In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Safwan Badr, the newly appointed editor of the Journal of Clinical Sleep Medicine and sleep medicine physician at Wayne State University, for an in-depth review of the most impactful articles published in JCSM during 2025.

Dr. Badr discusses his vision for the journal and the editorial selection process, then guides listeners through key research findings shaping clinical practice. The conversation highlights both highly popular papers and important studies that deserve more attention from practicing clinicians. 

A significant focus is placed on research confirming that traditional 4% hypopnea criteria and CMS definitions systematically underestimate sleep apnea in women, with expanded diagnostic criteria helping mitigate these gender disparities. The episode explores groundbreaking research on sleep architecture and Alzheimer's disease, examining how lower slow wave sleep and REM sleep correlate with brain atrophy in AD-vulnerable regions, particularly the inferior parietal lobe. 

Consumer sleep technology receives critical examination through a meta-analysis comparing wrist-worn devices to polysomnography, revealing significant limitations in accuracy. Dr. Badr discusses implications for physicians and consumers who increasingly rely on these devices. Mental health intersects with sleep medicine through research showing that nightmares and insomnia in the acute aftermath of trauma predict suicidal ideation—nearly half of acute trauma patients with both conditions experience suicidal ideation within two months, highlighting urgent need for early interventions. 

Additional topics include Canadian research on CBT-I effectiveness during pregnancy and findings from the TODAY study examining obstructive sleep apnea's relationship with glycemic control and cardiovascular risk in young adults with youth-onset type 2 diabetes.

Whether you're looking to stay current with evidence-based practice changes, interested in emerging research on sleep and neurodegeneration, or seeking to understand gender disparities in sleep medicine, this year-in-review provides essential updates. 

In this special live episode recorded at Sleep Medicine Disruptors in Austin, Texas, host Dr. Seema Khosla sits down with two standout innovators whose technologies captured the spirit of disruptive innovation in sleep medicine. Dr. Jason McKeown from Neurovalens and Dr. Onur Kilic from Bairitone Health present groundbreaking approaches to treating insomnia and personalizing obstructive sleep apnea therapy.

Dr. McKeown, a neurologist, introduces his FDA-cleared non-pharmacological treatment for insomnia using vestibular nerve stimulation. He explains how the technology works, why stimulating nerves in this manner is safe, and how it differs from vagus nerve devices. The conversation explores the relationship with cognitive behavioral therapy for insomnia (CBT-I), addresses the placebo effect question, and clarifies whether this is a long-term solution or temporary intervention. Dr. McKeown discusses contraindications including pregnancy and Inspire therapy, potential side effects, and ideal patient populations.

Dr. Kilic presents his sensor technology that enables non-invasive assessment of airway collapse location and severity—what he calls an "anatomic PSG." This innovation addresses a critical challenge: predicting which patients will respond to specific treatments like oral appliances, Inspire, or PAP therapy based on individual anatomical collapse patterns. Using a cheek-mounted sensor, the device identifies obstruction levels, differentiates between primary and secondary collapse sites, and detects collapse at the velopharyngeal level.

The discussion explores whether this represents a scalable alternative to drug-induced sleep endoscopy (DISE), how it integrates with OSA endotyping, and practical applications during titration studies to identify optimal pressure ranges and guide combination therapies. Both innovators emphasize moving beyond one-size-fits-all approaches toward personalized, anatomy-based treatment selection.

Whether you're interested in non-pharmacological insomnia treatments, precision medicine approaches to OSA, or the future of sleep diagnostics, this episode showcases innovative thinking driving the next generation of sleep medicine.

Join us for this exciting live conversation from Sleep Medicine Disruptors.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Dave Singh, a former Adjunct Professor in Sleep Medicine at Stanford University, with a PhD in craniofacial cleft palate development, and a third PhD in orthodontics, to explore the evolving field of craniofacial sleep medicine. As founder of REMA Sleep based in North Carolina, Dr. Singh introduces the concept of craniofacial sleep medicine—an etiology-based approach to treating obstructive sleep apnea guided by anthropomorphic features rather than solely AHI severity metrics.

Craniofacial sleep medicine represents a paradigm shift from license-based treatment allocation to collaborative, anatomy-driven care where dentists, surgeons, and sleep physicians work together to determine the most appropriate interventions based on individual structural characteristics. Dr. Singh explains why understanding craniofacial structures is crucial for personalizing OSA treatment, including why Asian populations show high OSA prevalence despite lower obesity rates.

The conversation provides a comprehensive crash course in assessing craniofacial anatomy: What is retrognathia and what causes it? How can clinicians alter jaw position by adjusting cranial base morphology? Dr. Singh explains the classification system for dental occlusion (Class I, II, and III bites), midface assessment techniques, and the palate evaluation method Dr. Guilleminault taught fellows. He discusses critical anatomical considerations including tongue positioning at rest and during sleep, lateral pharyngeal wall collapse, and cervical vertebrae influence on airway patency.

The episode explores both preventive approaches in children and interventions for adults, addressing whether craniofacial modifications require surgery or can be achieved through other means. Dr. Singh discusses palatal expansion, tongue traction techniques, and the physiological components that remain addressable even after skeletal maturity. He also explains age-related changes including loss of muscle tone, bone volume reduction, and maxillary drift that progressively narrow the airway.

Intriguing topics include the mechanisms behind why didgeridoo playing and conch shell blowing improve sleep apnea, the role of oromyofunctional therapy as a viable treatment option, evolutionary changes in human dentition that impact airway anatomy, and even the dental stem cell implications for regenerative approaches. Dr. Singh also clarifies surprising facts, such as why mouthguards in contact sports serve purposes beyond tooth protection.

Whether you're seeking to understand anatomical contributors to OSA beyond obesity, interested in multidisciplinary treatment approaches, or curious about how craniofacial structure influences treatment selection, this episode provides essential insights into personalized, anatomy-based sleep apnea management.

Join us for this fascinating exploration of how form determines function in the upper airway and how understanding craniofacial anatomy can revolutionize OSA treatment strategies. 

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes members of the AASM Artificial Intelligence in Sleep Medicine Committee—Dr. Margarita Oks, Dr. Subaila Zia, Dr. Ramesh Sachdeva, and Matt Anastasi—to discuss their recently published position statement on the responsible use of AI in sleep medicine practices.

Artificial intelligence is rapidly transforming healthcare, from AI-assisted sleep study scoring to clinical documentation tools and insurance claim processing. Yet AI is not a monolith—the technology encompasses various types with different capabilities, risks, and regulatory considerations. Matt Anastasi breaks down the different forms of AI clinicians encounter in practice, while the panel explains what "responsible use" actually means in practical terms.

The updated position statement, notably shorter and more accessible than previous versions, addresses four major pillars: data privacy, fairness and transparency, infrastructure requirements, and medical-legal considerations. The discussion explores critical questions facing sleep medicine practitioners: How do we understand and trust the AI systems we use? What happens when insurance payors deploy AI to deny claims—should we fight AI-generated denials with AI-generated appeals? Do patients need to be informed when AI is used in their care, and how specific must those disclosures be?

The conversation delves into liability concerns that keep practitioners awake at night: If your employer implements AI and it makes an error, who bears responsibility? What about ignoring AI prompts—does that create liability? Dr. Sachdeva explains the concept of vicarious responsibility and how it applies to AI implementation.

Practical implementation guidance is provided through discussion of governance checklists, equity considerations in AI deployment, and the limitations of FDA clearance for AI-assisted sleep study scoring. The experts introduce AASM Link and discuss how practitioners can evaluate AI tools beyond marketing claims, ensuring systems are trained on diverse, representative data sets.

The episode tackles a fundamental question: Is AI use inevitable in sleep medicine, or can practitioners opt out? The panel offers realistic perspectives on integrating AI responsibly while maintaining clinical judgment and patient-centered care.

Whether you're already using AI tools, considering implementation, or resistant to adoption, this episode provides essential guidance on navigating the AI transformation in sleep medicine while upholding professional and ethical standards.

Join us for this timely discussion about balancing innovation with responsibility in the AI era of sleep medicine.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Doug Kirsch, Medical Director of Atrium Health Sleep Medicine and Clinical Professor in the Department of Neurology at Wake Forest School of Medicine, and Dr. Fariha Abbasi-Feinberg, president-elect of the AASM and private practice physician with Millennium Physician Group in Fort Myers, Florida, to introduce PLATO—a groundbreaking longitudinal assessment tool for obstructive sleep apnea.

The Epworth Sleepiness Scale has been a cornerstone of sleep medicine practice for decades, yet clinicians universally acknowledge its limitations in capturing the full patient experience. Similarly, PAP adherence—while important and part of Medicare's MIPS program—tells only part of the story about treatment success. During his AASM presidency, Dr. Kirsch recognized the need for a more comprehensive metric and convened an expert advisory panel to develop a better solution.

The conversation traces PLATO's development journey, which Dr. Rosen described as "Doug's baby with a prolonged gestation." Starting with 44 potential questions and utilizing the ICON methodology, the panel carefully refined the tool to capture domains beyond simple sleepiness—including quality of life, functional impairment, and symptom burden that the Epworth overlooks. Dr. Kirsch and Dr. Abbasi-Feinberg explain the validation process, how the tool discriminates between OSA severity levels, and why certain seemingly similar questions about sleepiness were all retained.

The episode addresses practical implementation questions: How is PLATO scored? Why do the first two sections use 5-point scales while the final section uses 10 points? Is it free to use, and how does one access it? Will it integrate into electronic health record systems like Epic? Most importantly, how should clinicians use this tool—will it replace the Epworth for Medicare requirements, or does it serve a different purpose?

The discussion also explores how PLATO relates to the recent AHRQ report on OSA treatment outcomes and why the tool focuses on patient-reported symptoms rather than solely cardiovascular endpoints. Dr. Kirsch shares his vision for PLATO's future, including hopes for foundation grants to further study the tool and demonstrate that treating OSA and its associated sleepiness meaningfully improves patient outcomes.

Whether you're frustrated with current assessment limitations, interested in value-based care metrics, or seeking better ways to document treatment efficacy beyond adherence data, this episode provides essential insights into a tool that may reshape how we measure success in sleep medicine.

Join us for this important discussion about moving beyond PAP adherence and Epworth scores to truly capture what matters to our patients.

In this bonus episode of Talking Sleep, host Dr. Seema Khosla offers an exclusive preview of the upcoming SleepMedicine Disruptors course, taking place November 14-15 in Austin, Texas. She speaks with Steve Van Hout, executive director of the AASM, and Dr. David White, professor of medicine part time at Harvard Medical School, about the groundbreaking innovations reshaping sleep medicine.

Steve Van Hout explains what makes the Disruptors conference unique compared to other AASM meetings like Trends and the annual SLEEP conference. Designed to bring together clinicians, researchers, technology innovators,and venture capitalists, Disruptors aims to foster cross-industry collaboration and encourage investment in sleep medicine innovations. The conference features innovation award presentations similar to Shark Tank pitches with the audience voting on their favorites, keynote speakers, and discussions about emerging technologies that promise to transform how we diagnose and treat sleep disorders.

Dr. White provides an in-depth preview of his presentation on pharmacotherapy for obstructive sleep apnea, sharing exciting developments in multiple drug candidates. He discusses Apnimed’s AD-109, a combination of atomoxetine and R-oxybutynin, which has completed two phase three studies showing approximately 50% reduction in AHI across six-month and one-year trials involving over 650 patients each. With FDA submission planned for early 2026, this medication could reach the market by late 2026.

The conversation explores other promising agents including Incannex's combination of dronabinol and acetazolamide, carbonic anhydrase inhibitors like sulthiame (recently licensed by Apnimed), and innovative potassium channelantagonists that could be delivered via nasal spray for localized upper airway effects with minimal systemic absorption. Dr. White discusses the potential for poly therapy approaches, combining medications with devices like mandibular advancement devices or positional therapy, drawing parallels to how hypertension and diabetes are managed with multiple treatments.

The episode tackles important questions about the future of sleep medicine: Will pharmacotherapy replace PAP therapy, or will hybrid approaches become standard? What AHI reduction is clinically meaningful for cardiovascularprotection and symptom improvement? How will pricing and insurance coverage affect accessibility? They emphasize that while these medications may not replace CPAP entirely, they offer promising options for patients who struggle with existing therapies.

Whether you're a sleep medicine practitioner interested in emerging treatments, an entrepreneur exploring innovation opportunities, or simply curious about the future of sleep disorder management, this episode provides essential insights into the rapidly evolving landscape of sleep medicine.

Join us for this forward-looking conversation about innovation, investment, and the technologies poised to disrupt traditional sleep medicine practice.

 In this episode of Talking Sleep, host Dr. Seema Khosla sits down with Dr. Anita Shelgikar, current president of the American Academy of Sleep Medicine, neurologist, and sleep fellowship program director at the University of Michigan, for a transparent look at how the AASM makes critical decisions that shape the field of sleep medicine. 

Ever wondered how clinical practice guidelines are developed and why updates take so long? Dr. Shelgikar pulls back the curtain on the comprehensive process behind guideline creation, from topic selection to evidence review to final publication. She explains how the AASM prioritizes which guidelines need updating and how members can influence these decisions. 

The conversation addresses pressing concerns facing sleep medicine practitioners: the ongoing review of home sleep apnea testing codes, declining reimbursement rates, and the financial viability of sleep medicine practices. Dr. Shelgikar discusses the AASM's advocacy efforts, recent legislative wins and setbacks, and strategies for improving the value proposition of polysomnography in an evolving healthcare landscape. 

 Looking toward the future, the discussion explores emerging trends including the potential for inpatient sleep medicine services, the shift toward chronic disease management models, and new technologies like acoustic stimulation. Dr. Shelgikar shares insights on how the field might evolve beyond its traditional testing-focused approach and adapt to changing reimbursement structures. 

The episode also demystifies AASM governance: How are committees formed and sunset? Why can't every volunteer serve? What happens during board meetings? Is board membership reserved for academics? Dr. Shelgikar provides practical guidance on how members can engage more meaningfully with the organization and influence its direction. 

 Whether you're a longtime AASM member curious about organizational decision-making or a newer member seeking to understand how to get involved, this episode offers valuable transparency into the processes that shape sleep medicine policy and practice. 

Join us for this informative conversation that bridges organizational leadership with frontline clinical concerns in sleep medicine. 

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Faisal Ali, professor of dermatology at the University of Central Lancashire and consultant dermatologist specializing in Mohs micrographic and laser surgery, to explore the fascinating connections between sleep and skin health.

Drawing from recent research published in Clinical and Experimental Dermatology, Dr. Ali explains how sleep serves as a critical regulator of skin physiology, affecting everything from skin surface pH and transepidermal water loss to blood flow and temperature regulation. The conversation delves into the complex interplay of circadian rhythms, hormones, and inflammatory cytokines that govern both sleep patterns and skin homeostasis.

The discussion covers how sleep deprivation accelerates skin aging as an extrinsic factor alongside sun exposure and pollution, with compelling evidence from studies showing that good sleepers have significantly better skin aging scores and improved recovery from UV exposure. Dr. Ali explores the bidirectional nature of this relationship—while poor sleep worsens skin conditions, dermatological disorders like atopic dermatitis, psoriasis, and rosacea can severely disrupt sleep through mechanisms including the itch-scratch cycle and inflammatory processes.

The episode addresses practical clinical concerns including the higher prevalence of sleep disorders in patients with conditions like hidradenitis suppurativa and rosacea, the role of obstructive sleep apnea in various skin conditions, and evidence-based approaches to breaking the itch-scratch cycle that disrupts sleep in dermatological patients.

The conversation also tackles common sleep treatment-related skin issues, from CPAP mask irritation and "maskne" to headgear-induced hair loss, providing practical guidance for managing these complications. Dr. Ali discusses proper skincare routines for CPAP users, including the safety of retinol use under masks and strategies for preventing pressure-related skin breakdown.

Whether you're a sleep medicine practitioner encountering dermatological complaints, a dermatologist treating patients with sleep disruption, or simply interested in optimizing both sleep and skin health, this episode provides evidence-based insights into this often-overlooked connection.

Join us for this comprehensive discussion that bridges dermatology and sleep medicine to enhance patient care and understanding.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Greg Burek, a psychiatrist and former Marine, and Dr. Dmitriy Kogan, associate professor of medicine at the Medical College of Wisconsin and program director for the sleep medicine fellowship program, to discuss the unique sleep challenges facing military veterans and first responders.

The conversation explores how military and first responder training fundamentally changes individuals, creating an "adrenaline-focused" mindset that profoundly impacts their relationship with sleep and health. Dr. Burek provides insider insights into the stages of military service and the concept of "sacrifice" as a unifying characteristic among veterans, while explaining why many veterans may minimize or dismiss their service experiences.

The guests introduce the BRAVE program, an innovative initiative designed specifically for military veterans and first responders to address the "invisible wounds of service"—PTSD and TBI—and their complex interactions with sleep disorders. Unlike traditional VA programs, BRAVE takes a specialized approach to understanding how military culture and experiences create unique sleep medicine challenges.

The discussion covers critical clinical topics including insomnia management in veterans, the frequent use of clonidine as a treatment option, REM behavior disorder presentations that may differ from civilian populations, and the intricate relationships between PTSD, TBI, sleep-disordered breathing, and nightmare disorders. The experts address whether these sleep disturbances stem from combat trauma, brain injury, or the military experience itself.

This episode provides essential insights for healthcare providers treating veterans, including practical approaches to asking about TBI history, understanding military culture's impact on patient care, and recognizing when specialized referrals may be beneficial.

Whether you're a sleep medicine practitioner, mental health professional, or healthcare provider serving veteran populations, this episode offers valuable perspectives on culturally competent care for those who have served.

Join us for this enlightening discussion that bridges military culture and sleep medicine to improve care for our veterans and first responders.