Classic SleepCast

Totally CPAP by Dr. Steven Park: Part X (Final Words, Thoughts and Controversies)


Barry Krakow MD - April 19, 2018 - Expert Insight
Let’s conclude this ten-part blog series of Dr. Park's book, Totally CPAP, with a review of his final chapter. Dr. Park brings up highly relevant topics in summarizing key points in his programs, as well as offering additional options on how to proceed should CPAP simply not be the right fit for you. We will delve deeply into some of these themes, because they bring to light crucial controversies in the field of sleep medicine on how to deal with CPAP failure. At the outset, I wish to clarify some points from a recent conversation with Dr. Park in which I learned that he performs all the CPAP coaching himself in his office (very impressive!) and despite being a surgeon he is a stalwart defender of the use of PAP therapy in the majority of his patients. For those of you who follow his website, blogs and podcasts, you also... Read more

Totally CPAP by Dr. Steven Park: Part IX (CPAP Success Program and Where to Begin)


Barry Krakow MD - April 17, 2018 - Expert Insight
Continuing with our review of Totally CPAP, written by Dr. Steven Park, this next section discusses implementing a program for CPAP therapy success. Dr. Park has developed a very interesting seven-step, seven-day program to help someone integrate all the major instructions from the book. His goal is to enhance your first week of efforts to use the PAP machine, although as you will read below, the focus is more on the seven steps and not actually seven consecutive days. And, he begins quite rightly with the question, “Where do I even start?” His first step is all about “Education and Goal Setting.” He believes individuals should start with a sleep journal to track various data points such as how much you are sleeping with the mask, how you feel the morning after and related themes connecting CPAP effects to your sleep. Obviously, this step involves more than just one night... Read more

Totally CPAP by Dr. Steven Park: Part VIII (Surgical Options)


Barry Krakow MD - February 27, 2018 - Expert Insight
In the second half of Chapter 8, Dr. Park focuses on the surgical options for the three most common conditions causing nasal congestion that might not be relieved by the medical options we discussed in Section 1 of this post: deviated septums, swollen turbinates and flimsy nostrils. Septal Deviation and Septoplasty Dr. Park begins with a discussion on how the septum or midline structure that separates the nostrils into two openings has a cartilage portion in the front and a bony portion in the back. When the septum is crooked for whatever reason, you may be more susceptible to a stuffy nose, and a septoplasty (to straighten the septum) may improve the stuffiness. However, you might also possess a crook septum and not have a stuffy nose, so there is no requirement to undergo surgery on your nose in such circumstances. Dr. Park describes a very interesting theory about the... Read more

Thank You for Your Service


Barry Krakow MD - February 21, 2018 - Expert Insight
I recently watched the movie Thank You for Your Service, where many themes related directly or indirectly to the care of sleep disorders in military personnel (active duty or veterans) as well as relating to overall treatment issues in PTSD cases and traumatic brain injury (TBI). I use the term “direct” because the three main characters were shown in the course of the film to suffer from sleep disorders, notably insomnia and nightmares; but these issues were not a main theme regarding treatment for these soldiers. I use the term “indirect” because as you will read below the major emphasis in the movie was on the problem of avoidance behavior—the signature behavioral pattern that manifests in virtually anyone attempting to confront mental health problems. Avoidance behavior also is commonly observed in patients attempting new therapies, be it exposure therapy for PTSD or PAP therapy for OSA. To be clear, I... Read more

Totally CPAP by Dr. Steven Park: Part VIII (Non-surgical Options)


Barry Krakow MD - January 29, 2018 - Expert Insight
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 rate... Read more

Reader response to “UARS, Depression and Suicide”


Barry Krakow MD - January 16, 2018 - Expert Insight
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?


Barry Krakow MD - January 11, 2018 - Expert Insight
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