Talking Sleep

The recent FDA approval of oveporexton represents a major milestone in the treatment of narcolepsy type 1 and the culmination of decades of research into orexin and its critical role in regulating sleep and wakefulness. In this episode of Talking Sleep, host Dr. Seema Khosla is joined by Dr. Emmanuel Mignot, a longtime leader in narcolepsy research and co-recipient of the 2026 Lasker Award for research that helped uncover the role of orexin in narcolepsy. 

Unlike existing therapies that primarily target the symptoms of narcolepsy, oveporexton is an orexin receptor 2 agonist designed to address the underlying loss of orexin signaling associated with narcolepsy type 1. Dr. Mignot shares his perspective on the science behind this new treatment approach and what the approval could mean for patients and clinicians. Topics include findings from clinical trials, the potential impact on excessive daytime sleepiness and cataplexy, dosing and safety considerations, and how an orexin-targeted therapy may fit into the evolving treatment landscape. 

The episode also provides perspective on the scientific journey that made this advance possible. Research into the orexin system has transformed the understanding of narcolepsy and opened new possibilities for therapies that more directly address its underlying biology. The discussion considers the significance of translating those discoveries into a treatment for patients, as well as some of the questions clinicians may encounter as oveporexton enters clinical practice. 

Looking beyond this approval, orexin agonists may have implications that extend beyond narcolepsy. Dr. Mignot offers insight into the continued evolution of orexin research and the potential for this growing area of sleep medicine to shape the future understanding and treatment of sleep and other medical disorders. 

For sleep clinicians, this episode offers both a closer look at a new treatment option for narcolepsy type 1 and a broader perspective on how decades of scientific discovery can translate into meaningful advances in patient care.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes members of the American Academy of Sleep Medicine advocacy team for an inside look at the work being done behind the scenes to support sleep clinicians and advance patient access to care. Joined by Diedra Gray, Tracy Bunge, Eric Albrecht, and Melissa Clark, the conversation explores how physician reimbursement decisions are made and how sleep medicine professionals can help shape the future of the field.

Many sleep clinicians have experienced the frustration of declining reimbursement, changing payment policies, and increasing administrative burdens. While it can feel as though these decisions are beyond the influence of individual physicians, this episode highlights the many ways clinicians can contribute their expertise and advocate for sustainable sleep medicine practice.

The discussion examines the complex process behind physician payment, including the roles of CPT coding, the AMA Relative Value Scale Update Committee (RUC), Medicare payment rules, and private payer policies. Listeners will gain insight into how reimbursement values are determined, how proposed policy changes are evaluated, and why physician participation in surveys and feedback opportunities is essential to the process.

The episode also tackles key issues facing physicians today, including budget neutrality, inflationary pressures on physician practices, and recent reimbursement reductions that affect sleep medicine and other specialties. The guests explain how the AASM works to advocate for fair compensation while ensuring patients continue to have access to high-quality sleep care.

Beyond payment policy, the conversation explores legislative advocacy and the role sleep clinicians can play in shaping public policy. From contacting elected officials and participating in advocacy campaigns to supporting legislation that promotes sleep health, listeners will learn how individual voices can contribute to meaningful change. Topics include physician payment reform, sleep health legislation, delayed school start times, permanent standard time, and other policy initiatives important to the sleep medicine community.

Whether you're curious about how reimbursement decisions are made, interested in becoming more involved in advocacy efforts, or looking to better understand the forces shaping sleep medicine practice, this episode offers valuable insight into the people and processes working on behalf of sleep clinicians and their patients.

Join us for this informative conversation about reimbursement, advocacy, and how your voice can help shape the future of sleep medicine.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Binal Kancherla, Associate Professor of Pediatrics and Medical Director for the Sleep Program at Texas Children's Hospital, to discuss how sleep medicine practitioners can thoughtfully expand their practice to include pediatric patients.

Many adult sleep medicine clinicians have considered adding pediatrics to their practice but weren't sure where to start. Dr. Kancherla has created a comprehensive educational series addressing exactly this question—providing the clinical knowledge and practical framework needed to confidently treat children and adolescents with sleep disorders.

The landscape of pediatric sleep medicine has evolved significantly. Diagnostic approaches now include home sleep testing for appropriately selected adolescents, wearable technology, and refined polysomnography protocols specific to developmental stages. Sleep-disordered breathing in children presents differently than in adults, with updated assessment and treatment strategies. Meanwhile, insomnia and behavioral sleep issues in younger children are now understood through a more sophisticated lens that goes beyond simple behavioral management.

Pharmacotherapy in pediatrics raises important questions that clinicians treating adults may never encounter: How do you approach melatonin and magnesium supplementation that parents frequently use? What FDA-approved hypnotics exist for children, and when are they appropriate? These practical decisions require understanding pediatric-specific evidence and developmental considerations.

Pediatric sleep medicine encompasses conditions rarely seen in adult practice—parasomnias, circadian rhythm disorders in adolescents, restless leg syndrome in children, and pediatric narcolepsy. Recent advances in narcolepsy treatment create new clinical opportunities, though current approvals remain limited to adults, raising questions about future options for children.

Beyond disease-specific knowledge, Dr. Kancherla emphasizes building a pediatric sleep-informed practice—understanding workflow differences, family-centered communication, developmental considerations, and how to effectively partner with pediatric specialists and families.

Whether you're considering expanding into pediatrics, curious about how pediatric sleep medicine differs from adult practice, or seeking to deepen your understanding of conditions you may encounter, this episode provides clinical guidance and inspiration for professional growth.

Join us for this practical conversation about expanding your sleep medicine practice to serve the youngest patients.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Carrie Mahoney, a neuroscientist and faculty member in the Department of Neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, to discuss her groundbreaking research on how oxytocin may regulate social cataplexy in narcolepsy.

With FDA approval of new narcolepsy medications, understanding the neural mechanisms underlying cataplexy has never been more clinically relevant. Dr. Mahoney's research began with a simple but profound clinical observation: cataplexy attacks occurred reliably when patients laughed with close friends and family members, but rarely when joking with coworkers or strangers. This pattern of emotion-triggered muscle weakness in social contexts prompted investigation into whether oxytocin—the hormone associated with bonding and social connection—might play a role.

Dr. Mahoney explains social cataplexy and discusses whether most cataplexy episodes occur in social contexts. She traces how she came to hypothesize oxytocin's involvement, moving from clinical observation to basic science investigation. The research explores how the amygdala—typically associated with fear—also processes other emotional responses including the joy and bonding feelings that characterize close relationships.

The episode walks through her research methodology. Using orexin knock-out mice (which model narcolepsy), Dr. Mahoney observed increased cataplexy during social interactions. She then systematically investigated oxytocin signaling in the amygdala to understand the mechanism. She employed advanced neuroscience techniques including chemogenetics and optogenetics—tools that allow precise manipulation and observation of specific neural circuits. The conversation clarifies what these approaches reveal about oxytocin's role in triggering muscle atonia during emotional social situations.

A crucial ethical question emerges: If oxytocin facilitates social bonding but also triggers cataplexy, would blocking oxytocin eliminate this important neurochemical? Dr. Mahoney addresses whether targeted intervention might be possible without sacrificing the neurochemical foundation of human connection and social behavior.

The research faced significant setbacks during COVID-19, affecting experimental timelines and animal studies. Dr. Mahoney discusses how she navigated these disruptions and the collaborative nature of validating complex neuroscience findings. She co-published this work with John Peever, highlighting how competitive yet collaborative the field must be to advance understanding.

An intriguing comparison emerges: Just as AI models solving previously unsolved math problems require human validation, complex neuroscience discoveries need replication and independent confirmation. Dr. Mahoney explains how her research will be validated and what the competitive landscape looks like in basic sleep neuroscience.

The ultimate goal is translation to clinical benefit. Would oxytocin-targeted therapy be preventive medication taken before social events, or a daily medication to modulate cataplexy susceptibility? Dr. Mahoney discusses how she communicates detailed scientific findings to patients and clinicians in understandable language, acknowledging the collaboration with science communicators like Kara Weaver.

Her research extends beyond cataplexy—orexin knock-out mice are also being used to investigate menopause-related sleep changes, suggesting broader applications of her findings.

Whether you're interested in narcolepsy pathophysiology, basic neuroscience approaches to understanding sleep disorders, or how fundamental research translates to clinical treatments, this episode illuminates the meticulous work underlying next-generation narcolepsy therapies.

Join us for this fascinating discussion about how curiosity-driven neuroscience research may transform how we treat cataplexy and understand the biology of narcolepsy.