Sleep Technology

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.

I try to start my blogs in a lighthearted way, but there is nothing lighthearted about amyotrophic lateral sclerosis, more commonly known as ALS. ALS is a group of progressive diseases of upper and lower motor neurons, resulting in weakness of muscles. The course is often rapid, with most people dying from respiratory failure within three to five years from the onset of symptoms. Patients have difficulty breathing due to weakness of respiratory muscles. As the disease progresses, patients may require tracheostomy and ventilation. There is no known treatment.

Key opinion leaders who worked with me to develop the Predictions for Sleep Technology Profession in 2018 e-book emphasized the role that wearable monitors might play in the future of sleep medicine. In addition, I recently wrote a blog on a preliminary study using wrist monitors to diagnose OSA. This got me thinking about the potential value of the information collected by these devices beyond sleep disorders. A pair of articles in the most recent Journal of Clinical Sleep Medicine is the focus of the January Journal Club. Surprisingly, neither of these articles focused on sleep disorders – instead, the focus was on sleep health.

For the past five years I have been teaching in the Psychology Department at California State University, Long Beach (Go Beach! Of course, when you think about it, the beach can’t really go anywhere. And what school has a beach as a mascot? But I digress.). My students are very diverse and many are the first in their families to attend college. Communication skills and scientific knowledge are often lacking. But when I speak to my students during office hours I find that they are intelligent, enthusiastic and motivated to learn. They make me want to learn how to be a better teacher.

Don’t let the fancy name of the medication fool you. The cannabimimetic is dronabinol, a synthetic non-selective CB1 and CB2 receptor agonist. But really, it’s marijuana. As medical and recreational use of marijuana becomes legal state by state, research that has been impossible has now become available. And the therapeutic effects of marijuana are extending beyond the well-known positive effects for chemotherapy patients. High on that list of benefits is, believe it or not, obstructive sleep apnea.

So, after much deliberation, I ordered an Apple Watch. I ordered it because I can never hear the phone ring when it is in my pocket. The advertisements tell me that the watch will blink and vibrate and yell at me when the phone rings, and hopefully that will be enough to get my attention.

Lately, the news has not been great for CPAP users and the sleep centers that care for them. The USPSTF recommended against screening of asymptomatic patients and, in doing so, threw some major shade on the use of CPAP.