Talking Sleep

Central Sleep Apnea: Expert Insights & Treatment Priorities

In this episode, Dr. Seema Khosla examines the complexities of central sleep apnea 
(CSA) with sleep medicine experts Dr. Vaishnavi Kundel, Dr. Rami N. Khayat, and Dr. Aneesa Das. The discussion moves beyond basic definitions to explore the critical limitations of home sleep apnea testing in accurately detecting CSA and when in-lab polysomnography becomes essential.  The conversation addresses important clinical distinctions between post-arousal, transitional, and mixed apneas, challenging common assumptions about their significance and treatment approaches. The panel provides clarity on various CSA etiologies, including heart failure-related periodic breathing, medication-induced central apneas, treatment-emergent CSA, and neurological disorders.  Discover evidence-based perspectives on treatment strategies, including updated views on adaptive servo-ventilation since the SERVE-HF trial, indications for phrenic nerve stimulation, and the potential of combination therapies. Learn when to consider alternative approaches like dead-space ventilation, supplemental oxygen, and acetazolamide, either alone or as part of hybrid treatment plans.  The discussion also examines practical clinical questions: Does distinguishing between obstructive and central apnea matter if treatment approaches overlap? When should patients with suspected CSA undergo in-lab studies versus home testing? What guidance should clinicians follow for patients with ejection fractions below 45%? Whether you're managing complex sleep disorders or encountering CSA in primary care, this episode provides essential insights for optimizing patient outcomes through accurate diagnosis and appropriate treatment selection. 

Real World Strategies for Clinician Burnout

In this episode, Dr. Seema Khosla explores the critical issue of clinician burnout with Dr. Venktesh Ramnath, Associate Clinical Professor at UC San Diego. Moving beyond typical wellness advice, Dr. Ramnath offers practical strategies for addressing burnout at its systemic roots rather than treating it as an individual failure. 

The conversation examines how to recognize true burnout versus temporary fatigue and challenges the common rhetoric about "resilience" that shifts responsibility from broken systems to individuals. Dr. Ramnath shares his personal burnout experience and discusses whether dramatic career changes are necessary before making meaningful improvements to professional satisfaction. 

Discover actionable steps for reducing burnout, including negotiating with leadership, establishing horizontal professional networks, and eliminating low-value work. Learn how coding efficiency relates to burnout and understand the emerging role of "health architects" in creating sustainable medical workplaces. 

The discussion also addresses Dr. Ramnath's public response to demands for federal employee productivity reporting, techniques for constructive workplace conversations, and practical advice for saying "no" effectively—a crucial skill rarely taught in medical training. Whether considering a job change or trying to improve a current position, this episode provides essential guidance for creating a more sustainable medical career. 

Decoding Women's Sleep Health Across the Lifespan

In this episode, Dr. Seema Khosla talks with women's sleep expert Dr. Safia Khan about women's unique sleep challenges. Dr. Khan is an editor for "A Clinical Casebook of Sleep Disorders in Women" and specializes in women's sleep health at UT Southwestern. She explains how sleep disorders affect women differently across their lives, particularly during pregnancy and menopause, and how these transitions disrupt normal sleep patterns. 

Discover Dr. Khan's assessment strategies for insomnia in women, including decision-making frameworks for implementing CBT-I versus medication interventions. Learn about the underdiagnosis of sleep disorders in women, particularly during menopause, and strategies for changing this normalized narrative. The conversation explores the physiological differences in sleep-disordered breathing between men and women, explaining why sleep apnea incidence equalizes during menopause. 

The discussion addresses managing hypersomnia during pregnancy, approaches to fatigue without diagnosed sleep disorders, connections between PCOS and sleep disruption, and guidance on Restless Legs Syndrome management, including the critical role of iron deficiency screening in adolescent girls. 

This episode provides essential knowledge for practitioners seeking to better understand and treat the unique sleep health challenges women face across their lifespans. 

Tirzepatide & OSA: Implementation for Sleep Clinics

In this episode, host Dr. Seema Khosla explores a transformative development in sleep medicine: the FDA approval of tirzepatide for obstructive sleep apnea (OSA). Joined by an expert panel including Dr. Atul Malhotra, lead investigator of the SURMOUNT-OSA trial, and specialists Dr. Radhika Breaden, Dr. Jeremy McConnell, and Dr. Rafael Sepulveda-Acosta, the discussion examines how sleep clinicians can effectively incorporate this groundbreaking medication into their treatment protocols. 

Discover key insights about the SURMOUNT-OSA trial results published in the New England Journal of Medicine, including the mechanisms behind AHI improvement beyond weight reduction alone. Learn practical implementation strategies for private practices, including documentation requirements for insurance approval, necessary baseline labs, and optimal patient follow-up protocols. The experts address crucial questions about Medicare coverage, long-term medication management, the need for retesting at goal weight, and considerations for transitioning patients already using GLP-1 medications like Ozempic or Wegovy. 

This episode provides essential guidance for sleep medicine specialists considering expanding their treatment options beyond traditional PAP therapy, including collaborations with obesity medicine clinics and whether obtaining board certification in Obesity Medicine would benefit sleep clinicians. This timely discussion equips practitioners with the knowledge to navigate the intersection of sleep medicine and obesity treatment in managing OSA patients