The Missing Link in Insomnia and Sleep Disordered Breathing: Interview With Dr. Krakow

Insomnia is treated by sleep specialists as a completely different condition from obstructive sleep apnea. Similar to how sleep problem is now considered a “co-morbid” condition to depression and various other medical conditions, insomnia is now beginning to be considered a “co-morbid” condition alongside obstructive sleep apnea.  I’ve interviewed Dr. Barry Krakow in the past on upper airway resistance syndrome and complex insomnia (click here for the interviews; search for Krakow). Here’s a must-read interview that was just published in Sleep Review Magazine. The magazine interviews Dr. Krakow on complex insomnia and how everyone with severe insomnia should also be considered for a possible sleep-breathing disorder.

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3 thoughts on “The Missing Link in Insomnia and Sleep Disordered Breathing: Interview With Dr. Krakow

  1. So I learn a new term today that I have been thinking a lot about all week! Expiratory Pressure Intolerance (EPI).

    And then I am reminded of another issue I have been thinking about all week! “Noise induced [sleep] fragmentation”.

    I am thinking about these things because I am now enjoying a world more free from them.

    It all started on a quest to limit the “feel” of the nasty “clear airway sensing pulses” from my CPAP machine. I really do believe that these rob me of sleep I could have had and do not contribute to my sleep or enough to my knowledge to justify their presence. I know that “arousal threshold” is usually related to respiratory effort but the fact that there is also “noise induced sleep fragmentation” attests that other sensory means can also contribute to fragmented sleep.

    It occurred to me that if I added a bit of compressible air space (i.e. add air space to the circuit) the rise time of the pulses might well slow a bit and so be much less of the slap in the face that they seem to be to me. So I plumbed into the line a 2 liter soda bottle I had been using as water storage for a year or so. Yes this does limit the intrusive effects of the “clear airway sensing pulses” and I was happy to find that.

    But I was even more amazed how much more natural it seemed to breath with the extra compressible air space in the circuit. I never really thought about it before but as you inspire the fan must ramp up a bit to compensate. Then when you rapidly shift to expire your outgoing breath meets the inertia of the fast moving fan. I have not measured it but I would guess there is a bit of a spike in pressure at that moment. When you breath into the airspace that I added it gives much more like the air gives when you breath out naturally. It is a very welcome natural feel. It is wonderful!!!

    I liked it so much that I immediately plumbed in a second bottle! $20 in parts total.

    When I did so I added some elbows. I found another thing I liked.

    The “T”s used to plumb in the soda bottles also provide a place for sound and “vibration” to go and be dissipated. Frankly I never really knew how much I did not like the sound of the fan and all, which I can very definitely “hear” and feel with the air coming in through my nose, until the sound was not there. I added the elbows in the hope that some of the sound would be reflected back and more dissipated by having them in the way. There are now many visions of “CPAP mufflers” dancing in my head. I love the less sound and long for a truly quiet experience in my future.

  2. Wow, Dr. Krakow’s article sounds like my life before my septoplasty I still have sleep issues but 50% less RERAs. After reading the article. I was reminded of the insomnia, the frequent trips to the bathroom at night, daytime sleepiness, Because of the severe UARS and having demanding jobs, I ended up with chronic fatigue and ended up leaving my job and was not able to get disability. I really hope UARS is given more medical attention soon, because it can wreak havoc on your life.

  3. Great post! I think you’re exactly right here, the link between insomnia and sleep apnoea makes perfect sense as sleep apnoea provides an obstruction to your breathing. If you can’t breath properly when trying to sleep you’re not going to get a good nights rest.