I recently spoke with on NBC 10's dramatic reality weight-loss program, The Biggest Loser. His facility, Advanced Sleep Medicine Services, is the show's official provider for sleep testing.

Many contestants come in weighing 350 or 400 pounds with sleep studies revealing an apnea-hypopnea index of more than 100 and desaturation levels in the 50s or 60s, he said. But by the time they leave, those stats show a dramatic change.  

"You CPAP them, improve their lifestyle, they lose the weight, we test again and boom, their health is remarkably better," Dr. Mostafavi said. "I'm a pulmonary and sleep specialist so I've done my share of helping people and saving lives, but this is an amazing thing."

He also believes the show's choice to involve sleep specialists has had a dramatically impact on viewers at home who suffer from obstructive sleep apnea. "Patients come in and say, ‘Oh I saw you what you did for the people on The Biggest Loser, do it for us,'" Dr. Mostafavi said. "People see it, they believe it, and other than education, it sparks enthusiasm in people to seek attention for sleep apnea - that awareness wasn't there five years ago."

So how does a sleep facility become the to-go choice for a primetime network show? It's all about the quality, according to Dr. Mostafavi, who's been implementing the newest technologies in sleep medicine since 1990 when the specialty was not nearly as widely recognized. He has remained at the forefront of sleep medicine by teaching, researching, and practicing new concepts.

In our last e-newsletter, I included a link to download another patient handout on Sleep Testing in Your Own Bed (pdf)  in place of the link to this handout. It's one of ten great patient resources in our growing Sleep Patient Primer Center, but not the one subscribers expected.

So, for those of you still looking for a patient handout on Replacing Your CPAP Mask and Accessories, here it is (pdf).

My thanks to reader Ted Gress, RRT, for kindly pointing out my mistake. If you have comments on any of our website or e-newsletter content, please be in touch. You can reach me at kziegler@advanceweb.com.

And if you don't receive our twice-monthly e-newsletter and would like to join those learning about new ADVANCE content first, sign up by clicking here and scrolling down to enter your name, email address and zip code under the "Free E-newsletter" area on the right.

West Virginia's lack of sleep, about double the national rate, might be a side-effect of health problems like obesity, experts reported. One in five West Virginians reported they did not get a single good night's sleep during the previous month. On a national scale, the numbers are about one in 10.

Also high on the sleepy side were Tennessee, Kentucky and Oklahoma.

The best sleep patterns: North Dakota where only one in 13 residents reported sleep woes and Hawaii where 36 percent of residents reported they were fully rested every day.

Reasons for the lack of sleep were not part of a telephone survey of 400,000 Americans (at least 3,900 in each state). Nor did the survey try to determine the hours per night people slept or reasons for any sleep disruptions.

"We didn't ask: ‘Why didn't you get enough rest or sleep?'" said Lela McKnight-Elly, an epidemiologist for the Centers for Disease Control and Prevention, who led the study.

Experts point to several problem areas that might contribute to loss of sleep: obesity, smoking, heart disease, and disabilities. "You would expect to see poorer sleep within a chronically diseased population," noted Darrel Drobnich, of the National Sleep Foundation.

Fiscal stressors and odd-hour work shifts might play a contributing role, added Ronald Chervin, MD, a University of Michigan sleep disorders expert.

That may partially explain why West Virginia residents are so stressed out: The state is an economically depressed area with tens of thousands of people working in coal mining, according to CDC officials.

This study also mirrored earlier research that found women are more likely to have sleeping problems than are men and blacks are more likely than whites or Hispanics to get less sleep, officials reported.

States you may expect to have high stressors to disrupt sleep patterns-California and New York with their large, stressed out cities-were actually better than average as was the state of Washington, the setting for "Sleepless in Seattle."

According to the survey creators, seven to nine hours of sleep each night is recommended. About a third of the participants reported they were fully rested every day. And in every state, the majority of the respondents reported a mix of nights when they got enough sleep and nights they did not.

This exceptionally large study adds to the growing body of knowledge that helps define and quantify healthy sleeping patterns in the nation.

While polysomnographers center much of their attention to detecting sleep apnea, especially among more rotund patients, increased duties sometimes center on prevention of other diseases.

For example, an inadequate amount of nightly sleep on a recurring basis may help fuel the development of diabetes, according to the results of a study in the Journal of Clinical Endocrinology and Metabolism.

That study, conducted by Plamen Penev, MD, of the University of Chicago, found inadequate sleep, coupled with a sedentary lifestyle and overeating, could lead to diabetes.

As part of the study, Penev and associates, subjected 11 healthy but sedentary participants to two 14-day periods of sedentary living with free access to food and either 5.5 hours or 8.5 hours of sleep per night.

As sleep times changed, participants went to bed later and got out of bed earlier, with the average sleep reduced by about two hours a day.

When bedtimes decreased from a healthy 8.5 hours to 5.5 hours of sleep, participants showed changes in responses to two common sugar tests. Results were similar to those seen in people with an increased risk of developing diabetes.

"If confirmed by future larger studies, these results would indicate that a healthy lifestyle should include not only healthy eating habits and adequate amounts of physical activity, but also obtaining a sufficient amount of sleep," noted Penev.

In the meantime, polysomnographers can use this type of information as a means of enticing their patients to comply with CPAP use. Typically sleep education concentrates on prevention of heart attacks, high cholesterol, stroke or accidents through the use of CPAP therapy. But there is no reason it cannot be used in relationship to preventing other diseases like diabetes often associated with excessive weight.

The study also opens the door for polysomnographers to participate in various type of investigational sleep studies beyond detection of sleep apnea-related concerns.

Why is this important? Because they are in the sleep business, polysomnographers are sometimes asked questions about insomnia, which impacts a sizeable population.

Here is some advice from Sleep Holistic Online for using food and diet to curb insomnia.

Among foods that will promote sleep naturally are chlorophyll-rich foods like leafy, green vegetables (either steamed or boiled). Microalgae like chlorella and spirulina can be used as can oyster shell, available at health food stores as a nutritional supplement.

Whole grains: whole wheat, brown rice and oats have a calming and soothing effect on the nervous system and the mind and boost serotonin to promote better sleep.

Not to be overlooked are mushrooms of all types and fruits, especially mulberries and lemons. Jujube seeds are used to calm the spirit and support the heart while chia seeds have a sedative effect. Add to this dill and basil.

Warm milk laced with honey is one of the oldest and best remedies for insomnia. Milk contains tryptophan which induces sleep and prevents waking.

Surprisingly, lettuce ranks high in promoting sleep due to an opium-related ingredient that combines with traces of the anticramping agent hyoscyarnin to induce slumber. Holistic Online recommends lettuce be eaten regularly as part of the evening diet and augmented by items like legumes, peanuts, nutritional yeast, fish, or poultry and by foods containing vitamin B3.

Just as important, there are things to avoid in both food and non-food groups: coffee, tea, spicy foods, cola, chocolate, stimulant drugs, alcohol, refined carbohydrates, additives and preservatives, and canned foods that yield toxicity or heavy metals.

Also avoid sugar and foods high in sugar and refined carbohydrates because they raise blood-sugar levels and can cause bursts of energy that disturb sleep.

It goes without saying that foods on the no-no list would be those likely to cause gas, heartburn or indigestion. In this category are fatty and spicy foods, garlic-flavored foods, beans, cucumbers and peanuts.

Meat products that are high in protein can block the synthesis of serotonin, making the individual feel more alert. And monosodium glutamate often found in Chinese food can cause a stimulant reaction in some people.

Avoid cigarettes and tobacco products. They contain nicotine, a neurostimulant that can cause sleep problems.

Among the best pieces of advice: eat a high-carbohydrate snack and avoid high-protein foods in the hour or two before bedtime. Suggested foods good for promoting slumber are bananas, figs, dates, yogurt, milk, whole grain crackers and grapefruit.

Finally, because the digestive system slows at night, it is harder for the body to digest late meals so eat lighter in evening hours.

Diabetes risk may be two to three times higher among people who have daytime sleepiness along with sleep apnea, note key researchers in the study. They believe daytime sleepiness may be a key factor, Reuters Health reported.

This study "raises the intriguing possibility that sleepiness (or sleep disruption) may have an independent effect on the risk for diabetes," noted Willis H. Tsai, MD, of Rockview General Hospital in Calgary, Alberta.

His team looked at associations between diabetes and OSA among 1,346 males and 803 females when they were about 50 years old.

Of this group, a full quarter had severe OSA (defined in the study as more than 30 bouts of disturbed breathing); 21 percent were without OSA (five or fewer sleep disruptions nightly). The remaining 54 percent were classified as having mild to moderate sleep apnea (defined as 6 - 29 nightly disturbances).

About 8 percent of participants reported they had diabetes; but those with severe OSA were more likely to have diabetes than others even when factors like age, weight, gender, neck circumference, and smoking status were considered.

But most importantly in their research, Tsai and colleagues isolated one key factor to consider: an increased risk for diabetes among severe OSA participants who also reported daytime sleepiness.

Researchers stress continued studies may be needed to confirm their finding of the link between the two.

If verified in other studies, the outcome may help doctors identify those OSA patients at increased risk for developing diabetes.

This study again demonstrates the importance of polysomnographer participation in sleep research to better aid in the overall health of their patients. And certainly in the current framework of health care reform debate, much attention has been given to prevention of diseases, especially chronic conditions like diabetes.

Women who reported shorter and poorer quality of sleep actually had longer and less fragmented sleep than did elderly men, researchers noted.

Dutch clinicians studied 956 male and female study participants ages 59 to 97 years old. They were asked to wear an actigraph and keep a sleep diary for six consecutive nights.

Women typically reported a shorter sleep time, an increase in the time it takes to fall asleep, and poorer sleep efficiency and quality compared to the men.

And the data show (drum roll, please): Nonsense.

Actigraphs recorded data showing the women slept longer than the men and with fewer disturbances.

Researchers found that men actually overestimated the amount of sleep they got and the quality of sleep.

Males claimed to get seven hours of sleep, when in reality they got only six and a half hours.

Is this just part of a male trend toward overplaying their health status? Is this part of a cultural phenomenon showing the differences between the two sexes? And does that same trend to over-report or under-report exist among younger males and females? New studies may reveal more in the future.

Do a quick check of your spouse and try to determine whether what they say is accurate. But remember, these data will come from the same spouses who claim not to snore.

While polysomnographers center much of their attention to detecting sleep apnea, especially among more rotund patients, increased duties sometimes center on prevention of other diseases.

For example, an inadequate amount of nightly sleep on a recurring basis may help fuel the development of diabetes, according to the results of a study in the Journal of Clinical Endocrinology and Metabolism.

That study, conducted by Plamen Penev, MD, of the University of Chicago, found inadequate sleep, coupled with a sedentary lifestyle and overeating, could lead to diabetes.

As part of the study, Penev and associates, subjected 11 healthy but sedentary participants to two 14-day periods of sedentary living with free access to food and either 5.5 hours or 8.5 hours of sleep per night.

As sleep times changed, participants went to bed later and got out of bed earlier, with the average sleep reduced by about two hours a day.

When bedtimes decreased from a healthy 8.5 hours to 5.5 hours of sleep, participants showed changes in responses to two common sugar tests. Results were similar to those seen in people with an increased risk of developing diabetes.

"If confirmed by future larger studies, these results would indicate that a healthy lifestyle should include not only healthy eating habits and adequate amounts of physical activity, but also obtaining a sufficient amount of sleep," noted Penev.

In the meantime, polysomnographers can use this type of information as a means of enticing their patients to comply with CPAP use. Typically sleep education concentrates on prevention of heart attacks, high cholesterol, stroke or accidents through the use of CPAP therapy. But there is no reason it cannot be used in relationship to preventing other diseases like diabetes often associated with excessive weight.

The study also opens the door for polysomnographers to participate in various type of investigational sleep studies beyond detection of sleep apnea-related concerns.

Obstructive sleep apnea (OSA) may represent a novel risk factor for metabolic syndrome (MS) and diabetes, and polysomnographers should be encouraged to systematically evaluate the presence of metabolic abnormalities in OSA and vice versa, according to a study published last year in American Thoracic Society proceedings

MS--a commonly used term for the clustering of obesity, insulin resistance, hypertension and dyslipidemia--affects millions of people worldwide and is associated with an increased risk of cardiovascular diseases and type 2 diabetes.

Recently Esra Tasali, MD, of the University of Chicago, and colleague Mary S. M, Ip suggested that OSA may contribute to the development of MS and diabetes.

Despite substantial evidence from both clinical and population studies to suggest an independent link between OSA and metabolic abnormalities, the issue remains controversial.

As polysomnogoraphers know, obesity remains an important factor in the assessment of adverse metabolic outcome in OSA.

But prospective and interventional studies and randomization and control for any therapeutic intervention are clearly needed to address causality, the researchers noted.

There appear to be multiple mechanistic pathways involved in the interaction among OSA, obesity and metabolic derangements, they point out. Chronic intermittent hypoxia and sleep fragmentation in OSA are likely key triggers to either initiate or contribute to the sustenance of inflammation as a prominent phenomenon. Nonetheless, their complex interplay still remains to be explained, they noted.

Sleep experts, frustrated by patients who do not comply with CPAP therapy for obstructive sleep apnea (OSA), may soon have a new surgical treatment option available.

ImThera Medical Inc. of San Diego, announced earlier this week it has completed development of what is calls a "Targeted Hypoglossal Neurostimulation" (THN) system as an alternative.

The serious need for an alternative therapy cannot be denied. Polysomnographers typically find up to 50 percent of their patients do not comply with CPAP prescriptions. THN was developed as a surgical option to the growing number of Americans being diagnosed with OSA.

Here's how it works: THN sleep therapy delivers neurostimulation to the hypoglossal nerve to control certain muscles of the tongue. Using a multi-contact electrode and a programmable implantable pulse generator (IPG), the system delivers muscle tone to key tongue muscles to prevent the tongue from collapsing into the upper airway during sleep cycles.

The technology involved includes use of a small multi-current source IPG operating in continuous, open loop mode delivering targeted stimulation.

The system was designed to increase the airway flow, permitting normal and restful sleep of OSA patients, according to company literature.

"With numerous OSA patients still lacking an effective treatment, other methods such as surgical therapies that specifically target the tongue are evolving and become very compelling," said Marcelo G. Lima, MBA, chairman, president and CEO of ImThera. His firm's sleep therapy will offer an alternative to help patients regain quality sleep, he added.

THN technology is currently not available commercially because the firm is currently performing required safety and efficacy tests. But already, ImThera has successfully completed animal trials and human subject engineering experiments and is now preparing for human clinical trials in various European nations and in the U.S.

THN system is expected to help moderate-to-severe OSA patients who cannot or will not comply with CPAP. One of the principals in the firm is Lima who has an extensive 25-year background in medical equipment design. His previous work has been with Siemens Medical, Johnson and Johnson, Kodak Health Imaging and Hewlitt- Packard.

It is hoped the technology will soon find its way into the sleep lab marketplace where it is needed by many of the 800,000 people-mostly males--annually diagnosed with OSA.

Even if you are a sleep professional and watched the two-hour season premiere of The Biggest Loser earlier this week, you still may have missed some vital components taking place behind the scenes of the show.

All contestants on that show now get tested for obstructive sleep apnea; and it is making a world of difference for the contestants, according to the sleep experts.

"I have put in place a new policy that all contestants need to undergo a sleep study," explained Robert Huizenga, MD, medical expert for the show. He oversees the treatment of contestants and appears on the show itself.

"The results have been astonishing after two seasons of testing. Over three-quarters of contestants tested have needed sleep therapy while on the show," he explained.

Helping in the process in consulting roles are Royal Phillips Electronics and Respironics.

An estimated 18 million Americans have OSA, the majority of whom remain undiagnosed and untreated. Obesity is a risk factor. OSA has also been associated with increased risk of hypertension, heart failure, stroke, atrial fibrillation and Type 2 diabetes, as all polysomnographyers know.

Diagnosis takes place during pre-season preparations at Advanced Sleep Medicine Services Inc. facilities in California.

The results showed that all 16 contestants for the current season had sleep apnea at the beginning of the season. Huizenga and Clete Kushida, MD, of Stanford University Medical Center provided testing, diagnosis, treatment, therapy and medical equipment to contests competing in the show's eighth season.

After the testing, Drs. Huizenga and Kushida began work with each individual to administer and oversee the appropriate treatment. During their time on The Ranch, personnel consult with the contestants. Philips Respironics facilitated the entire process and provided advanced technologies and patient interfaces.

Among equipment used are masks, PAP and diagnostic equipment including sleep recorders, ambulatory digital pulse oximeters, and sensors.

The Biggest Loser challenges and encourages overweight contestants to shed pounds and become healthier. The unscripted and life-altering reality series gathers contestants from across the country to face real-life temptations while being provided with approved weight-loss skills and resources.

Contestants work out under the supervision of professional trainers Jillian Michaels and Bob Harper. The series is a worldwide hit airing in more than 90 countries and produced now in 25 countries.

The fact that sleep experts are in on the action is a tribute to the growing importance of the day-to-day work of polysomnographers who form a first line of defense in overturning OSA problems.

With the goal of establishing a tiered credentialing system in sleep technology and enhancing the professional growth of the field, the Board of Registered Polysomnographic Technologists now will offer the CPSGT, a certificate-level exam. A certificate holder will be a Certified Polysomnographic Technician.

The new certificate will not be a prerequisite to sitting for the RPSGT exam, but rather is being offered as an entry-level certificate for those entering the sleep field, the BRPT stated.

The CPSGT will be offered for the first time in March 2010. The certificate will be time-limited and valid for 36 months, within which time a certificate holder must earn the RPSGT credential, or the CPSGT certificate expires.

Readers- What do you think? What does this mean for the future of the sleep profession? And would you consider taking the CPSGT exam?

Read the BRPT's full news release here.

MSNBC specified that homicide means Jackson died at the hands of another, but it doesn't necessarily mean a crime occurred. While Dr. Conrad Murray's pharmaceutical treatment for Jackson's insomnia may or may not be considered murder, it was certainly medically negligent and obviously lethal.

According to the document released from the police investigation, Dr. Murray had been treating Jackson for insomnia for about six weeks with 50 mg of propofol every night via an intravenous drip. Because he feared Jackson was developing an addiction, he said he attempted to wean him by lowering the dose to 25 mg and adding sedatives lorazepam and midazolam.

According to the affidavit, Dr. Murray administered a cocktail of sedatives to Jackson the day he died, which MSNBC detailed in this timeline:

1:30 am: 10 mg tablet of Valium
2 am: 2 mg of lorazepam intravenously.
3 am: 2 mg of midazolam intravenously.
5 am: 2 mg of lorazepam intravenously.
7:30 am: 2 mg of midazolam intravenously.
10:40 am: 25 mg of propofol intravenously, diluted with lidocaine
10:50 am: Doctor leaves Jackson's room; returns minutes later to find Jackson not breathing. Begins CPR and gives 0.2 milligrams of flumazenil, used to reverse sedatives.

The article quoted Lee Cantrell, director of the San Diego division of the California Poison Control System, as saying it's perplexing that a doctor would administer various benzodiazepines if one was found not to be effective. He also said, "No one will treat an insomniac like this."

Do you think high-profile deaths like Michael Jackson's and Heath Ledger's, which involved misuse of prescription sedatives will bring more attention to pharmaceutical safety? Or are they just additional examples of prescription abuse and poor insomnia treatment in this country?

A long-time viewer of the show, Payne realized many of the contestants were at risk for OSA. So he wrote a letter to Robert Huizenga, MD, who oversees the participants' medical care. The show liked his idea and agreed to do sleep studies on the 22 contestants from last year. With the help of Philips Respironics, they found that 16 of them had OSA.

The news gets better.

"I no longer will accept any contestant on the show without a sleep study," Dr. Huizenga told a reporter. "Even I, with a very high index of suspicion, would have missed multiple cases of OSA (without the sleep studies), putting contestants at risk for adverse health consequences and at a huge disadvantage for optimal fat loss.

• The A-STEP Introductory Course requirement for Pathway #2 RPSGT exam candidates (previously set to go into effect July 2010)
• The requirement for all RPSGT candidates to graduate from a CAAHEP program (previously set to go into effect July 2012).

The BRPT also announced a new pathway for RPSGT exam candidates with minimum nine-month PSG experience and completion of both A-STEP Self-Study Online Modules and A-STEP Introductory Course.

"It is important to emphasize that the change in the 2010 and 2012 educational requirements for exam eligibility in no way reflects a step way from our commitment as a credentialing body to the development of strong educational pathways to the RPSGT credential," stated BRPT President Becky Appenzeller, RPSGT, REEGT, CNIM.

To read her full letter, click here. For a chart to RPSGT exam pathways and eligibility requirements, visit here.