Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea

November 14, 2012

In this Expert Interview, I interview Dr. Barry Krakow about his work on PTSD (post-traumatic stress disorder), insomnia, and obstructive sleep apnea. These are the questions I asked:

- How did you get involved with mental health patients who have sleep disorders?

- How is insomnia and sleep apnea related to post-traumatic stress disorder (PTSD)?

- What’s the hard evidence that sleep-breathing disorders and insomnia go hand-in-hand?

- Why do you use the term, complex insomnia to describe the co-existance of insomnia and sleep apnea?

- Tell us about your paper that’s coming out in SLEEP on complex insomnia.

- What comes first, insomnia or sleep apnea?

 

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4 Responses to “Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea”

  1. Jay on November 16th, 2012 10:18 am

    Any research with Gulf War syndrome and Sleep Apnea as well ?
    On another note, forward-deployed troops are now authorized uses of CPAP machines.

  2. S.A. on November 20th, 2012 3:58 pm

    Recognizing the 5 needs of basic human needs behavoir: Survival, Safety and Security, Self-Belonging, Esteem, and Self-Actualization. Our minds and bodies place a great deal of energy and stress on two of Survival’s components, Oxygen and Sleep. The other 4 categories become disabled and unable to be developed. Even when after the stressors are removed, behavoir associated with the 4 other needs can be muddled and diluted. OSA/PTSD patients should be considered to be embedded in a broken string of needs realizations and proper functioning.

  3. Rosemary Langton on November 21st, 2012 4:05 am

    Would you agree bullying can cause PTSD especially if repeated experience? What treatment do you recommend?

  4. Arthur M. Strauss on November 27th, 2012 12:31 pm

    I was the catalyst as a civilian dentist volunteer in the Walter Reed Dental Clinic, in actively bringing the use of Oral Appliances for treating OSA into the military where they have been used in active deployment of troops where CPAP is inappropriate and absurd.
    How do we constantly ignore the priority sequence of CPR beginning with airway patency to allow airflow and breathing? We can survive much longer without sleep than without airway patency to “allow” breathing and oxygen.
    Humans have rotational and translational jaw structures that hold the tongue and different throats where there is a intersecting of the breathing tube from the nose with the feeding (food) tube from the jaws, teeth and tongue allowing mouth breathing, speaking and even swallowing without blocking the airway and choking to death. It also allows the tongue and jaws to move and change shape and relax in ways that support this and to different degrees partially and fully block the throat and airflow.
    Medicine has identified this while asleep, where it is most obvious (snoring and OSA) to the ears eyes. It is likely the most immediate influence of triggering the stress response, thus stress as seen in PTSD and numerous psychological disorders. Interestingly, it is not present during meditation where there are no distracting stimuli there is and easy full flow of air. Remember, “Sticks and stones can break my bones but words can never harm me”/ The origin of immediate threat to survival is not thoughts or words or other stimuli it is only how they distract us and upset the structural (musculo-skeletal) balance keeping the airway patent, keeping us from fully and partially choking. The more stable the physical structural design that maintains airway patency in humans, the less susceptible it is to distractions.
    In a scientific based Medical/Dental system research can be done to examine this. Test the daytime stress response in those with OSA who have demonstrated significant improvement with oral appliances during sleep and mimic this stabilized jaw position while awake using HRV or other means of measuring stress response and see what is found. You already know the answer because of the observed calming effect of taking a few slow deep inhales then exhales to relax while awake. Notice how it calms the mind!
    Why is this trapped in sleep when it is structural and, therefore, a round-the-clock condition? Is it because there is no place within the Medical/Dental departmental, structure educational, research and practice position for it? Not seeing this is as understandable as thinking the earth is flat until shown otherwise. This is a possibility, in as my parents had reminded me as a teenager that intellect does not ensure common sense. Seeing this, which is in front of our eyes in all basic science literature, and in isolated areas of practice (like CPR), and ignoring it is inexcusable, yet understandable if you follow the dollar and the human desire for a quick fix! After all the sooner it is fixed, the sooner the distraction of it along with the destabilization of the airway and the stress response disappears.
    To me this, as other symptom rather than root cause management approach appears as a self defeating viscous cycle; however, when we can see a vicious cycle we can deal with it in a positive way.

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