Talking Sleep

Medications To Manage Central Disorders Of Hypersomnolence

In the last few years, more medications have been available to treat central disorders of hypersomnolence. While treatments for narcolepsy and idiopathic hypersomnia are similar, there are some specific considerations when trying to determine which combination of medications is most appropriate for a patient. Significant payor coverage and formulary variability add another layer to this conversation. Some are considered off-label and others are on-label but may be cost-prohibitive. Dr. Hrayr Attarian explains some of the nuances of these newer medications, how they perform for specific symptoms, and how to consider tailoring medication regimens with shared decision-making.

Legal Issues in a Sleep Medicine Practice

Drowsy driving accidents are just one of the many ways in which health care can interface with the legal system. Our guest for this episode is Dr. Ramesh Sachdeva, a sleep medicine and pediatric critical care physician who decided to go to law school several years ago and has previously served as an adjunct professor of law. He has a unique interest in the intersection of medicine, healthcare quality, and law and is here today to help us explore potential legal issues that can arise in a sleep medicine practice. 

 

Please note that this is not legal advice. This discussion is for educational purposes only and should not be relied upon as legal advice or legal opinion. 

Medications to Treat Obstructive Sleep Apnea

We have long known that CPAP therapy isn’t meant for everyone who has obstructive sleep apnea. There are plenty of non-PAP treatment options, including oral appliance therapy and hypoglossal nerve stimulation. Pharmacotherapy has been used as an adjunct therapy to treat persistent hypersomnolence despite well-treated OSA or to assist with PAP acclimatization. Now medications are being developed to treat OSA and its underlying obstruction. Here to help us understand more about these medications is Dr. Sanjay Patel.

Management of Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome can be challenging to manage. Obtaining the appropriate device for each patient is often complicated by insurance requirements and endless red tape. Previous guidelines have indicated that CPAP may be as effective as bi-level PAP; however, this doesn’t apply to all patients. How can we identify patients who may require more advanced treatment modalities while also ensuring that those treatments do not cause undue financial burden for them? Here to help us understand this better is Dr. Babak Mokhlesi.