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.
One of the most interesting sessions I attended in Baltimore delved into the impact of sleep disorders in mental health patients. As I’ve repeated, ad nauseum, how we specialize in mental health patients with sleep disorders, this topic naturally piqued my curiosity, and it did not disappoint. Three main speakers covered specific topics often including case report information, and a fourth served as a discussant; this final speaker also brought up hypothetical cases to review to integrate the material from the earlier speakers. The three speakers gave very thoughtful and detailed lectures, all of which pointed to the imperative to closely examine the nature of the sleep disorders in various psychiatric patients. The first presentation was entitled, “Common Psychiatric Conditions in Adults who Present with Sleep Problems.” This talk presented by Dr. Sam Fleishman set the table by clarifying the need to realize that sleep symptoms—all manner of sleep symptoms—can...Read more
There were many exciting developments to write about from this year’s annual SLEEP conference in Baltimore. In the weeks and months ahead, I will discuss several SLEEP topics that directly or indirectly relate to the problems inherent in the traditional model of sleep care and the potential benefits from transitioning to the experiential paradigm. There will be other topics covered as well. For these reasons, I will continue with the current series on newer models of care and attempt to arrive at its natural conclusion, because it is increasingly obvious more and more sleep centers and sleep specialists must move in the direction defined by our innovative paradigm. As sleep medicine evolves, it must experiment with and deploy more expedient methods to effectively help patients, and the experiential model stands to become one of the more engaging and comprehensive approaches to address several deficits currently affecting our field. In Part...Read more
In the field of sleep medicine, there are various models of care delivery that generally divide up into traditional medical versus non-traditional. The traditional model is based on a principle of initiating care with a doctor-patient encounter in which the individual seeking care enters the clinical environment to meet with a medical professional such as a physician, nurse practitioner, physician’s assistant or registered nurse. There are several premises that underlie this model, some of which are advantageous and others of which are outdated. The main beliefs about the traditional model of care include: -Patients must start with a discussion and education session with a medical professional as an essential launching point. -This initial type encounter greatly increases the chances the patient would follow through on taking action, because of the rapport established with the provider or from a change in motivation post-education or both. -Patient’s presenting knowledge or understanding about...Read more
Last year, I noticed a worsening of my restless leg syndrome (RLS) and my periodic limb movement disorder (PLMD) symptoms. For years, I only suffered from restless legs, and maintaining my serum ferritin levels above 50 with occasional iron supplements always solved the issue. Then, I suffered a decline in the quality of my sleep and visited my own lab here in New Mexico, where we discovered scattered independent leg movements, known as PLMD. Before taking the leap to test the standard, established evidence-based drugs, I pursued two other pathways. First, I bumped up my iron levels closer to 100 as one scientific publication suggested this step might further decrease RLS/PLMD symptoms. The second approach was to bump up my Vitamin D supplements as two recent publications have suggested a connection between RLS/PLMD and low levels. Neither of these efforts made any difference in the quality of my sleep. Before...Read more
One of the most reliable predictions anyone could make about the field of sleep medicine is that greater reliance on home sleep testing is a guaranteed wave of the future. Although many imagine this perspective is fueled by insurers attempting to cut costs, I would argue the driving influence will eventually prove to be related to the advances in the technology. The growth in the home sleep test (HST) system right now is probably in the range of mild but steady. I do predict it will take off like a rocket ship when the technological advances profoundly upgrade the data collection to the point of matching or surpassing what is acquired in the sleep lab. We are already there for HST in diagnosing mild to moderate obstructive sleep apnea, but not for UARS, central or complex sleep apnea. With this backdrop, my colleagues and I at our sleep research facility,...Read more
In a very recent issue of JAMA, I was reading about the general problem of the decline in small medical practices, “Can Small Physician Practices Survive? Sharing Services as a Path to Viability.”(1) Although the scope of this article is more concerned about the use of new resource models that would help small practices stay afloat, the beginning sections of the commentary speak about the very important topic of quality of care. After describing briefly a few of the examples the authors provide, I will illustrate how these ideas directly affect small vs larger sleep medicine practices. The first data point is the decline in solo practitioners from 1983 to 2014, a drop from 44% to 19%. In contrast, in 2015 34% of all doctors were in practices involving 100 or more physicians. These changes are dramatic to say the least, and the trends certainly do not bode well for...Read more
During my last blog post on the Classic SleepCast for Classic SleepCare, I discussed how I was invited to deliver two talks on sleep at the Southern Sleep Society’s 40th annual meeting. I will also be doing the same lectures during the September Sleep 2018 meeting as well. My talks delved into the “PTSD Sleep Clinic and Nightmare Triad Syndrome” and “Advanced PAP Therapy to Increase Compliance and Decrease Insomnia.” Both talks were received very well and sparked a number of discussions afterwards with several of my colleagues and other attendees. Several key points were offered in my talks, and my last post used a bullet point summary to make you aware of the most relevant. In that post, I also discussed how an atypical presentation of OSA/UARS in an insomniac often leads to the use of advanced PAP devices at our sleep center in New Mexico. Now, I want...Read more