Dr. Barry Krakow is a board certified internist and sleep disorders specialist who has spent over 30 years in medicine in the fields of internal, emergency, addiction and sleep medicine. He has conducted more than two decades of research in the treatment of chronic nightmares and disturbing dreams at the University of New Mexico School of Medicine (1988-1999) and the Sleep & Human Health Institute (2000-current).

Dr. Krakow graduated magna cum laude from the University of Maryland School of Medicine. He was residency trained and board certified in internal medicine and also has ten years of clinical work in emergency medicine. He is a member of the American Academy of Sleep Medicine and the Sleep Research Society and is the former medical director of University Hospital Sleep Disorders Center.

Dr. Krakow has published two books, Insomnia Cures and his most recent, Sound Sleep, Sound Mind, is the first book of its kind to focus on mental, emotional and physical causes to sleep disturbances. Dr. Krakow and his wife, Jessica Kohr-Krakow have also published Turning Nightmares into Dreams, an innovated self-help, audio series and workbook to eliminate bad dreams.

To listen to the interview, or to read more, click here…

Some take these drugs to relieve a “sleep disturbance,” treat a “stressed out” life, manage clinical depression, or for no clearcut reason according to the patient.

When I ask these patients what exactly antidepressants achieve for them, the following are the most typical replies:

1. Decrease in irritability
2. Decrease in emotional outbursts
3. Decrease in anxiety or depression symptoms.

Few of these patients ever state the following:

1. Elimination of anxiety or depression
2. Elimination of a sleep disturbance
3. Markedly improved emotional coping.

Instead, the typical patient I see in a sleep clinic, while reporting some benefits from antidepressants, often wonders what they are treating beyond high stress levels, almost always states that the pills “numb” their emotions instead of fixing anything, and frequently wonder whether their depression is a direct result of loss of sleep or poor sleep quality.

What continues to confuse and bother me is that there tends to be this general consensus that a low threshold for prescribing antidepressants becomes the commonly accepted approach to poor coping, as if poor coping is code for depression and therefore antidepressants are a reasonable option.

My biggest complaint about this perspective from a sleep medicine vantage point is that poor coping could just as easily be due to fatigue and sleepiness from a sleep disorder, in which case antidepressant treatment is inappropriate whereas diagnosing and treating the sleep disorder is the appropriate treatment.

However, an even more fundamental complaint is the very acceptance of poor coping as a diagnosable condition requiring a pharmacological treatment. Poor coping in my clinical experience usually is a sign of weak emotional processing skills. If you give the patient a few sessions built around the premise that identifying underlying emotional reactions yields a lot of insight that leads to improved coping, then I think many prescription pads would be unused.

Human emotion is a natural part of our makeup, and almost anyone can learn to improve some of their coping skills by learning to recognize and work through some of their emotional reactions instead of just labeling them stress and seeking a new pill to wash away the feelings.