The Classic SleepCast is a weekly blog dedicated to providing our patients with the latest in
sleep news and access to professionals who have dedicated their lives to this field.
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Barry Krakow, MD
Dr Krakow’s 27 years of sleep research have focused on the complex relationship between
physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical
center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.
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Janna Mantua is a PhD student in the Behavioral Neuroscience department at the University of Massachusetts. Her research focuses on sleep and aging, with specific projects on cognitive health, inflammation, memory formation, and neuroimaging. Prior to her PhD work, Janna was involved in research on sleep apnea and cognitive decline at the NYU Sleep Disorders Center.
In Chapter 8, Section 1, Dr. Park offers great tips on the critical issue of nasal patency. First, he reviews the medical or non-surgical approaches to the problem and then wades deeply into his bailiwick, the surgical interventions. And, we’ll discuss the whole chapter using the same format of highlighting some of his key pearls and occasionally providing our commentary. Dr Park unequivocally stresses the value of “keeping your nose clean.” He points out one of the most obvious factors, surprisingly overlooked by many sleep physicians; namely, when your nose is closed, your mouth is open. And, he incisively explains that even the use of a full face mask is no fail-safe method when nasal congestion issues are not adequately addressed. As much as his background began as an ENT surgeon, he clearly wants his patients to begin with medical or non-surgical interventions, because they often bring a high...Read more
We were delighted to receive an extensive reader comment on the blog article UARS, Depression, and Suicide Risks. We’ll insert the comments from the reader in italics and then follow with notes. I can’t emphasize enough how important this connection is. UARS is astonishingly underdiagnosed, maybe because there’s an insufficient recognition that deficiencies in specific stages of sleep (i.e., slow wave sleep) can occur with eight hours of sleep a night. Also, it’s well established but not well acknowledged that it’s incorrect to rule out UARS when snoring isn’t present: see Avram Gold’s work https://www.ncbi.nlm.nih.gov/m/pubmed/15164899/ I think your first point about deficiencies in sleep stages is valid because whenever irregularities in sleep architecture arise, the sleep physician should be suspicious that some pathophysiological disruption is occurring and breathing-related fragmentation would be the number one culprit to suspect. However, a much more common reason for the under-diagnosis of UARS is that...Read more
Why do you wake up at night? What causes these awakenings that prevent sleeping through the night? How do these middle of the night interruptions lead to insomnia, the prolonged episodes where you desperately desire sleep yet cannot catch one wink let alone forty? Most insomniacs imagine stress, an overactive mind, or a genetic background causes this vexing sleep loss. Remarkably, these questions had never been researched until Dr. Barry Krakow and his colleagues conducted a study on 20 classic insomniacs, all of whom believed their problems were due to stress, racing thoughts, or a genetic predisposition. In a landmark study, published in the journal SLEEP, they demonstrated 90% of awakenings experienced by these insomniacs were preceded by a disruption in their breathing while asleep. In effect, they found a major, and likely primary, cause for why people wake up at night and have continued to research and demonstrate this...Read more
Our paper on PTSD and PAP compliance was published last week, which provides me with the opportunity to delve more deeply into the nuances of the research paper. To my knowledge, this paper represents a milestone in demonstrating evidence of trauma survivors' ease of adaption and consistency with advanced PAP devices (e.g. ASV and ABPAP). There are many aspects of the paper that also relate to OSA/UARS patients in general and not just PTSD patients. So, as we delve into it, keep in mind the material may be relevant to many mental health patients using PAP therapy as well as those with more classic presentations of sleep apnea. The most difficult aspect in organizing a retrospective chart review of this type, which was the research design for this study, is the need to avoid cherry-picking the data that might make something appear more effective than it really is. Moreover, because our study was not with a sophisticated...Read more
In Chapter 7, Dr. Park adds “More Helpful CPAP Tips.” He covers several key factors such as cleaning your PAP equipment, travel tips, battery back-ups, situating your device in the bedroom, and how to manage your PAP device in the hospital should you be undergoing surgery. These were covered so well, I have no further comments. In the second half of the chapter, Dr. Park delves into other clinically relevant situations and factors, which we will discuss here, using the same format of highlighting some of his key pearls and occasionally providing our commentary. 1. Re-check or re-calibrate PAP pressures This area is of great interest, because it raises the question about what to do when the response is changing. Is the machine defective and needing re-calibration to confirm pressure settings are accurate and doing the job they are supposed to do? Or, has something changed necessitating a more thorough...Read more
In Chapter 6, Dr. Park addresses the top 15 questions he is asked most frequently or which arose in the past five years during his extensive work interviewing experts in the field and in his own teleseminar series Ask Dr. Park. We’ll list each of these topics, note Dr. Park’s pearl, and where relevant add a pearl of our own. 1. Dry Mouth Switching to a full face mask or applying a chinstrap are good options, and we would add that a substantial proportion of patients must use them simultaneously. We have also found RemZzzs mask liners solve the problem in some cases when the individual rests their lips against the bottom and wider half of the liner. Dr. Park also points out the necessity how for finding the correct humidification level for some cases of dry mouth. 2. Mask Leak He covers many key points here, some usually not...Read more
The AASM recently published a draft for new guidelines on the use of PAP therapy in order to spell out in reasonable detail the evidence that should steer sleep professionals in their efforts to treat OSA patients who use PAP. Because the process of developing guidelines is typically constrained by the premise that only high level evidence can be included in such consensus-style documents, the ensuing recommendations always end up with a fairly conservative tone. As the best example of this process, STRONG recommendations mean the evidence is very solid, whereas CONDITIONAL recommendations are more tentative. Of the 12 recommendations summarized at the beginning of the 63-page paper, only 4 fit the strong category and the remaining 8 are conditional. Quoting from the paper: “A CONDITIONAL recommendation reflects a lower degree of certainty in the appropriateness of the patient-care strategy, requires that the clinician use their clinical knowledge and experience,...Read more