Sleep Dynamic Therapy » SDB

Baltimore Trip to APSS

Dr. Krakow — Fri, 30 May 2008 00:34:25 +0000

My research team will be in Baltimore for the annual APSS, presenting 5 works from the past year, including:

1. Oral presentation by me on the topic of “Sleep Disordered Breathing in Patients Dependent on Prescription Sleep Medications.”
2. Oral presentation by Eddie Romero on the topic of “Nocturia as a Screening Tool for Sleep-Disordered Breathing.”
3. Poster by Linda Trujillo on the topic of “Self-Guided Imagery for Insomnia Patients undergoing Polysomnography Testing.”
4. Poster by Natalia McIver on the topic of “Self-Guided Imagery for SDB Patients undergoing a Polysomnography Titration.”
5. Poster by Eddie Romero on the topic of “Nocturia as a Screening Tool in Insomnia Patients with Potential Risk for Sleep-Disordered Breathing.”

Balancing UPPP Risks and Benefits

Dr. Krakow — Thu, 25 Oct 2007 14:40:58 +0000

This media piece on recent research about UPPP fails to make note of the frequent side-effects induced by this procedure. The technique sometimes worsens sleep breathing problems in patients, but more importantly, UPPP sometimes makes it more diifficult to use CPAP in the future. A simple Google search provides many links discussing these problems and more.

Another Sleep Duration Study on Death Rates

Dr. Krakow — Thu, 27 Sep 2007 05:23:13 +0000

Today, at my talk at Sandia National Laboratories, the audience was interested in my opinion on the recent article on sleep duration in relationship to premature death from heart disease. As I’ve pointed out previously, these studies are incomplete works because they are looking at a sleep quantity model. Yet, the real insight is mostly likely explained by underlying physiological sleep disorders that causes one group to sleep too long (for example, classic sleep apnea patients with hypersomnia) and one group to sleep too short (for example, sleep breathing patients with a co-occurring problem of insomnia). Both types of patients have an underlying physical sleep disorder, but they look very different due to their pronounced differences in sleep duration. So, is sleep duration the important risk, or is it really the underlying physical sleep disorder? Parsimony suggests that sleep breathing problems provide the best reason to explain premature death rates.

Hidden Barriers in Bariatric Surgery

Dr. Krakow — Tue, 25 Sep 2007 06:17:16 +0000

This report from the European Respiratory Society highlights two important problems in the way the media and bariatric researchers are framing the discussion about post-operative sleep breathing changes following significant weight loss. First and foremost, they only report the AHI, the apnea-hypopnea index, and not the RDI, the Respiratory Disturbance Index. Thus, it is safe to assume that the researchers did not use advanced respiratory technology to measure UARS events (a.k.a. flow limitation events), the subtle breathing patterns that also provoke sleep fragmentation and subsequent daytime impairment in ways quite similar to classic sleep apnea. The second issue is the comment that the surgical intervention reduced or eliminated snoring in some patients, as if to suggest that snoring is a reliable marker of sleep breathing problems.

In sum, we are faced with the dilemma that both the media and the bariatric researchers are accepting outdated metrics for assessing sleep-disordered breathing (SDB). In the first instance, the assumption is that the AHI tells the whole story. It’s wonderful news to hear that AHI drops post-weight loss, but by not defining and measuring the RDI, it is safe to assume that many of these patients still suffer from SDB that likely needs treatment. The commentary on snoring represents another outdated metric in that we know many patients don’t snore and have SDB, and there are some who do snore and don’t have SDB. Bottom line is that snoring doesn’t tell us a lot about someone’s SDB condition. Again, it’s wonderful news that snoring decreases or disappears with post-op weight loss, and it likely signals that SDB severity has decreased, but it doesn’t tell us whether or not the patient still suffers from SDB, and that is the most important issue in question about the patient’s sleep health.

Imagine if the heart surgeon told a patient, “Looks like we’ve cut down your coronary blockages by 50%.” No intelligent heart patient would be satisfied with such a claim. “Okay, but how much coronary blockage do I still have left?” Same goes for SDB, “how much SDB do these patients still suffer from?” is the question at hand.

More On Obesity Epidemic in Children

Dr. Krakow — Fri, 07 Sep 2007 11:54:19 +0000

Again, another high profile commentary on obesity and no mention of sleep. No discussion on how obesity worsens sleep breathing problems, which in turn may adversely influence eating behaviors, and no mention of how underlying poor sleep quality may influence eating behaviors and lead to obesity.

Obesity and Mortality: What About Sleep?

Dr. Krakow — Thu, 23 Aug 2007 04:45:31 +0000

In this Washington Post article covering recent research on longevity in patients undergoing weight loss surgery, the emphasis seems to favor bariatric procedures. That is, it appears that those who undergo weight loss surgery and lose weight increase their lifespan. I’ve not read the research articles yet, but the question raised would be why would these patients live longer. Obesity is a risk for many diseases, but the one least likely to get a mention would be obstructive sleep apnea. I’d bet the research articles mention SDB as one explanation for why patients might live longer, even though the Post didn’t make a comment on it. However, I doubt the research conducted pre and post weight loss sleep tests to find out what happened to the severity of SDB in these cases. That information might prove quite illuminating.

SDB and Depression

Dr. Krakow — Wed, 20 Jun 2007 15:56:07 +0000

Research continues to mount showing the benefits of CPAP use in decreasing depression symptoms. What’s even more exciting is that the article appears in the well respected Psychosomatic Medicine journal.

Sleep-Disordered Breathing and Heart Disease

Dr. Krakow — Wed, 20 Jun 2007 15:50:34 +0000

Exciting research out of Brazil shows much more precise evidence that sleep breathing problems cause or contribute to atherosclerosis. As has been said for a long time in the sleep medicine community, “untreated sleep apnea is like smoking a pack of cigarettes per day.”

Something To Sink Your Teeth Into…er your lips!

Dr. Krakow — Sun, 06 May 2007 00:50:13 +0000

There have been several claims over the past few years that the positioning of the tongue at rest predicts some degree of risk for sleep-disordered breathing (SDB). The tip or front of the tongue is supposed to rest against the roof of the mouth, elevated about a half inch to an inch above the back of the front teeth, on or just above the little ridges you can feel there. When the tongue rests in the bottom of the mouth (flat position), that is, the tip is closer to the back of the lower teeth, it is said that risk increases for SDB. If you try the two positions right now, you’ll notice it’s easier to breathe through your nose when the tongue is in the elevated position. Several small research studies over the years have suggested that if you can strengthen the muscles in the oral airway including the lips, it will promote improvement of the tongue position and may reduce SDB severity. Now, there is an actual device that lets you strengthen your lip muscles and claims by doing so to reduce SDB severity. The question that goes unanswered on their website is how to buy one if you in the USA.

Sleep Tests for Middle of the Night Insomniacs

Dr. Krakow — Tue, 01 May 2007 06:02:01 +0000

In this recent letter to the editor in the Annals of Clinical Psychiatry, we respond to Dr. Rosenberg’s critique, which outlines some of the weaknesses in medications for the treatment of sleep maintenance insomnia (middle of the night awakenings). As we continue to find in our research and clinical work, most of these patients suffer awakenings due to sleep-disordered breathing. Therefore, testing these patients with overnight sleep studies in the sleep lab often yields valuable insights into the patient’s underlying sleep fragmentation and may lead to dramatic treatment gains, if the insomniac chooses to treat the sleep breathing condition.