Sleep Technology

I’m a big fan of Sleep Review. It’s a good way to keep up with all things sleep related like technology developments, business prospects and scientific advances. It’s attractive and well-written. But a recent headline sent me into full-out grumpy old man mode.

  I was a postdoctoral fellow at Argonne National Laboratory and had the pleasure of working with George Sacher. At the time, he was president of the Gerontological Society of America and had spent his life working on ways to increase lifespan. He was a proponent of hormesis, the idea that moderation was the path to a longer life. Of course, some things should be off the list, like a moderate amount of murder. 

I often start the day with great expectations. I’ll finish the syllabus for my upcoming Sleep and Dreams class. I’ll write a blog or two. I’ll put together a Case of the Month. I’ll clean out the closet that filled up with boxes when we moved last year and hasn’t been touched since then. I’ll brew up some potent coffee to stimulate my thinking. I’ll sit down in front of my computer. I’ll check the email. I’ll look at a few pictures of cats stumbling around on catnip. I’ll shuffle a few lecture slides around. I’m ready for a nap.

During my site visiting years, I spent a considerable amount of time on planes reading accreditation applications. One thing that always puzzled me was that many centers included high and low ranges for sleep stages as a percentage of total sleep time. Despite the fact that my site visiting hit its peak in 2010, I think these numbers usually came from the 1974 opus by Williams, Karacan and Hirsch, which appears to be out of print. Patients with inadequate Stage 3 or excessive REM were branded as abnormal. But abnormal how?

Murray Johns developed the Epworth Sleepiness Scale (ESS) and published his methodology in 1991. (1) He subsequently tested its reliability in a group of 104 medical students (2) and found a test-retest correlation of r = .82. For those of us who are fans of Karl Pearson and his product-moment correlation coefficient (and I know there are many fans out there), this is a very large correlation and indicates that the measure is reliable.

My travel budget is limited, and I’m sure yours is as well. When I can’t make it to a meeting, I can always get the meeting to come to me through AAST’s Learning Center. I can watch and learn in the comfort of my own home. I can pause to take the dog for a walk, grab a snack from the fridge or whatever. Here are a few of my favorites from recent courses:

Every healthcare professional walks into the examination room with predetermined biases regarding the patients they see. Fifty-year-old obese man? OSA, of course. Twenty-year-old woman with daytime sleepiness? Could be narcolepsy. A man comes to the sleep center with his wife and she has a black eye? REM behavior disorder (RBD) is suddenly on your radar.

The AAST recently joined the Action Collaborative on Clinician Well-Being and Resilience of the National Academy of Medicine. The program has three goals: Improve the understanding of challenges to clinician well-being Raise the visibility of clinician stress and burnout Elevate solutions that will improve patient care by caring for the caregiver

The AASM recently released a position statement on the use of medical cannabis for the treatment of obstructive sleep apnea. (1) It states: “It is the position of the AASM: That medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability, and safety, and OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs.” (p. 680)

At AAST’s 39th Annual Meeting, Julie DeWitte provided an excellent lecture on capnography. She reviewed how the two main methods work (end-tidal and transcutaneous technologies), when they should be used and what it means when there are discrepancies between the two methods. She presented several illustrative cases for discussion. Unfortunately, due to a severe case of laryngitis, she didn’t really present the talk. Joel Porquez did an admirable job of filling in for Julie, but we didn’t have the opportunity to hear it directly from her. Now, thanks to the magic of a recording studio and some video editing, the lecture is available at the AAST website.