Emotional Health: Dr. Barry Krakow on Advocating for Better Sleep and Tips for Finding Quality Care

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Welcome to the A World of Difference podcast. I'm Lori Adams Brown, and this is a podcast for those who are different and want to make a difference. Hello, and I'm so excited to introduce today's guest. For all of you non sleepers out there or people who love people who struggle with sleep or any of you who are walking through difficulty in your life that for whatever reason have brought difficult sleep into your life we all, I think, struggle at one point or another, whether it's jet lag or illness or pregnancy or walking through the change that happens to women all around the world when we walk through menopause or perimenopause or just getting older and having mental health struggles, walking through a pandemic like COVID and being anxious about all kinds of things. Dr.

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Krakow, who is a medical doctor, is Barry Krakow is on the show today. He's a board certified internist and sleep medicine specialist who has worked in the field of sleep research and clinical sleep medicine for more than 30 years, pioneering innovative techniques for the treatment of chronic nightmares, chronic insomnia, complex insomnia, upper airway resistance syndrome, obstructive and sleep apnea, and restless leg syndrome, as well as periodic limb movement disorder. If you or anyone you know has struggled with any of these things, he is going to talk to us today about the research, about what's helpful, how he's helping his clients and patients. He lives in Savannah, Georgia, and holds a medical license in the state of Georgia, where he's a professor of Psychiatry and Behavioral Health in the Department of Psychiatry at Mercer University School of Medicine. Currently, he trains psychiatry residents in sleep disorders medicine and supervises their sleep medicine clinic.

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He also spent some time in New Mexico, which is a place I love and where my family lives, and he is here today to talk to us about all kinds of sleep treatments and options that are going to help you and your loved ones learn how to sleep better. Doesn't that sound great? I'm so excited to introduce to you today Dr. Barry Krakow.

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Hi, Barry. We have Barry on the show today talking about sleep and how it relates to mental health and emotional health. Welcome to the show, Barry. Good to be here. Thanks for the invitation.

00:02:34

You're welcome. Very excited to have been able to read some of your research and your book and excited to dig into this topic today. First, I just wanted to start with giving you an opportunity to tell us a little bit about your background and even what led you to focus on this relationship between sleep and mental health. I started in Sleep in 1988 working in a Department of Psychiatry in the University of New Mexico. Now I'm an internist and I've also worked in emergency medicine and addiction medicine, but this attraction to sleep really took off in the 1990s.

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We did this initial work treating nightmare patients and in doing. So we learned that by treating their nightmares, just their nightmares, we saw their mental health get better. And that was a surprise that had never been published before, and that was an opening in the field of connecting sleep and mental health that had never really been addressed. We were one of the first groups to do this, and throughout the 1990s, what we learned was nightmares were the tip of an iceberg, and that most people who had chronic nightmares, generally PTSD patients, had much more complexity to their sleep, including insomnia, sleep breathing disorders, restless legs, and leg jerks. And this complexity was clearly interfering with their ability to treat their PTSD.

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That is so fascinating. It's really fascinating. I mean, we have several people that listen to the podcast that suffer from PTSD or cPTSD or sleep disorders of different kinds. Explain a little bit more about that. So originally, all through the 1980s and 90s, if you had PTSD, you were told you either use this medication or you use something called exposure therapy.

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And from those two classes, there's a lot of variety, and some of them work, and some of them don't. But the thing that kept showing up, even in the trauma research groups, was that after they treated the PTSD, the nightmares and the insomnia persisted. And people are going, well, what's that all about? And the way it was approached back then, the is, oh, well, that's just a secondary problem. We need to give you some more medication, or maybe you could see a sleep doctor, but that probably won't help because it's your PTSD, your depression, your anxiety that's causing this problem.

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Well, all through the 1990s, in our initial set of work that decade, we learned that wasn't true at all. These were independent disorders, the nightmares, the insomnia, the sleep breathing in particular, and, of course, restless legs and leg jerks and circadian rhythm. All of these things were independently affecting these PTSD patients. So we said, don't call this post traumatic sleep disturbance, which is what the term was used in the we said, call it post traumatic sleep disorders because you're dealing with independent sleep disorders, and that is the key that unlocks all of this. And this is widespread mental health, and this is actually I use this word very cautiously, but it's kind of scandalous.

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The mental health profession really does not understand. More than 90% of mental health professionals, therapists, prescribing psychiatrists, prescribing psychologists do not understand that when they see these patients, they're dealing with and masking a sleep disorder, because they're saying, here's my prescription. Try this drug. If that doesn't work, try this drug. Some of them will say, we'll try this psychotherapy.

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But they're all missing the fact that all of these sleep disorders can be treated independently with excellent results. And, of course, the great news is, when you treat somebody's sleep disorder, not only do they sleep better, but their mental health improves. Sometimes very noticeably.

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I mean, it's almost like intuitively we know this and yet we've overcomplicated it. Right. This is why I say patients are so much smarter than doctors. Patients have been walking into doctors offices for decades saying, doctor, if you can fix my sleep problem, my depression is going to get better. When I was in training in sleep medicine in the 1990s, do you know what they told me?

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They told me if the patient tells you that narrative, that means the patient is depressed and doesn't understand their disorder. Oh, no. And that's exactly still today how many people practice. So the patients knew this a long time ago and kept clamoring for help. The only help they got was a medication.

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Sometimes psychotherapy, and I'm not saying psychotherapy or medications are bad, they can help people in many circumstances. But the boat has been missed for a very long time and this has led to so many people getting horribly frustrated. And of course, the worst outcome is that these links between untreated sleep disorders and suicidality are very real. There is absolutely no question that people who have untreated insomnia and nightmares in particular are at risk for suicidal ideation and behavior. Yeah, it all makes so much sense.

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In your book life Saving Sleep, New Horizons and Mental Health Treatment. You do highlight the power of better sleep. But as we look at how sleep is connected to mental health in such a profound way, what is your advice for somebody maybe listening right now who is struggling with sleep and mental health? Do they start off by going to a sleep doctor? I know that I read about this in your book, like what you advise, but some practitioners may not be as good as others.

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So what's a step one for people? Well, a great step one would be buy life saving sleep and see and read it all the way through because it's just packed with various ways to start. So I'll tell you what the single most important first step is for anybody. They've got to realize that their sleep problem is doing something to damage their sleep quality. Most people are hung up on this idea largely because of the doctors prescribing, but also in society.

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Society has so much disrespect for sleep that people get caught up in what the media advertises, which is number of hours of sleep. And that is really a myth. Hours of sleep is highly irrelevant to the largest number of patients. It doesn't mean numbers of sleep can't be useful at some point. Secondarily, but the real problem is there's something wrong with the quality of your sleep.

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Now, what does that mean? It means literally that when you sleep, you have fragmented sleep. Your brain waves are going crazy. They're not being rhythmical, they're not being smooth, they're not producing restorative quality sleep. And you wake up and you feel unrefreshed, and then you're tired and sleepy during the day.

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So if you have that problem, my plea to you is stop counting number of hours of sleep and look at the fact that, gosh, there must be something wrong with my sleep itself.

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Really good advice, and it's something I didn't really understand until I read that, and it is helpful. We have these devices now, whether it's our phones or our Apple Watches that are telling us how many hours we sleep and then rating it on a health scale. But what you're saying is that quality of sleep is something we need to pay more attention to. I know that you talk about, like in your research and your practice, there's some specific mechanisms that link sleep quality to improvements in stress and anxiety and depression. Could you give us a little more information about that?

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What we're talking about here is the issue of what is it that sleep really does? And sleep, of course, gives us energy. That's an obvious one. And energy is a huge deal because if you're tired and sleepy, how are you going to cope during the day? How are you going to respond to anxiety, depression and PTSD when you're tired, sleepy, if not exhausted?

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But sleep also does this amazing brainwashing technique in the middle of the night, so to speak, where it cleanses the brain of toxic molecules. So the brain has its own it's called the Glymphatic system, like we have in our bodies, the Lymphatic system, which of course is helping to remove waste biomolecules. The brain has its own version of that called GLIM, with a G on the front glymphatic system. We even believe that that Glymphatic system is probably related to why some people are more at risk for getting dementia, because the Glymphatic system only works well guess when you're sleeping and sleeping deeply, sleeping with high quality. So that's where it all starts.

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You've got this EEG. The EEG is actually not a very good measure of our sleep. We are doing the best we can. We need much more technology to really understand sleep because you can have certain kinds of brainwave patterns and some sleep doctors will look at it and say, okay, well, that's normal, when in fact another doctor with more advanced technology will say, well, no, that's not normal at all. And that's a horrible thing.

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You would like the technology to be there. In clinical practice that I've just described, it's not so we have a lot of outdated things going on in sleep medicine where people end up getting false negative tests both about their EEG, which is the brainwaves, and about their sleep breathing. So the bottom line is, if that sleep breathing, EEG, Glymphatic system, if that's not all working well, one of the most obvious things that happens that most people probably can relate to is that after just one bad night of sleep, a lot of people will say things like, I feel like I'm getting sick, I'm getting aches. And pains. I'm getting chills.

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I feel a little feverish. My throat's a little scratchy. And then this sounds funny, but you could have, like, a cup of coffee or some green tea, and the next thing you go, well, wait, that's all gone. I feel fine now. So wait, I guess I wasn't getting sick, but why would I feel like I'm getting sick now?

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Imagine the person who's doing that every single night. Every single night, every morning, they're getting up going, this is hard. This is a very difficult thing. And the person has no clue that this is happening. They can only point to, okay, well, I've got a sleep problem, and the doctor told me to take this pill and I need to get some more sleep and maybe I should take a nap.

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Oh, no, but if I take a nap, then it's going to mess up my sleep at night. And the poor advice that these individuals are receiving is absolutely either worsening directly their mental health or just dragging things out and letting these sleep disorders actually worsen their mental and physical health over years and decades. Just keep in mind, by having these problems with your sleep, it's not just all psychological. You end up with cardiovascular diseases, neurologic problems. I mean, sleep is a huge deal.

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It is such a huge deal. And when I just hear you put it that way, I think of so many people in so many situations that have suffered for so long. Do you have any examples or experiences of case studies where you really saw some of your advice helping somebody successfully, like, significantly improve their mental health and sleep at the same time? Only a few thousand. The one that represents a huge what I call case zero.

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For me, it's a bit involved because it occurred at a time when I had only recently finished my training in sleep medicine and had been mentored by the greatest sleep researcher in the world at the time. And even though he passed a few years ago, I still think he was the greatest. Dr. Christian Guimano at Stanford University, he discovered a condition called upper airway resistance syndrome, which is very common in mental health patients who go to a sleep center and get a sleep test, and the doctor says it's normal, and yet the test shows unusual things like spontaneous arousals. And the doctor says, well, those are just spontaneous arousals.

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And you go, well, what's spontaneous about them? And there's other researchers over the years who've said those aren't spontaneous arousals. Those are very subtle arousals from the breathing problem. So I learned all this from Dr. Guimino.

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And as I watched cases of this, I went back to the center. I was in New Mexico at the time, at the university, and we began to know different cases, and we didn't have good technology, so we're really eyeballing it and guessing a bit. Finally, we just opened up our own sleep center because we wanted to put in the best technology. It's called nasal cannula pressure transducer. It's a technology that just looks like an oxygen cannula, and it measures your breathing in a very specific way.

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Anyway, in the early going of our center, we saw this single mom, two children, administrative assistant, worked at various public schools, constantly getting into trouble at work. What do I mean? Sick, probations, absenteeism, unable to really carry on. She already went to two sleep centers. They both told her, well, number one, there's nothing wrong with your sleep because your sleep study is normal.

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Number two, sleep center said, we don't really treat patients like you. You should just go to a psychiatrist and get some pills, and you'll be fine. This lady was at her wits end. I mean, she was absolutely exhausted. And obviously she has a lot of what do you call it, grit and motivation that allowed her to continue working.

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But she herself was embarrassed and obviously a bit ashamed about the fact that she couldn't do her job well. And of course, she's trying to care for her two children. She came to see me, and I said, Well, I've looked at your oral airway, your exam. I've listened to your story. I've looked at the one sleep study.

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I said, you probably have this condition called upper airway resistance syndrome. But I have to tell you, a lot of insurance companies still don't pay attention to this, and we need to test you again in our sleep lab. So she got tested, and this was the part that just blew me away. Her breathing was the mildest form of UARS I had ever seen in my career then and since then. What I mean by that is, instead of her breathing signal looking really obvious because there's an obvious configuration, it's called flattening, and the breath actually flattens at the top while you're breathing in.

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She had the smallest, the most nominal amount of it. I said to her, Your story sounds like UARS. Your sleep study, no insurance company anywhere is going to allow you to be covered, but I believe it is worth your trying to do this. And she said, I'll pay for it out of pocket. She did this.

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I saw her again a couple of months later, expecting nothing. She goes, this is a miracle. You've changed my life. All those symptoms are gone. I am no longer exhausted.

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I am functioning like a normal human being, all because I love this machine now. And what's so really amazing to me is that she was on CPAP, which is a machine that we don't even prescribe anymore because we think it's more difficult for people to use, and we like to use more advanced technology. But that case is so memorable that she came back into the office. She was smiling. She had a glow on her face.

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You could just tell. Here's an individual whose sleep physiology had been restored to normal. And so now she's functioning and acting like a quote unquote normal human being. And it's delightful to see that. Sleep medicine is a wonderful field, by the way, because many sleep doctors, whatever level of practice they have, and some are mediocre, but nonetheless, we all get to see great results because when you treat sleep disorders, you often see great improvements.

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What a wonderful outcome for that woman, that mom, who's having to both provide for her family financially and needs to be able to show up to work, awake, right, and also be awake at the end of the day for a second shift, unpaid, to work and care for her children. So that's really exciting that you were able to make such a difference in her life. But it can feel, I'm sure, frustrating for many patients who might, for example, show up to get a sleep study and they don't get the answers that they need, or they get prescribed, maybe by a psychiatrist. Sleeping pills. And your book touches on reducing sedative dependency and sleeping pill use through improved sleep.

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What other strategies or techniques do you recommend, maybe, for the individuals who are relying so heavily on such medications? So if we step back one frame? Well, I just want to get across that in the book, I am repeatedly describing the words, the verbiage, the narrative that individuals have to use. In fact, in my coaching practice, which is at my Barrycracomd.com website, more than half the time, I'm encountering a patient who's struggling, just like you said, working with another sleep center. And so what I do is I say, let me tell you what the doctor is going to say to you, and I'm going to tell you what your response is going to be, because I want you to be so educated that you're going to put the doctor back on his heels going, wait a second.

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This person sounds like they know sleep medicine and they've read other things. And maybe I should consider what they're saying to be different for this particular case. And that, unfortunately, is happening to this day. It happened with a patient I just spoke to yesterday, a military vet, and he was very just so disjointed and disappointed because even though I told him all this stuff, he's going, I just don't think the doctor is going to listen to me. I said, well, then pick up the phone and call another doctor because you have got everything that suggests that you have UARS.

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You already had another doctor tell you that you had UARS and that you need to be treated with a different type of device anyway. So talking to these people is very important because even if you read my book, you don't get everything in there. You still have to go to a sleep center at some point to get certain things. Plus, there's many specialists out there that have other skills. What I like to say to people in the early going is you really need to ask yourself if it is a sleep quality problem.

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Do you want to do something about that right now? Because the beauty of this is if you have a sleep quality problem, the chances are 90% or greater that it's a sleep breathing issue. That means you can figure that out yourself within a matter of weeks, sometimes a matter of days, what do you do? We've had hundreds of patients hear this story and they were all reluctant, oh, no, you're telling me about CPAP. Forget that.

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I'm not going to do no. We're starting simple. We're going to ask you questions about your nasal breathing, because it turns out if you have a sleep breathing problem, all that friction caused by sleep disordered breathing ends up causing more congestion, runny nose stuffiness inside the nose. So we've had people just go on nasal saline, nothing else. Put nasal saline drops in 4610 times a day and they come back a couple of weeks later and they go, I'm already sleeping better.

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Same thing happens if you put them on nasal strips. You might even get a bigger bang for the buck with a little device called nasal dilators. By the way, we did a study 20 years ago that showed insomniacs who didn't know they had a sleep breathing disorder, but we suspected it because of the interviewing that we did with them. We put them on nasal strips and 75% of them got a notable statistically significant medium to large clinical effect, improving the insomnia only by putting on a nasal strip. So if you go through all that, if you're a person who does these things and you're learning that your nasal breathing is that important, that's going to completely change your attitude about what's going on with your sleep.

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You're going to say, Wait, do these pills that I've been taking, do they treat my sleep disordered breathing? And the answer largely is no. There are exceptions where they might be valuable in that situation, but for the most part, they don't work that way. They work on other transmitters. So if you now have this breathing disorder that's confirmed, you should be going, well, what else can I do?

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And there's dental devices out there that work very well. They're less intrusive. There are certain kinds of surgeries to consider, particularly if you have a deviated septum and large tonsils and large turbinates. So there's so much the individual can work on before they even set foot in a sleep center. If they want to find out if sleep quality really is the issue.

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And if someone is listening to this and they're now convinced they should go to a sleep center, is there any particular place you would have them start? Are some better than others? What should they be looking for in terms of finding the best care? That is such a great question, and sadly, the answer is very problematic. So many people in today's consensus medicine world and I use consensus medicine as a pejorative it's a very poor way to practice medicine.

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There's a lot of people who should take blame for it. Lots and lots of people the doctors, the insurance companies, the government, everybody has created a system that is not letting doctors innovate work in ways to see things differently. So do you know in sleep medicine, sleep doctors learn, well, CPAP is all anybody needs. There's no such thing as somebody needing something else. There's some now cardiovascular cases and they'll say, well they could use these other devices or a pulmonary condition and they say that and so that part is at least covered.

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But those are much sicker patients. There's millions of patients on CPAP, millions right now that are not getting a good response, and they want to give up, and they hate the device. And nobody comes along and says, well, by the way, did you know? There's something called bi level, which is two different pressures, and it makes it much more comfortable, and most people get a better response from it. Even research has already shown that.

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But in the consensus medicine mindset and so what do I say to people when either I'm coaching them, I go call up the center and ask them two questions do you treat upper airway resistance syndrome? Number two do you use Bi level devices instead of CPAP? Now if somebody on the other end of the line goes what is UARS? What is bi level? You should probably just say thank you very much, and hang up and then go to the next call.

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If you're lucky, you would try to push and say, well if you don't know the answer to that, do you have a sleep tech there who will talk to me for five minutes on the phone? And this is its own problem in sleep medicine just as it is in every other facet of medicine. You can't even get somebody on the phone and if you do they'll say, well we can't answer those questions. But the point is if you got the sleep tech on the phone and the sleep tech says oh yeah, we know what UARS is and we do treat that when we see that. And Bi level, well, we don't use it so much but we have used it in the past.

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I mean that's a good sign. That means that there's something open minded about that center where maybe they'll be the ones to work with. And the other direction of course, is you can just go in cold and you take the narratives that I've described in my book and you can say, well, I want to work with you but I need to know that you're going to evaluate me for upper every resistance and not just tell me that my test. You don't know what to say about it, but it's negative and send me away. And that happens.

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It happens countless times in the field of sleep medicine. Very unfortunate. It is. You know, obviously we have a very imperfect system here in the United States where we both live and other countries may or may not handle this differently and better or worse, depending on the case. But we do have a know, I guess, capitalistic society that wants to get people to buy certain things and there's people that make money off certain things and if they can be helpful it's not bad.

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But to mass produce something that's not going to meet everybody's needs can be frustrating, I'm sure. I'm thinking about right now we might have some teenagers listening or parents of teenagers. It's back to school time here in North America and sometimes over the summer sleep schedules get off. Adolescent brains are more likely to stay up later, wake up later, and then when school starts there's all this homework activities and it's no secret that Gen Z is really struggling with anxiety. What kind of advice would you have for maybe school administrators about how to be more accommodating toward this adolescent brain and their sleep needs as it relates to anxiety?

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I don't want to talk about the administrators. I want to talk about the kids and the adolescents. But I got to give you a clear, important piece of information about your comment about capitalism. Keep in mind the devices that are on the market now called auto bi level and ASV, and ASV is the device I'm on. These are unbelievable technologies.

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Who invented them? Capitalists. They have made these advances and they've brought them out into the marketplace. Guess who's not using them? The people who are involved.

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Not in capitalism. Because our health care system is not free market by any stretch of the imagination. Our healthcare system is much closer to socialism. It's a top down approach with hospital based practices and all the doctors have to toe the line five minutes with a patient. That influence is preventing all these people from using these great capitalist entrepreneurial inventions that will dramatically change the way sleep medicine is practiced and yet they're choosing not to use it.

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So it's very concerning. Anyway, I just wanted to get that point across. Anyway, thanks for clearing that up. Sure. No, people are often what is it?

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Every system is awful, including capitalism. But compared to capitalism everything is probably worse. So the issue here is adolescence is I had this problem as an adolescent, so I know it. I turned 13 and went through puberty and I could not stop napping. I had to nap every single day after school.

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I ended up napping for 38 years before I actually figured out what the problem was. Only because I became a sleep doctor and I met Dr. Gimano and he diagnosed me. So it's not fun to be an adolescent and have the two biggest problems would be nightmares and. Insomnia.

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Nightmares peak in the age range of four to six, but then they peak again in adolescents for pretty obvious reasons with all of the emotional chaos that can go on during that time. So nightmares are huge and in fact they're a huge red flag because if you have a child or adolescent with nightmares, especially in the teenage years, that itself is a risk factor for anxiety, depression, not being able to cope well with trauma. It might even mean that you've already been traumatized and that's in fact why you're having the nightmares. And then insomnia is even more common, not just because of the circadian rhythm problem of delayed sleep phase and that is important. But sleep quality in adolescence again is extremely important and often missed.

00:33:28

So for those individuals, they really need to work with therapists who understand how to treat insomnia and nightmares. So for example, the nightmare treatment that was developed in the psychiatry research team that I joined in 1988, dr. Kellner and Dr. Neithart developed Imagery Rehearsal Therapy which to this day is considered the leading nonpharmacological treatment for chronic nightmares practiced by almost nobody. Almost no mental health professionals know about it.

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But if you search around, depending upon where you live, you will find people that do practice it. And it's a very straightforward technique. It's not a deep psychotherapy type of process and it directly treats chronic nightmares for insomnia. There's a program called Cognitive Behavioral Therapy for insomnia. It's very specialized.

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It speaks to a couple of issues that we'll talk about right now just to give people get their feet wet to see how important it is to change the way you look at sleep. Number one, if you look at a clock during the night, you're teaching yourself to look at a clock during the night. Well, clock watching is not the same thing as being asleep. So you've just taught yourself it's a good thing to be in bed, thinking about time, worrying about time and the next thing you know you have insomnia or you've had insomnia and now clockwatching makes it worse. So stopping clockwatching is a very important tool.

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The second one is understanding that there's a huge difference, grand Canyon size difference between the feeling of being sleepy and being tired. And most people who develop the problem with insomnia for whatever reasons, and especially if they're on medication, lose the capacity to make that distinction. So they end up doing what? Getting into bed when they are tired. And now they're wondering, well why don't I fall asleep?

00:35:50

Well you didn't fall asleep because you're not sleepy. And so this is a huge step for some people. They actually have to go back to the drawing board and say, well do I remember what it's like to be sleepy? Oh yeah, I remember that time in church or during the third period in class, my eyes were getting droopy and I wanted to not, oh, that's sleepy so don't get into bed unless you feel that way, and then get out of bed if you feel tired only. So those are two big paradigms, and if people work on those paradigms, they end up with something very different in the way they approach their sleep, and they're on the path to actually overcoming the insomnia.

00:36:35

That is so insightful, and I read about this in your book, the whole cognitive behavioral therapy for insomnia. And it was something that had never really occurred to me in that exact way. So if somebody was going to look for a therapist that specialized for that, is that something therapists typically list? Or do you go more towards a sleep clinic? Is that available there?

00:36:55

Where do they find that much more towards sleep? The thing about CBTi that's very interesting is you're seeing now more online programs. So there's several people who do that coaching. I do that coaching. And it's not that difficult to find something online where it's a CBTi program.

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How good they are, we don't know. If you look at the credentials, they look pretty good for the people that are doing this. There's also people doing automated online programs that are obviously cheaper, and some of those have been tested with research. If you call sleep centers in your area, you can ask, do you have somebody who practices CBTi? And at least ten to 25% will say, yes, we do.

00:37:40

We have somebody that practices CBTi. If you go to a mental health clinic and you ask, do you have somebody that has CBTi skill? They'll go, what's that? They'll say, I know CBT, but I don't typically know CBTi. So there the rate might be 5% to 10% where you would find somebody so that is accessible.

00:38:05

People can find that the IRT treatment is more difficult to find. Again, if you go in a sleep angle, that's one sleep centers in the military, because of so much PTSD and nightmares, they have many, many mental health professionals in the military that practice the treatment of IRT. So that's a very interesting pathway for some. Good to know. Yeah, we definitely have some ex military and veterans that listen, so that could be helpful to some of them.

00:38:40

I know that as people go from adolescent into adulthood and then into later life, the way we sleep changes. I know many women listening are in the paramenopause phase where different things could happen from like hot flashes to all kinds of changes in women's bodies. What's some advice you have around sleep at that phase of life? I'm so glad you asked that question, because Dr. Gimeno pioneered the understanding of UARS in a very famous study of several hundred women that were premenopausal menopausal and postmenopausal.

00:39:19

And he found enormous rates of upper airway resistance syndrome in these individuals. So you know that most people going through this change of life will often say there's a sleep disturbance and they go into a doctor. And the doctor, unless they're up to date obstetrician gynecologist, unless they're up to date on this knowledge, they're thinking, oh, we'll practice some sleep hygiene, try this sleeping pill, when in fact, what's happening is as they lose progesterone levels, that means they're pretty much going to get a sleep breathing disorder. You're probably not old enough to know this, but in the 1960s and 70s, sleep apnea was treated with progesterone because it improves the respiratory drive. So we now know, and this is what Dr.

00:40:15

Gimeno found, these papers were published in the 1990s that's over 30 years ago that women going through this cycle and they're complaining of insomnia in particular, actually have a sleep breathing disorder, and most doctors don't know about it. Just as a side, just such an amazing thing about sleep and sleep breathing. The man who invented CPAP, dr. Colin Sullivan, in Australia in the early 1980s, he published a paper twice. Now, once was in the once was more recently, but I don't remember the date.

00:40:54

He actually showed that most women who suffer preeclampsia, which, you know, involves an elevation of blood pressure, have sleep apnea. He did a study. He put women hospitalized for preeclampsia on a PAP machine. He got them out of the hospital within 24 or 48 hours. Again, wow.

00:41:19

Nobody is looking at this data because people have so many blinders on when it comes to sleep, and they're thinking, oh, well, it couldn't be that. It couldn't be that. Sleep couldn't be that big. Well, that's it. Sleep is absolutely huge.

00:41:34

It's a monster affecting virtually every organ system of your body.

00:41:41

Yes, as a parent, since our first born was a non sleeper, you don't appreciate sleep until you have your first baby, but it's just like he's in college now and then I have two that are in high school, twins. And I think that all throughout my parenting. It's kind of a running joke in my family, like, just sleep, sleep's everything. If you can sleep, everything will be know. Even in jet lag.

00:42:06

It's like we just need to get our circadian rhythms switched to Asia or North America, where we're flying to. Then we'll be fine. I think intuitively, we know how important sleep is, and yet we'll go in sometimes, like you said, to our healthcare professionals, our therapists, different counselors, and the practice isn't integrating with these ways, and we can get medically gaslit as if we don't know what we're talking about. So are there any other tips you have with somebody who needs kind of a holistic team and how to kind of advocate for themselves in these ways? Well, knowledge is crucial here because what's happening is it's two different paradigms facing off.

00:42:46

There's a patient who with common sense, and I like the way you said that earlier. The patient knows there's got to be something better and that there is something clearly wrong, and yet they're being confronted by a doctor who, for whatever reasons, has self inflicted wounds and ties one hand behind their back and says, oh, well, CPAP cures everything. And if not, let's just give you a pill for sleep. And did they not do like a continuing education course and get some updates? Did they not go to an annual sleep conference?

00:43:23

Did they not talk to another person? Did they not read a research paper? I mean, what does it take to get people to change their attitude? And this is a very big deal in our society right now on many fronts, so we don't even have to mention all those fronts. But the point is when people go around not willing to consider other ideas and saying, oh, no, that idea is a bad idea, so we can't even talk about it.

00:43:51

And there are sleep doctors who literally shame people. They actually say to them, well, I don't know what's wrong with you. You're using the CPAP device for six, 7 hours a night. I don't know why you're not getting better. They should be saying, apparently this CPAP device is failing you.

00:44:15

We have to find a better device so you can succeed. And it's unbelievable. And I hear these stories, I get frustrated and I actually get angry to think that somebody would cheat somebody that way and not recognize that there could be just possibly missing something, because what's a doctor's role? The doctor is supposed to listen to the patient and say, well, that's very interesting. Like, gosh, you're using this CPAP all these hours and you're not getting a good response.

00:44:46

Gosh, I've only seen a few cases like this, but let's dig into this. Let's find out what's going on. And that just not seems to be very common in sleep medicine. It's very disturbing. It is disturbing.

00:45:02

Thank you so much for the research that you've mean all your work in New Mexico, by the way. My family's in New Mexico. We just got back from New Mexico yesterday. We did a whole New Mexico tour. My family lives in Las Cruces, but we also went up to see Los Alamos because we saw Oppenheimer and wouldn't do the whole tour and then did the near the Trinity site.

00:45:20

The Owl Cafe was as close as we got, but Santa Fe did all that. It's a beautiful state. I know there's a lot of great research that's come out of there and I'm so grateful for your book and your research that's helping clearly help people understand what we don't know. We can't know unless we're told. And I think that knowledge is power both for us and our doctors and our therapists that can help us.

00:45:43

If people want to reach out to you to know more or follow your research and your writing or even get coaching, how do they find you? So my main website is Barrycracomd.com, and that's where I do more coaching service. People also contact me like mental health professionals want training programs, so I do that too. I have a substac newsletter where I try to do a weekly update on things going on either in my research or in other people's research and commenting on it. And that's Fastasleep substac.com.

00:46:15

And then, of course, the book Life Saving Sleep is new and that's on Amazon and wherever books are sold, and it's now on Kindle everywhere. So there's two different paperback and Kindle. Wonderful. Thank you so much, Dr. Krakow, for being on today and helping us understand more about sleep.

00:46:34

We'll continue the conversation in our Difference Maker paid community, and we're going to learn a little more from you about some of the exciting research that you're hoping is coming out and what you're kind of covering in your substac newsletter a little bit, hopefully. So for those of you who aren't in our Difference Maker community now's, your invitation to join you're warmly welcome to join us there. Thanks so much for your time today, Doctor, and I really appreciate all your research that's helping us learn how to sleep and work on our mental health. Thank you very much. Oh, I learned so much about sleep.

00:47:04

It is it's a thing in my family where I just have this thing for years where I'm just like, if you could just sleep, it would get better. I don't care what's going on in your life, whether it's a physical illness, a mental illness. I know that that's probably way simplifying things, but I feel like today we could make the case for how important sleep really is to just health in general. So check out Dr. Krakow's book, life Saving Sleep.

00:47:30

Also, he has a substac where I'm sure there's so much information that can be helpful in various particular aspects of your issues around sleep or the sleep of loved ones in your home or maybe loved ones outside of your home. Go to his substac newsletter at Fastasleep substack.com. Also check out his website, BarryKrakowmd.com. And he also has one lifesavingsleep.com sleeptreatment.com nightmaretreatment.com. He is just a wealth of information.

00:48:02

I'm so grateful for people in our lives that come into our lives and can help educate us on things that. We just don't have time to research. But somebody like him who's just an expert on this, has been working in it for over 30 years, is teaching people about it, and is really helping change the game in terms of how we understand sleep. So grateful for him. Check out all of his resources.

00:48:24

Let people know that are struggling with sleep. About this Podcast this is one podcast that could really make a difference in their lives, and that's what we're all about here. We want to make a difference in your life. We're grateful you're making a difference in the lives of others. We're glad you're bringing your differences around this table.

00:48:40

And I'm so glad Dr. Krakow brought his differences to the table today. What a unique research that he's been a part of, what a unique profession he's a part of. I'm so grateful for him. And already I just learned some things that are going to help me sleep better and my family.

00:48:57

So I hope that's the case for you. Once again, share this episode with anybody who might want to hear it. He will be on our Difference Maker community, sharing even more in depth as I ask him more stuff just for our Difference Maker community. So if you're not a part of that yet, please join us for as little as $5 a month and get extra content with people like Dr. Akako and over 30 other episodes that are available for you just exclusively.

00:49:20

When you join this community, we'd love for you to be a part of it. Everybody go get some sleep. Spread the news about how to sleep better with this episode with anybody in your life that might want to hear it. Thanks for sharing it. Have a great day and keep making a difference.

00:49:35

Friends, wherever you are. Bye.