Sleep Doctors Show

00:00:00 - Introduction 00:02:39 - Catch-Up 00:08:03 - Sleep Inertia 00:13:31 - Chronotype and Permanent DST 00:18:51 - Indications for Sleep Tracking 00:20:47 - Polysomnography (PSG) 00:22:49 - Epoch-Based Sleep Staging 00:26:13 - ORP and N3 Amplitude Criteria 00:29:06 - Wearable Validation vs PSG 00:31:45 - Actigraphy 00:34:11 - Oura and FDA Wellness Criteria 00:38:01 - Consumer Health Trackers 00:42:02 - Psychological Flexibility Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://newsletter.sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com Episode Summary: Is polysomnography really the gold standard, and what does that mean for the accuracy claims on consumer sleep trackers? The Sleep Doctors Show takes a critical look at sleep measurement, from the sleep lab to the ring on your finger. Dr. Jesse Cook (sleep psychologist, behavioral sleep medicine), Dr. Cathy Goldstein (sleep neurologist, professor of neurology, University of Michigan) and Dr. Shelby Harris (clinical associate professor, Albert Einstein College of Medicine, private practice in New York City) start with sleep inertia: how you should feel in the first minutes after waking, and why a slow ramp-up is normal. Dr. Saema Tahir sits this one out. A listener comment on the Sunshine Protection Act opens a debate on permanent standard time versus daylight saving time, evening chronotypes, dark winter mornings, the 1974 year-round DST experiment, Save Standard Time, and the Sleep Research Society position statement by Beth Malow. Dr. Goldstein explains why Susan Redline calls polysomnography (PSG) a bronze standard: inter-rater reliability in the mid-80s, sleep staging as discretizing a continuum, the 30-second epoch inherited from paper recordings, surface EEG with as few as three leads, local versus global sleep, and the odds ratio product (ORP) and hypnodensity. Dr. Cook adds the age and sex bias in N3 (slow wave sleep) amplitude criteria from Shaun Davidson and colleagues, and how human-scored PSG caps the AI staging algorithms trained on it. Then consumer sleep technology: why benchmarking wearables that measure acceleration and cardiac autonomic activity against EEG-defined sleep may be unfair (Massimiliano de Zambotti's validation framework), sleep state misperception, actigraphy for circadian phenotyping, the Oura class action over its 95 percent accuracy claim, FDA wellness device criteria, influencer marketing, the World Sleep Society consumer health tracker recommendations led by Michael Chee, Dr. Cook's wearable study with University of Wisconsin women's volleyball, and acceptance and commitment therapy (ACT) and psychological flexibility over obsessive tracking.

00:00:00 - Introduction 00:02:33 - Catch-Up 00:12:38 - Vetting CBT-I Providers 00:14:23 - DBSM and SBSM Credentials 00:18:54 - When Patients Say CBT-I Failed 00:21:38 - Sleep Hygiene Is Not CBT-I 00:24:32 - Practicing Within Competency 00:27:51 - The CBT-I Referral Note 00:33:38 - Motivation and Adherence 00:37:15 - A Standard Pre-CBT-I Workup 00:38:39 - How to Pitch CBT-I to Patients 00:42:55 - Relapse Prevention 00:44:44 - ACT vs Cognitive Therapy 00:48:15 - Cognitive Defusion and Values 00:50:06 - Acceptance in the Sleep Clinic 00:54:29 - Control vs Letting Go 00:56:23 - Outro Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://newsletter.sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com Episode Summary: How do you find the right CBT-I provider, and what makes a useful referral? The Sleep Doctors Show continues its discussion of cognitive behavioral therapy for insomnia (CBT-I), focusing on connecting patients with care. Dr. Shelby Harris (Albert Einstein College of Medicine, private practice in New York City) explains how to assess a provider's qualifications. She covers DBSM and CBSM credentials, the Society of Behavioral Sleep Medicine (SBSM) provider directory, training programs from Michael Perlis and Colleen Carney, and questions about supervised hours and caseload. The hosts explain why a sleep hygiene handout is not CBT-I, share Rachel Manber's dental hygiene analogy, and discuss what to ask when a patient says CBT-I has already failed. Dr. Cathy Goldstein (sleep neurologist, University of Michigan) and Dr. Saema Tahir (pulmonologist and sleep physician, New York City) outline what belongs in a referral note: sleep disorders ruled out, obstructive sleep apnea and circadian rhythm findings, medications, sleep habits, and motivation for change. The panel also discusses patients' ability to follow stimulus control and sleep restriction, equitable access to treatment, a standardized assessment before referral, presenting CBT-I as first-line treatment ahead of medication, and relapse prevention. Finally, Dr. Jesse Cook (sleep psychologist, behavioral sleep medicine) introduces acceptance and commitment therapy (ACT) for insomnia, exploring cognitive defusion, psychological flexibility, allowance versus acceptance, and letting go of control over sleep.

00:00:00 - Introduction 00:02:27 - Catch-Up 00:09:52 - What Is CBT-I 00:12:25 - CBT-I in Physician Training 00:16:34 - Group vs Individual CBT-I 00:18:16 - CBT-I Beyond Insomnia 00:22:11 - Dropping the I From CBT-I 00:25:24 - The Problem With CBT-I Name 00:27:14 - Digital CBT-I and Cadence 00:30:42 - Best and Worst Ingredients 00:33:06 - Choosing Medication Options 00:41:45 - Tapering and Rebound Insomnia 00:44:23 - Trazodone and Seroquel 00:46:41 - PRN vs Nightly Dosing 00:48:34 - Combination Treatment 00:50:57 - Sleep Confidence 00:52:14 - Sleep Tracking and Orthosomnia 01:03:56 - Reflections Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com Watch last week's episode: https://youtu.be/CmW8bvx5FPU CBT-I is the gold standard for insomnia. It is also, by the panel's own admission, a slightly magical black box to the physicians who refer for it, a hard sell to the patients who hear "therapy," and a treatment that rarely unfolds the way the manual says it will. Part two of the insomnia series takes the acronym apart: which ingredients actually move the needle, which ones the psychologists would happily drop, and why Dr. Jesse Cook wants everyone to forget the "I" for a minute. Dr. Shelby Harris walks through the CBT-I toolkit (sleep hygiene, sleep restriction, stimulus control, cognitive restructuring) and names her favorite and least favorite. Dr. Saema Tahir explains why she recommends it for nearly every sleep patient, including idiopathic hypersomnia. Dr. Cathy Goldstein lays out how she chooses an insomnia medication by onset, maintenance and comorbidity, and delivers a memorably firm verdict on Seroquel and trazodone. The panel covers digital CBT-I apps, session cadence, the pandemic-era medication cocktails now being tapered, rebound insomnia from tapers done too fast, whether to take a hypnotic every night or only "if needed," and the case for combination treatment. They close by lifting the lid on orthosomnia, the Oura class action, and the potential harm of sleep tracking technology in the context of insomnia, a conversation that continues next episode.

Chapters: 00:00:00 - Introduction 00:02:19 - Catch-Up 00:04:39 - Rams vs 49ers Circadian Debate 00:16:32 - Clinic Models and Burnout 00:29:38 - Defining Insomnia 00:34:51 - Referrals and Access to Sleep Care 00:42:34 - How Insomnia Develops 00:47:04 - Building a Treatment Plan 00:56:34 - What Is CBT-I 01:02:01 - Next Episode Preview Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://newsletter.sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com Everyone has had a bad night. The reason insomnia is the single most common thing a sleep clinician sees is that the line between a rough week and an actual disorder is blurrier than anyone admits. This is part one of the panel's two-part sit-down on insomnia, and before they reach the bedroom they make a stop on a football field: two California teams, the Rams and the 49ers, flying to Australia for a week one kickoff that starts at 10:30 a.m. local time, which is roughly 5:30 p.m. back home. One team is acclimating, the other is refusing to, and four sleep doctors have very strong opinions about who has it right. From there, Dr. Jesse Cook, Dr. Cathy Goldstein, Dr. Saema Tahir and Dr. Shelby Harris compare what a real clinical day looks like (Cathy sees a patient every 30 minutes, Saema caps hers at four) before building the case on insomnia: the three-nights-a-week, three-months definition and why distress matters more than the stopwatch, when a bad stretch is simply normal, the referral and access gap that can leave patients waiting six months, how insomnia takes hold through Art Spielman's three-P model, and whether you treat the sleep apnea, the mood and the insomnia all at once or one thing at a time. Shelby lands it with a plain-language tour of CBT-I. The deep dive into CBT-I's ingredients, the medication debate with Cathy and Saema, and how to taper are saved for part two.

Chapters: 00:00:00 - Introduction 00:02:32 - Catch-Up 00:04:37 - Circadian Confessions 00:12:05 - COVID and Circadian Shifts 00:16:01 - Chronotypes Across the Lifespan 00:18:50 - Chronotype vs. Diurnal Preference 00:21:52 - Melatonin as a Phase Marker 00:25:50 - Are Chronotypes Fixed? 00:35:58 - Daylight Saving vs. Standard Time 00:43:32 - Who the Clock Change Hurts 00:47:41 - The Sunshine Protection Act 00:49:42 - Advocacy and Closing Arguments 01:00:10 - Outro Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://newsletter.sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com Your body clock runs on genes you did not pick, then spends your whole life negotiating with your alarm. This episode is the panel's argument over how much of that is actually negotiable. Cathy Goldstein makes the case that your chronotype is essentially fixed, a genetic feedback loop you can nudge but never rewrite. Jesse Cook is not convinced, and pushes back that development, light and lived experience may leave the system more flexible than the textbook admits. It is the rare episode with a real, unresolved disagreement between four sleep doctors, and they let it breathe. Along the way: how circadian timing drifts from the ultradian newborn to the phase-delayed teenager to the early-rising older adult, why melatonin is both an honest phase marker and a slippery one (it moves with your behavior), and what Chuck Czeisler's non-24 sighted cases reveal about the gap between your clock and your schedule. Then the panel turns to the fight in Congress: the House passed the Sunshine Protection Act 308 to 117, sleep medicine wants permanent standard time instead, and the hosts take apart the marketing that makes "saving daylight" sound like a gift. School start times got teased and then saved for a future episode, so hold that thought.

Chapters: 00:00:00 - Introduction 00:02:25 - Clinic Check-In 00:05:50 - Circadian Confessions 00:13:40 - Plants to Molecular Clocks 00:24:36 - Desynchrony & Jet Lag 00:35:04 - Chronodisruption 00:44:32 - Phase Response Curves 00:56:00 - Chronotypes Preview 00:57:23 - Outro Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions. Subscribe to the newsletter: https://newsletter.sleep-show.com/ Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/ Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/ If you have any suggestions or questions, do reach out to us: sleep@it-bn.com The human clock keeps slightly bad time. It runs about 24 hours and 11 minutes, so every morning it has to be pulled back into line, mostly by light you never think about. This episode is the panel's tour of that machinery, from the first plant experiments of the 1700s to the molecular feedback loop ticking inside nearly every cell. After a round of circadian confessions, the hosts build the science: de Mairan's plants, Kleitman's 1938 Mammoth Cave study, the suprachiasmatic nucleus and the melanopsin that entrains it, the BMAL1/CLOCK loop behind the roughly 24.2-hour period, and the peripheral clocks that fall out of sync when you fly the Atlantic. Then they get practical, and a little contrarian, about light at night (the bedtime screen delays sleep by minutes, not hours), shift work, jet lag, and the phase response curve that explains why mistimed morning light and bedtime melatonin backfire. Chronotypes and the Sunshine Protection Act are saved for part two.

Chapters:00:00:00 - Introduction00:02:24 - Catch-up00:03:51 - Subjective vs. Objective Sleepiness00:15:01 - Cataplexy in Narcolepsy Type 100:19:17 - Type 2 Narcolepsy vs. Hypersomnia00:24:46 - Medication Changes Before the MSLT00:31:04 - Orexin’s Role in Sleep-Wake Regulation00:40:46 - Behavioral Treatment for Hypersomnia00:49:00 - Treating Central Hypersomnolence00:51:31 - How Oxybates May Work in HypersomniaMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.Subscribe to the newsletter: https://newsletter.sleep-show.com/Follow us on LinkedIn:https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram:https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: sleep@it-bn.comMeasuring sleepiness has a mismatch problem. The Epworth can say one thing, the MSLT another, and the patient’s actual Tuesday something else entirely. Welcome to the narcolepsy borderland, where tidy diagnostic boxes quickly lose their edges.In this episode, the panel gets practical about the gray areas: separating narcolepsy type 1, type 2 and idiopathic hypersomnia; deciding when medication withdrawal before an MSLT creates more risk than clarity; and understanding what orexin, cataplexy and sleep inertia reveal about current classifications. They also cover modafinil, oxybates and CBT for hypersomnia, plus the less glamorous but essential work of managing caffeine, naps, time, workplace disclosure and family expectations.

An Epworth score says one thing. The MSLT says another. The patient, inconveniently for tidy diagnostic boxes, may say something else again. In this episode, the panel works through the gray zones of central disorders of hypersomnolence: why reported sleepiness and objective testing often diverge, what separates narcolepsy type 1 from the murkier boundaries between type 2 and idiopathic hypersomnia, and when medication withdrawal before an MSLT may create more risk than clarity. They also cover orexin, cataplexy, sleep inertia, modafinil, oxybates, CBT for hypersomnia and the practical work of treating the person when the diagnostic box refuses to stay tidy. Medical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911. Sponsor disclosure: This episode includes paid promotion from Wakix: https://wakixhcp.com/ The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show. Chapters:00:00:00 - Introduction00:02:20 - SLEEP 2026 Recap00:05:19 - Jet Lag & Circadian Adjustment00:06:50 - Caffeine and Sleep00:09:34 - Understanding Somnolence00:14:29 - Assessing Sleepiness and Fatigue00:26:14 - Sleep Apnea and Daytime Sleepiness00:31:07 - Starting and Supporting CPAP00:36:15 - Motivating Patients to Use CPAP00:40:22 - The Epworth Sleepiness Scale00:46:17 - Multiple Sleep Latency Test00:58:37 - Outro Subscribe to the newsletter: https://newsletter.sleep-show.com/ If you have any suggestions or questions, do reach out to us: ​sleep@it-bn.com​ All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.