Knock Knock, Hi! with the Glaucomfleckens

This week we sit down with Dr. Chris Allen, board-certified sleep medicine physician, board-certified pediatric neurologist, and a man who has been on CPAP therapy for 22 years. We cover how a sleep study actually works, the real misconceptions around sleep apnea, why CPAP isn't the only treatment option, and what the difference is between a home sleep test and a full in-lab polysomnogram. Oh, and we get into parasomnias, which is the fancy medical word for "doing things in your sleep you shouldn't be doing", a category that, as Kristin helpfully reveals, includes me putting on dress pants in the middle of the night and getting back into bed. We also go deep on kids and sleep. Turns out a lot of children diagnosed with ADHD actually have undiagnosed sleep apnea, and treating it can change everything. Plus night terrors , revenge bedtime procrastination, neurodivergent sleep challenges, and why your brain isn't actually out to get you, it just really needs you to stop scrolling. Chris also has a children's book called Sweet Dreams, which is his personal story adapted for kids, and it's exactly the kind of advocacy that makes this stuff actually land. Takeaways: Snoring is never normal, it always means your airway is partially obstructed during sleep, and while it doesn't automatically mean sleep apnea, it's always worth asking the questions. Sleep apnea isn't just a "big guy" problem, anyone can have it regardless of body size, it affects women at the same rate as men after menopause, and in children it often shows up as inattention, hyperactivity, and moodiness that gets mistaken for ADHD. CPAP is great but it's not the only treatment, there are multiple ways to treat obstructive sleep apnea depending on your anatomy, age, and situation, so don't let the Darth Vader mask reputation scare you away from getting evaluated. Parasomnias like sleepwalking, night terrors, and confusional arousals are all under one umbrella, they're common, they're often made worse by other untreated sleep disorders, and there are actual medications that can help if they're disruptive enough. Revenge bedtime procrastination is real and your brain chemistry explains it, caffeine blocks adenosine (your sleep hunger signal), screens suppress melatonin, and cortisol from daily stress keeps your fight-or-flight response lit, which is why 11 PM you keeps doing laundry instead of going to bed. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Heather Gatcombe, a clinical radiation oncologist at Emory, who immediately humbles me by explaining that her job involves a lot more than drawing circles on a screen, it involves medical physics boards, cancer biology exams, and oral evaluations with the world's leading subspecialty experts. I'm putting radiation oncology in my "insanely smart doctors" tier, effective immediately. But Heather isn't just here to talk about contouring tumors. When her son was in second grade, his teacher noticed he couldn't move half his body and called 911. By the time EMS arrived, he seemed fine. Thus began a five-year diagnostic odyssey involving genetic testing, a muscle biopsy, a "variant of unknown significance," and ultimately a diagnosis of mitochondrial disease, a mutation that disrupts the body's ability to produce energy at the cellular level and can affect, well, pretty much every organ system you've got. We get into all of it: what metabolic strokes actually are (an energy failure, not a clot), how heat, fasting, and illness can trigger a crisis, why the average time to diagnosis is a decade, and what happened when Heather's son arrived at the ER during COVID in acute heart failure and ended up on ECMO within 10 hours. He was 12. He received a heart transplant. He's now 17, knows his own body better than most doctors in the room, and asks for naps between soccer and his SATs. We also talk about what clinicians and patients can actually do to change the odds, including the United Mitochondrial Disease Foundation's mini-fellowship program at umdf.org. And yes, I finally admit the Krebs cycle is useful. The sad medical geneticist at the lunch table was right all along. Takeaways: Mitochondrial disease is a mutation that disrupts cellular energy production, affecting about 1 in 4,000 people, capable of impacting virtually any organ system, and taking an average of 10 years to diagnose in adults because it presents so differently in every patient. A metabolic stroke is an energy failure, not a vascular event, a part of the brain simply runs out of fuel and shuts down, and it's treated with dextrose-containing IV fluids and IV arginine rather than clot-busting drugs. For patients with mitochondrial disease, managing triggers is everything, fever, fasting, dehydration, heat, certain anesthetics, and even intense cognitive or physical stress can all precipitate a metabolic crisis or stroke. Even having two physician parents and strong institutional connections didn't speed up the diagnosis, it still took five years, and for families without those resources, the average wait is closer to a decade, especially outside the Northeast where most of the 19 certified mitochondrial care centers are located. There's a critical shortage of mitochondrial disease specialists, and the UMDF is working to fix it, their mini-fellowship program at umdf.org is open to residents and fellows PGY3 and above across all specialties, because mitochondria are in every cell and every kind of doctor needs to know what to look for. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices