BarryKrakowMD New Sleep Newsletter

[BarryKrakowMD]

I started a sleep newsletter via Substack (Fast Asleep). Please click this link to sign-up for a FREE subscription (no credit cards or other strings attached): https://fastasleep.substack.com/embed

My first post delves briefly into "Finding the Right Sleep Center." My next post due out this week delves into UARS.

Next week, I will be offering my first monthly Discussion Thread, and topic is...you guessed it...UARS. Showtime is Thursday, September 2nd 8 pm Eastern. If you sign up for the FREE newsletter, you will automatically get invites/reminders for the Discussion.

It's been awhile since I've posted, so I wanted to share a few items. As you may know from a post two years ago, we finally published our RCT proving ASV superior to CPAP in the treatment of chronic insomnia. Whole paper available at Lancet website: https://www.thelancet.com/journals/ecli ... X/fulltext

Sold Maimonides Sleep Arts & Sciences sleep center in Albuquerque, NM and we moved to Savannah, Georgia where I now practice at www.barrykrakowmd.com. For those who may not know my background, I started in the field of dream research (nightmare treatment) prior to my involvement in sleep medicine. In my current practice, I am working with insomnia, nightmare and OSA/UARS patients. Here's a link to a Carlat Psychiatry Reports podcast that was published yesterday on my work with chronic nightmare patients: https://www.thecarlatreport.com/podcast ... es_matter/.

Still sleeping every night with ResMed AirCurve ASVAuto and won't leave home without it!

Rest wishes,
BK

[ChicagoGranny]

Thanks for the update!

How are you bearing the change in humidity? Google says the annual average in Savannah is 56% as compared to 36% in Albuquerque!

[JLROhio]

Thanks!

It would interesting to get your take on the Philips recall (or maybe not - I don't want to get you in professional trouble)!

...or your opinions on dentists selling all sorts of treatments for sleep apnea - I understand another dental device was approved by the FDA yesterday...for the treatment of sleep apnea!

[mper!?]

Hi, Dr. Barry
_ good to hear from you downhere; great admiror of your work, book, articles, etc. So grateful!
_ I started CPAP some 4 years ago; very minor OSA, and UARS all night, then. RLS also, properly battled these days;
_ Now, since some 3 years ago, on BilevelResmed, I think I have suceeded on properly round my curves; no remaining flatted top flow limitations;
_ however, keep arousal/awakening during REM sleep due to very minor flow reduction (< 25%), together with bad dreams/nightmares all nights - see attached. I have been handled such remaining drawbacks rather nicely by taking 0.4 mg of Clonazepam (in line with Dr. Robert J. Thomas, and trying to cope with my intact nervous system) sleeping in two phases, etc;
_ do you think ASV could improve these remaining issues? (I tend to doubt it);

many thanks, waiting for the new book!

[BarryKrakowMD]

Hi, Dr. Barry
_ good to hear from you downhere; great admiror of your work, book, articles, etc. So grateful!
_ I started CPAP some 4 years ago; very minor OSA, and UARS all night, then. RLS also, properly battled these days;
_ Now, since some 3 years ago, on BilevelResmed, I think I have suceeded on properly round my curves; no remaining flatted top flow limitations;
_ however, keep arousal/awakening during REM sleep due to very minor flow reduction (< 25%), together with bad dreams/nightmares all nights - see attached. I have been handled such remaining drawbacks rather nicely by taking 0.4 mg of Clonazepam (in line with Dr. Robert J. Thomas, and trying to cope with my intact nervous system) sleeping in two phases, etc;
_ do you think ASV could improve these remaining issues? (I tend to doubt it);

many thanks, waiting for the new book!

The first discussion group topic on thursday evening at 8 PM eastern time is devoted to UARS, so you might want to sign up for my substack site to participate: https://fastasleep.substack.com/. I certainly anticipate ASV will come up.

[Jlfinkels]

Thanks for the update!

How are you bearing the change in humidity? Google says the annual average in Savannah is 56% as compared to 36% in Albuquerque!

After living in Savannah for many years 56% humidity is desert-like conditions for that area. 85% is a typical heat-of-the-day reading with mid-to-upper 50% at night. That’s why the great architect of the universe gave us AC!

[ChicagoGranny]

85% is a typical heat-of-the-day reading

Relative humidity is lower during the highest heat of the day.



Dew point is a better measure of how the humidity feels. Annual averages distort the issue.

[Jlfinkels]

85% is a typical heat-of-the-day reading

Relative humidity is lower during the highest heat of the day.



Dew point is a better measure of how the humidity feels. Annual averages distort the issue.

No disagreement, but you originally just said humidity which to most is absolute and not relative. After living in Savannah it doesn't matter what you call it, you come out of your AC and you need another shower. Beautiful city, wonderful people, great music and food.

[Morbius]

Next week, I will be offering my first monthly Discussion Thread, and topic is...you guessed it...UARS. Showtime is Thursday, September 2nd 8 pm Eastern. If you sign up for the FREE newsletter, you will automatically get invites/reminders for the Discussion.

It's been awhile since I've posted, so I wanted to share a few items. As you may know from a post two years ago, we finally published our RCT proving ASV superior to CPAP in the treatment of chronic insomnia. Whole paper available at Lancet website: https://www.thelancet.com/journals/ecli ... X/fulltext

Sorry I missed it, kinda short notice! Woulda like to have talked a little about the pharmacologicals where twice as many ASV patients got drugs:

A total of 19 patients (13 ASV, 6 CPAP) used either prescription sleep aids or sedating psychotropic prescription medication as a sleep aid (SA+) and 21 did not (SA-).

Or ~2/3 of ASV got drugs vs. ~1/3 of CPAP.

Also what kind of CPAP was used. Was it fixed pressure without enhancements, or what. I guess info could have been in the paper, but tl;dr.

[BarryKrakowMD]

Here's a link to the Discussion thread: https://fastasleep.substack.com/p/premi ... t/comments
A few other responses:

We love Savannah. Thanks.
ASV in my experience is outlandishly more effective than all the other devices I've tried, which is a common refrain among our patients who also had tried all the other devices as well before their insurance would let us prescribe ASV.
I'm fairly confident ASV could on its own increase the gross domestic product by 1% and decrease the national debt simultaneously if every PAP patient had the opportunity to try ASV when first prescribed PAP, meaning I believe we would start seeing compliance rates in the 80% range routinely. Of course, it cannot and does not work miracles in every patient, but I've seen enough astonishment (including my own) in so many patients' faces to know it's a very different order of magnitude in physiologic delivery of pressurized air.
We've been working on a paper for a few years looking at changes in nightmare frequency with ABPAP and ASV (ResMed only), but don't know when we'll get it published, let alone finding the time to complete the data analysis and manuscript.
I only have a vague memory that the medication profile was not providing much to analyze on the RCT (ASV vs CPAP) or what we looked at didn't say much. From our own experiences, especially in the mental health cohorts who were treated at our center, we typically see those with more meds having worse sleep, so in that light it's interesting that ASV did so well even tho more were using meds. Nevertheless, that's just anecdotal and the point certainly merits research investigation, especially if the research could look at something like Magdy Younes emerging research on ORP measurement of sleep quality, given increasingly noticeable deficits in our current metrics like AHI and sleep archictecture, etc.

Next Discussion Q & A should be October 7th, 8 pm Eastern, most likely on topic(s) involving Insomnia.
Til next time,
Rest wishes,
BK