neurologic conditions such as stroke, multiple sclerosis, ALS, and myasthenic disorders, and highlights key considerations for diagnosis and management. Learn how emerging technologies, personalized treatment strategies, and advances in sleep medicine are improving outcomes for patients with this heterogeneous group of disorders. In this episode, Teshamae Monteith, MD, FAAN, speaks with Ran R. Liu, MD, FRCPC, MSc, author of the article "Central Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Liu is an Adjunct Clinical Assistant Professor at McMaster University in Hamilton, Canada, and an Adjunct Lecturer at the University of Toronto in Toronto, Canada. Additional Resources Read the article: Central Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @SleepyNeuroDoc  Full episode transcript available here Dr Monteith: You may be familiar with obstructive sleep apnea, but central sleep apnea is often less understood and frequently underdiagnosed. In this podcast, we break down the key clinical pearls to sharpen your diagnostic reasoning, discuss why central sleep apnea matters, and to explore some of the fascinating advances transforming the field. Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Monteith: This is Dr. Teshamae Monteith. Today, I'm interviewing Dr. Richard Liu about his article on central sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Welcome to our podcast. How are you?  Dr Liu: Good. Thank you, Dr. Monteith, for having me today.  Dr Monteith: Please introduce yourself to our audience.  Dr Liu: Hello, everybody. My name is Richard Liu. I am a sleep neurologist. I am working out of Toronto at both Sunnybrook Health Science Center and MedSleep. I did my residency at Queen's for neurology and my sleep medicine fellowship at Harvard University.  Dr Monteith: Great. And what got you interested in sleep?  Dr Liu: Thank you very much for asking. For me, sleep medicine is a field where essentially everything is connected. Certainly, impaired sleep can affect many other conditions, including many neurological conditions. And even within sleep medicine, when somebody has a sleep disorder, often the entire system is connected. So as an example, if you have insomnia and fragmented sleep and periodic limb movements of sleep, certainly these conditions can impact sleep apnea. And certainly, for today's topic of central sleep apnea, this is an extremely complicated disorder where it's a very in-depth integration between neurological and respiratory physiology, among other systems as well.  Dr Monteith: So, I guess you're kind of like the cornerstone, sleep being the cornerstone of neurology. Everyone has to sleep. That's for sure. Great. So why don't we talk about what central sleep apnea is, and how prevalent is it as a collective group of disorders compared to obstructive sleep apnea?  Dr Liu: So, one way to think about central sleep apnea is that this is a heterogeneous group of etiology. But the primary concept here for central sleep apnea is that there's a reduction in respiratory drive. This is in contrast to obstructive sleep apnea, where essentially this is some form of airway obstruction in the presence of relatively intact respiratory drive. And of course, there's mixed apneas where they may contain features of both. But of course, now we know that even obstructive sleep apnea, there's a certain degree of drive dependence somewhat blurring these distinctions. The overall prevalence of central sleep apnea is about five to ten percent of all patients with sleep- disorder breathing. And certainly, it could be higher in some neurological conditions, such as things like stroke, multiple sclerosis, and multisystem atrophy.  Dr Monteith: Great. So certainly, it's out there. Why don't you tell us about the objectives of your article?  Dr Liu: Absolutely. Thank you for asking. I think the main objective of this article is really to highlight that central sleep apnea is a complex syndrome resulting from a large group of heterogeneous etiologies. And of course, again, it could be associated with many neurological conditions. And really here, I want to highlight advancements, both medicine and technology, on both the side of diagnosis of central sleep apnea, as well as the multimodal targeted treatment.  Dr Monteith: And what do you want our listeners to take away from this talk and certainly your article? What are the key essential points?  Dr Liu: Thank you very much for asking. I think that one way of looking at central sleep apnea to etiologically divide this into both hypocapnic and hypercapnic central sleep apnea. And of course, loop gain being a major driver for a hypocapnic central sleep apnea, and that one can actually think about hypocapnic central sleep apnea beyond a phenotypic spectrum with obstructive sleep apnea, with many patients having overlapping features of both obstruction and central component. On the other hand, hypercapnic central sleep apnea, often also known as hyperventilation syndrome, can span etiology from chemoreflex dysfunction to a broad range of neuroanatomical localization, such as central nervous system, peripheral nervous system, neuromuscular junction, and muscle disorders.  Dr Monteith: And what are some of the symptoms of central sleep apnea? Do any of them differ from obstructive sleep apnea?  Dr Liu: Thank you for asking, that's an excellent question. So certainly, central sleep apnea symptoms can overlap with obstructive sleep apnea symptoms. And of course, given the large range of underlying etiology, often the CSA symptoms depend on the underlying etiology. There may be less snoring compared to obstructive sleep apnea patients, especially the hypocapnic CSA patients. Of course, these patients, like OSA, may have frequent awakenings, gasping and choking their sleep, and nocturia, and so on.These patients may have daytime sleepiness, insomnia-like symptoms, or they could be asymptomatic. Interestingly, the hypocarbnic central sleep apnea patients, they're a bit more prone to have the insomnia-like symptoms, whereas the hypercarbnic central sleep apnea patients, they tend to have a bit more of the daytime sleepiness and morning headaches.  Dr Monteith: You spoke about some of the neurological disorders that might be associated with central sleep apnea, like stroke and multiple sclerosis. What about some of the more traditional risk factors associated with obstructive sleep apnea or conditions associated with it, like obesity and hypertension? Or does that just mix the picture?  Dr Liu: There is many overlap between risk factors between obstructive sleep apnea and central sleep apnea, and certainly one of the things that I highlight in this article is really that often it's not just black and white, that this could be a spectrum with overlapping disease between both conditions. So certainly, in our neurological world, stroke is the most common thing that may be associated with central sleep apnea. But overall, cardiovascular issues such as heart failure, atrial fibrillation, these things can also be associated with central sleep apnea. And again, from the neurological perspective, if we were to divide from hypocarbnic versus hypercarbnic central sleep apnea, by thinking about the hypercarbic central sleep apnea, again, this is where we're thinking about hypoventilation syndromes. You know, anything that can cause neuromuscular weakness, this is something that we should have a high alarm for, that potentially there may be a hypoventilation component. So, things like any myasthenic syndromes and ALS.  Dr Monteith: Great. Why don't we also talk about the classification? When was the last time central sleep apnea's classification was updated, and what should we know about the classification?  Dr Liu: The most recent classification for central sleep apnea is written in the International Classification of Sleep Disorders, third edition. In this edition, it's classified with six central sleep apnea syndromes. So, these are the CSA with Cheyne-Stoke breathing, CSA due to high altitude periodic breathing, primary CSA, CSA due to medication or substance, CSA due to medical disorder without Cheyne-Stoke breathing, and treatment-emergent central sleep apnea. These classifications more so describe the circumstance of when CSA occurs. A more etiological classification that we can consider would be classifying them by the underlying pathophysiology, which is dividing this from hypercarbnic central sleep apnea versus a hypocarbnic central sleep apnea. Certainly, both set of classification are discussed in this article.  Dr Monteith: Yeah. You discussed at length, the major physiological factors that our audience is just going to have to read. I don't want them to hear this too much while they're driving or on the treadmill, cause its super high level. But why don't we just start with some very basic factors that we need to know about this circuitry?  Dr Liu: Perhaps I can start with this concept of loop gain, which is the most important concept under hypocarbnic central sleep apnea. For any one of my colleagues who's listening to this, they're probably laughing right now cause they think that loop gain is my favorite word. So, loop gain is an engineering term referring to the sensitivity of a feedback loop. So, in the context of sleep medicine, this is an overly sensitive respiratory control to carbon dioxide and oxygen fluctuation. There are three components. The main one is controller gain. This is a chemosensitivity predominant to CO2. The second is plant gain, which is the lung's effectiveness for carbon dioxide excretion. And the last is what's called the mixing gain. This is circuitry delay from the time the signal travels from the pulmonary artery to the peripheral and central chemoreceptors. So conceptually, one may think, let's say something decreases your ventilation, so for example, apnea or hypopnea. With this, as you can imagine, when you stop breathing, your CO2 builds up, and this builds up according to the curve of the plant gain. And of course, this build of CO2 signal takes time to go from your lung to your chemoreceptor. That's your mixing gain. And of course, here it meets the overly sensitive chemoreceptors. This is your controller gain. As a result, this results in amplification of your ventilation to the initial respiratory disturbance. So, you have a overshoot of ventilation. All of a sudden, you're blowing out too much carbon dioxide, then you become hypocarbnic. At one point, if you blow out way too much carbon dioxide, your CO2 goes below what's called a PCO2 apneic threshold. After this, if your CO2's below, you essentially stop breathing. And of course, after that, you can imagine your CO2s are building up again. So, when this loop goes over and over, you generate what's called a chemoreflex-driven respiratory oscillation, where you create a crescendo, decrescendo-like flow pattern, which is underneath what we see in periodic breathing in central sleep apnea.  Dr Monteith: So, without going into too much detail, what is the key way to target restoration of equilibrium? Are there anatomical targets, physiologic targets that we're trying to manipulate here? Dr Liu: Again, thank you very much for that wonderful question. There's certainly many approaches that we could do to improve the stability of the system. Certainly, there are treatments for ventilation, either CPAP or in the case of hypocarbon central sleep apnea, things like adaptive servo ventilation. There is also medications that we can certainly discuss later that can double down the entire system for loop gain. Positional therapy can help for many of these patients. For the appropriate patient, improving their arousal threshold can actually reduce arousal-induced amplification of loop gain. Many of these patients, again, if appropriate, certainly weight loss may be helpful, and these are among many things that we can potentially do to improve the ventilatory stability of these patients.  Dr Monteith: Okay, great. But let's also talk about the general overall approach to diagnosing, and much of it is by history, as you mentioned. There's also sometimes a need, as you say, to differentiate out how much is obstructive. So, what is the thinking process there when you're approaching a patient?  Dr Liu: So perhaps I can start with in terms of the diagnostic modalities that we could use for this. So, the gold standard for diagnosis of central sleep apnea is still our polysonogram. The home sleep apnea test sometimes may be harder to distinguish between obstructive and central events. In addition, on a PSG, you have EEG. This allows you to assess for sleep quality and arousals, as well as the EMGs, which can help you pick up periodic limb movements of sleep. And of course, all of these things themselves can affect the central sleep apnea and can be a potential treatment factor.  Dr Monteith: Before we get into treatment, can you just give us, like, the top five or six drugs or drug classes we need to look for so that, you know, we can discontinue or try something else for our patients that might be complicating their presentation?  Dr Liu: Certainly medications, in some cases, can help central sleep apnea, but other cases can certainly be a precipitant of central sleep apnea. So, one thing to consider would be opioid medication. They can certainly cause very complicated central sleep apnea, something called ataxic breathing, where you have irregularity to the tidal volume and the rate of breathing. Other medications such as Oxybate, baclofen, valproic acid, gabapentin, all of which can certainly contribute to central sleep apnea. And of course, in the stroke world, something that we should always think about is that Tetagelor can also contribute to central sleep apnea. And outside of this, things like muscle relaxants, anesthetic agents can also be a contributor.  Dr Monteith: Great. Now let's get into some of the treatment.  Dr Liu: I like to divide treatment into targeting a hypercarbnic central sleep apnea and a hypocarbonic central sleep apnea. For hypocarbonic central sleep apnea, the first line is CPAP treatment. But for many patients, CPAP therapy is insufficient. There's also adaptive servo ventilation, which is an advanced device designed for hypocarbonic central sleep apnea. For hypercarbic central sleep apnea, again, first line is CPAP treatment, with more advanced devices being a bilevel therapy as well as volume-assured pressure support ventilation. There are also medications that can reduce loop gain, with the most researched one being acetazolamide. We can also reduce arousal thresholds, which could be appropriate for certain patients. And for certain patients, improving arousal threshold can be helpful as, especially in hypocarbic central sleep apnea, that arousals can amplify loop gain. Weight loss can be helpful for both hyper- and hypocarbonic central sleep apnea, and we have great new medication on the market for this. Other therapy can include supplemental oxygen that can be added to PAP devices, as well as phrenic nerve stimulation, positional therapy, as well as carbon dioxide modulation.  Dr Monteith: Excellent. So, it sounds like there's a lot of opportunity to help patients. Now, what are you most excited about in terms of latest development for detection as well as for intervention?  Dr Liu: Thank you very much. I'm actually excited about many things in sleep medicine. Perhaps the thing that I'm most excited about in detection in sleep medicine would be the wearable technologies. So, these technologies may use photoplethysmography to detect peripheral artertonometry. This is where we're measuring the pulsatile arterial volume signals as a surrogate of cardiac and respiratory function. And when paired, that was often desaturation. With these technologies, we can actually detect the staging, autonomic arousals, and HI. So of course, these technologies do not have flow, and they do not have EEG. But they're very powerful technology that allows us to do multi-night testing from home. And of course, understanding both the potential limitation of these technology in the context of patients can be very useful. In terms of treatment-wise, we're learning so much about the underlying contributing drivers of different forms of central sleep apnea. So again, this is highlighted in my article that many of these patients needs multimodal targeted treatment, both between either a PAP device in addition to other things such as medication, oxygen, positional therapy, and so on.  Dr Monteith: Great. So, I mean, I think there's so much to this field. Your article is very extensive. Thank you very much for writing this. I know it may have taken a bit of time, and I appreciate you being on our podcast.  Dr Liu: Thank you very much.  Dr Monteith: Again today, I've been interviewing Dr. Richard Liu about his article on central sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio. 

This episode looks back at APSS Sleep 2026 with Dr. Gerald George Mannikarote, Emerson Kerr, and Robert Miller. The conversation focuses on how the conference reflected a shift in sleep medicine toward more options, more pharmaceutical involvement, and a stronger need for technologists to stay grounded in fundamentals.We discuss why the live conference experience still matters, how AI and automation are changing scoring and diagnosis, and why pharmacy, telehealth, oral appliances, and new reimbursement codes are reshaping the future of sleep care.Chapters1 - Welcome to the APSS Sleep 2026 annual review2 - Baltimore conference turnout and the return of large in-person meetings3 - Emerson hands off the AST presidency to Massey Arrington4 - Why fundamentals matter in an AI-driven sleep industry5 - Scoring, false positives, and the risk of trusting automation too much6 - Why technologists must keep learning beyond the basics7 - Pharma's growing footprint on the exhibit floor8 - Home PSG systems and the coming CPT code changes9 - Sleep apnea, GLP-1s, and the move toward precision therapy10 - Why the old CPAP-only pathway no longer fits every patient11 - Seven treatment options and the challenge of choosing the right one12 - Why failed protocols and failed home sleep tests need rethinking13 - Pharmacy as a new screening and referral gateway14 - Why more entry points could help more patients get treated15 - Where the future of sleep medicine is headed16 - Moving from AHI alone to why a patient has sleep-disordered breathing17 - Why mild OSA may benefit from earlier non-CPAP treatment18 - Oral appliance therapy education gaps and first-line use19 - A mild OSA patient who benefited from an oral appliance after CPAP struggle20 - Consumer tech, awareness, and the Rise of sleep telehealth referrals20 - Why local sleep conferences still matter for technologists21 - Sleep navigation, education, and where technologists fit in the new model22 - Future guests, new projects, and what to expect next from the showA huge thanks to our sponsors:Fisher & Paykel Healthcare  Discover how F&P full-face masks have led millions of people to a great night's sleep at https://www.fphcare.com/curiosityhttps://www.fphcare.com/us/homecare/sleep-apnea/Philips Healthcare  See how Philips is supporting you and your patients with meaningful innovation. Visit https://www.philips.com/matters Soliish https://www.soliish.com/React Health  https://www.reacthealth.com/myWaveshttps://mywaves.tech/More resources for clinicians can be found at Sleep Review Magazine  https://sleepreviewmag.com/Credits:Intro Music: Pierce G. MannikaroteAudio/ Video: Diego R. MannikaroteHosts: J. Emerson Kerr, Robert Miller, Gerald George MannikaroteCopyright: ⓒ 2026 SleepTech Talk ProductionsEpisode 130The views and opinions expressed by guests on SleepTech Talk are their own and do not necessarily reflect those of the podcast hosts or SleepTech Talk as a whole. This podcast is intended for educational and informational purposes only and should not be considered medical advice. Listeners are encouraged to consult with a qualified healthcare professional for any medical concerns or questions.Don't forget to Like, Share, and Comment! Subscribe for more conversations with leaders shaping the future of sleep medicine, sleep technology, and patient care.

Welcome to another episode of Spooky Gay Bullsh!t, our weekly hangout where we break down all of the hot topics from the world of the weird, the scary, and issues that affect the LGBTQIA2+ community! This week, we cover: part of DC gets shut down over an adult toy, an 8-foot python on the loose causes a middle school fire, a mystery unfolding over a skull left at a charity shop, a monumental Otter Watch in the Bronx, and a homicide jury gets sent home after someone's suspected of smoking up on the job. See you next Friday for more Spooky Gay Bullsh!t!   Join the Secret Society That Doesn't Suck for exclusive weekly mini episodes, livestreams, and a whole lot more! patreon.com/thatsspooky Get into our new apparel store and the rest of our merch! thatsspooky.com/store Check out our website for show notes, photos, and more at thatsspooky.com Follow us on Instagram for photos from today's episode and all the memes @thatsspookypod We're on Twitter! Follow us at @thatsspookypod Don't forget to send your spooky gay B.S. to thatsspookypod@gmail.com  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Thomas Sammons – Bringing Technology, Compassion and a Preventive Approach to Dentistry Dr. Thomas “Tom” Sammons of Dental Artistry joins Discover Lafayette to discuss his path into dentistry, his commitment to continuing education and advanced technology, and his philosophy that good dental care is about far more than simply fixing teeth. A Youngsville native and UL Lafayette graduate, Dr. Sammons grew up in Acadiana after his family moved here in 1995. His father, Tom Sammons, taught architecture at UL Lafayette, and education was strongly emphasized in the Sammons household. Dr. Sammons graduated summa cum laude with a Bachelor of Science in Biology from UL Lafayette before earning his Doctor of Dental Surgery from LSU School of Dentistry in New Orleans. His connection to UL Lafayette runs deep. As a student, Dr. Sammons was active in the pre-professional society, student government and honor society, and participated in Up 'til Dawn, which supported St. Jude Children's Research Hospital. He says UL is where he truly found his community in Lafayette. Today, that sense of community remains important. Dr. Sammons and his wife, Abby, both grew up here and even attended the same church, where Abby's father once taught him in Sunday school. Their parents live nearby, and Dr. Sammons and Abby are raising two energetic young sons, Gabriel and Everett. “I love being with them. I love being with my family.” A Childhood Spent in the Dental Chair Led to a Career Dr. Sammon’s decision to become a dentist was shaped in part by his own difficult dental history. His permanent teeth erupted with enamel hypoplasia, leaving them soft and yellow and requiring extensive dental work. He also admits he did not take particularly good care of his teeth as a teenager. Fortunately, he had dentists he genuinely liked, Drs. Thomas and Harmon in Youngsville. “I actually loved my dentist. I didn't like being in the dental chair, but I liked him,” Tom recalled. For years, Tom thought he would become an engineer. Then he attended orientation at UL Lafayette, toured the engineering program and abruptly announced to his parents that he was going to become a dentist. The more he learned about dentistry, the more certain he became that he had found the right profession. That personal history also helps explain the empathy Dr. Sammons brings to patients who fear dental treatment. He discovered early in his career that many people had experienced frightening or painful dental care as children. For some patients, he says, simply opening the front door of a dental office can feel like “a very heavy weight.” When Dr. Sammons joined the practice of longtime Lafayette dentist Dr. Ann Laurent, he found a mentor whose philosophy closely matched his own. Dr. Laurent had built a practice around caring for patients with dental anxiety and treating their fears with empathy. “It's not the most fun place to be. I understand that,” Dr. Sammons said of the dental chair. “It doesn't have to be the worst place to be. We can make it comfortable. We can make it fun.” That philosophy is reflected throughout Lafayette Dental Artistry. Patients who need additional help with anxiety can receive nitrous oxide, commonly known as laughing gas, at no additional charge. The practice also offers oral sedation and, when appropriate, IV sedation administered with a nurse anesthetist. Your Mouth Is Connected to the Rest of Your Body One of Dr. Sammon's strongest messages is that oral health should never be viewed in isolation. “The mouth is also connected to the whole body. It is systemic health. It is not just oral health.” Dr. Sammons and his team spend considerable time educating patients about brushing, flossing, diet and the habits that contribute to dental disease. Chronic infection and inflammation in the mouth can have consequences beyond the teeth and gums, and periodontal disease can progress without causing significant pain. One of the biggest misconceptions Dr. Sammons sees today involves sugar-free beverages. Eliminating sugar does not necessarily make a drink tooth-friendly because acidity can damage enamel. “Acid is worse,” he explained. Energy drinks, soft drinks, coffee and other acidic beverages can create an environment that promotes enamel erosion and decay. Dr. Sammons explained that when bacteria consume sugar, they produce acid, but drinking an already acidic beverage exposes teeth directly to that damaging environment. He sees the consequences particularly among younger patients. Someone can leave high school with few or no cavities, head to college, develop a habit of consuming energy drinks throughout the day, and return with significant decay. The problem is compounded when a person sips the beverage over several hours. After each exposure, saliva needs time to buffer the acidic environment. Dr. Sammons’ advice includes limiting acidic drinks, drinking water and, for some patients, using an alkaline mouth rinse. He also discussed products containing xylitol as another tool for fighting cavity-causing bacteria. Lafayette Dental Artistry provides comprehensive care ranging from preventive dentistry to full-mouth rehabilitation, cosmetic dentistry, crowns, veneers, bonding, implants, bridges and clear aligner therapy. Dr. Sammons particularly enjoys cosmetic dentistry and clear aligners. In some complex cases, moving the teeth into a better position before restorative work can dramatically reduce the number of crowns or veneers a patient needs. “The less I do is more in a lot of ways. The best dentistry is no dentistry. The second best dentistry is preventative dentistry.” His goal is to perform dentistry today that prevents larger problems tomorrow. That philosophy becomes especially meaningful when patients arrive after years of avoiding dental care because of fear, embarrassment, finances or difficult life circumstances. Dr. Sammons has watched patients regain not only their oral health but their confidence. After restoring a person's smile, he may see them six months later having made other changes: exercising, losing weight, quitting smoking or simply taking better care of themselves. “It changes their whole life. It changes their whole trajectory.” Dentistry's Role in Sleep Health Dentists are playing a growing role in recognizing potential sleep disorders. Because dentists routinely examine the mouth, jaw and airway, they may see signs that suggest a patient should be evaluated for sleep apnea. Lafayette Dental Artistry has equipment patients can take home for a sleep study, although Dr. Sammons emphasized that a medical doctor reads the study and makes the diagnosis. For appropriate patients with mild to moderate sleep apnea, a dental appliance may help keep the airway open by positioning the jaw forward. More severe cases generally require CPAP therapy. Implantable airway-stimulation devices are an option for some patients who cannot tolerate either CPAP or a dental appliance; those devices are placed by specialists. Dr. Sammons also uses Botox primarily as a therapeutic treatment for patients suffering from TMD, often called TMJ, including people who clench their jaws and develop muscle pain and headaches. While he occasionally uses Botox cosmetically, his primary interest is relieving pain and muscle tension. More Than 100 Hours a Year of Continuing Education Louisiana dentists are required to complete 40 hours of continuing education every two years. Dr. Sammons regularly pursues more than 100 hours annually. Why? “I'm just a huge nerd. I love it. I love to learn.” That appetite for learning has helped him incorporate rapidly changing technology into his practice, including digital scanning, same-day crowns, 3D printing and digitally created surgical guides for implant procedures. Approximately 99 % of the impressions in his practice are now digital. A tooth can be scanned, the crown designed virtually, milled in the office and placed in the patient's mouth the same day. For anxious patients, avoiding a temporary crown, a second appointment and another injection can make an enormous difference. Artificial intelligence is also becoming part of the practice. Dr. Sammons uses AI with digital X-rays to help identify possible cavities, bone loss and calculus. He views it as an additional set of eyes rather than a replacement for professional judgment. The technology is also a powerful educational tool. Instead of asking patients to decipher shades of gray on an X-ray, the software can highlight areas of concern, making it easier for patients to understand what the team members of Dental Artistry are seeing. “It's kind of like a second set of eyes,” he explained, noting that the technology can occasionally flag a tiny area that deserves a closer look. Lafayette Dental Artistry Is Growing Lafayette Dental Artistry is preparing for a major renovation and expansion of its longtime office. Dr. Sammons discussed the reality that modern digital dentistry requires different spaces for equipment, laboratories and treatment areas than were needed when the original office was built. During construction, the practice will temporarily relocate about five minutes away while the existing office is rebuilt. The temporary move is expected to last approximately nine months. The goal is to create a more modern environment while preserving what patients already value about the practice: comfort, relaxation and personal attention. And Dr. Ann Laurent remains very much a part of the practice. “She's been an amazing mentor to me, both as a clinician and also just as a leader.” Dr. Laurent continues to see patients while enjoying a little more time to travel. Dentist, Business Owner, Husband and Dad Running a dental practice also means running a small business, something Dr. Sammons jokes can be difficult “when you got your fingers in people's mouths.” He generally treats patients Monday through Thursday and reserves Fridays for administrative work, meetings and catching up on the business side of the practice. He made a commitment to himself to leave the office on time whenever possible so he can be home with Abby and their boys. His days start early, often around 3:30 a.m., with quiet time followed by a workout or swimming. When he does find spare time, Dr. Sammons loves to read, alternating between science fiction or fantasy and books on business, professional development and self-improvement. He enjoys movies, working out and swimming, but these days much of his free time is devoted to his sons. That means building blocks, jumping on the trampoline and, much to his delight, a recent family discovery of Legos. “I love doing Legos.” Perhaps the most revealing part of our conversation was hearing Dr. Sammons describe what makes dentistry rewarding. Sometimes it is as immediate as helping someone who walks into the office after spending a sleepless night with an excruciating toothache. Other times, it is watching someone who has neglected their oral health regain a healthy smile and the confidence that comes with it. “I don't know of many professions…that can do all that. It's so much fun and rewarding to do that. And I really can't imagine doing anything else.” We thank Dr. Thomas Sammons and the entire team at Lafayette Dental Artistry for their support of Discover Lafayette and for their commitment to helping Acadiana residents achieve better oral health while making the dental experience as comfortable and positive as possible. Learn more about Lafayette Dental Artistry through its website at https://www.lafayettedentalartistry.com/ and follow the practice on Facebook and Instagram under Lafayette Dental Artistry.

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Advances in sleep technology are transforming how neurologists identify and manage obstructive sleep apnea, a condition that affects up to 70% of patients with certain neurologic disorders and can negatively impact cognitive and neurologic outcomes if left untreated. In this episode, Dr. Joyce Lee-Iannotti discusses the growing role of wearable and nearable sleep-monitoring devices, when home sleep studies are appropriate, and how emerging technologies are expanding access to diagnosis and treatment. Learn practical strategies for screening patients, interpreting sleep data, and partnering with sleep specialists to improve long-term neurologic health through better sleep. In this episode, Casey S. Albin, MD, FAAN, speaks with Joyce K. Lee-Iannotti, MD, FAAN, FAASM, author of the article "Sleep Diagnostics and Monitoring Technology in Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Lee-Iannotti is a Professor of Neurology at the Barrow Neurological Institute, University of Arizona College of Medicine, and Creighton School of Medicine in Phoenix, Arizona. Additional Resources Read the article: Sleep Diagnostics and Monitoring Technology in Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @jleeiannotti Full episode transcript available here Dr Albin: Through the neurology of sleep issue, I think we have all been convinced that we all need better sleep, both for ourselves and for our patients. And fortunately, there is an abundance of new technology that can enable us to diagnose sleep problems, and then also make sure that our patients are getting the rest that's going to give them the best chance at a good cognitive recovery, and improve their cognitive function even if they are not currently suffering from a neurologic condition. Today, I am so excited to dive deeper into this topic.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello, this is Dr. Casey Albin. Today I'm interviewing Dr. Joyce Lee-Iannotti about her article on sleep diagnostics and monitoring technology in obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Welcome to the podcast, I'd love to just start by having you introduce yourself to our audience.  Dr Lee-Iannotti: Sure. Thank you so much for having me, Dr. Albin. I'm Joyce Lee-Iannotti. I'm a professor of neurology at Barrow Neurological Institute. I am boarded in general neurology, stroke, and sleep, but I spend most of my time in the sleep world, so I jokingly say that I get more sleep doing sleep than I certainly did in stroke.  Dr Albin: Absolutely. I mean, wow, what a fascinating career, and I suspect that we're actually gonna get to some of how all of those pathophysiologies might overlap in the world of sleep. But you had the really exciting task of trying to distill this exciting, rapidly evolving field of sleep diagnostics, and I suspect it's relevant to many of the patients who end up in the neurology clinic, and I suspect that it's actually pretty relevant to many of our listeners who themselves might actually be wearing sleep tracking devices. And all of us probably wonder, well, how can we use that data to improve our own cognitive function and certainly make our patient's life even better? Before we even get into some of the meat and potatoes of this, I thought it would be really helpful for us to define some terms that come up in your article, one of which is wearables. We might figure that out, but the other is nearable. Walk us through what's a wearable, what's a nearable, how are they different?  Dr Lee-Iannotti: I'm happy to do that. First of all, the article is entitled Sleep Diagnostics and Monitoring Technology, and this was a super fun article for me to write because it's very practical, and it's generalizable to everybody. So, I'm going to start with a wearable, and a wearable is really a device that is simply worn on the body. And we're all familiar with wearables like smart watches, they're rings, they're patches, they're headbands, and the most validated form of a wearable that you've probably heard about is actigraphy, which we use in the sleep clinic.  Dr Albin: Tell us a little bit more. So, what is actigraphy? I've heard the word before, but don't actually know what it means.  Dr Lee-Iannotti: Actigraphy has been a tool that we've used in the sleep clinic for a really long time. Traditionally, we used it to monitor circadian rhythm patterns in people who are night owls or morning larks. And then more currently, we actually use it to track sleep patterns in people with suspected narcolepsy. So, before they come in for a sleep study, we actually have them wear an actigraphy for about a week just to get a sense of their sleep duration and their circadian pattern.  Dr Albin: Got it. And what is it monitoring? Our movement or the patterns that we may or may not make?  Dr Lee-Iannotti: It's really based on movement. You're exactly right.  Dr Albin: Cool. Okay, so most of this is based on gold standard monitoring with actigraphy. What other things can be incorporated into these wearable devices?  Dr Lee-Iannotti: Yeah, the technology is really advanced, and every day it changes, which is super exciting. So, on top of movement, these wearables can look at temperature. They can look at even EEG, like limited EEG, heart rate variability, and a really big word that we like to use in sleep technology, which is PPG, or photoplethysmography data, and that's really looking at heart rate variability and oxygenation, saturations, and following those levels as well.  Dr Albin: Wow, so you basically can get most of the data that you might have historically needed to go to a sleep lab to get.  Dr Lee-Iannotti: Most of them. They're still a surrogate. You'll hear me emphasize in the article as well that the gold standard remains the in-lab polysomnogram, but these are good surrogate markers that patients can wear long term to look at trends and patterns.  Dr Albin: Absolutely. And we're gonna unpack a little bit about who specifically those are best for and, really what it gives you in the clinic. But before we jump into that, what's a nearable, and how is that different?  Dr Lee-Iannotti: Yeah. Nearables are really exciting too. So, these are devices that monitor sleep but don't require direct contact on the body. So, these are devices that our patients will use, but it'll be at the bedside table. They're devices that actually go underneath the mattress, or they can be in, like, the ambient environment to detect sleep patterns.  Dr Albin: Oh my gosh. How is it doing that if it's not actually something you're wearing? Dr Lee-Iannotti: I know. It seems a little Big Brother-ish, doesn't it?  Dr Albin: Yes.  Dr Lee-Iannotti: So, they use a technology called radio frequency signals, sometimes radar, sometimes sonar, pressure sensors, even microphones, and they're picking up things like respiration, movement, snoring, and that's how they can decipher sleep patterns.  Dr Albin: Crazy. I mean, I guess the benefit of that is that it's less disruptive to the user 'cause it's not actually on them and having contact with them, and I suspect there's probably some downsides in terms of just it's a more limited data set you're getting.  Dr Lee-Iannotti: Absolutely. Yeah, you're exactly right. It's more convenient because it's not touching them, so, in theory, they're gonna sleep more comfortably. But I would like to think that the most validated forms of devices that we use to track sleep have to have some form of contact with the body, and this technology is new and probably needs a few layers of more sophistication to be as accurate as the wearables.  Dr Albin: Absolutely. I feel like we're going to have this conversation in five, maybe even less than that, years, and this data will have become like, oh, we all have something in our room that's monitoring everything. The world is crazy. All right. One of the places where your article really stood out to me is that sleep diagnostics have really taken off, particularly when we're thinking about obstructive sleep apnea. And I think we all might sort of scratch our heads and be like, "This is a neurology podcast. Why should I, as a neurologist, care about obstructive sleep apnea?" But I think you laid out a very convincing argument in the article. Walk us through why we should care about this.  Dr Lee-Iannotti: Absolutely. So, for neurologists, sleep matters, and I hope that my article translates that. Obstructive sleep apnea, which I'm gonna call OSA, is incredibly common in all of our neurologic patients, whether you see epilepsy, Parkinson's, stroke, Alzheimer's, neuromuscular, or even chronic headache patients. The prevalence of sleep apnea is as high as 70% in these patients.  Dr Albin: Wow. That's incredible. That is an incredibly high number.  Dr Lee-Iannotti: And if I can add, Dr. Albin, there's growing literature in multiple studies across the literature that show that untreated sleep apnea negatively impacts neurologic outcomes in our patients. So, it is really important to ask the question about sleep, and if the red flags pop up, to then screen for sleep apnea in particular.  Dr Albin: I think that that's a great point for us to drill down on, and obviously you're a sleep neurologist. You're very used to screening people in the clinic. But say someone comes in, and I'm gonna have you put your former stroke hat on, and say someone comes into the stroke clinic, and you're just making sure that they're optimized on their aspirin or dual antiplatelet therapy, and you're doing secondary risk modification. How would screening for OSA fit into that?  Dr Lee-Iannotti: It would be a part of that screening process to look at preventative ways to prevent strokes, whether it be primary or secondary prevention. So, we did a survey a while back, and it actually showed that 17% of stroke neurologists are screening for sleep apnea. It has quadrupled, fortunately, in the last few years due to public awareness and a lot of education that the AAN has done, in fact. So, at this point, I would say not asking about sleep apnea to a stroke patient is similar to not asking about diabetes.  Dr Albin: So, we really have to be cognizant and conscious about saying, you know, "Do you snore at night? Do you have episodes of apnea, or does someone witness you stop?" Are there things that you ask that maybe I wouldn't be aware and thinking of?  Dr Lee-Iannotti: Those are the right questions, and then very practically, very easy questionnaires to implement that literally take a minute that your nurses or medical assistants can administer to the patient, and the most commonly one that is used in stroke patients is called the STOP BANG, S-T-O-P B-A-N-G, which is a validated questionnaire to screen for symptoms.  Dr Albin: Absolutely. So okay, so this is easy to do. We should all be doing this. If you're not, now's the time. And I suspect if they screen positive, next steps, it can be hard to get into a sleep lab, and we're gonna talk about some workarounds, but I think some of our listeners may never have spent time in the actual sleep lab. So, let's say you refer a patient and you actually can get them in for a gold standard in-lab sleep study. What's gonna happen in that sleep study?  Dr Lee-Iannotti: Yeah. And I just want to preface this by saying that my article hopefully highlights that we've come a long way where we understand that there are many neurologic populations then that can undergo home ambulatory sleep studies with just as much accuracy as an in-lab polysomnogram. But with that, I wanna say an in-lab polysomnogram is actually a highly sophisticated physiologic recording overnight, typically, unless somebody is a day sleeper. So, if I could take a minute to kinda describe the data that we're monitoring throughout the night. There is a limited EEG. We concentrate on frontal, central, occipital leads to look at sleep staging. We have eye leads. We have EMG leads on the chin and the leg. We look at EKG, flow monitors, belt, and then we also do pulse oximetry, snoring mics, and even body position sensors. So, a lot is going on.  Dr Albin: This is incredible. Yeah, it truly is. I mean, this is like... I'm a neurointensivist, and so I think that you have just really outdone what I consider multimodal monitoring in your sleep study patients. I'm not even sure our neuro ICU patients accumulate that much data. All right, so tell me, they go through, and they can get this. But like you said, there's actually a lot of data that you've presented that, you know, not everyone needs to go to the in-lab sleep study. So how do you decide who actually needs to be in a sleep lab versus who can do this at home? And then how do you set them up with getting this done at home?  Dr Lee-Iannotti: Yeah. The home sleep studies are really more accessible ways for us to assess for sleep apnea in our neurologic patients, especially patients who live in very rural areas and don't have access or have very long wait times for an in-lab polysomnogram. With that being said, though, Dr. Albin, I will say that there are a subset of patients who have to go into the lab, and those are patients where you suspect a sleep disorder other than obstructive sleep apnea, so like parasomnias or central sleep apnea, patients with severe cognitive or physical debilitation, like our stroke patients who are hemiplegic and won't be able to apply the home sleep study. But for the most part, I do feel like a home sleep study is a good beginner study to screen the patient. And if there are red flags, then you can always get the in-lab afterwards.  Dr Albin: That's super helpful. And just from a pragmatic standpoint, will insurance cover the home sleep study?  Dr Lee-Iannotti: They will, yes, and it's all about documenting. So, if I could get really practical, for neurologists, it really just requires documenting snoring, for one, whether it's noted by the patient or by their bed partner, and then any form of hypersomnia, which is daytime sleepiness or even a sense of fatigue, having low energy or napping during the day.  Dr Albin: I suspect so many of our patients meet those criterias. That seems, like, wildly simple to do.  Dr Lee-Iannotti: Yes. And if you wanna be the favorite referral person to your sleep neurologist or your sleep specialist, then take another step and do that STOP-Bang. And if you record a score greater than three, that automatically gets them at least a home sleep study.  Dr Albin: It's amazing. And then when you get this data, again, this is really practical, pragmatic stuff, how do you get the report? Does it integrate in your electronic medical record? Does the patient bring it in? How do you get that data back?  Dr Lee-Iannotti: Yeah, so this is where technology is amazing, Dr. Albin. Now we have disposable devices. Sometimes they sync to the WatchPat, or the greater Wi-Fi. So we can get them all through password-protected internet forums that transmits the data, so sometimes the patients don't even have to come back to give us the data. And then we have different forms where we can actually relay the results as well, either through the electronic medical record or through systems themselves to relay those results directly to the patient.  Dr Albin: Yeah, and your article really laid out in beautiful tables, like, all the different devices that are available to patients, and it's honestly mind-blowing how many of these companies and devices exist. So, seems like the world is your oyster in terms of picking from them.  Dr Lee-Iannotti: Absolutely. I think there's... The last time I counted, there was over 20 different home sleep study devices for obstructive sleep apnea. And it's a great thing to have, but sometimes too many choices can be a little bit confusing. So that's where I do say partner with your sleep specialist close by, and they will find the right type of home sleep study device for your particular patient.  Dr Albin: Drilling down a little further, let's say your patient does get diagnosed with OSA. One of the things that really stuck out to me is that there's a whole range of now devices that are new that make this treatment easy so that we can actually prevent and treat neurological conditions by just improving patient sleep. So, walk us through a little bit about how that landscape has changed.  Dr Lee-Iannotti: Sure. And I'll start with the gold standard of treatment, which is still CPAP, which is continuous positive airway pressure. Not only can we monitor the pressure, look at adherence, change the humidification for the patient all remotely through, again, password-protected internet forums, but we can even change the pressure with patients 300-plus miles away.  Dr Albin: Wow.  Dr Lee-Iannotti: It's really cool, right? It prevents patients, especially with significant neurologic debilitation, from having to come into the office for adjustments. The other thing I wanted to mention, Dr. Albin, is for patients, a lot of patients like positive feedback on a daily basis. And a lot of these companies, if you are on CPAP, have come up with a smartphone app that you can look at how many hours you used your CPAP device. They give you a score, and they even tell you how many times you had stoppage of breathing that night.  Dr Albin: I think that this is what's really exciting about where we are in neurology and, like, neurologic care, is we have gotten so much better at getting patients their own data and allowing people to really see that data, integrate lifestyle changes, and see how it impacts them. And that positive feedback loop, I think, is a really powerful tool for our patients to say, "Look, this makes me better," or, "Oh, this makes me worse." I'm just really excited by how much data we can give directly to our patients.  Dr Lee-Iannotti: I agree. It's so empowering. You know, as a CPAP user myself, you want that positive affirmation that all of your efforts at night and cleaning your mask and your machine paid off, and everybody likes to see an A+ on their report card.  Dr Albin: I love that. Now I'm going to ask you on the flip side, I imagine, and I myself am a sleep tracker, like I have my little device and I look at, you know, the score in the morning and I kind of perseverate on like what makes it better, what makes it worse, and I can imagine that sometimes in sleep clinic, people are coming in to you and they have just pages and pages and, you know, they're flipping through all their data from the last year. And I imagine that's pretty overwhelming when you have just the insane amount of data that these devices can generate. So, from another pragmatic, practical standpoint, how are you integrating all that data when someone comes in for a sleep visit?  Dr Lee-Iannotti: I love that question. So first of all, I will say myself, and I think a lot of my sleep colleagues, we love objective data, right? Because it's something that we can see. We can see whether it matches their subject's symptoms. Sometimes it can be a lot of reassurance that, "Look, you actually got more sleep than you thought you did." But sometimes patients will bring in like a month's worth, and that's really hard to analyze, you know, in a 30 or 60-minute visit. So oftentimes what I do is I look at like the last week or last two weeks, and I look at trends. And I think a lot of the apps for whatever device you decide to use have done a really good job in terms of visual graphics to show how much sleep on average you're getting, how much deep sleep or REM sleep or wake-up times that you have. So, I, again, I feel like the technology has really helped us consolidate a lot of data, but also be efficient with the messaging that we relay to our patients.  Dr Albin: Absolutely. And I know personally, at least for the sleep tracker I wear, it also allows you to diary. So, you can say like, "Oh, last night I had a glass of wine," or, "Yesterday I had a really hard workout," or, "I stayed out late with friends," or, "I was on call." Turns out call is really, really bad for my sleep. But it does allow you to sort of track what behaviors, and I wonder how much of that informs what you're counseling patients to do in terms of trying to notice the things that either improve their sleep performance or their subjective feeling of restlessness or restfulness, and how all of that plays into what you're doing in the clinic.  Dr Lee-Iannotti: I love all of those comments. It is validation for the patient. Again, it's empowering for them to look at, what did I do last night to get more REM sleep than the night prior? I want to mention that the best people who do this so well are professional athletes, and they look at, how am I going to cater my day to make sure that I'm sleeping well, that I reduce my risk of injury and concussion and increase my reaction time? And I feel like all of us should do that. That's such a great philosophy, to analyze how we can do things better.  Dr Albin: I love that. This whole issue, but this article in particular, really emphasized to me that sleep, again, it's not a passive time that we're taking a nap. It's a really active form of sort of neurologic healing. There's important removal of toxins through the lymphatics. And like there's a lot happening in sleep, and there are so many more tools that allow us to unpack that sort of peak performance of sleep, which again, sort of is that athletic mentality of like, how can I make this better? Not just to treat a neurologic condition, but also really importantly, to prevent one.  Dr Lee-Iannotti: I often refer to sleep as icing on the cake. With our patients, when you're doing everything right, for example, a multiple sclerosis patient, they're on the right medications, they are exercising, they're participating in rehab, their mood is good, but they're just not getting to the quality-of-life metric that they want to be, it usually is sleep. And if you can add that as a neurologist to your piece of the algorithm to help your patient, it really does improve their quality of life and ultimately their neurologic outcome. I'm a true believer of that.  Dr Albin: I was a true believer. I've been made even more of a true believer through your article and getting to talk to you. I always like to close by asking the person I'm interviewing, what's one really exciting thing in this field? What are you kind of most looking forward to as you think about sleep medicine and its impact in neurology in the next five or 10 years?  Dr Lee-Iannotti: Oh, I love that question, too. So, the thing I'm most excited about in the field of sleep, and specifically sleep neurology, is the power of preventative care. When I did a lot of stroke, I would see young people, older people, healthy people, people with a lot of genetic risk factors come in, and one minute they were totally normal. The second minute, they're paralyzed and can't speak. And for a lot of these patients, I would ask, "Why am I seeing you now? Why couldn't I have seen you 10 years earlier, worked on risk factors, and prevented this outcome?" And I truly believe that is exactly where sleep lies. If you work on sleep, whether you're an adolescent, 20 year old, 30, et cetera, you are ultimately going to prevent horrible cardiovascular, cerebrovascular, neurologic diseases in the long run.  Dr Albin: So important. I really want to direct our listeners back to your article because all of the articles are really practical, but this one in particular looks at how do you do this? What are your options? How do you get this to patients? It really is sort of a step-by-step guidebook on like, A, why this is important, how you should screen, what you should do if someone screens positive for needing to have a sleep study.There's so much more technology that allows really anyone anywhere to have access to the testing that they need to get the right diagnosis, to improve their sleep, to improve their cognitive outcomes, to improve their neurologic health. It's pretty amazing.  Dr Lee-Iannotti: It is amazing. And in the article, I do allude to certain devices and then websites that are very helpful. If I can announce, Dr. Albin, I'm super excited about this. Through work with the American Academy of Sleep Medicine, endorsement with the AAN, we are coming out with a new clinical guideline specifically on home sleep study devices and looking at the validation studies. So, I think that's going to be very helpful. But I hope that everybody after listening to this picks up the phone, call your friendly sleep specialist, and align with them and partner with them. And this will ultimately help your patients, I guarantee it.  Dr Albin: Again, today I've been interviewing Dr. Joyce Lee-Iannotti about her article on sleep diagnostics and monitoring technology in obstructive sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners, and thank you, Dr. Lee-Iannotti, for joining us today. Dr Lee-Iannotti: Thank you.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audiocme. Thank you for listening to Continuum Audio. 

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No Estate Plan. No problem. The State will decide who inherits - not you. Do you really want that? 50% plus of individuals have NO estate plan. The other 50% - majority have a Last Will and Testament. Here is the real "gotcha": Wealth Alignment™ - Estate Planning. This is the next level of estate planning. Implement asset protection trusts and testamentary trusts so the surviving spouse cannot leave everything to the new spouse that you worked your lifetime to accumulate. Protect your estate from your spendthrift kids. Protect your assets for your surviving spouse who may not be able to manage the portfolio. You get the point. You don't need multiple millions of dollars to benefit from Wealth Alignment™ - Estate Planning. You are the only one responsible for your planning: Investment / Tax / Estate Planning / Asset Protection. The only way you are going to accomplish anything is to take action. One action which I know you will benefit: Wealth Alignment™ - Estate Planning. Will you inadvertently disinherit your children? If you are a "do-it yourself" kinda person this is a must listen. Your low cost 1-800 financial firm could very easily cost your family your entire 401(k). Let that sink in.Did you name your spouse as the primary beneficiary on your life Insurance policy? Bet you did.... this could be one of the biggest financial mistakes you make.Wealth Alignment™ when your Portfolio / Tax Reduction Strategies / Estate Planning are all coordinated into alignment by one set of professionals: Tax Attorney / CFP® / CPA.Uniquely qualified to provide you with a single cohesive clarified plan. One professional advisor. One Aligned Strategy. Zero Conflict. Call today, 404-250-9798, to begin benefitting from your personal Wealth Alignment™ analysis.To a prosperous and happy 2026!!Sean G. Todd, Esq., M. Tax, CFP®, CPAP.S. Wealth Alignment™ : When your tax, estate and investment portfolio are all in sync via one set of professionals, Tax Attorney, CFP®, CPA, who see the whole picture.

Send us Fan MailThe full week of Journal Club in one place. Monday, the PLaNT trial of prophylactic CPAP for late preterm infants born by cesarean, with senior author Dr. Edgardo Szyld. Tuesday, whether parental holding during therapeutic hypothermia changes feeding and length of stay. Wednesday, the Connection Study, the first live biotherapeutic product tested under an IND, and what it means for probiotics returning to the NICU. Thursday, a handheld light probe that reads bowel through the skin to catch NEC before the X-ray does. Friday, Dr. Dinushan Kaluarachchi on the respiratory severity score and what its trajectory tells us.----First-in-human pilot study of broadband optical spectroscopy (BOS) as noninvasive surveillance for necrotizing enterocolitis (NEC). Dodd AC, Lehane AJ, Lee A, Hurlock A, Su Y, Ilahi I, Lautz TB, Backman V, Goldstein SD.J Pediatr Surg. 2026 May;61(5):162978. doi: 10.1016/j.jpedsurg.2026.162978. Epub 2026 Feb 3.PMID: 41643767Association of parental holding during therapeutic hypothermia and NICU outcomes for infants with hypoxic-ischemic encephalopathy. Nguyen TT, Glass HC, Chan N, Taketa E, Pineda R, Cornet MC, Miller MJ.J Perinatol. 2026 Jun 22. doi: 10.1038/s41372-026-02753-3. Online ahead of print.PMID: 42332041Live biotherapeutic product IBP-9414 (L. reuteri) in very low birth weight infants: the Connection Study. Neu J, Del Moral T, Guthrie SO, Hudak ML, Indrio F, Kim JH, Kronström A, Martin CR, Modi N, Rastad J, Schnitzer TJ, Singh R, Strömberg S, Szajewska H, Thuresson M, Caplan M.Pediatr Res. 2026 Feb 20. doi: 10.1038/s41390-026-04826-7. Online ahead of print.PMID: 41721054Prophylactic CPAP at Cesarean Birth in Late-Preterm Newborns: A Multicenter RCT. Shah BA, DeShea L, Schmölzer GM, Josephsen JB, Fabres J, Wetzel EA, Rykovich H, Thomas A, Law B, Garrido C, Szyld E.Pediatrics. 2026 Aug 1;158(2):e2025070998. doi: 10.1542/peds.2025-070998.PMID: 42457181 Clinical Trial.Association Between Delivery Room Continuous Positive Airway Pressure and Neonatal Outcomes in Late Preterm and Term Infants: A Systematic Review and Meta-Analysis. Chin Y, Hill M, Sett A, Thomas N, Razak A.J Paediatr Child Health. 2026 Jul 28. doi: 10.1111/jpc.70516. Online ahead of print.PMID: 42517258 Review.Bronchopulmonary Dysplasia Definition Based on Respiratory Severity Score. Kaluarachchi DC, Peebles PJ, Lasarev MR, Guthrie SO, Laughon MM.Pediatr Pulmonol. 2026 Jul;61(7):e71750. doi: 10.1002/ppul.71750.PMID: 42478108 Free PMC article. No abstract available.Respiratory severity score patterns by birth gestational age among a cohort of extremely preterm infants. Peebles PJ, Lasarev MR, Guthrie SO, Laughon MM, Keller RL, Kaluarachchi DC.J Perinatol. 2026 Jun 29. doi: 10.1038/s41372-026-02778-8. Online ahead of print.PMID: 42374145 No abstract available.Respiratory severity score as a predictor for need for tracheostomy in infants with severe bronchopulmonary dysplasia. Kaluarachchi NM, Afah Annah S, Lasarev MR, Peebles PJ, Kaluarachchi DC.J Perinatol. 2026 Jun 25. doi: 10.1038/s41372-026-02720-y. Online ahead of print.PMID: 42350618 No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Obstructive sleep apnea affects approximately one in four adults and is especially common among patients with neurologic disorders, including stroke, Parkinson disease, dementia, epilepsy, and neuromuscular conditions. In this episode, Dr. Stephanie Stahl discusses why neurologists should routinely screen for OSA, highlights key symptoms and risk factors, reviews important considerations when interpreting sleep studies, and outlines current treatment options beyond CPAP. Learn how recognizing and treating sleep apnea can improve quality of life, optimize management of neurologic disease, and reduce long-term health risks. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Stephanie M. Stahl, MD, FAASM, author of the article "Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Stahl is an Associate Professor of Clinical Medicine and Sleep Medicine Fellowship Program Director at Indiana University School of Medicine in Indianapolis, Indiana, where she also serves as Sleep Laboratory Medical Director in the Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine. Additional Resources Read the article: Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz  Full episode transcript available here Dr Berkowitz: Obstructive sleep apnea is very common. It can cause or contribute to common neurologic symptoms, such as headache and impaired cognition, and it's a risk factor for stroke. And yet, if you're like me, you may not know too much more about sleep apnea than that. Today, I have the pleasure of talking to sleep expert Dr. Stephanie Stahl to learn what every neurologist should know about OSA.  Dr Jones:  This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Berkowitz: This is Dr. Aaron Berkowitz. Today I'm interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the 2026 Continuum issue on Neurology of Sleep. Welcome to the podcast, Dr. Stahl, and could you please introduce yourself to our audience?  Dr Stahl: Yeah. Thank you for having me. I'm a sleep medicine physician and neurologist and medical director of the Indianapolis Sleep Lab at Indiana University Health. I serve as the director of the Sleep Medicine Fellowship program. I'm faculty advisor for our very first student interest group in sleep medicine at Indiana University School of Medicine. I'm also actively involved in some national leadership roles, including the incoming chair of the American Academy of Sleep Medicine's Education Committee and co-chair of the Academy's Inter-Scorer Reliability Gold Standard Panel. So, I really appreciate this opportunity. I look forward to our discussion.  Dr Berkowitz: Me too, and we appreciate the opportunity too to get to talk to you. You have so much expertise in this area, and I certainly encourage our listeners to look at your article, which is very comprehensive and up to date, and I learned a ton from it. I didn't get much exposure to sleep neurology as a trainee, and I've always worked in academic centers where we have a sleep group and we can refer patients there. So, I have to admit, sleep may probably be the area of neurology I know the least about, and felt like I was learning something new from pretty much every line of your article, and I know our readers will too. So, your article has a lot of excellent detail for our readers on the diagnosis and treatment of this very common condition. But I'd like to keep our interview relatively high level today and focus on the essentials for the practicing general neurologist. So, to start, can you just give us a sense of what obstructive sleep apnea is, and what every neurologist should know about it?  Dr Stahl: Yeah. So obstructive sleep apnea is characterized by either partial or full obstructions in the upper airway. That may sound pretty simple, but this leads to a whole bunch of issues. It leads to oxygen desaturations, arousals from sleep, leading to sleep fragmentation. This can then lead to sympathetic nervous system activation, cerebral hypoperfusion, leading to a whole bunch of symptoms or neurologic conditions.  Dr Berkowitz: Great. And you mentioned this in your article, but just to emphasize, how common is obstructive sleep apnea in the general population?  Dr Stahl: Yeah. So, about a quarter of the general population have obstructive sleep apnea. Much more common in many neurologic conditions.  Dr Berkowitz: Yeah, so very common disorder. We are seeing patients with it quite frequently, whether that's the reason they are seeing us in neurology or not. And this leads to my next question, which is what neurologic symptoms or presenting concerns of a patient should make us think about OSA and the differential diagnosis, and what factors based on the history or the exam or the context would make you suspicious for OSA as the cause of a neurologic symptom? In other words, the patient's presenting with classic symptoms of OSA, and that's why they're seeing a neurologist or seeing a primary care doctor, but is coming for evaluation of, say, headache or other symptoms. And what symptoms would make you think of wanting to consider OSA, and then what aspects of the history or otherwise would make you want to evaluate the patient for OSA?  Dr Stahl: I think a really important takeaway is for neurologists to know that obstructive sleep apnea is very common in neurologic conditions and has that potential to worsen a lot of these conditions or their associated symptoms. And so, it should be on our radar. There are certainly some basic questions and signs and symptoms that we can ask patients about or, or take a look at on exam. And so particular symptoms include snoring. Anybody that snores loudly or frequently, that's a strong risk factor for obstructive sleep apnea. If someone's seeing them stop breathing in their sleep, if they are waking up a lot throughout the night. There are some other symptoms that we may not necessarily attribute upfront to obstructive sleep apnea, such as nocturia, nocturnal reflux, night sweats. There are some daytime symptoms, of course, too, like unrefreshing sleep, daytime sleepiness, morning headaches, an important one in neurology. And then we take a look at the patient's exam. And so, some things that neurologists might want to be thinking about are people with obesity are certainly at a risk for obstructive sleep apnea. But it's also very important to know that someone does not need to have obesity in order to have obstructive sleep apnea. We look at neck size, other morphologic characteristics, such as how much that we can see in the back of their mouth. Can we see their uvula? Does their tongue size appear large in their mouth? And then some other risk factors too, such as male gender, older age, family history, post-menopausal state in women. All that being said, though, sometimes in neurologic conditions, we don't have all of those symptoms or risk factors to be thinking about. And so, in certain neurologic conditions such as stroke where obstructive sleep apnea is very common and has the potential to increase the risk of another stroke, we may need to be thinking about testing these patients even with minimal symptoms or other risk factors.  Dr Berkowitz: That's very helpful. So, you mentioned their headache might be the presenting symptom, right, to a neurologist, and we should certainly be thinking about obstructive sleep apnea as a potential diagnosis, even the cause of the patient's headache, particularly you said patients with morning headache. I often try to think about in patients presenting with, for memory loss, or other cognitive concerns, and that may be due more to inattention from poor sleep, so asking about sleep and symptoms of sleep apnea in those contexts. Are there any other presenting neurologic symptoms not particularly related to sleep? I'm thinking of headache, memory loss, other symptoms that would make you think, "Oh, I should actually screen this patient for sleep apnea also."  Dr Stahl: Yeah, other symptoms to think about in pediatrics, hyperactivity, people that have impaired vigilance, as you alluded to, that poor attention. Sometimes people get misdiagnosed with ADHD, and it's actually just a manifestation of obstructive sleep apnea.  Dr Berkowitz: You alluded to this, Dr. Stahl, that stroke, for example, patients are at higher risk of developing sleep apnea as a result of stroke, and it's also a risk factor for stroke. What other neurologic conditions, primary neurologic diseases, put patients at a higher risk of OSA? And again, similar to the last question I asked you, what are some clues that we should evaluate for? We might be following a patient for their post-stroke care over time and not necessarily thinking about diagnosing a separate condition in them since we're following them for their stroke or their degenerative disease. What are the conditions that put patients at a higher risk of OSA as a result of the condition, and then when would you think about screening them for it?  Dr Stahl: Some particular neurologic conditions where obstructive sleep apnea are very common, in addition to stroke and, and TIA, include Parkinson disease. It can worsen a lot of the motor, cognitive symptoms, sleep disruption that we can see in Parkinson disease. Very common in all causes of dementia, but in particular Alzheimer disease and Lewy body dementia. Very common in neuromuscular conditions. We should definitely have obstructive sleep apnea and all forms of sleep-disordered breathing high on our radar. In conditions like myotonic dystrophy. Charcot-Marie-Tooth is another one where obstructive sleep apnea is very common. Myasthenia gravis, it can worsen the symptoms of that. In particular, a pearl is if somebody has morning weakness in myasthenia gravis, obstructive sleep apnea should be high on your radar. And also, as you mentioned, any forms of headaches. There are some other things too. If somebody has poor seizure control, especially nocturnal seizures, you might have obstructive sleep apnea on your radar as well.  Dr Berkowitz: So, I think you've covered essentially every category of neurologic disease, right? We have cerebrovascular, movement, neurodegenerative, neuromuscular, epilepsy, all conditions where either the disorder itself, such as stroke or the, correct me if I'm wrong, the neurodegenerative disease puts the patient at risk. Or the patient may be at risk for exacerbations of their disease, as you mentioned in myasthenia. I love that pearl. Not fatiguable at the end of the day, but if the patient with myasthenia is telling you they're feeling weaker at the beginning of the day, then think about obstructive sleep apnea and that obstructive sleep apnea worsening control of epilepsy due to poor sleep. So really a lot of bidirectional interactions with this common condition. Okay, so if we're concerned about obstructive sleep apnea, again, myself, a general neurologist speaking perhaps on behalf of other general neurologists, we see a patient with headache or reporting memory loss that we find to be impaired attention, or we see exacerbation of their underlying primary neurologic disease. As you mentioned, we think, "Oh, I've listened to this podcast. I've read Dr. Stahl's article. I should probably be thinking about OSA in this patient, and I should order a sleep study." Now, I admit when I get the sleep study back, I scroll to the bottom, I see they do have obstructive sleep apnea, I'm going to send them over to a sleep specialist. But for the general neurologist, what are some high-yield pearls and some pitfalls to be aware of when we get sleep studies for obstructive sleep apnea, and we are looking at the results? Dr Stahl: The first thing is to understand that there are two main types of sleep studies: in-lab polysomnography and home sleep apnea test. In-lab studies are typically what we consider the more accurate type of study. Main reason for that is that we have EEG, so we can see if someone is awake versus asleep. Most home sleep apnea tests do not utilize EEG, and so when we're looking at respiratory events, apneas or hypopneas, we're looking at over the total recording time rather than the total sleep time. So, we know we're going to capture some time where a person is awake, where we don't have sleep apnea events, and that can be a big amount of time in people with insomnia, poor sleep efficiency. And as a result of that, it can lead to an underestimation of the apnea-hypopnea index. That's really important for people to understand that that means we can end up with a false negative home sleep apnea test, or it can put them in a category of lower severity than what they actually have. And so, if you get a home sleep study report back that's negative for sleep apnea and you remain concerned, you need to go on to do an in-lab study, where about twenty to fifty percent of people will go on to have a positive in-lab study. You can also get false positives with home sleep apnea tests too, and so ideally, we should only be doing home sleep apnea tests in people that are at high risk of having obstructive sleep apnea to decrease our chance of false positive study. When we get that sleep study report, what's important to take a look at? So the main number that we look at currently is the apnea-hypopnea index. The number of apneas, which are full obstructions in that upper airway, or hypopneas, partial obstructions in the upper airway where either there's an oxygen desaturation or an arousal associated with that. Less than five is considered to be normal. Anything five or more gives them a diagnosis of obstructive sleep apnea, and then we stratify them based on the AHI. But it's important to take a look at more than just the apnea-hypopnea index. And while my eyes too on various reports like echocardiograms want to jump to the impression, it is important to take a look at that full report, see what their oxygen levels averaged and what they dipped down to. The arousal index, which is how many times a patient may have woken up briefly throughout the night. Take a look at the histogram, usually an image at the bottom of their report that shows what sleep fragmentation may have been like so that you can take that all in and make that decision. How important are these study findings, and is this a person that would benefit from treatment?  Dr Berkowitz: That's a fantastic overview of sleep studies and some of the highlights to look out for, even if we won't be understanding every detail as you would to know most importantly the caveats about home sleep testing having a fairly high percentage of false negative and false positive results. So being wary if our suspicion is high, and that test is normal or inconclusive to get an in-lab sleep study. And if our suspicion is low or maybe we haven't ordered the test and the patient has had it done elsewhere, and the history doesn't really match up to know that there are false positives on the home studies as well, and again, an in-lab study to settle the diagnosis. Is that right?  Dr Stahl: Yes.  Dr Berkowitz: Okay. Now, for most neurologists, probably if we diagnose OSA, we will be referring the patient to a sleep specialist like yourself for treatment. I think we're all familiar with CPAP and patients being on CPAP. Your article mentions a number of treatment modalities I admit I have not heard of before or maybe heard of in passing, acknowledging most general neurologists are not going to be prescribing or knowing with the nuance that you do as an expert how to decide which treatment a patient would most benefit from or most qualify for. So, can you just give us a broad overview, again, for the general neurologist acknowledging we might see a patient whose past medical history says OSA being treated with fill in the blank. What are the different treatment modalities, and how do you think, just so we can learn from you in broad brush strokes, about particular treatments for particular patients?  Dr Stahl: As you mentioned, most people are familiar with positive airway pressure or PAP therapy, and that does remain our most efficacious treatment. The way I explain it to patients is why PAP therapy is the most effective treatment is it's the only treatment that can take all of the tissues of that upper airway and open them up. Whereas all of our other treatments, we're going to target smaller spaces of that upper airway. So, our first option is if we can get somebody on PAP therapy, we know that that's going to be the best option for the majority. PAP therapy works by basically acting as an air splint to open up the air tissues. Know that masks are not interchangeable. There are masks that cover the nose and go over the nose and mouth and under the nose. Full face masks that cover the nose and mouth, they do typically require higher pressures, also tend to be less comfortable for a lot of patients as well. In addition to different PAP masks, there's different modalities of positive airway pressure therapy too. There are machines that auto-adjust, some that provide fixed pressure, bi-level PAP that provides a higher inspiratory pressure, lower expiratory pressure. Then outside of PAP therapy, there are, as you alluded to, a lot of options and more, continuing to come down the pipeline as well. Mandibular advancement devices or a form of oral appliances has been around for a while. This is device that somebody wears in their mouth. It's preferably customized for their teeth and titratable, meaning that they can make adjustments that pulls their mandible forward in relation to the maxilla in order to pull those tongue tissues further away from the back of the upper airway. That's ideally managed by a qualified sleep dentist or someone that specializes in oral appliance management. Other treatments include surgical options, including hypoglossal nerve stimulation, which is an implanted device that causes the tongue to protrude repetitively throughout their sleep period to hopefully open up the airspace. There's some other surgical options too that open up various places of the upper airway. There's a daytime treatment of obstructive sleep apnea, transoral neuromuscular electrical stimulation that changes the muscle fiber type of the tongue. And then there's some adjunctive treatments that can be helpful too, such as positional therapy, oral facial myofunctional therapy that helps a person breathe better through their nose and may help train the upper airway muscles.  Dr Berkowitz: Great. Well, that's a very helpful overview, and again, I refer our listeners to your article, which talks about all of those modalities in very comprehensive detail. So, Dr. Stahl, as we wrap up our conversation, you have a captive audience of neurologists and neurology trainees here. What would you like to leave us with that every neurologist should know about obstructive sleep apnea?  Dr Stahl: The most important, again, is for neurologists to know that obstructive sleep apnea is so common in your patient population, and it can have a significant negative impact on quality of life and health, including many neurologic conditions. And at the same time, obstructive sleep apnea is very treatable. We have so many options nowadays that we can usually get someone onto adequate treatment. And treatment has that potential to improve several neurologic symptoms and disorders, even at times when you don't think that there's an opportunity to improve symptoms such as say in, headache. So, neurologists really should be screening for signs and symptoms of obstructive sleep apnea, as well as considering testing in high-risk, potentially asymptomatic or minimally symptomatic patients.  Dr Berkowitz: That's a fantastic overview of some of the many pearls that you shared with us today, as well as in your article. So, thank you so much again. Today, I've been interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining today, and thank you again, Dr. Stahl.  Dr Stahl: Thank you again for having me.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.  

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Diagnosis and Management of Obstructive Sleep ApneaShow description: Explore the interpretation of sleep studies in the diagnosis of obstructive sleep apnea. Master treatment of OSA and how to troubleshoot CPAP challenges with Dr. Aneesa Das. Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro and guest bio Case from Kashlak Definitions Sleep Testing and Interpretation Management of OSA  Outro Credits  Written and produced by: Alise Burke MD  Infographic and Cover Art: Dylan Naldzin Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD  Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Aneesa Das MD  DisclosuresDr. Das reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: FreedGo to freed.ai and use code FREED50 for fifty dollars off your first month.  Sponsor: DeleteMe Get 20% off your DeleteMe plan when you go to www.joindeleteme.com/CURB and use promo code CURB at checkout. Sponsor: Continuing Education CompanyVisit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts. 

Send us Fan MailLate preterm babies born by cesarean fill our NICUs, and most of them are there for respiratory distress that resolves in a day or two. Could 20 minutes of CPAP in the operating room keep them out? This week on Journal Club, Ben and Daphna break down the PLaNT trial, a five center randomized pilot of prophylactic CPAP at 5 to 6 cm of water in spontaneously breathing infants born at 34 to 36 weeks by cesarean. They then sit down with senior author Dr. Edgardo Szyld to talk pneumothorax risk, the 35 to 36 week subgroup, consenting families, and what PLaNT 2 must prove.----Prophylactic CPAP at Cesarean Birth in Late-Preterm Newborns: A Multicenter RCT. Shah BA, DeShea L, Schmölzer GM, Josephsen JB, Fabres J, Wetzel EA, Rykovich H, Thomas A, Law B, Garrido C, Szyld E.Pediatrics. 2026 Aug 1;158(2):e2025070998. doi: 10.1542/peds.2025-070998.PMID: 42457181 Clinical Trial.Association Between Delivery Room Continuous Positive Airway Pressure and Neonatal Outcomes in Late Preterm and Term Infants: A Systematic Review and Meta-Analysis. Chin Y, Hill M, Sett A, Thomas N, Razak A.J Paediatr Child Health. 2026 Jul 28. doi: 10.1111/jpc.70516. Online ahead of print.PMID: 42517258 Review.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Sleep apnea can cause you to stop breathing repeatedly during the night — sometimes dozens or even hundreds of times — without you realizing it. And while loud snoring is a common warning sign, it is not the only one.In this episode of Baptist HealthTalk, host Dr. Anthony Gonzalez talks with sleep specialist Dr. Edward Mezerhane about how sleep apnea affects the body, the symptoms people often miss, and what can happen when the condition goes untreated.They also break down how sleep apnea is diagnosed, why weight and airway anatomy matter, what to do if CPAP is difficult to tolerate, and the other treatment options available. What sleep apnea is and how common it may be  Why people can stop breathing without realizing it  Common and overlooked symptoms of sleep apnea  The connection between sleep apnea, weight gain and heart health  Whether losing weight can improve sleep apnea  How sleep studies confirm a diagnosis  Ways to make CPAP easier to tolerate  Alternatives to CPAP, including oral appliances and surgical options Sleep apnea is highly treatable. If you regularly wake up exhausted, snore loudly, or a bed partner notices pauses in your breathing, getting evaluated may help improve both your sleep and your long-term health.For more health and wellness information, visit BaptistHealth.net/News.Host:Anthony Gonzalez, M.D.Chief of Surgery, Baptist Health Baptist HospitalMedical Director of Bariatric Surgery, Baptist HealthGuest:Edward Mezerhane, M.D.Sleep Medicine PhysicianIf you found this episode helpful, you may also enjoy:7 Ways Summer Can Wreck Your SleepThis is What Lack of Sleep Does to your Brain and HeartPillow Talk: Uncovering the Sleep-Heart Link

I couldn't swallow a pill until I was almost eight years old. I'd hold it in my mouth for a minute and a half, counting down in the bathroom mirror, and still not get it down. My grandmother could take five at a time. My mom could take ten. In this video I read "Grown-Up Pills," a poem I wrote years ago that's featured in my book Spira Speaks: Dialogues and Essays on the Mucusless Diet Healing System, and then I break down the true story underneath it. The yellow bathroom counter that exploded with pill bottles. The seven-day pill organizer that every adult in my house owned. Seldane, which they eventually pulled off the market because it was killing adults, and which I had been taking since I was six years old. Then Allegra-D. Then Zyrtec. Then Claritin. Eight years as a lab rat, and I still had every single symptom those drugs were supposed to be treating. I woke up with my eyes crusted shut so often that at four years old I would plan my route to the bathroom before bed and feel my way along the walls, because the first few times I thought I had gone blind. I sat in class with tissue screwed into my nose from the daily nosebleeds. That was normal. It was normal to everyone around me. And it took me years to understand that it was never normal at all. I have been emancipated from that entire reality for 23 years. I lost 100 pounds, the symptoms went away, I stopped taking the drugs, and I got off the CPAP machine for sleep apnea. The doctors told me I would be on medication for the rest of my life. This is not medical advice, and it is not a criticism of my family. They didn't know any better. It's an invitation to look at the world a little differently, and to understand that you do not have to suffer as much as they have convinced you is normal. CHAPTERS 0:00 Do you believe medication is normal? 1:24 Disclaimer 2:11 Who I am and how long I've been free 2:18 The poem: Grown-Up Pills 3:40 The true story behind the poem 3:59 They took Seldane off the market 5:59 Everybody had a pill organizer 6:50 A predatory system 8:35 Allegra-D, Zyrtec, Claritin: the lab rat years 10:23 23 years, 100 pounds, no more CPAP 10:52 The daily nosebleeds 12:33 The actual cause of human illness 12:44 Waking up with my eyes crusted shut 14:55 How they normalized it 15:55 Side effects include death 17:10 You can emancipate yourself 19:09 Work with me 21:48 Peace, love, and breath If you're serious about learning the Mucusless Diet Healing System and want support applying it in real life, use the links below: Book a clarity call for Transition Diet Bootcamp: https://live.mucusfreelife.com/bootcamp-apply Join the Mucus-Free Life Membership: https://go.mucusfreelife.com/join-ytc Join the newsletter: https://bit.ly/mfl-fb-join Mucus-Free Life is an educational platform exploring the Mucusless Diet Healing System. Content reflects study and experience and is not medical advice. Always consult a qualified professional before making changes to your diet, fasting, or health practices. Peace, Love, and Breath!

Join Dr. Pinkston as she sits down with John Goldman, founder and CEO of Rebel Health Alliance. John shares his journey from feeling chronically exhausted, pre-diabetic, and dependent on a CPAP machine to revitalizing his metabolic health and training to qualify for the Boston Marathon. Together, they discuss the limitations of traditional primary care, the power of deep-dive diagnostics, lifestyle medicine, and alternative models like high-performance primary care paired with community health sharing. Key Topics Covered: The Broken Primary Care System: Why traditional insurance-driven models fail to catch early markers of metabolic dysfunction, visceral fat, and inflammation. Deep Diagnostics: How comprehensive testing—including DEXA scans, VO2 max, DNA analysis, and coronary calcium scores—forms the foundation for long-term vitality. Overcoming Obstructive Sleep Apnea: John's personal experience transitioning to a CPAP/BiPAP and eventually resolving his condition through weight loss and metabolic restoration. The Rebel Health Model: Combining full-time physicians, strength coaches, registered dietitians, and genetic counselors into a seamless, accessible care team. Ejecting from Insurance: How direct primary care paired with community-based health sharing offers financial protection without corporate middleman restrictions. Project Unreasonable: John’s public journey at age 50 to qualify for the Boston Marathon while showcasing human potential. Rebel Health Alliance: Explore high-performance primary care and longevity protocols at rebelhealthalliance.io Visit drpbetterlife.com to access show archives, guest links, and integrative health resourcesSee omnystudio.com/listener for privacy information.

The girls are back, and this time, to ask two very reasonable questions. One, why would you invite a Gettysburg ghost into your home. And, two, why does the Christopher Nolan brother rumor have so much truth to it? First, Monique tells the story of Trina, a skeptic who went on a Gettysburg ghost tour during her honeymoon, mocked the whole thing and then jokingly invited an entity home like it was a refrigerator magnet. Her husband told her to take it back but she just had to double down. The haunting that followed was water-based and weirdly poetic: scalding showers, exploding water, light bulbs burning out near sinks, CPAP issues, pneumonia that made her feel like she was drowning, and eventually a black shadow figure sliding across the floor toward a pond. Lesson: respect the dead. Then Amy takes us into the real story behind the viral rumor about Christopher Nolan's “fugitive hitman brother.” The truth is messier: Matthew Nolan, the filmmaker's older brother, allegedly used the alias Matthew Oppenheimer while posing as an heir to the Oppenheimer diamond fortune. That alias pulled him into the orbit of Robert Cohen, a tax accountant tied to missing money, fake passports, a kidnapping, a brutal murder, an Interpol red notice, a prison escape plan, and a justice system that somehow still left Cohen's daughter without the accountability she deserved. This one has a strong AFHP moral of the story: stop being shitty while you're alive, because neither ghosts nor consequences are ever impressed with that behavior.

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Karin G. Johnson, MD, FAAN, who served as the guest editor of the August 2026 Sleep Neurology issue. They provide a preview of the issue, which publishes on August 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Johnson is a Professor in the Department of Neurology at the University of Massachusetts Chan School of Medicine–Baystate and the Sleep Medicine Division Chief at Baystate Medical Center in Springfield, Massachusetts Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @drsleepykarin  Full episode transcript available here Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Albin: All right, welcome all. For the first time ever in the history of Continuum Audio, we are coming to you live from Chicago here at the AAN annual meeting. And now over to your host, the one and only editor-in-chief, Dr. Lyell Jones.  Dr Jones: Welcome, everybody. My name is Lyell Jones, editor-in-chief of Continuum, and I'm here today with Dr. Karin Johnson, and we're interviewing Dr. Johnson for the upcoming and recently published issue of Continuum on Sleep Neurology. We have been doing Continuum Audio for a while, but we're doing something different this time. As our listeners online can tell, we are recording this for the first time ever with a live studio audience at the American Academy of Neurology annual meeting in Chicago, Illinois. So, this is a fun experience for us. I hope it's been fun so far for you, Dr. Johnson.  Dr Johnson: Great to be here.  Dr Jones: It's great to have you. So, before we get into the interview, I do wanna introduce our team here for the live recording of the podcast. You've already heard Dr. Casey Albin's voice. Dr. Casey Albin is an associate professor of neurology at Emory University. Also serves as one of our associate editors at the journal and one of our Continuum Audio interviewers. So, she's going to be working the crowd today. Let's have a round of applause for Dr. Albin. And our guest of honor today is Dr. Karin Johnson. Dr. Johnson is a professor of neurology at UMass Chan Medical School and, Baystate Medical Center in Massachusetts. She is a world-renowned expert in sleep neurology and is the guest editor for the most recent issue of Continuum on Sleep Neurology. Dr. Johnson, welcome. Why don't you introduce yourself to our audience?  Dr Johnson: You did a great introduction, but I'm a clinical sleep medicine specialist. Spend my days seeing patients, taking care of people with narcolepsy, sleep apnea, restless legs, everything that comes my way. And then I have a side interest in doing sleep medicine advocacy, especially for permanent standard time.  Dr Jones: And we may get to that. I mean, that might be part of our conversation today. So, you've now read all of the articles in this issue, and it's a really great issue. There's a lot of new developments in sleep neurology. There are some updates for clinicians, people who see patients with sleep disorders that I think are, are timely and important updates. You have this unique view because you have just read all of these articles, really good articles by expert authors. When you read through these, Dr. Johnson, what was the biggest, what was the biggest thing that surprised you?  Dr Johnson: I think the biggest surprise for me is just so many changes in, in all of these articles. I realized how easy it was for us to make a journal that is so different from a few years ago. Whether it's Dr. Stahl's obstructive sleep apnea and new ways to think about endotyping sleep apnea that is gonna have treatment implications or the new treatments that are out there like tirzepatide, the changes that we're having with restless leg treatment. I particularly wanted to have a chapter on circadian neurology that Dr. Abbott did a great job really highlighting how if we think about the timing of when we give meds, the timing of when we eat, how that really can help neurological health, brain health, overall health, as well as mental health and cognition, especially as the AAN thinks about brain health as a whole, not just treating our patients, but how we can treat the population of people by improving sleep. I like how we hit on all these different areas in this issue.  Dr Jones: And I don't know how you managed to do it. They're just a small number of articles. We cover a lot of existing territory with well-characterized diseases, with new advances. But there's a lot of new stuff in sleep, and so somehow, it's all packed in there. It's really impressive. One of the things I was gonna ask you about was an evolution, and this has been a number of years now in how we manage restless leg syndrome. When I was training, it was all about dopamine agonists, and that was your first line. And over time, the evidence has supported moving away from that, and now we have more recent guidelines that have come out, and it's really the alpha-two delta-one calcium channel antagonists. How is that transition going? Do you still see people in practice who come in on dopamine agonists? How is that going? How's the field responding to that?  Dr Johnson: That's one of my most frequent restless leg consults. So even though it's been years since I have really initiated dopamine agonists in my patient, every day we get in people often on very high doses of dopamine agonists, and their doctors have just been escalating and escalating these meds over the years, and they come in with horrible augmentation. Their symptoms are much worse than they used to be, happening earlier in the day. And so, trying to get these patients off of these meds that are addictive, the way I like to teach about it is these dopamine agonists are the Fioricets of the sleep world. We know they work great, but in the long run, the patients are gonna be worse overall. And so, it's so hard to get people off these dopamine agonists, just like it's so hard to convince a headache patient that they don't need their Fioricet and that they're gonna be better off if we can get them off of it. What I think has really changed is we have more options to use. So, the alpha-delta-like agonists like gabapentin are now considered first line, but there's a lot of patients who they just don't work well enough with or they don't tolerate. And so, what do you do in that case? It's easy when that works, but and, when that doesn't work, we are being much more aggressive these days with iron replacement, potentially even trying to push ferritin levels in refractory patients up to three hundred, and using IV iron rather than just oral iron to get over the absorption issues to get the brain levels high enough. Motor stimulators, little cuffs that kind of go around the leg and stimulate the peroneal nerve in a certain way that not only can give people immediate relief, but also some data that suggests that over time it actually lessens their restless legs. We have agents like dipyridamole that work on the adenosine system in a sort of new novel pathway at addressing restless legs. And then the opiates, often meds like methadone or Suboxone can be used in some patients. But as we're getting more of these other options, often we don't need to go to those levels because we do have more to work with.  Dr Jones: So, the key point is lots of options. We're not starting with dopamine agonists anymore. And I think the fact that you're still seeing a lot of patients who have been initiated on that probably tells us there's an education gap field that we need to work on. So, another thing that I noticed reading through the issue was, and this feels like a change over the last few years, is the availability and the tendency to use in-home sleep apnea testing as opposed to formal, traditional in-lab. And that feels like a great new option, and maybe that increases and improves availability for patients who need access to the test. But how do you work through that?  Dr Johnson: So, I love in-home testing. We've been using it for over a decade. Other parts of the country where insurances didn't sort of mandate it are now being more mandated. I think the real change happened for a lot of places over the pandemic when labs closed down. But I think it's good because it brings a lot more patients to us. They get tested, they get tested quicker. People who would say, "I would never go into a lab. Oh, I'll do a home study." So, it just does bring more people in, and it gets them to treatment that they need that can really be life-changing. But it's not for everybody. The biggest people are people that have other bad pulmonary issues. If you're on oxygen therapy, you should not be getting a home study. That really should be a group of people that come in the lab. Similarly, if you have bad COPD, you probably should be getting a full in-lab study, so we can get more monitoring. Central sleep apnea is an interesting one. It can be very hard in some cases to differentiate the centrals and obstructive nature as well on a home study. Doesn't mean you can't do a home. So, if it's a person that just can't get an in-lab study easily, maybe you start with the home. If it looks purely obstructive, and you're all set, then you got an answer, and you can move on. But if you get back a home study that looks questionably central, they're gonna need to come into that lab. So, if you already know they're high risk because they're on narcotics, cause they have congestive heart failure, it's usually worth going straight to the lab. But again, you may consider a home study based on the patient. Patients that really cannot use the equipment can also be an issue. So, if they've had a debilitating stroke and have no one to help them put on that device, or cognitively they just can't handle the device, they're gonna be someone who's gonna benefit from coming into the lab and getting the help from the techs. So, those are the big populations that you might go starting for a home. And then the other thing that confuses a lot of people, the home is only for diagnostics. It really isn't for treatment. So, I have patients that say, "Oh, like, you can just titrate my CPAP with a home study." No. So if it's a treatment decision where they're not doing well on treatment, or I need to figure out do they need CPAP or BiPAP or IVAPS or one of these more complicated treatments, those are people that are gonna need to come into the lab to get that treatment portion of the evaluation.  Dr Jones: What a great summary. That's like everything I needed to know about who do I need to bring into the lab and who do I think maybe could do an at-home study. Really great. And speaking of devices, I think all of us who see patients in the room here and our listeners out there online have experienced patients, and this feels like a very recent phenomenon to me, are coming in with their commercial at-home wearable device. And they have printouts sometimes, and they show me their phone, and they give me some numbers that I don't really know how to interpret. Reading through this issue, I learned a couple of great new words. I learned about orthosomnia, right? So, people who become so preoccupied with their sleep, it keeps them awake at night, literally, right? I mean, it's a complete paradox. I learned about nearables, so things that aren't necessarily wearables that are just in the room while the patient is sleeping that monitor proxies for sleep quality, sleep stage, and other things. And I frankly, I'm not really sure what to tell patients. So, what do you tell patients who come in with all the data? Like, or how do you tell patients to use these?  Dr Johnson: I think these devices can go both ways. So, I do kind of say the pros and cons of these devices. I think for a lot of patients, they're empowering. It's getting them to think about sleep, to wanna know how good their sleep is. Are they getting enough sleep? So, if it's used in those ways, it's gonna be very helpful. I actually had a patient last week, and they noted that they're having big desats all night and could show me essentially an overnight oximetry data rather than me having to order it, and I had days of data, which sometimes can be too much. But in this case, it's like, oh, when he was on his side that night, he looked a lot better, so I can use that to give advice to the patient about particular treatments. He actually went down to Mexico, and a doctor friend gave him oxygen therapy while he was there randomly. And we could see on the nights that he had the oxygen therapy, it did really help his central sleep apnea pattern. And so that pushed us towards saying, "Let's qualify you for that up here in the States." So, I think in some cases it can give really important data. Now, I saw a posting on social media the other day of someone saying, "Can I get advice on how to improve my REM sleep? My tracker says I have no REM sleep, and I need to do something about it." There's really not data to support needing to do something about it. And so, I do think it can get some people on these wild goose chases, trying to get to a certain percentage of sleep. And these trackers, they're good in a lot of ways, but they're not perfect. He could be getting REM sleep that the tracker on him does not show. You want to relate it to what symptoms are they having. I think they can be very good for trying something out. So, let's say someone, has their tracker telling them they get five hours of sleep, and they try this intervention, and that helps them show that they got the seven hours of sleep, or they went from no REM to REM and it goes in the right direction. It can help give them that positive feedback that something they're trying, is working. But the absolutes for any given patient, it's hard to over-- What does it mean if it says you've got a 50% score versus a 70% score? That may or may not be meaningful in any given person, but again, they can compare themselves to themselves. If they were a lower score and now they're a higher sleep score because they did something that was meaningful, and that goes along with them feeling better, that can help give them that positive feedback to do something good.  Dr Jones: So, a little bit of a mixed picture.  Dr Johnson: Yeah.  Dr Jones: Sometimes they help. Sometimes they distract. Hopefully- Dr Johnson: And as a provider, sometimes it can be overwhelming because they're like, "Come look at my year's worth of data." And you're like, "No."  Dr Jones: Yeah.  Dr Johnson: You know, let me see one page or two pages of data and be like, "Yep, okay, I get it." Dr Jones: Just show of hands in the audience, who in the room wears a sleep device at night, like a ring or a, some kind of sleep monitoring app? That's about half the audience.  Dr Johnson: This is why they're here.  Dr Jones: So that's really helpful, and I think it is. You want to be supported by the data. You want to be supported by evidence and high-quality biometric evidence. Another big trend, and this has been a number of years in the making, is the understanding, Dr. Johnson, of the relationship between sleep physiology and neurodegenerative disease. One of the things I love about neurology is there's still so much left to learn about the normal physiologic functioning of the brain. So glymphatics and other aspects of sleep physiology that we didn't know about a decade or two ago. When you think about how that relationship has developed, sleep physiology, maybe sleep disorders and neurodegenerative disease, how has that changed your approach to talking to patients? Do you counsel patients differently now because of what we understand better about that?  Dr Johnson: Yeah, I mean, we are still limited with our data. We have so many studies that show the associations between whether it's not enough sleep, too much sleep, or having a sleep disorder like obstructive sleep apnea, and that being a risk factor for stroke or Alzheimer's or Parkinson's. But we still sort of lack the treatment trials that necessarily say, "If you treat obstructive sleep apnea, you're gonna have less dementia," or, "You're gonna be less likely to have that stroke." So, we have a lot of physiological studies, a lot of reasons why it makes sense, but we don't have that final, nail in the coffin to say, "If you do this, you'll definitely be better." So, we know certain groups are more at risk. If you have obstructive sleep apnea and you are symptomatic, you seem to have higher cardiovascular risk. If you have a person who's had a stroke and we find a milder case of sleep apnea, and they're someone that's totally asymptomatic. They say, "I sleep fine. I feel fine." There's not great data to say, "If you treat your sleep apnea, you're gonna be less likely to have a stroke." Now, if they come in and they're sleepy and their sleep apnea is really severe, and they have more hypoxic burden, which is also more connected with a lot of these risks, I'm going to say, "I think you are in the higher risk group of sleep apnea people who it's probably gonna be more likely to help your cardiovascular risk, your dementia risk." We can counsel them, and then it's really a personal decision. Some people are like, "No way. I'm never gonna use a CPAP machine, ever." And other people are like, "You know, my mom had a stroke. My dad had Alzheimer's. I want to do every possible thing I can to make it less likely that I have this outcome that I want to avoid." And so, you're going to take that in to, you know, do you want to try this treatment or not? It's a lot easier when you have outcomes that you can follow, like, "If I try CPAP, does my blood pressure get better? Do I stop having AFib attacks?" It's a lot harder when, will I or not get Alzheimer's ten years down the road or have that stroke?  Dr Jones: It's hard to get people to do things for kind of an abstract prevention down the road, but could be important. Are there trials going on that are going to assess this data?  Dr Johnson: Yeah. We currently have a big trial getting people right away, right after their stroke, on CPAP, and not only looking at prevention, but also looking at recovery outcome. It's been running for several years. Hopefully, we'll get enough data to close out the study coming up.  Dr Jones: We'll look forward to that.  Dr Johnson: Yeah.  Dr Jones: So, I'm really excited to get to our audience here, but before we do that, I do want to ask Dr. Johnson one more question. Dr. Johnson is famous for her advocacy for sleep in general, but specifically related to Standard Time. So, let's do a little experiment here. I didn't warn Dr. Johnson about this, so we'll see how she does. She does a ton of advocacy. She's a pro. So, pretend like we're in DC, and I'm a senator, and we just got in an elevator. You're going to give me your elevator pitch on what we should do.  Dr Johnson: So, you know, sleep is one of the few essential things in life. We need to eat, we need to drink, we need to have clean air, and we need to sleep and when we improve sleep, we can improve basically every outcome, whether it's academics, whether it's productivity, whether it's our physical health, our mental health. And the problem is we structure our lives in a way that really keep people, and especially our teenagers, from getting the sleep they need. And one of these structural things we do is permanent daylight savings time. Essentially, what you're doing is you're putting the sun out later, makes it harder to go to bed. I was just talking to someone, the sun's going down at 9:00, and you need to get your kid to sleep at 7:30, 8:00 so they can get the amount of sleep they need. That is almost an impossible task because their circadian rhythms are being pushed later, they can't fall asleep on time. Then you're setting their clocks an hour earlier, so when that alarm clock is going off at 6:00 AM in the morning, it's actually 5:00 AM in the morning. You're squeezing sleep from both sides, and it's basically impossible to get enough sleep. A lot of people think the only problem with daylight savings time is twice a year with the changes, and there are certainly harms related to that. So, a lot of people think if we went to permanent daylight savings time it would be better, and we got rid of those changes. What they don't realize is that permanent circadian misalignment by setting the sun more ahead, at 1:00 to 2:00 instead of at noon causes the sleep and circadian disruption all year round that leads to increased incidents of strokes, of heart attacks, of obesity, of cancer, of suicides, of depression, of worse academic grades. Again, pretty much every outcome you have there that relates to brain health, we have now data that shows that it's worse. And so, we can improve our lives if we can go to permanent Standard Time.  Dr Jones: You convinced me. How about that? If there were any skeptics in the room, I doubt there are any left. We only went to like the fifth floor there, and she... I'm like, "I'm voting for this. Whatever, whatever this bill is, I'm gonna vote for it." So, I'm excited to get to the audience here. Before we get to questions and answers, and we want you to get your questions ready for Dr. Johnson. I do have a couple of trivia questions. And we've been doing this for a little while now on the podcast. The first trivia question actually relates to arts and culture.  Dr Jones: What famous artist used transitions between sleep and wake states to inspire his art? Anybody know?  Guest Speaker 1: Is it Van Gogh?  Dr Jones: Not Van Gogh that I know of. There in the back.  Guest Speaker 2: Picasso.  Dr Jones: Picasso, not that I know of. Right here.  Guest Speaker 3: Salvador Dali.  Dr Jones: Salvador Dali. We have a winner. Thank you for your answer. So apparently, I read this. Salvador Dali would sit in a chair holding onto a metal key and wait until he fell asleep, and it would fall out of his hands and drop into a bowl, and it would wake him up. So, then he would pick it back up, and he would go in and out of sleep trying to generate hypnagogic hallucinations, basically, and he would use that to inspire his art. And you think about his art, maybe that kind of makes sense. All right, now I've got a neurology trivia question. Okay, so maybe we're a little more comfortable with the neurology trivia in here. What is the center in the brain that is responsible for REM sleep atonia?  Guest Speaker 4: The receptor is for erection in the lateral hypothalamus.  Dr Jones: That is not correct. REM sleep atonia. Right here.  Guest Speaker 4: Emilio Malgona, Hyannis, Massachusetts. Dorsal raphe nucleus.  Dr Jones: We'll give you credit for that. Very good. Excellent. So, the-  Dr Johnson: Well, no. That's actually the serotonin. He's talking about another one.  Dr Jones: Oh, I thought I heard, I thought I heard-  Dr Johnson: You heard dorsal  Dr Jones: ... I heard dorsolateral tegmental nucleus of the pod.  Dr Johnson: Not quite.  Dr Jones: You get a prize anyway, sir, just for, just for answering. Thank you very much. All right. So, we're all warmed up here. So, Dr. Albin, what do you think? Should we get some questions from the audience?  Dr Johnson: All right, we've got some questions.  Guest Speaker 5: I have a statement and a question.  Dr Jones: Please tell the podcast your name again, sir.  Guest Speaker 5: Steve Spar, New York City. The tyranny of the morning people. You don't want people, you don't want the sun to go down too late because it'll keep people up longer. I spent my whole life fighting people like you. I am a nighttime person. Why do I have to go to sleep earlier? I want to go to sleep later. I want to wake up later. I don't want to wake up at 7:00 in the morning. I want to wake up at 10:00. There's a certain tyranny that we must use circadian rhythms of the majority, and it persecutes people like me who are night people.  Dr Johnson: So that is a great question.  Guest Speaker 5: What say you?  Dr Johnson: What say me is actually the harms of daylight savings time are actually to the night owls, and don't really affect the morning people. I can still go to sleep on time and get up on time without that pressure of needing to go to work. The night owl people, they can't fall asleep until later. They want to sleep in earlier, but we're forcing them to get up an hour earlier for work and school. And because we're doing daylight savings time, you're not getting the morning light you need, you're getting too much light at night, and you are more sensitive to a delay in your circadian rhythm, which makes you even more of a night owl and increase the degree of social jet lag. So, we actually see that the harms and risks of things like depression, cardiovascular risks are much greater in night owls than they are in normal people or morning larks. And this is again why the risks are the highest for our teenagers, who are essentially all night owls. You're making it harder for them to fall asleep on time. You're making them more and more of a night owl that it becomes more out of line with our standard social schedule. So, what we can do for a night owl is say to our schools, say to life that we want to change our society norms of getting up early. But that has nothing to do with daylight savings time. That has to do with how we make our schedule Dr Jones: All right, next question. And introduce yourself to the audience.  Guest Speaker 6: Sure. I'm Sanjay Rathi from New Haven area, Neurology. Movement disorders, Parkinson's disease, sleep disruptions, sleep-regulating REM, RBD issues, what are your recommendations? And as things get worse, what additional intervention should we do?  Dr Johnson: Yeah, I think it's hard with a lot of our neurodegenerative disorders, it's a two-way sleep. The disorders themselves often worsen sleep quality, have decrease in their sort of circadian amplitudes, and so that can affect sleep ability. And so, trying to do the things that promote sleep, like getting lights down in the evening, keeping things dark and quiet, doing cognitive behavioral sort of therapies if that's needed can all be helpful. Very high incidence of obstructive sleep apnea or other sleep-disordered breathing, whether it's Parkinson's or other neurodegenerative disorders, so evaluating and treating that if need be. And some of these people, especially as they get later on, you may end up considering medication for insomnia because their underlying disorders was causing it and there's, and you're not going to CBTI your way out of it. We do have the new orexin antagonist sleep agents, which are more recommended for older people and probably safer agents than your Z drugs and some of the other sleep meds out there. So, some people should be on some of those meds if their sleep is so disrupted. I've seen some sleep studies where it's basically like wake, sleep, wake, sleep, wake, sleep all night long. And it's like, wow, you really cannot sustain sleep, and we think it's not just a behavioral thing. I think it is part of their underlying Parkinson's and underlying disorders that can really cause major sleep disruption.  Dr Jones: It's a great question. Before we get more from the audience here, Dr. Albin, I'm just curious, you know, you got some questions from online. Don't know if any of those stood out to you. And the other thing is, I think about your practice, Dr. Albin, as a neurointensivist, there's some great content in this issue on how to maintain an adequate sleep environment in the hospital and the importance of that for the acute episode, maybe for some long-term outcomes. When I was reading the article, I didn't really didn't think about the ICU setting. That must be-- what do you do in the ICU?  Dr Albin: Well, we happen to have a question about just that. Dr Jones: Well, there you go  Dr Albin: From Dr. Manners of Baltimore, Maryland. "What meds should I be giving patients in the ICU or the inpatient setting to preserve or recalibrate their sleep-wake cycles? Is there anything that we can do besides just getting them out of bed during the day?"  Dr Johnson: Meds are always hard cause as sleep doctors, we're usually the last one to recommend meds. But there are situations and scenarios where meds may be appropriate. I can't say what's one better than the other, and some of the meds we have probably aren't even available as options in the hospital. So, the, you know, again, the orexin antagonist may be a good class to try to use, but they may not be an option. There was a good study that looked at empowering the patient and whether or not the ICU patients are empowerable. But they give a card to the patients in the hospital and say, "Tell your nurse to turn off my TV and my lights. Do I need all the blood draws all throughout the night, or can it be put off to the morning?" And trying to empower the patient to ask for these things and do some of the behavioral things. And they found that doing that did improve the duration of sleep, did reduce some of the number of awakenings that people ended up having at night. So, I think the ICU is a very particular population where there's a lot of things you can't get rid of. But certainly, turning on the lights, turning off the lights, and trying to limit noises as much as you can, in those night hours, trying to give some sense of a 24-hour day. The other thing is feeding is really important to circadian rhythms. I had a patient that had a brain bleed and, after it, she just her circadian rhythms were just off, and part of it was she was getting tube feeds through the night. So, one of the very first interventions we did was to move her timing of her feeding so that it wasn't in sleep, and that really did help make a difference in getting her back on a pattern, along with light therapy and other behavioral techniques as well.  Dr Jones: It's a great question.  Dr Albin: Absolutely. I mean, I think that validates just that we spend a lot of time actually asking like, "Can we feed people during the day?" Or, "Can we, can we limit the amount of baths that are happening at 3:00 in the morning?" We also had another one from the audience that came from Dr. Lavina Singla of Mississippi, and I think a lot of our patients are asking this question. Is melatonin addictive?  Dr Johnson: Is melatonin safe? Is melatonin addictive? I think with any sleeping aid, people become addictive to what they perceive is the outcome. So, if they said, "This got me to sleep, and now I'm sleeping great, I don't want to come off of it." And so, you get this to meds that are truly addictive, but even meds that aren't felt to have that addiction, there is certainly a behavioral change. And that's a lot of what cognitive behavioral therapy is working with these patients on, is challenging that belief of maybe it isn't the med, maybe it's your internal belief and your worry about doing this. One thing about sleep is sleep happens when you are relaxed and calm and not worried. When you're worried about thinking that thing you're worried about is whether or not you're getting sleep, then you don't sleep. In terms of melatonin, if you don't need to use it, I wouldn't use it. If you are gonna use it, I'd try to use as low doses as possible. Do we know all the risks? We don't know. And especially I think there are potentially more risks in a growing child than, maybe someone who isn't having the same sort of hormonal, needs and growth needs. But then again, if you have, let's say, a kid with autism and melatonin helps him sleep, I'd much rather use melatonin than a lot of other agents, and if that really changes their functionality, that probably is very good for them and better than having them not get sleep. So, I think you have to weigh each individual situation and combine it, especially with the behavioral approaches so that hopefully this is not a long-term addictive thing you're on.  Dr Jones: So, it's complicated. Sounds like it.  Dr Albin: Not a straightforward answer.   Dr Jones: I thought that was gonna be just this hard no, but I guess it is something you have to think about. So, I want to really take a minute here to thank Dr. Karin Johnson, who has been our interviewee for this episode of the Continuum Audio Podcast sleep issue just came out. Really want to encourage our subscribers, our listeners, and our studio audience here to enjoy it. Thank you, Dr. Johnson, for joining us today. I want to give a big round of applause to Dr. Casey Albin for managing this crowd. Thank you to our listeners. Thank you to our subscribers. Thank you to you all for coming today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.   

The most common treatment for obstructive sleep apnea (OSA) is an at-home CPAP machine, but patients often remove their mask in their sleep or stop using the machine all together. Neomi Shah, MD, Mount Sinai Hospital, and host Ugo Ezema, MD, Tulane University, discuss a novel oral medication that opens a patient's airway, exponentially improving their quality of sleep.  

Send us Fan MailNeste episódio, comentamos quatro artigos recentes que atravessam a linha de frente da neonatologia — da sala de parto ao acompanhamento de longo prazo.Começamos pelo estudo PLaNT (Pediatrics), um ensaio clínico randomizado que testou o CPAP profilático em recém-nascidos pré-termo tardios nascidos de cesárea, avaliando segurança, viabilidade e impacto na necessidade de suporte respiratório. https://pubmed.ncbi.nlm.nih.gov/42457181/Em seguida, um estudo sueco (Journal of Perinatology) traz dados inéditos sobre estabilidade térmica durante o cuidado pele a pele em prematuros extremos, de 22 a 25 semanas — território pouco explorado até aqui. https://www.nature.com/articles/s41372-026-02829-0No terceiro bloco, discutimos os resultados do ensaio PAEAN (JAMA Pediatrics), que testou a eritropoetina como terapia adjuvante à hipotermia na encefalopatia hipóxico-isquêmica neonatal. http://10.1001/jamapediatrics.2026.3082E fechamos com um estudo canadense (Journal of Perinatology) sobre a associação entre número de tentativas de laringoscopia nos primeiros dias de vida e hemorragia intraventricular grave em prematuros extremos. https://www.nature.com/articles/s41372-026-02811-wCiência atual, leitura crítica e implicações práticas para quem cuida de recém-nascidos — sempre com um olhar para a nossa realidade assistencial.A Incubadora é o Podcast oficila do CINEO 2026, que acontece em Brasília, DF nos dias 26, 27 e 28 de Novembro. Esperamos vocês? O link para inscrições no CINEO 2026 você encontra aqui: https://cineo.com.br/ Não esqueça: você  pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1Lembrando que o Podcast está no Instagram, @incubadora.podcast, onde a gente posta as figuras e tabelas de alguns artigos. Se estiver gostando do nosso Podcast, por favor dedique um pouquinho do seu tempo para deixar sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. Isso é importante para a gente poder continuar produzindo os episódios. O nosso objetivo é democratizar a informação.Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.orgEvidência, cuidado e contexto brasileiro - esse é o nosso roteiro.

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.

A fun Friday show kicking off with Double Thumbs Up and Knock Off Fridays. Plus, more listener tales of doing things the wrong way on The Wrong, we built the ultimate People’s Playlist: Numbers In The Title, shared the legendary dadisms passed down through generations, and wrapped up with Bedroom Songs fpr At Work Time Waster.See omnystudio.com/listener for privacy information.

Geoff, Gavin and Andrew talk about Discord color, strike count, Rockay City, GTA, hamburger update, San Francisco, one slice of pizza, whole pizza, Utz, doritos, Costco Guys, Gurple Jacket creation, sweat, death timer, Saliva, Eat the Pencil Band, grade one book, CPAP sneeze, Texas Surplus, shaved ice, dog poppers, smashed mirrors, wife revenge, Paul Blart, and tire service crime. Sponsored by Mint Mobile. Make the switch! MINTMOBILE.com/REGULATION Support us directly at https://www.patreon.com/TheRegulationPod Stay up to date, get exclusive supplemental content, and connect with other Regulation Listeners. Learn more about your ad choices. Visit megaphone.fm/adchoices

Bobby tests a CPAP machine, binging TV shows while falling asleep, and dealing with Father's Day emotions by locking them up in the back of the mind. B.L.A.C.K. Label Art   https://blacklabelart.shop/You can read more about Bobby and prison reform on our website:   notesfromthepen.com

Our favourite My Cousin Vlad is back in the Sooshi Cave this week. We talk through our experiences travelling through Turkey and Macedonia. He has a very different way of parenting his children than we do and making the most of a CPAP machine. Subscribe'a now! Tank'a you... - https://linktr.ee/sooshimango Ptou you bastard!

Is nasal obstruction the overlooked culprit behind CPAP intolerance? On this episode of BackTable ENT & Allergy, Dr. Gopi Shah interviews Dr. Atul Malhotra and Dr. Michael Hutz to examine the critical but often underappreciated role of the nose in obstructive sleep apnea management. They discuss how nasal obstruction can undermine CPAP adherence, why relying solely on AHI may miss key issues, and how identifying the true cause of intolerance can lead to more personalized and effective therapy. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Aerin Medicalhttps://vivaer.com/ --- Timestamps 00:00 - Introduction04:05 - OSA Presentation and AHI Limitations08:13 - Understanding CPAP Intolerance and Nasal Obstruction15:24 - Evaluating Nasal Obstruction20:32 - Nasal Anatomy and Workup27:47 - DICE Technique and Assessing Dynamic Nasal Collapse32:51 - Medical and Non-Surgical Management37:29 - Surgical Options and VivAer43:39 - Nasal Procedures and CPAP Success51:57 - Nasal Surgery and Heart Outcomes55:23 - Beyond CPAP: Nasal Breathing, Myofunctional Therapy, and Collaborative Care01:04:51 - Wrap Up --- More about this episode The physicians review practical strategies for evaluating nasal obstruction, from targeted patient questionnaires, physical exams, nasal endoscopy, and selective imaging. The doctors also detail medical and surgical treatment options, from allergy management and nasal sprays to septoplasty, turbinate reduction, functional rhinoplasty, and temperature-controlled radiofrequency (VivAer). Throughout the episode, they highlight how comprehensive nasal evaluation and intervention can significantly improve CPAP comfort and adherence. --- Resources Dr. Atul Malhotra - https://providers.ucsd.edu/details/22362/sleep-medicine-pulmonology-(lung) Dr. Michael Hutz- https://doctors.rush.edu/details/19100 CPAP treatment persistence following nasal procedures in obstructive sleep apnea - https://www.tandfonline.com/doi/pdf/10.1080/13696998.2026.2671550 Design and rationale for treating Obstructive Sleep Apnea using Targeted Hypoglossal Nerve Stimulation trial - https://www.sciencedirect.com/science/article/pii/S1551714422001306 The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea - https://pmc.ncbi.nlm.nih.gov/articles/PMC9498537/ VATRAC Trial of VivAer - https://aerinmedical.com/company/news-and-media/aerin-medical-announces-positive-two-year-outcomes-from-the-vatrac-trial-of-vivaer/ --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When USAID was dissolved, Sasha Gallant didn't let the work she'd spent years building disappear with it. As the former head of Development Innovation Ventures (DIV), USAID's evidence-driven innovation fund, Gallant watched stop-work orders freeze over 100 active awards overnight. Rather than let that portfolio die, she did two things: Helped mobilize more than $130 million to keep the most critical, life-saving USAID projects alive through an initiative called Project Resource Optimization, and Co-founded DIV as an independent nonprofit–the DIV Fund–to test and scale new, potentially cost-effective global development innovations.In this conversation with co-hosts Jonathan Jackson and Amie Vaccaro, Gallant unpacks why innovation funding in global development is chronically underfunded, how DIV evaluates ideas on evidence, cost-effectiveness, and potential for scale, and why the biggest wins are often "supremely unshiny": pedagogical tweaks, cheaper CPAP machines, smarter delivery models. She also grapples with a strange moment of dissonance: surviving deep funding cuts just as a new wave of AI-driven wealth approaches the sector. As she puts it, believing we've already found our best solutions is "basically giving up on human progress." For funders, innovators, and development leaders navigating a rapidly changing funding landscape, this episode offers thoughtful guidance on building a future where every dollar creates greater impact.Related Resources:DIV Fund – The independent nonprofit Sasha Gallant co-founded, continuing USAID's Development Innovation Ventures model of tiered, evidence-driven innovation grants.Project Resource Optimization (PRO) – The initiative (hosted by the Center for Global Development) that Gallant helped launch to triage and match donors to the most cost-effective USAID programs left without funding.GiveWell – The charity evaluator referenced for its rigorously vetted "best buy" list of cost-effective global health and development programs.Sign up to our newsletter⁠, and stay informed of Dimagi's workWe are on social media - follow us for the latest from Dimagi: ⁠LinkedIn⁠, ⁠Twitter⁠, ⁠Facebook⁠⁠⁠, ⁠Youtube⁠⁠⁠⁠If you enjoy this show, please leave us a 5-Star Review and share your favorite episodes with friends. Hosts: ⁠Jonathan Jackson⁠ and ⁠Amie Vaccaro

Do you have trouble sleeping? An occasional late night or early morning is probably not dangerous, but too many people get too little sleep on a regular basis. How does that affect their health? Even more importantly, what can they do to change the situation? You'll want to listen to find out if you need a sleep reset. At The People's Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, July 18, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can't listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 20, 2026. The podcast will be available on Monday (July 20, 2026) Do You Need a Sleep Reset? Why is sleep so important for good health? Our guest is a sleep medicine specialist who uses a metaphor of Disneyland. Crucial maintenance on the theme park happens at night, when there are no visitors. Streets are cleaned, flower beds are weeded, and rides are inspected and, if needed, repaired. None of that can happen while the park is open for business. Our bodies and brains also need time for maintenance and repair, and some of that happens while we are sleeping. When we don't get the rest we need, we may find ourselves at increased risk for diabetes, cardiovascular problems, cancer, cognitive challenges and even premature death. Unfortunately, anxiety about not sleeping can keep people awake all on its own. How can people break that cycle? We'll also discuss ways that people can get help avoiding screens at night. That is an important part of a sleep reset. Blue light from the screen signals the brain to be alert instead of relax. Scrolling social media can often be emotionally upsetting, which also makes it more difficult to fall asleep. Is Your Diet Keeping You Awake? Most of us recognize that a big midnight snack, á la Dagwood Bumstead of the Blondie comic, is probably not conducive to sleeping well. How does nighttime eating affect our circadian rhythm? Are there diets that we should avoid because of their impact on sleep? Dr. Seheult describes a study in which volunteers had their sleep stages monitored closely during the time they were consuming different diets (Obesity, July 2023). When they followed a high-fat, high-sugar diet, it disturbed the pattern of their brain waves during what should have been restorative sleep. How Do Sleep Problems Affect Eating Habits? A lot of us are aware that when we are sleep deprived, we are more inclined to become hangry and we may be less discerning about what we eat. A recent study shows that the sleep deprivation can have an effect even if it is fairly mild and short-term. Scientists recruited people who normally sleep seven to eight hours a night and asked them to stay up an extra hour and a half (Annals of Internal Medicine, July 7, 2026).  During the six weeks of that part of the experiment, people were less active during the day. They also ate more, so they gained about a pound, on average, during those six weeks. Presumably, disrupting sleep for a longer period of time would result in greater weight gain and metabolic disruption. Would a Ketogenic Diet Help with a Sleep Reset? A ketogenic diet, in which the body relies on ketones rather than glucose for energy production, may be helpful. In particular, fasting overnight for at least 14 hours helps the body do what it must during sleep time. To figure out when you should stop eating, identify when you usually start to feel sleepy. That should be your bedtime. Having your last meal of the day about three hours before that will generally offer enough time for digestion so that you don't experience reflux in the middle of the night. Morning Light and Afternoon Naps Your sleep reset may depend on getting your own circadian rhythm to synchronize with the rest of the world. That is where early exposure to morning light comes in. It's beginning to feel a bit like The People's Pharmacy is on repeat: get morning light exposure! It sets your system up for feeling awake and alert during the day and starting to feel sleepy as the light fades in the evening. Obviously, this is most helpful for people who work during daylight hours. Those working overnight shifts would have to organize their days differently. People who have trouble falling asleep may be tempted to take a nap in the afternoon to make up for the lost sleep. That could be a mistake, as it relieves the sleep pressure that helps people fall asleep without trying. Learning to Fall Asleep If you interact with parents of very young children, you may have heard of sleep training. People have strong feelings about this, both pro and con. Adults rarely need sleep training, though. What we are more likely to need is “not-sleeping un-training.” Too many people approach the bedroom as though it were a stage, and sleep is the performance. No wonder they may develop some performance anxiety about sleeping! Other individuals have learned to associate the bedroom with tossing, turning and watching the clock. Consequently, their bodies tense up instead of relaxing when they get between the sheets. There is no easy quick fix for this problem, but cognitive behavior therapy for insomnia has been proven effective for most people. How About PM Pain Relievers? Even though there isn't an easy fix for sleep troubles, many people want one. They reach for the PM pain reliever and hope it will offer them a good night's sleep without a prescription. The “PM” part of that pain reliever is an old-fashioned antihistamine called diphenhydramine. You might be more familiar with its brand name: Benadryl. You'll also find it in Tylenol PM, Advil PM and all the other PM meds because it tends to make people feel drowsy. What's wrong with that? To start with, it isn't clear that it remains effective after a week or two. In addition, people with restless leg syndrome often find that it makes their condition worse. Other folks report that diphenhydramine can result in an unpleasant “hangover” the next day, in which they feel drowsy though not asleep for a good part of their waking hours. What Wakes You Up at Night? If your sleep problem is waking in the wee hours and having trouble getting back to sleep, you should consider the possibility that you have sleep apnea. The REM sleep of those early morning hours is not as deep as some other sleep stages. Consequently, an alarm signal from your brain saying you haven't taken a breath for 20 or 30 seconds may be more likely to wake you. Sleep apnea may be treated by providing air so that the pressure props the collapsing airway open. We discuss this in greater detail along with a new alternative to a CPAP machine in the podcast for this week. This Week’s Guest Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for MedCram.com, a site that offers concise and easy-to-follow medical videos on a range of topics. Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside Listen to the Podcast The podcast of this program will be available Monday, July 20, 2026, after broadcast on July 18. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Become a paid channel member of YMH to get Your Mom's House episodes one day early and AD-FREE here: https://www.youtube.com/channel/UCYIgiXwJck_Pb5Nj-wIrsqg/join SPONSORS: -Ready to upgrade your home for way less? Head to https://www.wayfair.com right now to shop all things home and get your space ready for less. -Right now, when you buy two months of BlueChew Gold, you get the third for FREE with promo code YMH at https://BlueChew.com -Go to https://helixsleep.com/ymh for 27% Off Sitewide — Exclusive for listeners of Your Mom's House. -Start your free trial at https://SHOPIFY.COM/ymh On this week's episode, Main Mommy Christina P holds down the fart with stand-up comic Dave Landau. He's the perfect co-captain to match our dark and twisted-ness, starting with a shared love of David Lynch. After a brief interruption of a staff member (male) in short shorts, Dave recounts his trippy days totaling in approx. 400 hits. Kids these days will never understand. Christina introduces Dave to some Cool Guys and Gals including, but not limited to, a CPAP monster, a pirate, and a guy that looks eerily similar to Robin Williams in Toys. Wrapping up the episode with Christina's TikTok Curations, Dave and Christina take a few detours into closeted celebrities (shout out George Michael) and hidden toilet cams. Your Mom's House Ep. 868 https://tomsegura.com/tourhttps://christinap.com/https://store.ymhstudios.comhttps://www.reddit.com/r/yourmomshousepodcast Chapters 00:00:00 - Intro 00:04:16 - Short Shorts 00:09:48 - Opening Clip 00:15:42 - Trippy Dave 00:27:15 - Kids These Days are Screwed 00:34:51 - CPAP 00:42:04 - Pazsitzky Effects 00:45:29 - Closeted Celebs 00:55:31 - Christina's Curations 01:06:09 - Worst Cigs 01:14:08 - Hidden Toilet Cams 01:22:27 - Closing Song: Cool Girls Club By Versace Kolache Learn more about your ad choices. Visit megaphone.fm/adchoices

Sign up for the Complete Sleep Solution Program here (https://l.bttr.to/9LmUt) or talk to me first by scheduling a consultation (https://p.bttr.to/3VJwvDs).In this episode, I break down sleep apnea and insomnia and explains little-known health issues that could be causing both.You'll learn:How to tell whether you have sleep apnea, insomnia, or bothWhy a CPAP can work perfectly and still leave you waking up through the nightWhat sleep apnea and insomnia have in common beneath the surfaceWhy a sleep study won't catch what's really driving your sleep problemsWhat I found in one client's labs that his apnea diagnosis had never explainedHow my client went from constantly waking and struggling to fall back asleep to sleeping through the night and feeling rested during the day00:00 Apnea or Insomnia00:58 Adam's CPAP Mystery01:53 Apnea Warning Signs03:11 What Counts as Insomnia04:08 Can You Have Both04:29 Inflammation Root Causes05:08 Gut Bugs and Toxins06:20 Hormones and Next Steps07:33 Sleep Studies Limits08:33 Adam's Real Fix09:13 You're Meant to Sleep

Nick Wilson and Jonathan Peterlin bond over their shared experiences using CPAP machines and being part of a sleep apnea brotherhood. They shift focus to the ongoing LeBron James free agency rumors and how Cleveland's roster might change under new head coach Kenny Atkinson. 02:13 - Afternoon Drive Intro 03:35 - Sleep Apnea Brotherhood 08:01 - LeBron Watch Rolls On 09:00 - Soccer Tactics Talk 12:04 - Atkinson's Big Jump

What if the best Sleep Apnea ENT solution isn't surgery?In this episode of SleepTech Talk, we sit down with Madan Kandula, MD, board-certified ENT, founder and CEO of ADVENT, to explore a different approach to treating obstructive sleep apnea, snoring, breathing problems, and other ENT-related conditions.Dr. Kandula challenges the idea that seeing a surgeon must lead to surgery. Instead, the conversation focuses on understanding the whole patient, identifying the underlying causes of their breathing and sleep problems, and finding the treatment that best fits their individual needs.We discuss:• Why surgery is not always the answer• Non-invasive and minimally invasive approaches to obstructive sleep apnea and breathing problems• Why listening to the patient is essential to finding the right solution• The importance of understanding each patient's struggles, goals, and treatment preferences• Why a patient-centered approach can lead to better care and better outcomes• How putting patients first can also contribute to the long-term success of a healthcare organizationDr. Kandula also shares his perspective on building a different kind of ENT practice—one focused on simplifying the patient journey and offering multiple treatment pathways rather than approaching every problem with the same solution.This conversation goes beyond ENT and sleep apnea. It's about rethinking healthcare around the person who matters most: the patient.

Doing the right workouts, eating well, and still waking up exhausted? What if your “good” sleep score is missing the real problem?I talk with Dr. Shereen Lim, dentist, dental sleep medicine expert, and author of Breathe, Sleep, Thrive, about sleep-disordered breathing, airway health, and why women over 40 are so often missed.You'll learn why snoring, teeth grinding, mouth breathing, nocturia, and unrefreshed sleep can point to airway issues even when you're lean, fit, and doing “everything right.” We cover sleep apnea, upper airway resistance, CPAP, dental devices, palate expansion, mouth taping, and why nasal breathing matters for hormone health, metabolism, longevity, and evidence-based fitness.Join Eat More Lift Heavy to build strength, lose fat, and learn what works for your body, 1 week at a time. Learn to eat more and lift heavy with confidence.Timestamps:0:00 – Why sleep still feels broken2:27 – Sleep disordered breathing explained4:52 – Jaw structure and airway collapse7:43 – Midlife changes and women's risk9:36 – Sleep trackers versus real testing11:40 – Grinding, nocturia, and red flags15:19 – When mouth guards make breathing worse16:35 – CPAP and dental device tradeoffs21:46 – Mouth taping and tongue postureEpisode resources:Dr. Lim's book – Breathe, Sleep, ThriveWebsite: drshereenlim.com.auFacebook: @drshereenlimInstagram: @dr.shereenlim 

In episode 309 of Beyond The Story, Sebastian Rusk interviews Dr. Michael J. Breus, a sleep expert, as he shares his game-changing five-step plan for mastering sleep, optimizing your wellbeing, and leading high-performing teams. Tune in now to transform your sleep, empower your leadership, and achieve new milestones by applying proven strategies.TIMESTAMPS[00:00:00] Meet Dr. Michael J. Breus: The Sleep Doctor's Journey[00:05:38] Why Sleep Is the Currency of Effective Leadership[00:08:09] The Five-Step Action Plan for Game-Changing Sleep[00:15:00] High Performance & Handling Anticipatory Anxiety[00:16:30] The Power of the “Napa Latte” for Peak Energy[00:20:46] Sleep Disruptors: Alcohol, Movement, and Real Solutions[00:22:00] The Truth About Mouth Tape & Sleep Apnea Risks[00:24:53] Modern Solutions for Sleep Testing & Results[00:31:33] Optimizing Your Sleep Environment—and Your Team[00:43:39] Magnesium: The Real Supplement Advantage[00:47:21] Sleep, Cannabis, and the Science of Restoration[00:51:30] Practical Takeaways and Final Inspiration QUOTES"Literally everything you do, you do better with a good night's sleep." – Dr. Michael J. Breus"The currency of life is time... and sleep is the currency of attention." – Dr. Michael J. Breus"You get to practice sleep every night. You'll get better, you'll get better, you'll get better. Sleep is flexible." – Dr. Michael J. Breus  ==========================Need help launching your podcast?Schedule a Free Podcast Strategy Call TODAY!PodcastLaunchLabNow.com==========================SOCIAL MEDIA LINKSInstagram: https://www.instagram.com/podcastlaunchlab/Facebook: Facebook.com/sruskLinkedIn: LinkedIn.com/in/sebastianrusk/YouTube: Youtube.com/@PodcastLaunchLab==========================Take the FREE Sleep Quiz:sleepdoctor.com/pages/sleep-quiz Follow The Sleep Doctor:instagram.com/thesleepdoctor Purchasing a CPAP machine? Get the FREE CPAP Success Course with your machine purchase:sleepdoctor.com ==========================Take the quiz now! https://podcastquiz.online/==========================Need Money For Your Business? Our Friends at Closer Capital can help! Click here for more info: PodcastsSUCK.com/money==========================PAYING RENT? Earn airline miles when you use the Bilt Rewards MastercardAPPLY HERE: https://bilt.page/r/2H93-5474 

Join Elevated GP: https://www.theelevatedgp.com/sales-page In this highly practical episode of Dental Digest, host Dr. Melissa Seibert sits down with Dr. Jeff Rouse to dive deep into the clinical realities of airway dentistry . Moving past high-level philosophies, Dr. Rouse explains how to identify specific airway patient phenotypes, the hidden biological costs of traditional sleep appliances, and the structural treatment adjuncts changing dentistry in 2026 .

(00:00-27:23) When did Doug first join Augusta National? Doug still wants to go with Libby and the Cardinals getting the W down in Atlanta. Shams texting while answering questions. Both Nick AND The Badger will join us (separately). Bring the kids to work. The Evil David Letterman era. Wednesday Homer Roll. TMA Reunion. Going from a 6 to a 9. Ryan Fernandez....yikes.(27:31-45:22) Is Akoostic Session opening for Billy Joel or vice versa? Clinton on hold and wants to talk Lebron and the Lakers. Lose It or Clues It. He thinks he was calling Unsportsmanlike. Could you hear his CPAP machine in the background? Audio of Cade Cavalli talking about the dust up with Wilson Contreras. Audio of Wilson Contreras giving his perspective.(45:32-1:07:52) Producer Joe joins the show to get you ready for USA vs. Bosnia. Joe's gonna be watching at home and gives his prediction for the match. What the new coach has done for the team. Pretty long shot to go all the way. The infamous remote out at Rams Park with the t-shirts. Short sleeves and organizational differences. No interest in popping into ATMA.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

When did Doug first join Augusta National? Doug still wants to go with Libby and the Cardinals getting the W down in Atlanta. Shams texting while answering questions. Both Nick AND The Badger will join us (separately). Bring the kids to work. The Evil David Letterman era. Wednesday Homer Roll. TMA Reunion. Going from a 6 to a 9. Ryan Fernandez....yikes.Is Akoostic Session opening for Billy Joel or vice versa? Clinton on hold and wants to talk Lebron and the Lakers. Lose It or Clues It. He thinks he was calling Unsportsmanlike. Could you hear his CPAP machine in the background? Audio of Cade Cavalli talking about the dust up with Wilson Contreras. Audio of Wilson Contreras giving his perspective.Producer Joe joins the show to get you ready for USA vs. Bosnia. Joe's gonna be watching at home and gives his prediction for the match. What the new coach has done for the team. Pretty long shot to go all the way. The infamous remote out at Rams Park with the t-shirts. Short sleeves and organizational differences. No interest in popping into ATMA.Presidential eating habits. Is Jackson anti-Jefferson? Dave Portnoy's new book. Happy Bobby Bonilla Day. The phone lines are all lit up. Let's start with The Last My Space User. Chairman made the wrong call. Next up is Arman The Bosnian who wants to give the Bosnian perspective ahead of the match tonight.Puck Talk with Jeremy Rutherford. What's so great about Sweden? JR's takeaways from Steen and Armstrong's presser yesterday. Taking some questions from the text inbox and YouTube chat. JR didn't bring his kid into the studio today. Is Robert Thomas re-energized? Defensive pairings going into the season. Binnington and Hofer. And all of a sudden its a day care in here.Hey look, it's Charlie Marlow. Star of Nick & The Badger. NASCAR and soccer. Charlie's kids getting into sports. What's Jeff Fisher up to? Ohio State is the one team Charlie still cares about. Charlie's unrivaled work ethic in covering high school sports. The untimely passing of Kyle Busch. Martin looked a bloated old astronaut in his fire suit at the race track.RIP Aviici. Bunch of failed midday shows. Charlie remembers the day his favorite DJ passed away. EDC. A quick look around the National League. Charlie's buddy is the assistant hitting coach for the Guardians. Teaching Charlie about So What'd Your Grandma Think.Charlie frequented Double D's for karaoke. Ryan Day and Ohio State. Producers and news directors love live shots.Design Aire Heating & Cooling EMOTDThe good ol' Spags days. Martin stayed just for Charlie. Charlie explains YouTube to Doug. Editing like The Dickens. He is NOT a slum lord.Young Charles is really focused in on this tablet over here. People want Charlie in more often.And the winner of the Design Aire Heating & Cooling EMOTD is...See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

A few things on the agenda today. First, RFK Jr. and the MAHA crew want medical schools to dedicate around 40 hours, roughly 20% of preclinical training, to nutrition education. I have some thoughts. We already have dietitians, med school is already a fire hydrant, and the Krebs cycle had it coming, but this isn't the way. Then a Mark Cuban appreciation segment, because he's out there on X dragging the entire healthcare system toward transparency. His latest pitch: someone buy a hospital, charge Medicare rates for every single thing, expose every dollar in and out, and prove whether Medicare for All can actually work. In theory, I'm in. In practice, you can't slash physician pay without first addressing the $500,000 in debt that gets people into the door. The Australian model, a real public safety net coexisting with a private system, makes more sense to me, but only if we fix the training pipeline first. After the break, ophthalmology. A young man got a bamboo shoot to the eye six months ago. Healed up fine. Now he's waking up at 2 AM in excruciating pain, no trauma involved. That's a recurrent corneal erosion. I walk through why it happens, why CPAP can make it worse, and the whole treatment ladder, ointment, bandage contact lenses, superficial keratectomy, corneal micropuncture. Also: don't let your cornea melt. That's the headline. Takeaways: RFK Jr. and MAHA are pushing medical schools to dedicate around 40 hours, or 20%, of preclinical training to nutrition, a shift that ignores the existence of dietitians and would crowd out essential physiology and disease education Mark Cuban has floated a real-world test case for Medicare for All: buy a hospital, charge only Medicare rates, and operate with complete financial transparency to show whether the model is sustainable Any serious move toward Medicare for All or an Australian-style public-private hybrid will require addressing the roughly $500K in training debt physicians carry; otherwise the math doesn't work and recruitment collapses Recurrent corneal erosion happens when an old abrasion never fully reattaches to the underlying stroma, patients typically wake up in severe pain because the eyelid scrapes loose epithelium across a dry cornea overnight, and CPAP without a good seal makes it worse Treatment escalates from aggressive nighttime lubrication (erythromycin ointment, Genteal gel) to a bandage contact lens, and in stubborn cases to a superficial keratectomy or corneal micropuncture to create a smoother, more firmly attached corneal surface To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://glaucomflecken.com/glauc-to-me/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices