Mayo Proceedings: Pharmacotherapy Failure in Chronic Insomnia Patients

Barry Krakow, MD, Victor Ulibarri, RPGST, and Natalia McIver, RPGST from the Sleep & Human Health Institute, and the Maimonides Sleep Arts and Sciences, Ltd, in Albuquerque, NM, and the Los Alamos Medical Center, in Los Alamos, NM, preview their article appearing online ahead of print and in the December 2014 issue of Mayo Clinic Proceedings, to provide clinicians with a new theory on the co-morbidity of insomnia and sleep apnea among insomnia patients failing drug therapy, including new assessment tools to diagnose sleep apnea when medications fail. Available at:

Using Nasal Dilator Strips to Treat OSA/UARS

Sourced from Classic Sleep Care I am often asked the question of whether or not nasal dilator strips (NDS), most commonly seen on the noses of NFL players, provide any benefits to patients with OSA/UARS. Most people are perplexed when without reservation I affirm that...

Need Another Titration in the Lab: Who Decides, You or Your Sleep Doc?

With the growth of the HST model, sleep apnea patients are increasingly complaining about the lack of opportunities to undergo a titration in the sleep lab when their responses are suboptimal to PAP. In our second opinion practice, we occasionally meet sleep apnea patients dissatisfied with their care at a sleep center in another state; and, believe it or not, some of these patients have never spent a night in the lab. A sleep study was never recommended, or if a patient requested a titration it was refused. Despite their best efforts to express their suboptimal responses, the sleep professionals they dealt with argued back that nothing new would be gained by a titration or retitration in a sleep lab. In this brave new world of auto-adjusting devices, we are informed that the sleep lab is essentially obsolete.

PAP Therapy Rejection and the Role of Emotion: Fear

Sourced from : Classic Sleep Care Many factors influence a patient’s decision to use PAP therapy. Most frequently mentioned are issues regarding masks or pressurized airflow. For others, it may be problems with humidification or figuring out the set-up in the bedroom....