A Missing Link: Dr Barry Krakow’s Research on Insomnia and SDB

SR: Our discussion all ties in with your new relationship with Classic Sleepcare. Please comment.

Krakow: I’m very excited about my work with Classic Sleepcare because the company has a strong desire to address the comorbidity of insomnia and SDB and is coming at the issue from the unique position of a durable medical equipment (DME) company.

Classic Sleepcare is exploring a number of different approaches to tackle this problem, and, most importantly, they recognize that efforts to manage the insomnia component in their sleep apnea patients will increase PAP therapy compliance while at the same time improve their patients’ insomnia. Classic Sleepcare is highly motivated to integrate appropriate treatment steps within this domain of care, because they have become very aware of how much insomnia is interfering with their patients’ ability to use PAP devices. I was very impressed by their decision to move in this direction, and I know of no other DME companies that are doing so.

SR: How did your relationship with Classic Sleepcare start?

Krakow: We started about 1 year ago, because we discovered we shared a mutual perspective on the need for very intensive and extensive follow-up in managing sleep apnea patients.

SR: Finally, does your research have clinical ramifications on whether we should be thinking of insomnia as a symptom or a disorder?

Krakow: It is both a symptom and a disorder. However, for the purposes of advancing our efforts to help patients with complex insomnia and to create a paradigm that draws more attention to this comorbidity, it is advisable to label insomnia as a disorder. The current “symptom” paradigm may create confusion if a patient’s complaints of sleeplessness steer the doctor away from any discussion of SDB. In my opinion, when you think of insomnia as a disorder, you are more likely to view the condition more seriously and therefore complete a more thorough evaluation, hopefully one that includes polysomnography. 

Sree Roy is editor of Sleep Review. She can be reached at [email protected].

Read about Krakow’s work with PTSD sufferers in “Vision in the Desert.“ You can also ask Krakow questions about sleep therapy via SR’s Expert Insight page.

 

 

 

 

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CITATIONS

1. Krakow B, Romero E, Ulibarri V. Prospective assessment of nocturnal awakenings in a case series of treatment-seeking chronic insomnia patients: a pilot study of subjective and objective causes. Sleep. 2012;35(12):1685-1692.
2. Krakow B, Ulibarri V, Romero E, McIver N. A two-year prospective study on the frequency and co-occurrence of insomnia and sleep-disordered breathing symptoms in a primary care population. Sleep Med. 2013;14:814-823.
3. Sériès F, Roy N, Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994;150(2):481-5.4.
4. Krakow B, Ulibarri V, Romero E. Persistent insomnia in chronic hypnotic users presenting to a sleep medical center. J Nerv Ment Dis. 2010;198(10):1-8.
5. Krakow B, Ulibarri V, Romero E. Patients with treatment-resistant insomnia taking nightly prescription medications for sleep: a retrospective assessment of diagnostic and treatment variables. Prim Care Companion J Clin Psychiatry. 2010;12(4):PCC.09m00873.
6. Krakow B, Krakow J, Ulibarri V, McIver N. Commentary on frequency and accuracy of “RERA” and “RDI” terms in the Journal of Clinical Sleep Medicine from 2006 to 2012. Journal of Clinical Sleep Medicine. In press.
7. Krakow B, Ulibarri VA. Prevalence of sleep breathing complaints reported by treatment-seeking insomnia patients on presentation to a sleep medical center: a preliminary report. Sleep Breath. 2013;17(1):317-22.
8. Littner M, Hirshkowitz M, Kramer M, et al; American Academy of Sleep Medicine, Standards of Practice Committee. Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep. 2003;26(6):754-60.