Sleep Dynamic Therapy

Tim Russert’s Death

Dr. Krakow — Sat, 14 Jun 2008 07:31:01 +0000

This is the one graph I’ve found about the cause of Russert’s death, “Russert’s internist, Michael A. Newman, told MSNBC that an autopsy showed the journalist had an enlarged heart and that cholesterol plaque ruptured an artery, causing coronary thrombosis. He said Russert had been diagnosed earlier with coronary artery disease, but that it was controlled with medication and exercise and Russert had performed well on a stress test in late April.” He was only 58 years-old. One can only speculate whether undiagnosed sleep apnea was another risk factor in this case.

Baltimore Trip to APSS

Dr. Krakow — Fri, 30 May 2008 00:34:25 +0000

My research team will be in Baltimore for the annual APSS, presenting 5 works from the past year, including:

1. Oral presentation by me on the topic of “Sleep Disordered Breathing in Patients Dependent on Prescription Sleep Medications.”
2. Oral presentation by Eddie Romero on the topic of “Nocturia as a Screening Tool for Sleep-Disordered Breathing.”
3. Poster by Linda Trujillo on the topic of “Self-Guided Imagery for Insomnia Patients undergoing Polysomnography Testing.”
4. Poster by Natalia McIver on the topic of “Self-Guided Imagery for SDB Patients undergoing a Polysomnography Titration.”
5. Poster by Eddie Romero on the topic of “Nocturia as a Screening Tool in Insomnia Patients with Potential Risk for Sleep-Disordered Breathing.”

Why are doctors moving to Texas?

Dr. Krakow — Sat, 17 May 2008 15:55:36 +0000

How to solve a malpractice crisis in just a few years.

Overmedicating Children

Dr. Krakow — Mon, 05 May 2008 11:13:13 +0000

Some reporting on Fox News about the study in Pediatrics on overmedicating children in UK and USA. As always not a word about the possible link between those prescribed Ritalin and underlying sleep disorders.

D.C. trip

Dr. Krakow — Mon, 28 Apr 2008 05:34:03 +0000

I’ll be in D.C. Metro area May 2 to 7 promoting my book Sound Sleep, Sound Mind. Media events scheduled so far include booksignings in Frederick and Bethesda, Maryland, and a webinar I’ll conduct through the non-profit, Witness Justice, a support group and educational resource for trauma survivors. More details to follow.

Frontline’s Program on Overmedicated Children

Dr. Krakow — Wed, 09 Apr 2008 04:29:10 +0000

What’s remarkable and disappointing about this program is the number of kids with obvious sleep disorders. Many of the kids highlighted with bipolar disorder were clear mouth breathers. Several had thick necks or retrognathia (recessed chins). And, of course several of the kids had sleep complaints. You would think that such findings would spark some interest in pursuing overnight sleep studies. For future research, it certainly would be fascinating to see how many of these bipolar patients can be turned into successful bilevel patients.

Sleep Patterns Affect Obesity in Young Children

Dr. Krakow — Tue, 08 Apr 2008 04:02:35 +0000

This new study is intriguing, but more analysis is needed. First, we would suspect that sleep-disordered breathing is present in some of these kids, which could produce fragmented sleep, awakenings, and ultimately short sleep duration, a fairly common presentation for SDB in children. Second, the connection to TV viewing also suggests something about family dynamics. If parents let their kids watch too much television, it may say a lot about the parents’ own energy levels and the need to use “surrogates” to entertain the kids, while the parents try to recover their own energy or manage other tasks. In short, the more the parents let their kids watch TV, then the more the parents may suffer from their own sleep problems, which they pass on genetically to the kids. And these sleep disorders may be an obesity trigger or contributor.

In sum, I doubt it’s as simplistic as just the number of hours these children sleep. Rather, the number of hours they sleep is a marker of another process that also influences weight.

Infant Abuse and Parental Sleep Deprivation

Dr. Krakow — Mon, 07 Apr 2008 12:58:25 +0000

Infant abuse numbers are reported in this article, but one of the missing links here is likely to be sleep-related. When infants don’t sleep well, they cry more or they are simply awake when parents want to be asleep. The extreme sleep deprivation in the parents increases their chances of engaging in inappropriate and impulsive behavior.

Bilevel Preferred Over CPAP

Dr. Krakow — Thu, 03 Apr 2008 06:21:21 +0000

One thing that continues to puzzle us in our work at our sleep center is how frequently patients are prescribed CPAP when we suspect they should have been initiated with bilevel therapy. We work on 2nd opinion patients quite a bit, and in nearly 90% of cases, the patient presents with a failed response to CPAP. Few if any of these patients ever report that their physicians discussed the potential to use bilevel instead of CPAP. Some had been exposed to auto-CPAP, Cflex, and other expiratory relief systems, but very few had even heard of the term bilevel.

In our clinical experience, where we specialize in mental health patients with insomnia and SDB, we quickly transition the patient to bilevel once they have failed CPAP therapy either initially during the desensitization procedure before the overnight titration or during the titration when it becomes apparent that they are struggling to breathe out against pressurized airflow coming in (expiratory intolerance).

Washington Post is at it again: More disdainful comments about sleep

Dr. Krakow — Mon, 31 Mar 2008 00:55:28 +0000

The author’s article suffers from a specific and very serious flaw with respect to her disdainful comments about sleep.

The flaw shows up in two related ways. First, she only discusses sleep in the context of “quantity,” based on the so-called need for more hours of sleep. But that model itself is flawed, because what people really need is greater “quality” in their sleep, because “sleep quality drives sleep quantity.”

The second flaw derives from the first. By focusing on sleep quantity, she avoids the most important advances in the field of sleep medicine–advances that have already saved lives and dramatically increased quality of life.

For example, she reports on the connection that sleeping more hours might prevent car accidents, and as a sleep specialist I concur that it might. But, a much more powerful way to prevent accidents would be to find out why the individual is sleeping less than they supposedly should be sleeping.

The answer to this question, more than 70% of the time is that the person suffers from undiagnosed and untreated sleep apnea. The author may believe she is not dissuading someone from doing something about their sleep deprivation. But, the tone of the article dismisses a lack of sleep as another thing we needn’t worry about.

In fact, a lack of sleep is an excellent marker for people suffering marked sleep fragmentation caused by physical sleep disorders such as sleep apnea.

Thus, a very useful and cost-effective approach to healthcare in the case of sleep disturbance strongly supports a proactive stance to diagnose sleep disorders early to avoid not just accidents but also to reduce morbidity associated with strokes, depression, diabetes, heart disease and daytime fatigue and sleepiness.

To do so requires going well beyond the superficialities embedded within this author’s commentary.

Furthermore, as I propose on my site, “aggressive treatment of a sleep disorder is one of the cheapest health insurance policies you can buy!”

This author’s misleading commentary about sleep will steer people in the wrong direction and lead to greater health care costs and worse outcomes.

Maybe after a good night’s sleep, she’ll reconsider!