The White Noise Podcast The White Noise Podcast

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

Show notes will be up shortly. Thank you for your patience!

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
– Introduction



2:30
– Interview starts



7:40
– Picks of the month



12:50
– Case



13:50
– Initial thoughts on case



14:00 – Diagnosis of restless legs syndrome



16:50 – Diagnostic criteria for restless legs syndrome



17:40
– Difficulties in diagnosis



22:20
– Key questions to ask in taking history



24:00 – Periodic limbs vs restless legs syndrome



28:30 – Pathogenesis of restless legs syndrome



31:00
– History of Willis-Ekbom disease



35:50
– Case



36:40 – Medications for restless legs syndrome



38:30
– Dopamine agonists



43:30
– Alpha-2-delta-ligands



45:00
– Iron therapy



50:10
– PO vs IV iron supplementation



58:45
– IV iron formulations



1:00:30
– Narcotics



1:05:03
– Augmentation



1:09:00
– Non pharmacologic therapies



1:11:10
– Medications that worsen restless leg syndrome



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
– Take home points



1:22:00
– Interview end







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



Restless legs is a clinical diagnosisThe hallmark of the disease is a SENSATION  of the need to move. There must be a circadian component to make a diagnosis. Augmentation will almost inevitably occur

Episode written and produced by John Barkham, MD, Mohan Dutt, MD, and Alok Sachdeva MD.







The White Noise Podcast discusses the medical management of nightmare disorders with our very own Dr. John Barkham, who is a clinical lecturer at the Ann Arbor VA. This is part one of our two part series on nightmare disorders.







Show Notes Season 1-Episode 2- Nightmare Disorder Part 1 



Time Stamps



0:00 – Introduction



4:51 – Guest Introduction



8:10 – Picks of the month



Maps of Meaning by Jordan Peterson 12 Rules for Life by Jordan Peterson The Big Fella by Jane Leavy Star Trek: Discovery



11:29 – Clinical case begins



11:40 – Evaluation of nightmares



The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA).



22:00 – Nightmares in the veteran population



25:30 – Prazosin use for nightmare disorder



Clinical case series: the use of Prazosin for combat-related recurrent nightmares among Operation Iraqi Freedom combat veterans.



28:00 – Diagnostic criteria for nightmare disorder



Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper



32:05 – Disturbing dreams and nightmare severity index (DDNSI)



Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: diagnostic and treatment implications.



34:00 – Resumption of case



37:45 – Prazosin dosing



41:50 – Problems with the DDNSI



47:18 – Pharmacologic alternatives to prazosin



51:00 – Alternatives to pharmacotherapy



Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial.







Additional Information











From: Callen et al, Nightmare Disorders in Adults







From: Callen et al, Nightmare Disorders in Adults







Disclosures



The authors of The White Noise Podcast have no financial disclosures