Talking Sleep

OSA and PLMD

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment.

Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment.

The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes.

Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption.

Whether you're treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms.

Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice. 

Predicting RBD Phenoconversion via Autonomic Reflex Testing

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Luca Baldelli, a neurologist from the University of Bologna and Treasurer-Elect of the International REM Sleep Behavior Disorder Study Group, to discuss breakthrough research on predicting which RBD patients will develop neurodegenerative diseases.

Building on the AASM's updated RBD guidelines, Dr. Baldelli presents compelling evidence for using simple autonomic reflex testing to identify patients at highest risk for phenoconversion to conditions like Parkinson's disease and dementia with Lewy bodies. His research demonstrates that objective autonomic testing, particularly orthostatic assessments, can reveal early neurogenic orthostatic hypotension that precedes overt neurodegeneration by years.

The conversation explores practical clinical applications: How can sleep medicine practitioners implement these screening protocols? What constitutes abnormal autonomic function in RBD patients? How do we interpret changes over time, and when should patients be referred for neurological evaluation? Dr. Baldelli shares his longitudinal monitoring framework that could transform how we counsel RBD patients about their future risk.

This episode addresses critical questions about biomarker development in prodromal neurodegeneration, the timeline of autonomic changes, and evidence-based approaches to patient discussions about prognosis. Dr. Baldelli also discusses current research initiatives and potential therapeutic interventions for high-risk patients.

Whether you're a sleep medicine physician, neurologist, or researcher interested in neurodegenerative diseases, this episode provides essential insights into improving early detection and patient care in RBD.

Join us for this informative discussion that bridges sleep medicine and neurology to enhance clinical decision-making and patient outcomes.

Zolpidem and the Glymphatic System

In this episode of Talking Sleep, host Dr. Seema Khosla sits down with Dr. Natalie Hauglund to discuss a groundbreaking mouse study on how the popular sleep medication zolpidem affects the brain’s natural cleaning system during sleep.

Building on Dr. Maiken Nedergard's award-winning work on the glymphatic system, Dr. Hauglund's latest study published in Nature reveals surprising findings about how sleep medications may interfere with the brain's ability to clear waste products. Through innovative mouse studies using advanced imaging techniques, her research demonstrates that zolpidem reduces glymphatic clearance by 30%, raising important questions about long-term cognitive health. 

The conversation explores fascinating discoveries about micro arousals during sleep—are these brief awakenings actually beneficial for brain clearance rather than disruptive? Dr. Hauglund explains the delicate balance between sleep quality and the brain's cleaning mechanisms, and how different neurotransmitters orchestrate these crucial overnight processes. 

This episode addresses critical clinical questions: Should we reconsider our prescribing practices for sleep medications? How do we weigh the benefits of medicated sleep against potential impacts on brain health? What are the implications for patients using zolpidem long-term, particularly regarding neurodegenerative disease risk? 

Whether you're a sleep medicine practitioner, researcher, or interested in understanding how sleep affects brain health, this episode provides essential insights into the complex relationship between sleep medications and neurological well-being. 

Join us for this thought-provoking discussion that may reshape how we think about treating insomnia and protecting long-term brain health. 

Teledentistry

In this episode of Talking Sleep, Drs. Michelle Cantwell and Aaron Glick discuss the updated American Academy of Dental Sleep Medicine (AADSM) Standards for Practice.

Dr. Michelle Cantwell received her DMD through the University of Pittsburgh's School of Dental Medicine, where she also completed a three-year residency in prosthodontics. Following dental school, she served as a lieutenant commander in the US Navy. She is a diplomate of the ABDSM and the president-elect of the AADSM. She works in the pulmonary and sleep medicine department of WellSpan Health.

Aaron Glick, DDS, FAGD, FICOI, D.ABDSM, is a dentist who has committed his practice to dental sleep medicine. He has been recognized as a “Top 10 Dentist to Watch” and works clinically utilizing teledentistry for efficient patient care. Dr. Glick educates fellow practitioners as the Mastery Program Director at the American Academy of Dental Sleep Medicine, focusing on mandibular advancement devices. Additionally, he is on the faculty at the University of Texas Health Science Center at Houston School of Dentistry. He actively lectures nationally and publishes on obstructive sleep apnea and technology. He enjoys all technologies and has a medical device and software programming background