The White Noise Podcast

In this months episode we chat with Dr. Miranda Lim of OHSU about Trauma Associated Sleep Disorder. Is it a new disorder? Does it always evolve into REM sleep Behavior Disorder? Are there any treatments? Listen to find out! 

In this months episode we discuss narcolepsy with Matthew Horsnell. Matt is a narcolepsy patient and advocate, and we discuss his journey of living with narcolepsy. 

SHOW NOTES

Links to articles and guidelines referenced in this episode are included 

Trotti LM. Central Disorders of Hypersomnolence. Continuum (Minneap Minn). 2020 Aug;26(4):890-907.

Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline

Join us this month as we discuss parasomnias with psychologist Dr. Alan Eiser. 

Join us this month as we discuss OSA and cardiovascular disease with Dr. Peter Farrehi, a cardiologist at the University of Michigan. We focus on arrhythmias, but do delve into other topics as well. We hope you enjoy!

Time Stamps

00:45 intro
3:00 best advice
6:50 pick of the month
12:12 discussion begins
12:30 What should we be looking for on a sleep ECG?
14:00 See the patient or do the sleep study first?
16:38 should every patient with afib get a sleep study?
17:15 STOP BANG screening and afib
19:30 arrhythmia and auto-cpap
21:30 heart failure and preserved EF
22:50 why does OSA predispose to atrial fibrillation
26:00 anti arrhythmic drugs for afib with co-morbid sleep apnea
29:00 minutes coughing can be edited if you want
29:30 rate or rhythm control for afib?
31:00 fatigue or sleepiness?
32:20 Other sleep related arrhythmias
32:36 Non sustained ventricular tachycardia
33:00 Sustained ventricular tachycardia
36:00 arrhythmia and management on the sleep end
37:40 Long QT
38:00 Chronic afib
38:30 sinus pause
39:30 AV block
42:00 2 Lead ECG problems
43:00 medicare games
44:30 positional therapy
47:15 virtual visits discussed vs face to face

48:30 screening afib for OSA
50:33 compliance and non compliance - sleep heart health study
51:00 Meta –review JAMA
52:40 arrhythmia and cpap, when will my arrhythmia improve?
54:30 treat sleep apnea prior to cardioversion?
58:50 PVC’s
1:01:00 7 pvc/minute
1:02:00 PACs?
1:03:00 bigeminy or trigemini?
1:04:20 oxygen nadir and oxygen desaturation index
1:12:30 using oxygen nadir to reach the patient
1:15 wrap up

Join us as we talk with Dr. Barbara Felt about the management of ADHD in children with sleep disorders,

37:14 – Second-line medications for ADHD

38:08 – How late in the day can stimulant medications be given without risk of sleep disruption?

38:28 – How to approach the evaluation of night terrors in the patient from our case

40:22 – What is a “normal” ferritin in children?

41:15 – What is average ferritin in pre-school children?

41:40 – How do you approach a vague history provided by children regarding RLS symptoms?

43:12 – What dose of iron should be used to treat children with RLS?

44:00 – If treatment of OSA improves ADHD symptoms, is it reasonable to wean stimulant medications?

45:57 – How frequently should one re-evaluate medication doses for children with ADHD?

47:23 – Can ADHD resolve over time? Is ADHD a life-long disease?

50:32 – How commonly do children with ADHD have difficulty falling asleep?

52:15 – Discussion about behavioral insomnia of childhood, limit-setting type and combined type

54:35 – What sort of behavioral treatments are useful for children with insomnia?

56:20 – Are children with ADHD more likely to have circadian rhythm disorders?

59:00 – On the importance of sleep routines for children with ADHD

59:47 – Opportunities for research in the field of ADHD and sleep

1:02:42 – What dose of melatonin should be recommended for children?

1:05:01 – Take-home points from Dr. Felt

Legs bothering you? Well join the The White Noise Podcast as we pick the brain of Dr. Andy Berkowski, clinical associate professor and restless leg expert at the University of Michigan. Learn all about the diagnosis and management of restless legs syndrome. There is also a guest appearance by hepcidin, the bouncer at Club Ferritin.

CME credit link will be here when available

Show Notes – Season 1, Episode 4 – Restless legs syndrome

Time stamps

0:30

2:30

7:40

12:50

13:50

14:00 – Diagnosis of restless legs syndrome

16:50 – Diagnostic criteria for restless legs syndrome

17:40

22:20

24:00 – Periodic limbs vs restless legs syndrome

28:30 – Pathogenesis of restless legs syndrome

31:00

35:50

36:40 – Medications for restless legs syndrome

38:30

43:30

45:00

50:10

58:45

1:00:30

1:05:03

1:09:00

1:11:10

1:16:00 – Screening for restless legs syndrome

1:18:00 – Follow-up of restless legs syndrome patients

1:18:50 – Sleep apnea and restless legs syndrome

1:20:10

1:22:00

Definitions

Augmentation: The process by which the symptoms of restless legs syndrome occur earlier in the day, become more severe, are less responsive to treatment, and spread to other parts of the body (e.g. arms and trunk), usually due to treatment with escalating doses of dopaminergic medications.

Restless legs syndrome: A condition characterized by an urge to move one’s legs (often accompanied by unpleasant sensations in the legs) that is most prominent at rest, partially or totally relieved by movement, and classically worse in the evening. The symptoms must not be better explained by another condition such as peripheral neuropathy.

Periodic limb movements of sleep: Periodic, repetitive, stereotyped limb movements that occur during sleep. American Academy of Sleep Medicine (AASM) scoring criteria require a minimum of 4 limb movements in series with 5-90 seconds between movements. Periodic limb movements of sleep are seen in the majority of patients with restless legs syndrome who undergo polysomnography.

Periodic limb movement disorder: A disorder characterized by more than 15 periodic limb movements per hour of sleep in adults (greater than 5 in children) that cause a significant sleep disturbance and/or functional impairment not better explained by a different disease entity.

Akathisia: An inner sense of restlessness and desire to move that is often caused by dopamine antagonist medications, is usually generalized (not limited to the legs), and is unlikely to be totally relieved by movement.

Clinical Pearls

Diagnosis of restless legs syndrome:

Treatment of restless legs syndrome:

Goals and objectives

Goals

Listeners of this episode will able to recognize restless legs syndrome in the clinic and be familiar with treatment strategies.

Objectives

After listening to this episode, listeners will be able to…

1. Recognize patients with restless legs syndrome disorder based on history.

2. Compare the different forms of iron supplementation, and formulate a therapeutic plan for the patient. 

3. Describe the various treatments for restless legs syndrome. 

4. Implement a treatment plan based on a patient’s specific needs. 

5. Recognize patients undergoing augmentation, and formulate treatment plans. 

6. Be familiar with the opioids used in management of restless legs syndrome.

7. Discuss the risks and benefits of different pharmacologic treatment options with the patient.

Dr. Berkowski's Suggested reading list.

Patient resources

Picks of the month

Disclosures

The authors of The White Noise Podcast do not have any relevant financial disclosures.