In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Greg Burek, a psychiatrist and former Marine, and Dr. Dmitriy Kogan, associate professor of medicine at the Medical College of Wisconsin and program director for the sleep medicine fellowship program, to discuss the unique sleep challenges facing military veterans and first responders.

The conversation explores how military and first responder training fundamentally changes individuals, creating an "adrenaline-focused" mindset that profoundly impacts their relationship with sleep and health. Dr. Burek provides insider insights into the stages of military service and the concept of "sacrifice" as a unifying characteristic among veterans, while explaining why many veterans may minimize or dismiss their service experiences.

The guests introduce the BRAVE program, an innovative initiative designed specifically for military veterans and first responders to address the "invisible wounds of service"—PTSD and TBI—and their complex interactions with sleep disorders. Unlike traditional VA programs, BRAVE takes a specialized approach to understanding how military culture and experiences create unique sleep medicine challenges.

The discussion covers critical clinical topics including insomnia management in veterans, the frequent use of clonidine as a treatment option, REM behavior disorder presentations that may differ from civilian populations, and the intricate relationships between PTSD, TBI, sleep-disordered breathing, and nightmare disorders. The experts address whether these sleep disturbances stem from combat trauma, brain injury, or the military experience itself.

This episode provides essential insights for healthcare providers treating veterans, including practical approaches to asking about TBI history, understanding military culture's impact on patient care, and recognizing when specialized referrals may be beneficial.

Whether you're a sleep medicine practitioner, mental health professional, or healthcare provider serving veteran populations, this episode offers valuable perspectives on culturally competent care for those who have served.

Join us for this enlightening discussion that bridges military culture and sleep medicine to improve care for our veterans and first responders.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment.

Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment.

The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes.

Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption.

Whether you're treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms.

Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice.