We’re back with another sleep story, this time highlighting a Jill-of-all-trades, a mother of three, a detail-oriented idea machine, and the queen of volunteer work in sleep medicine.
She’s a woman who is always ready to step up and step in when needed. Unafraid of a challenge, she’s passionate about finding ways to provide better sleep care both for her patient population in Fargo, North Dakota and in the greater sleep community. She was part of an award-winning team in the inaugural AASM Change Agents competition. And, she hosts one of the sleep industry’s best podcasts. If you haven’t guessed it by now, this month’s story features the one and only, Dr. Seema Khosla, MD, FCCP, FAASM.
The two had a bit of a heart-to-heart conversation. He explained what was happening, and she listened. Her main takeaway, and a moment she still thinks about often: he didn’t feel heard as a patient.
During the conversation with him, she was able to understand that he didn’t like the CPAP, and he really struggled using it. He felt like people wrote him off as lazy or stubborn. In remembering this patient, Dr. Khosla referenced the sleep team notes: he was non-compliant with CPAP. That’s all she could remember being listed.
At that point, she wondered out loud in our conversation, what does compliance really mean for patients?
Seema Khosla: Dedicated to Sleep Health
Seema Khosla, MD, is board certified in sleep medicine, pulmonary disease, critical care medicine, and internal medicine. Dr. Khosla has worked in sleep care for over 15 years, and currently serves as the medical director of the North Dakota Center for Sleep and is a Medical Advisor for MedBridge Health. Dr. Khosla’s role can be distilled into one driving mission: help people get better sleep. Like many sleep centers around the country, the primary focus for the North Dakota Center for Sleep is identifying and diagnosing sleep disorders. They perform sleep testing both in the lab (PSGs) and via home sleep apnea tests (HSATs). In her own words, “Our goal is to partner with our patients so that they have better sleep, which we really believe translates into better health overall,” said Dr. Khosla.The Lightbulb Moment
In the first years following her fellowship, Dr. Khosla was doing a lot of critical care work in Grand Forks, North Dakota. She remembers being in the ICU intubating a patient who was in with congestive heart failure. He also suffered from obstructive sleep apnea (OSA). He had a prolonged stay on the ventilator and underwent tracheostomy. Once he started getting better and she was getting ready to remove his tracheostomy tube, when she asked him, What’s the deal? Was it so hard to wear a CPAP? How did you wind up in this situation where you’re dying from untreated OSA? She really emphasized the word dying.
The two had a bit of a heart-to-heart conversation. He explained what was happening, and she listened. Her main takeaway, and a moment she still thinks about often: he didn’t feel heard as a patient.
During the conversation with him, she was able to understand that he didn’t like the CPAP, and he really struggled using it. He felt like people wrote him off as lazy or stubborn. In remembering this patient, Dr. Khosla referenced the sleep team notes: he was non-compliant with CPAP. That’s all she could remember being listed.
At that point, she wondered out loud in our conversation, what does compliance really mean for patients?
What Really is Non-Compliance in Sleep Medicine?
Non-compliance isn’t really the same for each patient. It changes for every person. People can be non-compliant for a lot of reasons. Dr. Khosla referenced many reasons a patient might be non-compliant that are completely outside of the realm of a “lazy person” who doesn’t like their CPAP. Instead, she emphasized that a lot of compliance issues are a direct result of a lack of proper access to care. For someone who doesn’t have access to a car, it’s hard to go anywhere. For someone who might struggle with claustrophobia, a CPAP can be triggering. For someone who’s not super technologically savvy, setting up a home sleep test can be overwhelming. For someone struggling with the CPAP airflows, a one-to-one conversation can mitigate a lot of fears. Dr. Khosla strongly advocates that better patient education is the answer, but also that perfection isn’t always achievable. Sometimes, better than before is the best case scenario.“In many cases, patients and clinicians need to be willing to accept that their sleep apnea might not be treated perfectly, but their sleep is better than it was,” said Dr. Khosla. “It’s also about aiming our sights at goals down the road, rather than being perfect the first week of therapy.”
Compliance isn’t a Race with a Finish Line
Dr. Khosla went on to highlight the importance of continued progress when it comes to therapy for sleep apnea and other sleep disorders. Risk-reduction is extremely important in the cases of many OSA comorbidities, so limiting your exposure to challenges is important. She recommends understanding patient personal risk factors, and encouraging patients to take actions to modify and mitigate that risk. Per Dr. Khosla, the most effective actions are weight reduction, exercise, or a change in sleep timelines. In other cases, a person’s shift work, specifically overnight shifts, can be detrimental to their health. Sleep providers really need to be willing to slow down, and understand each individual patient’s needs. Dr. Khosla sums it up best:“Right now, patients need sleep physicians to really, truly partner with them instead of being dismissive and writing them off,” she said. “That really made me realize and recognize that we need to be much better about treating this in the outpatient world before people come into the ICU.”
The Role of Clinicians and Techs in Patient Compliance
Sleep professionals are human. We all have off days. For sleep physicians and technologists, an off day impacts more than just yourself. Some days, connecting with a patient is difficult. Other days, personal life matters seep into the workday. It’s not ideal, but it happens, and ultimately, the people who experience the consequences of these actions are the patients. Dr. Khosla emphasized the importance of bringing her A-game each day, especially when the best approach to improving sleep health in a patient population is a proactive approach. Her big focus? Make sure patients receive a STOP-Bang test or an Epworth Sleepiness Scale. Double check appointments and timelines with patients to ensure lower no-show rates for testing. And, come to work every day with an open ear for your patients. While serving her patients is her primary focus, the regular 9-5 is just where Dr. Khosla gets warmed up.Talking Sleep, the Premiere AASM Sleep Industry Podcast
If you’re a consumer of sleep medicine content, you’ve likely caught an episode or two of the Talking Sleep podcast. The podcast follows the ever-evolving field of sleep medicine. A podcast of the American Academy of Sleep Medicine (AASM), the series aims to keep up on the latest developments in the practice of clinical sleep medicine and sleep disorders. Dr. Khosla is the host of the podcast which caters to sleep clinicians, physicians, and occasionally the engaged sleep patient. “We really want to be doing something different with each episode, so we’re very receptive to people reaching out to us with topics,” noted Dr. Khosla. The host and guests all volunteer their time and the AASM produces it as a free resource for anyone who wants to listen. For Dr. Khosla, there’s a decent amount of preparation and execution work, including an hour pre-podcast interview to understand the messaging and talking points that the guest will want to cover. This pre-interview takes place about a week before each show is recorded, and gives both Dr. Khosla and the scheduled guests a good chance to connect on the upcoming topics. Dr. Khosla and the team also want to make sure there is enough “meat on the bones” to make a topic worth the time for the listeners. When asked about a favorite, she couldn’t pick just one, rather stating, “The latest one is always my favorite one.” With that in mind, there are two recent episodes that are worthy of a listen.Talking Sleep Episodes to Catch
In an April 2021 episode titled “Artificial Intelligence in Sleep Medicine,” our President and Co-founder Sam Rusk was interviewed, along with fellow AASM AI committee member Dr. Anuja Bandyopadhyay. The three engaged in a riveting discussion on AI’s past, present, and future impact on sleep medicine. Another recent episode that Dr. Khosla cited as a particularly popular topic, “Diversity, Equity, and Inclusion in Sleep Medicine,” generated a lot of buzz from the community of sleep clinicians who make a habit of listening to the podcast. No matter the topic, Dr. Khosla and the AASM want to provide insightful, educational, engaging conversations, and the growing audience has responded well. “I think our community is very supportive,” said Dr. Khosla of the Talking Sleep audience. “I think sleep medicine people are very kind hearted, easy to talk to, and interested in a lot of different topics, and I love that.” She’s excited and honored to be part of the team bringing these insights to the sleep medicine community. If you haven’t before, now may be the right time to give Talking Sleep a listen.
Volunteering with the Dakota Sleep Society
Dr. Khosla also volunteers with the Dakota Sleep Society (DSS). The sleep society which brings both North and South Dakota sleep clinicians together, is one of the younger sleep societies in the nation. The DSS is also set to host its first ever virtual society conference, coming up in late September. The one-day event on September 25th is a great opportunity for sleep technologists and other sleep professionals to earn their CEUs. In launching the inaugural DSS Conference, the planning team partnered with the Dakota Medical Foundation,. This is an organization that also underwrites the expenses of her favorite local non profit Lend A Hand Up – a program that supports local families in times of medical crisis. Dr. Khosla is excited to both give the Dakota sleep professional community a needed local (albeit virtual) conference to talk about today’s major sleep challenges and opportunities. You can learn more about the event on the DSS website, which Dr. Khosla made in her free time during the pandemic, of course! What can’t she do? Register for the event online. The goals of the conference are twofold: provide actionable takeaways for sleep professionals, while at the same time, give techs, RTs, and others a chance to share information, receive education, and learn about new things happening in sleep medicine. Beyond organizing and advocating for the event, Dr. Khosla will also be speaking at the virtual conference. Her topic, “Non-PAP Treatment Options for Patients,” is expected to be a highly attended discussion. Another pair of exciting topics will be the CCSH credential discussion from our own Andrea Ramberg, and an insightful DME discussion about documentation pitfalls and how to make life easier for both patients and staff from Linda Skiple. Dr. Khosla is particularly interested in hearing the talk about the scoring changes of REM behavioral events (RBE) and RBD, being presented by Tara Vander Laan.MySleepVillage Project Set to Take Flight
The final volunteer effort of Dr. Khosla’s that we’re highlighting today gained a lot of attention at this year’s Sleep Disruptors Change Agents Event. Dr. Khosla worked with a power-packed team of engaged sleep professionals on the MySleepVillage project for the inaugural AASM Change Agent competition. Composed of Rachel Marie E. Salas, MD, Med; John Mathias, BS; Barry Fields, MD, MSEd; Robert Miller, RPSGT, RST; Jaspal Singh, MD, FAASM., and Dr. Khosla, the team’s goal is to find a better solution to the sleep education challenge and improve the sleep health of their communities. More specifically, to create a platform to better educate all patients on their unique sleep experiences with a library of educational resources for patients and providers alike, which can provide answers to common questions, like:- What to expect during a sleep study?
- When will my results be available?
- What are my options for treatment?
- What can I do if I’m having CPAP issues?
MySleepVillage Community Centers and Sleep Forums
On top of these resources, the MySleepVillage is also designed to have community centers, which will serve as live forums. These community centers will have meetings for different groups of people with similar sleep disorders and complications. They’ll also provide opportunities for regular Q&As with experts in non-threatening settings, and without the costs associated with making an appointment with your personal care provider. “The goal of the MySleepVillage is to let the patient be the boss of the equation,” said Dr. Khosla. She noted the American healthcare system’s tendency to focus on the physician’s timeline and schedule, as healthcare professionals are stretched ever more thinly and hiring is more complicated than ever. This puts the doctor’s timeline ahead of a patients, and MySleepVillage is aimed to flip the script. “The Village is all about partnering with a patient. If they feel that they need more time before they’re ready for a visit, it may be more about education,” she added. The goal is creating a patient-friendly experience. Dr. Khosla noted that the site is primarily built for people the medical world has failed. If you follow the typical path, get on your CPAP, and see success, Dr. Khosla said that this site isn’t necessarily for you. But, if patients have a diagnosis of OSA and have challenges with therapy, education can be crucial. In an ideal world, Dr. Khosla imagines the community centers will have weekly topics of discussion, but also more forums for detailed, unique questions.The Launch is Coming
Even thoughMySleepVillage was a Change Agents award second-place winner, there are still hurdles to overcome before the site can officially launch. You can sign up to receive an email alert when it goes live on their tentative site, but the resources and community center forums are not yet ready for launch. That day can’t come soon enough for Dr. Khosla and the team. As you can tell from her dedication both professionally with the North Dakota Center for Sleep, a MedBridge Healthcare affiliate, and as a volunteer with the AASM (Talking Sleep and various committees), and the Dakota Sleep Society, Dr. Seema Khosla is doing everything she can to improve the sleep quality of patients everywhere. Why? The same reason we all work in this business.“Sleep is not something that only some people need,” she said. “Everybody needs to sleep. Even if you don’t have a sleep disorder, I think it’s beneficial for all people to have some guidance on how to sleep better.”Thanks to Dr. Khosla for taking the time to meet with our team and discuss a variety of entertaining topics in this month’s sleep story. It was one of our favorites so far. To read any of our other stories, click one of the links below:
