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Vision in the Desert | October 2010


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2010-10Barry Krakow, MD, PTSD Sleep Clinic founder, hopes the concept will catch on with others.

Is the Maimonides PTSD Sleep Clinic that opened in Albuquerque, NM, in March a vision of the future? Barry Krakow, MD, its founder, certainly hopes so.

The clinic exists inside Krakow's already well-established Maimonides Sleep Arts & Sciences Ltd sleep center and nightmare treatment clinic, but is unique by focusing specifically on treating sleep disorders in patients with posttraumatic stress disorder (PTSD).

The occurrence of sleep disturbances such as nightmares and insomnia is, of course, one of the diagnostic criteria for PTSD, and the PTSD Sleep Clinic offers the cognitive behavioral therapy and imagery rehearsal therapy that researchers, including Krakow, have shown can ease nightmares in PTSD patients. However, they also take a holistic view of patients and ask what other factors might be disrupting the patients' sleep, including sleep-disordered breathing, restless leg syndrome, or circadian rhythm disorders.

Incoming chronic insomnia patients routinely undergo a sleep study at Maimonides, and Krakow says approximately 70% end up having an apnea-hypopnea index (AHI) greater than 5 and another 20% have upper airway resistance syndrome. In other words, about 90% of insomnia patients present with some form of comorbid sleep-disordered breathing, a condition Krakow, along with fellow researcher Dominic Melendrez, termed "complex insomnia" in 2001. Krakow sees similar rates among incoming PTSD patients, which may explain why the standard approach to treating PTSD-related sleep disturbance was not working for them, and why many of these patients report so much frustration in working on their sleep problems with many well-intentioned PTSD therapists.

"We ask our new PTSD patients how they arrived at our clinic and it is not unusual to get the raised eyebrow or turned down lip that says, ‘Boy, you don't know what it took to get here,'" Krakow says.


Read full article at Sleep Review