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Talking Sleep: Daily Summaries Delivered
by AASM
The vast field of sleep medicine is always evolving. Listen to Talking Sleep, a podcast of the American Academy of Sleep Medicine (AASM), to keep up on the latest developments in clinical sleep medicine and sleep disorders. Our host, Dr. Seema Khosla, medical director of the North Dakota Center for Sleep in Fargo, will take an in-depth look at issues impacting the diagnosis and treatment of sleep disorders. Episodes will feature conversations with clinicians, researchers, sleep team members and other health care experts working to help us sleep well so we can live well.
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- Today56 min
Oveporexton and the Future of Narcolepsy Treatment
The recent FDA approval of oveporexton represents a major milestone in the treatment of narcolepsy type 1 and the culmination of decades of research into orexin and its critical role in regulating sleep and wakefulness. In this episode of Talking Sleep, host Dr. Seema Khosla is joined by Dr. Emmanuel Mignot, a longtime leader in narcolepsy research and co-recipient of the 2026 Lasker Award for research that helped uncover the role of orexin in narcolepsy. Unlike existing therapies that primarily target the symptoms of narcolepsy, oveporexton is an orexin receptor 2 agonist designed to address the underlying loss of orexin signaling associated with narcolepsy type 1. Dr. Mignot shares his perspective on the science behind this new treatment approach and what the approval could mean for patients and clinicians. Topics include findings from clinical trials, the potential impact on excessive daytime sleepiness and cataplexy, dosing and safety considerations, and how an orexin-targeted therapy may fit into the evolving treatment landscape. The episode also provides perspective on the scientific journey that made this advance possible. Research into the orexin system has transformed the understanding of narcolepsy and opened new possibilities for therapies that more directly address its underlying biology. The discussion considers the significance of translating those discoveries into a treatment for patients, as well as some of the questions clinicians may encounter as oveporexton enters clinical practice. Looking beyond this approval, orexin agonists may have implications that extend beyond narcolepsy. Dr. Mignot offers insight into the continued evolution of orexin research and the potential for this growing area of sleep medicine to shape the future understanding and treatment of sleep and other medical disorders. For sleep clinicians, this episode offers both a closer look at a new treatment option for narcolepsy type 1 and a broader perspective on how decades of scientific discovery can translate into meaningful advances in patient care.
- 2 weeks ago46 min
Using Your Voice to Improve Reimbursement
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes members of the American Academy of Sleep Medicine advocacy team for an inside look at the work being done behind the scenes to support sleep clinicians and advance patient access to care. Joined by Diedra Gray, Tracy Bunge, Eric Albrecht, and Melissa Clark, the conversation explores how physician reimbursement decisions are made and how sleep medicine professionals can help shape the future of the field. Many sleep clinicians have experienced the frustration of declining reimbursement, changing payment policies, and increasing administrative burdens. While it can feel as though these decisions are beyond the influence of individual physicians, this episode highlights the many ways clinicians can contribute their expertise and advocate for sustainable sleep medicine practice. The discussion examines the complex process behind physician payment, including the roles of CPT coding, the AMA Relative Value Scale Update Committee (RUC), Medicare payment rules, and private payer policies. Listeners will gain insight into how reimbursement values are determined, how proposed policy changes are evaluated, and why physician participation in surveys and feedback opportunities is essential to the process. The episode also tackles key issues facing physicians today, including budget neutrality, inflationary pressures on physician practices, and recent reimbursement reductions that affect sleep medicine and other specialties. The guests explain how the AASM works to advocate for fair compensation while ensuring patients continue to have access to high-quality sleep care. Beyond payment policy, the conversation explores legislative advocacy and the role sleep clinicians can play in shaping public policy. From contacting elected officials and participating in advocacy campaigns to supporting legislation that promotes sleep health, listeners will learn how individual voices can contribute to meaningful change. Topics include physician payment reform, sleep health legislation, delayed school start times, permanent standard time, and other policy initiatives important to the sleep medicine community. Whether you're curious about how reimbursement decisions are made, interested in becoming more involved in advocacy efforts, or looking to better understand the forces shaping sleep medicine practice, this episode offers valuable insight into the people and processes working on behalf of sleep clinicians and their patients. Join us for this informative conversation about reimbursement, advocacy, and how your voice can help shape the future of sleep medicine.
- 4 weeks ago45 min
Pediatric Sleep Medicine: Expanding your Practice
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Binal Kancherla, Associate Professor of Pediatrics and Medical Director for the Sleep Program at Texas Children's Hospital, to discuss how sleep medicine practitioners can thoughtfully expand their practice to include pediatric patients. Many adult sleep medicine clinicians have considered adding pediatrics to their practice but weren't sure where to start. Dr. Kancherla has created a comprehensive educational series addressing exactly this question—providing the clinical knowledge and practical framework needed to confidently treat children and adolescents with sleep disorders. The landscape of pediatric sleep medicine has evolved significantly. Diagnostic approaches now include home sleep testing for appropriately selected adolescents, wearable technology, and refined polysomnography protocols specific to developmental stages. Sleep-disordered breathing in children presents differently than in adults, with updated assessment and treatment strategies. Meanwhile, insomnia and behavioral sleep issues in younger children are now understood through a more sophisticated lens that goes beyond simple behavioral management. Pharmacotherapy in pediatrics raises important questions that clinicians treating adults may never encounter: How do you approach melatonin and magnesium supplementation that parents frequently use? What FDA-approved hypnotics exist for children, and when are they appropriate? These practical decisions require understanding pediatric-specific evidence and developmental considerations. Pediatric sleep medicine encompasses conditions rarely seen in adult practice—parasomnias, circadian rhythm disorders in adolescents, restless leg syndrome in children, and pediatric narcolepsy. Recent advances in narcolepsy treatment create new clinical opportunities, though current approvals remain limited to adults, raising questions about future options for children. Beyond disease-specific knowledge, Dr. Kancherla emphasizes building a pediatric sleep-informed practice—understanding workflow differences, family-centered communication, developmental considerations, and how to effectively partner with pediatric specialists and families. Whether you're considering expanding into pediatrics, curious about how pediatric sleep medicine differs from adult practice, or seeking to deepen your understanding of conditions you may encounter, this episode provides clinical guidance and inspiration for professional growth. Join us for this practical conversation about expanding your sleep medicine practice to serve the youngest patients.
- Sep 25, 202634 min
Oxytocin and Social Cataplexy
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Carrie Mahoney, a neuroscientist and faculty member in the Department of Neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, to discuss her groundbreaking research on how oxytocin may regulate social cataplexy in narcolepsy. With FDA approval of new narcolepsy medications, understanding the neural mechanisms underlying cataplexy has never been more clinically relevant. Dr. Mahoney's research began with a simple but profound clinical observation: cataplexy attacks occurred reliably when patients laughed with close friends and family members, but rarely when joking with coworkers or strangers. This pattern of emotion-triggered muscle weakness in social contexts prompted investigation into whether oxytocin—the hormone associated with bonding and social connection—might play a role. Dr. Mahoney explains social cataplexy and discusses whether most cataplexy episodes occur in social contexts. She traces how she came to hypothesize oxytocin's involvement, moving from clinical observation to basic science investigation. The research explores how the amygdala—typically associated with fear—also processes other emotional responses including the joy and bonding feelings that characterize close relationships. The episode walks through her research methodology. Using orexin knock-out mice (which model narcolepsy), Dr. Mahoney observed increased cataplexy during social interactions. She then systematically investigated oxytocin signaling in the amygdala to understand the mechanism. She employed advanced neuroscience techniques including chemogenetics and optogenetics—tools that allow precise manipulation and observation of specific neural circuits. The conversation clarifies what these approaches reveal about oxytocin's role in triggering muscle atonia during emotional social situations. A crucial ethical question emerges: If oxytocin facilitates social bonding but also triggers cataplexy, would blocking oxytocin eliminate this important neurochemical? Dr. Mahoney addresses whether targeted intervention might be possible without sacrificing the neurochemical foundation of human connection and social behavior. The research faced significant setbacks during COVID-19, affecting experimental timelines and animal studies. Dr. Mahoney discusses how she navigated these disruptions and the collaborative nature of validating complex neuroscience findings. She co-published this work with John Peever, highlighting how competitive yet collaborative the field must be to advance understanding. An intriguing comparison emerges: Just as AI models solving previously unsolved math problems require human validation, complex neuroscience discoveries need replication and independent confirmation. Dr. Mahoney explains how her research will be validated and what the competitive landscape looks like in basic sleep neuroscience. The ultimate goal is translation to clinical benefit. Would oxytocin-targeted therapy be preventive medication taken before social events, or a daily medication to modulate cataplexy susceptibility? Dr. Mahoney discusses how she communicates detailed scientific findings to patients and clinicians in understandable language, acknowledging the collaboration with science communicators like Kara Weaver. Her research extends beyond cataplexy—orexin knock-out mice are also being used to investigate menopause-related sleep changes, suggesting broader applications of her findings. Whether you're interested in narcolepsy pathophysiology, basic neuroscience approaches to understanding sleep disorders, or how fundamental research translates to clinical treatments, this episode illuminates the meticulous work underlying next-generation narcolepsy therapies. Join us for this fascinating discussion about how curiosity-driven neuroscience research may transform how we treat cataplexy and understand the biology of narcolepsy.
- Sep 11, 202657 min
Patient Advocacy in Sleep Medicine
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes three patient advocates who are reshaping how sleep medicine is practiced and funded. Matt Horsnell, living with two sleep disorders and active as an author and panelist; Emma Cooksey, a patient-advocate and host of the Sleep Apnea Stories podcast; and Julie Flygare, a lawyer, author, and founder of Project Sleep, share their transformative advocacy work. While clinicians often think of advocacy as writing letters or making donations, these three demonstrate that patient advocacy encompasses far more complexity and impact. They explain the multiple dimensions of advocacy work: legislative advocacy that influences policy and funding, educational advocacy that raises awareness and understanding, and research advocacy that shapes the scientific agenda. The conversation begins with personal stories—what brought each advocate to this work and how living with sleep disorders motivated their commitment to systemic change. Matt shares insights as someone navigating two sleep conditions, while Emma and Julie discuss how legal training informed their approaches to advocacy and systems change. Legislative advocacy receives detailed exploration. The guests explain how patient voices influence congressional action, regulatory decisions, and funding priorities. They discuss educational advocacy—raising public awareness, changing misconceptions, and helping people recognize sleep disorders they might otherwise dismiss or normalize. Project Sleep, Julie's organization, serves as a centerpiece for discussion. While Project Sleep doesn't fund research directly, the conversation addresses which organizations do fund sleep medicine research and how clinicians and patients can access federal funding mechanisms. The guests provide insights into how disease-specific organizations like Wake-up Narcolepsy secure funding and the lessons applicable to sleep medicine more broadly. Project Sleep's helpline receives attention—what it offers, who it serves, and the critical challenge of sustainability when grant funding ends. The guests discuss Rising Voices, an initiative amplifying patient narratives and lived experience in policy and clinical discussions. A particularly valuable discussion addresses how clinicians can meaningfully engage with patient advocacy. Is this space exclusively for people living with sleep disorders, or can healthcare providers contribute? The conversation explores collaboration opportunities without appropriating patient voices or experiences. The guests address practical questions: How do you sustain advocacy work without becoming discouraged? What does advocacy look like at local versus federal levels? What's on the wish list for sleep medicine advocacy? A recurring theme emerges: sustained funding remains elusive despite growing recognition of sleep disorders' impact on public health. The episode acknowledges that patients bring irreplaceable perspectives to clinical practice, research prioritization, and policy development. Their lived experience of navigating diagnoses, treatments, and healthcare systems provides insights clinicians cannot access through clinical practice alone. Whether you're interested in supporting patient-led advocacy, seeking to collaborate with patient organizations, curious about how to engage in legislative efforts, or simply wanting to understand the power of patient voices in healthcare transformation, this episode provides essential perspectives and practical guidance. Join us for this important conversation with patient advocates who are leading meaningful change in sleep medicine. Episode Correction: During the audio recording, federal funding for circadian research was misspoken as $60 Million. The correct amount is $600 Million. Project Sleep Links https://project-sleep.com/ https://www.instagram.com/project_sleep/
- Aug 28, 202649 min
Residual AHI vs Objective Testing: Which is Accurate?
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Sahil Chopra to discuss research challenging a fundamental assumption: that residual AHI measurements from PAP device downloads accurately reflect whether patients' sleep apnea is adequately treated. Sleep medicine clinicians routinely rely on residual AHI from PAP downloads to determine treatment success, typically targeting an AHI under 5. But what if this metric significantly underestimates untreated sleep apnea? Dr. Chopra's study comparing PAP-determined residual AHIs to cardiopulmonary coupling (CPC)-derived AHIs reveals striking discrepancies: mean residual AHI was 2.4 via PAP download versus 12.1 via objective testing. Even more concerning, 85% of nights showing residual AHI under 5 on PAP downloads had elevated AHI based on objective CPC measurement. Dr. Chopra explains why he chose cardiopulmonary coupling as the comparator metric, using a PPG-based wearable ring worn for 7-10 nights. He clarifies why PAP devices may systematically underestimate residual disease through mask leak, unstable breathing, and periodic breathing patterns. A particularly concerning finding involves residual hypoxia. Dr. Chopra discovered significant hypoxic burden in many patients considered "well-treated" by PAP standards—important since hypoxic burden, not just AHI, drives cardiovascular risk. Dr. Chopra's conclusion isn't that PAP-derived AHI is "bad"—rather, that it shouldn't be the sole metric for assessing treatment efficacy. Even patients with good symptoms may have significant residual respiratory events and hypoxia that PAP downloads fail to detect. Clinical applications are discussed, including when to pursue objective testing and what interventions to consider when objective testing reveals inadequate control despite acceptable AHI. Whether you rely on PAP downloads to assess treatment efficacy, manage patients with residual symptoms, or seek emerging objective metrics, this episode provides essential perspectives on optimizing PAP therapy. Join us for this important discussion that challenges current assumptions about measuring treatment success in sleep apnea.
- Aug 14, 202654 min
Sleep and Perimenopause
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Andrea Matsumura, a sleep physician with specialized certification in menopause medicine and national advisor for Monarch MD, to discuss how sleep clinicians can better support patients struggling with perimenopausal sleep disturbances. Since the FDA removed the black box warning on hormone replacement therapy, more patients are inquiring about medications to treat perimenopausal sleep symptoms. Dr. Matsumura, who left traditional practice to pursue menopause certification and now works at the intersection of sleep medicine, mental health, and women's midlife health, provides practical guidance on this increasingly important clinical area. The conversation begins with Dr. Matsumura's career evolution. After training as an internist with a leadership role at Kaiser Permanente and practicing sleep medicine in a group setting, she pursued specialized menopause certification—a credentialing process explained in detail. Dr. Matsumura discusses what menopause certification encompasses, who can pursue it, and her own path into this specialty. She also discusses her work developing specialized supplements for perimenopausal sleep support. The episode systematically addresses how perimenopause disrupts sleep. Rather than focusing solely on hot flashes, Dr. Matsumura explains the full spectrum of sleep-related changes. She clarifies the timeline of perimenopause—when it starts and ends—and discusses less commonly recognized phenomena like menstrual hypersomnia that clinicians may not immediately associate with menopause. A critical discussion addresses patient expectations around hormone replacement therapy. Many patients expect sleep clinicians to prescribe HRT, which raises legitimate concerns for providers unfamiliar with menopause management. Dr. Matsumura provides practical guidance on these conversations and clarifies the role of hormone level testing—addressing the debate between treating symptoms versus checking levels before initiating therapy. The conversation explores the complex relationship between sleep apnea and menopause. Dr. Matsumura explains why and how obstructive sleep apnea may worsen during perimenopause, how to have these conversations with patients, and when referral to OBGYN colleagues is appropriate for collaborative care. Additional topics include the role of hypnotics in perimenopausal sleep disorders, absolute contraindications to hormone replacement therapy, how to initiate HRT when appropriate, and whether restless leg syndrome worsens with perimenopause. Dr. Matsumura addresses common misconceptions about menopause and sleep, helping clinicians understand what practitioners and patients frequently get wrong about this life stage. The episode emphasizes that sleep medicine clinicians don't need to become menopause specialists, but understanding these connections enables better patient care and appropriate referrals. Join us for this important conversation about supporting women's sleep health through midlife transitions.
- Jul 31, 202651 min
Sleep Medicine's Environmental Footprint and Impact
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Laura Donahue, an assistant professor of sleep medicine at Vanderbilt University with a background in internal medicine and a researcher in sustainable healthcare, to discuss the environmental impact of sleep medicine practice and practical strategies for reducing carbon footprint and medical waste. Recent environmental challenges—heat waves exacerbating insomnia, wildfires affecting respiratory and sleep health—highlight how climate directly impacts patient wellbeing. But do sleep medicine clinicians have an obligation to reduce their own environmental footprint? Dr. Donahue explores this question, examining the waste generated by sleep testing, PAP therapy, and ongoing supplies. The conversation begins with foundational concepts: How does climate change impact sleep health? What exactly constitutes medical waste, and how does it differ from carbon footprint? Dr. Donahue explains methods for calculating carbon footprint and how the US healthcare system compares globally. She introduces life cycle analysis—a comprehensive tool for understanding environmental impact across product lifecycles. Sleep lab waste assessments receive detailed attention. Dr. Donahue walks through how to conduct a waste audit of sleep facilities and why examining both carbon footprint and waste matters, acknowledging that these metrics don't always move directionally. Her research on PAP device waste, conducted with Dr. Morgenthaler, revealed substantial environmental costs associated with standard OSA therapy—findings that prompted examination of alternatives. Telemedicine emerges as a potential sustainability strategy. Dr. Donahue compares carbon footprints of virtual versus in-person sleep consultations, exploring how practice model choices affect environmental impact. However, the analysis doesn't focus solely on PAP therapy—hypoglossal nerve stimulators and other non-PAP treatment options receive consideration as alternatives with potentially different environmental profiles. SHAPE, an organization dedicated to helping healthcare providers examine their carbon footprint and waste generation, receives discussion. Dr. Donahue explains SHAPE's mission and practical resources available to sleep medicine programs. She provides concrete guidance on reducing environmental impact: waste audits, supply chain evaluation, and transitioning to circular economy models where possible. A particularly relevant discussion addresses plastic waste from CPAP devices and consumable supplies. Dr. Donahue explains how waste audits serve as the first step toward identifying reduction opportunities and discusses strategies for minimizing single-use plastics in sleep medicine practice. The episode acknowledges that sustainability requires institutional commitment and individual awareness. Dr. Donahue emphasizes that small changes—from supply selection to practice model design—accumulate to meaningful environmental impact. Whether you're interested in sustainable healthcare, concerned about medical waste, seeking to reduce your sleep practice's carbon footprint, or wanting to better understand climate impacts on sleep health, this episode provides practical guidance and evidence-based approaches. Join us for this important conversation about environmental responsibility in sleep medicine practice.
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About Talking Sleep
The vast field of sleep medicine is always evolving. Listen to Talking Sleep, a podcast of the American Academy of Sleep Medicine (AASM), to keep up on the latest developments in clinical sleep medicine and sleep disorders. Our host, Dr. Seema Khosla, medical director of the North Dakota Center for Sleep in Fargo, will take an in-depth look at issues impacting the diagnosis and treatment of sleep disorders. Episodes will feature conversations with clinicians, researchers, sleep team members and other health care experts working to help us sleep well so we can live well.
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Frequently Asked Questions
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It's a free AI-powered email that summarizes new episodes of Talking Sleep as soon as they're published. You get the key takeaways, notable quotes, and links & mentions — all in a quick read.
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When a new episode drops, our AI transcribes and analyzes it, then generates a personalized summary tailored to your interests and profession. It's delivered to your inbox every morning.
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Talking Sleep publishes biweekly. Our AI generates a summary within hours of each new episode.
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Talking Sleep covers topics including Science, Medicine, Fitness, Health & Fitness. Our AI identifies the specific themes in each episode and highlights what matters most to you.
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