The White Noise Podcast The White Noise Podcast

In this months episode we will be discussing all things Inspire with Dr. Paul Hoff, an ENT at Michigan Medicine.  What is Hypoglossal Nerve Stimulation? Who can get it? Does it Even work? Listen as we answer all your burning questions. 
Show Notes
3:00 get to know you questions

9:20 Favorite Book

Best Advice 10:00

The Inspire Case 11:00

What type of sleep study? 18:20

AHI Cutofffs: 18:55

Goals of Care? 21:50

What is considered effective therapy? 24:30

Star Trial link: Upper-Airway Stimulation for Obstructive Sleep Apnea | NEJM

Adhere Registry Link: Results of the ADHERE upper airway stimulation registry and predictors of therapy

efficacy - Thaler - 2020 - The Laryngoscope - Wiley Online Library

Define CPAP failure? 26:00

Nasal obstruction causing CPAP failure 28:00

Floppy Epiglottis causing Aerophagia? 28:30

Surgery for Aerophagia 29:30

Risks and medical contraindications 33:00

MRI compatibility? 33:30

Surgery description/length 34:30

ICD compatibility? 35:00

Avg Voltage ranges? 37:00

Removing devices 39:00

Recovery time 39:40

Incision size 40:45

Back to the case, parameters for referral 43:00

Drug Induced Sleep Endoscopy (DISE) 43:45

What percentage of patients fail DISE? 47:00

Management after Inspire placement 48:15

Inspire sync: 49:15

Battery life 11 years: 51:00

Explant 51:30

Surgical options other than Inspire 53:15

Does UPPP work? 56:00

What can we expect from surgery? 57:00

When to refer for large tonsils 59:00

Closing comments 1:01:00

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

Introduction of Guest: (5:00)
Matt’s Best Advice (11:00)
Matt’s Role in the sleep community (12:40)
Matt’s symptoms onset (15:00)
Matt’s additional symptoms (19:00)
Matt’s onset of cataplexy (23:00)
Cataplexy triggers (24:45)
Delayed diagnosis: (27:00)
Nightmares and sleep paralysis onset (31:30)
One more question about sleep paralysis (34:15)
Partial cataplexy (37:50)
Diagnosis and Management: (39:00)
Pitolisant (43:45)
Strategic Napping (44:15)
Bitter Pills (45:15)
AASM revised Guidelines (47:22)
Sodium Oxybate and Cataplexy (49:00)
Finding a sleep physician to manage narcolepsy (55:00)
Sleep apnea (60:30)
MSLT (62:15)
Treat Clinically (65:00)
4 pillars of management (66:00)
Patient request/feedback (68:00)
Academic vs private practice (71:30)

 
 
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 intro3:00 best advice6:50 pick of the month12:12 discussion begins12:30 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 afib19:30 arrhythmia and auto-cpap21:30 heart failure and preserved EF22:50 why does OSA predispose to atrial fibrillation26:00 anti arrhythmic drugs for afib with co-morbid sleep apnea29:00 minutes coughing can be edited if you want29:30 rate or rhythm control for afib?31:00 fatigue or sleepiness?32:20 Other sleep related arrhythmias32:36 Non sustained ventricular tachycardia33:00 Sustained ventricular tachycardia36:00 arrhythmia and management on the sleep end37:40 Long QT38:00 Chronic afib38:30 sinus pause39:30 AV block42:00 2 Lead ECG problems43:00 medicare games44:30 positional therapy47:15 virtual visits discussed vs face to face
48:30 screening afib for OSA50:33 compliance and non compliance - sleep heart health study51:00 Meta –review JAMA52:40 arrhythmia and cpap, when will my arrhythmia improve?54:30 treat sleep apnea prior to cardioversion?58:50 PVC’s1:01:00 7 pvc/minute1:02:00 PACs?1:03:00 bigeminy or trigemini?1:04:20 oxygen nadir and oxygen desaturation index1:12:30 using oxygen nadir to reach the patient1:15 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