Dr. Krakow's book

Got an Amazon GC from Xmas, so I ordered the Doc's book. It arrived today. I'll let you know if I found any good advice in it. It looks pretty interesting. In case someone missed his post, he wrote a book titled, "Sound Sleep, Sound Mind. 7 keys to sleeping through the Night". That's what I'm looking for....sleeping thru the night. Usually wake up from 1 to 4 times a night, even on CPAP.


JeffH

I bought the book also. I'm a little over half-way thru it. He has some good advice along with a lot of chaff. I'm not into physcological (sp) treatment so alot of the book was over my head. I did pick up on some good pointers on getting the mind ready for sleep.

I plan to re-read it once I finish and try to understand more of the theory he is trying to project into getting a good nights sleep. He did do a lot of research and put a lot of time into writing this. jim b

I enjoyed the book. Unlike most books on the subject this focuses on the whole experience and what is necessary for truly great sleep. It was an easy read. Dr Krakow did a good job of making the issues understandable and solvable. It included lots of tips and good pointers.

I hope he adds a second book that deals with some of the advanced topics he is posting about on this board.

Hey, thanks much for the positive feedback. I very much appreciate your taking the time to comment on the book.

Perhaps questions may arise from time to time on certain aspects of the book, about which periodically I could offer some additional pointers, commentary or clarification.

Thanks again.

Rest Wishes

Hi, This book is definately on my list.......will finish soon on 2 of the great ones from Kushida Stanford University. Dr.Krakow self experience as sleep apnea patience provides real life experience in sleep disorder research is highly valueable. Mckooi

I just finished reading Dr. Krakow's book and recommend it. It's refreshing to get a body-mind approach to sleep from a knowledgeable sleep doctor. Most of the book is a carefully thought-out method of working with your thoughts and feelings, very useful for waking life (even if you don't have sleep problems), which can then lead to being peaceful enough to fall asleep.

If I or a friend with insomnia and sleep apnea also had anxiety, stress, depression, trauma, PTSD, or other mental health issue, I'd recommend they consider going to his sleep clinic in Albuquerque.

My favorite parts of the book are near the end, when Dr. Krakow gets into sleep apnea issues. From his clinical experience, he clustered some symptoms together than are often overlooked in importance in diagnosing sleep apnea. There are four useful checklists for early sleep apnea screening, monitoring your progress on PAP, etc. He highlights night time urination (nocturia) as a very important symptom, often overlooked by doctors and patients. His explanation of the cause of nocturia is also linked from his website http://www.nocturiacures.com/ He has some valuable tips about dental appliances and surgery. His opinion on why DMEs and DME respiratory therapists are the way they are, and what could be done to improve treatment for the patient, are enlightening.

In addition to his considerable clinical experience and body-mind approach, Dr. Krakow has a talent for explaining complex subjects very simply to increase understanding.

My three wishes: First, that Dr. Krakow write another book focusing on sleep apnea and its treatments, an expansion of the last few chapters of his current book - or that he puts this information on his website http://sleeptreatment.com/

Second, that all sleep doctors were as knowledgeable and communicated as well with patients.

Third, that our society, particularly Medicare and the insurance companies, put the responsibility and payment for sleep apnea PAP therapy (setting up and monitoring PAP therapy) in the hands of well qualified healthcare professionals and organizations, not with the questionable DMEs where it now resides.

Thanks for starting the thread JeffH. My wife has a copy on order for one of my birthday presents.

I am looking forward to reading it, although I must admit to big problems staying awake long enough to read a book.

So far it makes lots of sense to me. It's one of those "it's so simple I never thought of it before" books. I think it might be a life changer.

Long ago someone shared this with me and it has helped me with accepting new ideas...

“There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance—that principle is contempt prior to investigation.”

—Herbert Spencer

Thanks for the information re Dr. Krakow's book, it looks interesting and informative.

I just now ordered it from Amazon, then went to his website and signed up for the snoozeletter.

It's refreshing to see a physician so immersed in the topic.

Regards all - - Tom

Thanks again for all the kind words about the book!

I just want to comment on the DME issue, because I concur that it is one of the biggest and most glaring flaws in the sleep medical healthcare system, and we are trying to find a solution to address this problem.

In many frank conversations with insurance officials, including those who work with what's known as DMERC, the branch of Medicare that determines policy on DME issues, I routinely ask the question: "what type of prescribed medical equipment would you say is analogous to a prescription for PAP therapy devices?"

The answer is always the same: "crutches, wheelchairs or supplemental oxygen." Once they provides these answers, I then show them that the analogy is illogical and deeply flawed. Point by point I explain how you can teach someone to use crutches in less the 15 minutes and never see them again.

PAP therapy instructions and management requires days, weeks, months, and in extremely complex psychiatric cases, more than a year to ingrain the knowledge and skill within the patient's mind and body to make them a successful user.

That's a lot of time, but the health benefits of PAP therapy are so obvious and so meaningful, you would think insurance carriers would get it. You would think they would realize they can save a ton of money by pushing and supporting PAP therapy usage.

But even if insurance companies pushed hard, the Catch-22 is that DME companies are not sleep medical centers (in general). They do not have the experience or expertise to manage the complexities and nuances of PAP therapy. In short, they should not be the ones dispensing PAP therapy, but they are and will be for the foreseeable future.

So, you can see we have a major system problem here, which is only going to get worse as Stark Laws continue to impede the efforts of sleep medical centers to sell DME equipment. Because this barrier will not go away soon, we are all faced with a sizeable hurdle that continues to plague and undermine the efforts of many sleep medical centers.

We believe we have developed a potential means for overcoming some of these inherent flaws in this system. And, we just received word last week on acceptance of a research paper in the Journal of Clinical Sleep Medicine that describes our innovative approach. The basic idea is to give sleep centers much more opportunity to work with patients during the daytime to help them adjust to PAP therapy devices.

The research paper reports on our technique called the PAP-NAP, which combines the expertise of a sleep tech with a daytime, abbreviated procedure focusing on adaptation as opposed to titration issues. I think an abstract is available at http://www.aasmnet.org/jcsm/JCSMAcceptedPapers.aspx. Members of the sleep society (American Academy of Sleep Medicine) can apparently read the whole article now online, and it should be in print in 2008.

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CPAPopedia Keywords Contained In This Post (Click For Definition): medicare, Titration, DME, Prescription

I have to admit, my greatest interest is in Dr Karkow's opinion on why DMEs and DME respiratory therapists are the way they are, and what could be done to improve treatment for the patient.

But, I'm not so sure about too many of these "sleep doctors" who never see the patients they are evaluating and dictating titration results for and who only consult w/the referring physicians. The way I'm seeing the sleep profession is that it is a "cash cow" on the rise as a sub-specialty.

"I" want a say in what equipment I receive. "I" want easy access to my data, I don't want to have to rely on someone else to "share" it w/me.

If I have or suspect a problem w/my therapy I'd like to have a "professional": RT, RPSGT, NP, or PA I can turn to who is familiar w/"my" choice of brand and model device and w/titration, etc. to answer my questions or satisfy my curiosity, someone as familiar w/leaks and leak effects, etc. as several of our experienced members in this forum.

Given the multitude of brands and models of CPAPs, autoPAPs, bi-levels, RADs, the software reporting methods, etc. the above could be a specialty in and of itself!

A funny related to this book.

I've told my GF a couple of the ideas suggested in this book. She is the opposite of me and has no trouble getting or staying asleep.

Not to give too much away, but one suggestion is turning your clock toward the wall so you can't see what time it is. I unplugged mine and put it in the closet. My GF turned hers were I can't see it.

When I got up this morning, she said to me a little angrily, "don't tell me anything else in that book. I couldn't get back to sleep last night after I got up to go to the bathroom because I was thinking, I'm not doing things right".

JeffH...LOL

Dr.

On your web site you mentioned a condition associated with Sleep Apnea called Nocturia. I have been diagnosed with sleep apnea and have been on CPAP for 3 weeks but I wake up several times a night because I have to go to the bathroom. Do you have any suggestions on how to take care of this problem.

Frank

Regarding nocturia, we have a website http://www.nocturiacures.com that gives some clear details on how sleep-disordered breathing causes increased urine production from the kidneys, thus triggering trips to the bathroom. What's most interesting in the clinical setting is that if a patient reports a persistence of nocturia after starting PAP therapy, we are immediately suspicious that we have either prescribed the wrong pressures for that patient or something is preventing the patient from receiving optimal pressures (e.g. leak, mouth breathing, etc.). So the persistence of nocturia almost always leads to a retitration in the lab if no other explanation illuminates the issue.

Regarding the quality of care issue, we share many of these same concerns, and on the current Bilevel Pearls topic that I'm regularly posting on, I'm quoting below the last post to give you some ideas on how the American Academy of Sleep Medicine is trying to push for greater quality standards to deal with these types of problems.

I think the idea of a specialist who only works with patients to tweak their numbers, etc. is an intriguing idea and probably has a lot of business potential, but as I've stated in other posts, I have my suspicions about the intrinsic value of some of the data obtained from these machines. Believe me, I love the self-reliance fostered by the "data approach" and have been especially impressed by the use of data as discussed on this forum; I'm just stuck on sleep lab retitrations, because I've seen so many instances where the ultimate solution was arrived at through hands-on experience in which real-time data was vigilantly acquired and responded to by very capable sleep techs.

BarryKrakowMD wrote:The wide variation in standards at various sleep centers is very disturbing, and the American Academy of Sleep Medicine is pushing very hard to mandate higher quality benchmarks through the process known as accreditation.

Accreditation directly impacts not only logistics, environment and convenience issues for patients, but there is also an expectation that practitioners adhere to practice parameters established by the AASM.

For example, one practice parameter clearly mandates that Bilevel therapy should be considered in a patient who reports difficulty breathing out against pressurized airflow. So, what's ironic is that we're having this discussion about the value of bilevel, and most readers are reporting that they would anticipate difficulties in communicating about a bilevel trial with their sleep providers; and, yet, the AASM has already indicated a practice parameter supporting such a need for select patients.

Thus, we can see that the dissemination of very good information has not yet made it into many sleep facilities for whatever reasons, but I don't think this problem is going to last much longer for the following reason: There is a move afoot to push accreditation to the point that no sleep facility will receive insurance contracts without it. No accreditation, no reimbursement. Money issues move things very quickly, and within a few years, the issue of accreditation should lead to much greater standards at a much larger proportion of sleep centers.

Our facility was created to provide a "B & B" feel, although we've not quite figured out the breakfast angle. Most patients love the cozy layout with no TVs, no phones, no hospital look, and lots of artwork. We invest a lot in very comfortable beds, linens, comforters and bedside lamps and armoires. We even designed special "holding" areas for our insomnia patients who we sometimes insist on practicing good sleep hygiene by leaving the bedroom in the middle of the night to work on imagery techniques, reading, or other relaxation approaches before returning to sleep.

While these logistical elements are a real plus, the strength of our sleep medical center is our sleep techs as we invest an enormous amount of time and training in developing their skills to interact at an extremely high level with our patients. The vast majority of our sleep techs have either completed, entered, or plan to enroll in a graduate program in a health-related field, and all are highly motivated to learn key elements of our Sleep Dynamic Therapy model.

I think one of the most exciting developments in the field of sleep medicine is the recognition among nearly all my colleagues of how much more training and skills are going to be needed for sleep techs. I think as sleep tech advancement catches on, it's going to have the largest impact on patient satisfaction.

Ok I finally received my card reader today and down loaded my data. It looks really good to me but I still wake up several times a night mostly to go to the bathroom. Can someone tell me how my data looks and any suggestions you have. Here is the URL I don’t know if I am doing this right or not so let me know.

http://s267.photobucket.com/albums/ii311/fehler/

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