Expert Interview: Dr. Barry Krakow on Complex Insomnia, UARS, & PTSD
With Dr. Steven Park - November 30th, 2010
Albuquerque the Magazine has released their 15th Annual TopDocs issue.
Dr. Barry Krakow is one of the most well respected and liked sleep doctors in the city for good reason. He’s extremely knowledgeable, and he makes sure he stays that way by keeping up on all of the newest technologies in this quickly evolving field. But he also helps patients deal with every sleep related issue they might have, from sleep apnea, to headaches, to nightmares.
Susan M. Smith, a longtime patient of Dr. Krakow’s says:
"It was approximately 10 years ago that I had a consultation with Dr. Krakow. I was very nervous meeting with him. He scheduled a sleep study for me and his staff helped me set it up. Since then, I have been to several additional sleep studies.
Dr. Krakow took the time to help me understand why I had problems sleeping at night and had sleep apnea. He also helped me learn why I had bad headaches every morning. It turns out that my oxygen was low at night and Dr. Krakow quickly put me on three liters of oxygen at night. He ordered a C-Pap machine and still helps me get new and updated C-Pap machines.
Dr. Krakow was instrumental in helping me deal with my constant nightmares. He provided films and books that include information to help with my condition. This alone has been a big help.
Also, I am very claustrophobic and had a lot of concerns about wearing a mask [the C-Pap machine]. But he was able to help me feel at ease. He helped me with my anxieties with some of these films he had me watch.
Dr. Krakow and his staff were always available to answer my questions and concerns. I was always treated well and in a professional manner. When there was any new technology on C-Pap machines I was always on their list to get new technology. I always felt that my wellbeing was Dr. Krakow's top concern. All these things have had a profound effect on my quality of life. I will always be so grateful to Dr. Krakow and his staff."
With Dr. Steven Park - November 30th, 2010
Military personnel returning from wars in Afghanistan and Iraq show increasing rates of post-traumatic stress disorder (PTSD) and post-traumatic nightmares. Media coverage of these two vexing mental health conditions is also intensifying and raising public awareness about the need for more effective therapeutic options. With growing attention focused on patients with nightmares, sleep centers have an opportunity to engage these patients. Successfully doing so hinges on applying a standard of care for nightmare assessment and treatment through behavioral sleep medicine specialists.
In the years ahead as health care reform invades, infects, or inspires (take your pick) the medical community toward new models of practice, sleep medicine physicians and technologists must discover innovative treatment pathways. Currently, the most widely used sequence begins with a patient-physician clinic appointment to assess sleep complaints and develop a plan, which typically moves through testing in the sleep lab to long-term use of positive airway pressure therapy (PAP-T).
How effective is this system? Not so impressive judging by PAP-T adherence rates often hovering above 50%.
The highest-profile quick-fixer may be Barry Krakow, MD, founder of the PTSD Sleep Clinic at the Maimonides Sleep Arts & Sciences center in Albuquerque, New Mexico. Krakow champions an approach called imagery rehearsal therapy (IRT), based on the notion that by actively rescripting our dreams through visualization, we can change their narratives after we fall asleep. Whether they’re freshly returned Iraq vets or desperate housewives, patients who suffer from nightmares (usually a product of post-traumatic stress, but also a result of my type of “run-of-the-mill anxiety,” he tells me by phone) or disorders such as sleep apnea spend nights at Krakow’s four-bedroom clinic and undergo group and individual therapy sessions over the course of a few weeks. Patients articulate their bad dreams and then, with Krakow’s encouragement, repeatedly reimagine them, often in a different light. If a young soldier dreams of being chased by the plumes of an exploding IED, for instance, she might picture instead the breeze of the Pacific or even the cold blast of an air conditioner—whichever she finds most soothing.
The Sleep and Human Health Institute (SHHI) was awarded a grant to study one of the most controversial aspects of Chronic Insomnia. Conventional wisdom connects insomnia to psychological factors -- stress, racing thoughts, and worries -- and is usually treated with sleeping pills or talk therapy. Pitted against the CW is the provocative theory that a large percentage of Chronic Insomniacs suffer from Obstructive Sleep Apnea (OSA), a physical breathing problem that might cause unwanted or unexpected sleeplessness.