Ep. 036 | Sleep's Critical Role: Unveiling the Nexus Between PTSD, Sleep Disorders, and Health w/ Dr. Barry Krakow

Dr. Barry Krakow discusses the relationship between sleep, PTSD, and sleep disorders, emphasizing the importance of sleep quality and the impact of sleep fragmentation on overall health. He also highlights the significance of early conservative treatments for sleep disorders and the need for proper evaluation and diagnosis. Dr. Barry Krakow discusses the prevalence of sleep disorders, the impact of sleep on overall health, and the importance of recognizing and addressing sleep-related issues. He emphasizes the need for a comprehensive approach to sleep health and highlights the potential risks of undiagnosed sleep disorders. Dr. Krakow also provides insights into integrating sleep health into high-stress professions and the significance of assessing one's sleep quality.

Check out the Episode Blog

Takeaways

• Understanding the complex link between sleep, PTSD, and sleep disorders is vital for mental health care.
• Early interventions like treating nasal issues can greatly improve sleep and health.
• Shift work and sleep fragmentation risk developing conditions like sleep apnea.
• Accurate sleep disorder diagnosis through sleep studies is critical for management.
• Sleep disorders significantly affect mental health, workplace safety, and well-being, highlighting the need for prioritizing sleep quality.
• Recognizing sleep issues is essential for health and risk prevention.
• Incorporating sleep health in high-stress jobs requires awareness and active engagement.
• Self-assessing sleep quality hinges on feeling refreshed within 30 minutes of waking, without relying on stimulants or exercise.
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Links :

• Website ( barrykrakowmd.com )
• Life Saving Sleep: New Horizons in Mental Health Treatment

Transcript

Chris Warden (00:01.182)
Good morning. Welcome back to priority traffic podcast. Today I have with me and I was going to ask you, doctor, how do I pronounce your last name? And I can edit that out, but Krayco.

Barry Krakow (00:09.636)
Two long valves, Krayco.

Chris Warden (00:13.119)
Dr. Kraiko is here with us today and we're going to dig into sleep, PTSD and sleep disorders and maybe shed some light on the idea of sleep and how we as first responders can get a little bit more out of it, maybe learn something today. So Dr. Kraiko, thanks for joining us.

Barry Krakow (00:36.676)
Happy to be here, thank you.

Chris Warden (00:39.423)
So I'm going to just jump right in. You're a doctor of sleep medicine. Can you kind of give us a little introduction on your background and maybe a little bit of backstory about how you ended up being a doctor of sleep? Because sleep is such a profound topic to me.

Barry Krakow (00:55.524)
Indeed it is to all of us who are interested in our sleep and surprisingly or not, there's a lot of people that are not interested in their sleep and they should be. And maybe we can get a few of them to take it more seriously. I trained as an internist and practiced emergency medicine for 10 years. So I was intricately involved with first responders, you know, working in a level one trauma center for that decade.

Chris Warden (00:57.502)
Yeah.

Chris Warden (01:16.818)
you

Barry Krakow (01:25.668)
And that was back in the 1980s and 90s. And then I ended up getting involved in a research project, treating people with chronic nightmares. And that eventually led to understanding the relationship between chronic nightmares and post -traumatic stress disorder, because that's one of the cardinal symptoms that people, particularly those who have more severe PTSD, they will have these disturbing dreams and nightmares.

Chris Warden (01:25.918)
Okay.

Barry Krakow (01:55.364)
And many of them don't even recognize that that's part of PTSD. They just think they've got these bad dreams. They don't know what to do about them. They may not even be seeking help, which is unfortunate because there are treatments for nightmares. Anyway, once I went into the field of nightmare research, that opened up this whole window of wait. There's something out there called sleep medicine. I'd never even heard of it. So this was 1990.

Chris Warden (01:55.774)
Sure.

Chris Warden (02:12.862)
Yeah.

Barry Krakow (02:23.844)
And from then on, I went to all the sleep meetings. I ended up doing all the training to get a board certification in sleep medicine. I became a clinical sleep doctor, but even though I worked at sleep centers, opened up my own sleep center, our work, because I started in mental health, stayed with mental health. So my whole specialty has been treating sleep disorders.

Chris Warden (02:26.11)
I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys coming out and watching this. I appreciate you guys

Barry Krakow (02:50.116)
in mental health patients, particularly PTSD. We've published more research data on the treatment of sleep problems in PTSD than any other research group. And my most recent book, Life Saving Sleep, New Horizons in Mental Health Treatment, is the compilation of what is largely my life's work in helping people realize that there's so much you can do.

Chris Warden (02:54.592)
Yep.

Barry Krakow (03:19.588)
for sleep in PTSD without using a prescription pad.

Chris Warden (03:24.128)
Really? So when you when you talk about nightmares, can you kind of give us an idea of like maybe what is a nightmare? And I know we probably all had it. It's that disturbing thing that happens while we sleep that's frightful and uncomfortable. But can you kind of explain what's going on there?

Barry Krakow (03:45.476)
For PTSD patients or people who wonder if they have post -traumatic stress, whether they're formally diagnosed or not, there's a lot of things in, as we call it, can go bump in the night. That's an old expression, they go bump in the night. And that's a category called parasomnia. The biggest one, of course, is nightmares. You have disturbing dreams, typically in REM sleep. Most of these bad dreams would occur more likely in the second half of sleep.

Chris Warden (03:53.345)
Okay.

Chris Warden (04:01.985)
Mm -hmm.

Barry Krakow (04:15.748)
However, in PTSD, there's a lot of research showing that people can have disturbing dreams at various points in the night, and it's not really clear what stage of sleep they may be in at that time. We also know that some PTSD patients are prone to something called sleep or night terrors, which is a different kind of event. Usually there's not like, there can be dream activity, but most people would never remember it.

Chris Warden (04:39.585)
We're also experiencing a lot of people saying, hey, we're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're going to be able to do this. We're

Barry Krakow (04:45.604)
They wake up very startled. They may not even know they just woke up. They may scream and yell and then go right back to sleep. Those are also very disabling because they disrupt your sleep. And of course, if somebody else is in the room, if you've got a nightmare or a sleep terror, they obviously have their sleep disrupted and they get very scared watching these people.

Chris Warden (05:05.185)
Sure. Yeah, that would be quite de -ordial, especially if you're not sure or if it's the first time you've experienced that. That would be pretty, could be traumatic, I suppose.

Barry Krakow (05:19.236)
Absolutely. Not only that, but the worst case, and it's not so rare, is that people with both nightmares or sleep terrors do thrash around in bed and they can injure the person sleeping with them. They can injure themselves. They can fall out of bed. They can break bones. They can get scratches, bruises. These are all indications, by the way, if anybody has that kind of activity in their sleep, they unequivocally...

Chris Warden (05:28.705)
Yeah. Yeah. Mm -hmm. Mm -hmm.

Barry Krakow (05:48.228)
need to go to a sleep center, they have to get a sleep study, they've got to get that big hookup with all the EEG wires, they got to figure out what is going on in their sleep to cause that, because that is very abnormal.

Chris Warden (05:57.696)
Yeah, that sounds like a pretty abnormal way to rest. So real quick, before we get too far along, as I have plenty of questions, can you give our audience just a basic 10 ,000 foot view of sleep and its importance and what starts to show up when we don't have it, and especially in a high risk profession like firefighting?

Barry Krakow (06:22.884)
Sure, sure. So the big issue here, especially from 10, 30 or 100 ,000 feet, is that people don't understand that the sleep deprivation word that gets thrown around all the time and like number of hours of sleep that gets thrown around, that's not where the money is. Sure, there are people who want more sleep. And sure, there are people burning the candle at both ends.

Chris Warden (06:28.927)
Yeah, yeah, whatever.

Chris Warden (06:46.047)
Mm -hmm.

Barry Krakow (06:50.884)
because they use Red Bull and high energy drinks and they do that. So absolutely there's a whole category of those individuals and there's not much you can say to them because they're committed to that lifestyle for whatever reason, that's a deeper issue. But amongst that group and amongst a whole other set of people, there's what we call a sleep quality problem. And that's where the money is. And that's where people don't realize that they keep hearing this,

Chris Warden (06:56.96)
Sure. Okay.

Barry Krakow (07:19.812)
Well, don't you have to get eight hours of sleep? Don't you have to get seven hours? Why do you keep, and it turns out that's wrong. It's useful information, but it's wrong in terms of saying, what is your problem? Your problem is almost always based on a concept called sleep fragmentation. So sleep is this thing that absolutely restores your mind and body at night.

Chris Warden (07:26.816)
Okay.

Chris Warden (07:42.56)
Okay.

Barry Krakow (07:47.972)
And it even has a system in it called the glymphatic system, which cleanses the brain of toxins and waste material during the night. Well, guess when that glymphatic system works best? During sleep and during deep sleep. Well, deep sleep means high quality restorative slumber. So when somebody has a sleep complaint, and I like to say this, even though it's a lot of words, a sleep complaint,

Chris Warden (08:13.279)
Okay.

Barry Krakow (08:17.988)
a sleep issue, a sleep symptom, a sleep condition. I throw all those words out the window. Those words are useless. The correct word is a sleep disorder. There's something physiologically active in that person's EEG, their brain waves, that's messing up their sleep, and that has to be diagnosed and treated. And so why? Because the people who don't treat it,

Chris Warden (08:40.8)
Sure

Barry Krakow (08:47.172)
end up with what? PTSD, memory problems, concentration problems, hypertension, cardiovascular disease, dementia, workplace accidents. Sleep is this amazing thing that can restore you mentally, physically, even spiritually, according to some, that if you don't really pay heed to it, if you don't respect it, you're going to pay the price.

Chris Warden (09:07.615)
Sure.

Barry Krakow (09:16.836)
And there's many people when they're younger, certainly, believe, well, I can just sleep when I'm dead. It's a very famous expression. Many people use it in many cultures. And it's probably not true. I don't actually think you sleep when you're dead. You got a lot of stuff going on after you're dead, and I don't think it involves sleeping. So in this life,

Chris Warden (09:27.871)
Yeah, you probably, you won't wake up, but you're definitely not sleeping.

Chris Warden (09:40.863)
Yeah.

Barry Krakow (09:43.908)
You have an opportunity to make yourself as I like to tell people, smarter, quicker, clearer thinking, better judgments, happier. All these great things happen for people who sleep well. And for those people suffering a mental health issue, what's so tragic and sad is how many people in the mental health profession are not telling their patients this.

Chris Warden (09:59.134)
Okay.

Barry Krakow (10:11.076)
They're saying, okay, well you have depression, anxiety, and PTSD, here's the medications, here's the psychotherapy, and by the way, these medications and this psychotherapy, maybe that'll help your sleep. And unfortunately, it doesn't help to sleep consistently. That's why sleep disorders medicine is so important for mental health.

Chris Warden (10:26.592)
When you were explaining this, you kind of, you caught me off guard when you, you labeled the order. You said sleep problems and then specifically PTSD. and the way the fire service or personally for me, the way I always imagined it, it was PTSD and then sleep disorders. Can you kind of...

Barry Krakow (10:52.484)
I just, yeah, yeah, yeah, I gotta tell you this story. I was talking to a buddy of mine just this past weekend. He's a mental health professional. And I said, here's the experiment somebody's gonna do one day. I don't know when it's gonna be done. It's gonna be done soon though. Because other people are already starting. There's about 10 research studies in the scientific literature that are already beginning to address this. And then another 20 or 30 more that are indirectly addressing. And I'll tell you what I'm getting at. Give me 100 PTSD patients.

Chris Warden (10:55.295)
Yeah.

Chris Warden (10:59.775)
Okay.

Chris Warden (11:03.196)
you

Barry Krakow (11:22.468)
and I'm gonna treat them for their nightmares, their insomnia, their sleep apnea, their restless legs and leg jerks, their circadian rhythm problems, and that's all I'm gonna do. And I'm gonna compare them to 100 PTSD patients who get medications or psychotherapy or exposure therapy, and we're gonna compare who does better. And my money, biased as it is,

Chris Warden (11:44.703)
Mm -hmm. Hmm.

Barry Krakow (11:51.204)
My money is on the group that gets this full course of sleep treatment. And here's one of the reasons why I feel so strongly about it. It's that when I did all of these trainings a decade ago, I went around to multiple military bases in the United States. I went to Hawaii, I went to Germany. I also went to other places in Canada and in Israel.

Chris Warden (12:02.75)
Mm -hmm.

Chris Warden (12:11.584)
in the United States.

Barry Krakow (12:21.732)
And I started meeting people who already knew about many of the innovations we had done for treating nightmares and treating insomnia. And you know what they were doing? They were taking their PTSD patients and starting treatment with nightmare treatment called imagery rehearsal therapy. They were taking a patient and starting a treatment called cognitive behavioral therapy for insomnia. And again, starting that.

Chris Warden (12:31.807)
Mm -hmm.

Chris Warden (12:40.065)
Mm -hmm.

Barry Krakow (12:50.98)
They weren't even going anywhere near the patient with psychotherapy or exposure therapy, and in some cases, not even medication. And they were amazed that by treating the nightmares and the insomnia first, all these patients were saying, gosh, I'm feeling so much better. Like, well, do I need something else or am I done? And then some of them were saying, okay, well, if you say I need more, fine. I'm

Chris Warden (12:53.569)
Huh.

Barry Krakow (13:19.684)
I'm motivated to try more now. So in other words, they found so much receptivity and so much benefit by targeting the sleep problems first. They were saying, no, this has to change. Mental health has to change. We can't keep saying to them, you've got PTSD, here's your PTSD treatment. They were saying, no, we're gonna look at your sleep stuff first. So that's motivated me to begin asking this question because we had done research 20,

Chris Warden (13:23.265)
Right? Hmm.

Barry Krakow (13:49.348)
Five years ago, we were the second study published, 25 years ago, that showed that if you treat somebody's PTSD with a CPAP machine, because most PTSD patients that report sleep problems have sleep apnea, we demonstrated 50 % improvement in PTSD with that study. By the way, it wasn't a great scientific study. It was called a chart review study, but we demonstrated that.

Chris Warden (13:53.506)
Okay Wow Okay

Barry Krakow (14:19.172)
Another paper demonstrated that somebody else up in Philadelphia. And since then, there's been several studies showing that PTSD symptoms do get better with nightmare treatment, insomnia treatment, CPAP treatment. So I have said for a long time, we could rename this condition post -traumatic sleep disorders. And it would be quite valid, be quite valid for a large contingency of the people.

Chris Warden (14:24.93)
Yeah. Wow. I.

Barry Krakow (14:48.932)
who are diagnosed with what is called PTSD.

Chris Warden (14:54.882)
That is, that's a very unique way. And it sounds like it's been going this way for a while, but it's new, absolutely new to me, but to, to address a, a P symptom or a disorder like PTSD, just by targeting, targeting the sleep is amazing. And one thing that from my experience in the fire service is we have this, a shift schedule, right? So we, we work 24, we're off 48, and there's a variation of these schedules where,

You can work one day, be off a day and alternate between work and off for three days and then have four days off. And maybe you'll work two days in a row and have four days off. How do you see sleep disorders showing up in that disrupted cycle of work where you're on call for 24 and it seems like we take most of our calls after 10 30 at night or, you know, at the nighttime when we need to be sleeping. And then we only have a.

a really small amount of time to, I guess you would say recover and specifically let's just say sleep, those sleep opportunity days where you're not at work.

Barry Krakow (16:01.604)
Yeah, shift work is a big can of worms. We looked at this in different ways back in the 1990s. We made certain predictions. Other people are coming up with the same conclusion. Shift work is dangerous to health. There's no question about it. And shift work probably is a risk factor for leading to the development of physiological sleep disorders, namely sleep apnea.

Chris Warden (16:04.098)
Okay.

Chris Warden (16:10.37)
Okay.

Chris Warden (16:31.011)
Hmm.

Barry Krakow (16:31.812)
By working shift work, you probably increase your chances of developing sleep apnea because sleep apnea is not simply what's going on in your airway. It may also have something to do with how fragmented your sleep is because it turns out when your sleep is fragmented, and this possibly is the explanation for why so many PTSD patients have sleep apnea, when your sleep is fragmented, it interferes with your breathing.

Chris Warden (16:41.666)
right

Chris Warden (16:56.675)
Mm -hmm. Wow.

Barry Krakow (17:02.692)
So sleep fragmentation itself makes your airway less stable is the best way to describe it. You know, the research we did show that 80 to 90 % of people with chronic PTSD and a complaint of sleep have sleep apnea or sleep disorder breathing. Many other people have lower numbers. They say 30%, 50%, 60%. Nonetheless, those are huge numbers.

Chris Warden (17:25.315)
Yeah. Mm -hmm. Okay.

Barry Krakow (17:30.084)
And that's a lot higher than saying everybody has hypertension. I mean, these are very, very astronomical prevalence rates of a breathing disorder affecting these people. Everybody wants to know why. One theory is this sleep fragmentation theory. And of course, night shift work exacerbates that. And so one of the things that we tell people, if you go into shift work and you're doing shift work for more than a year or two,

Chris Warden (17:59.139)
Mm -hmm.

Barry Krakow (17:59.332)
you've got to get a sleep study. You've got to get that evaluated to find out because those people can benefit tremendously if they have a sleep breathing condition. Well, then that means they can start using their PAP machine on the nights they're off. And in some cases, if they're allowed to sleep on 24 hour shifts, they may be able to get in some PAP time then as well. And all of that can be very valuable with one caveat.

And that is PEP therapy makes your sleep so deep and so much higher quality that when you come out of the sleep, it's much more like when you were young and you didn't always necessarily wake up ready to go, but you woke up and like, gosh, I, that was a really intense dream or I was in deep sleep and gosh, I need a cup of coffee. I need something to get me going here because I still feel like I want to go back to sleep.

Chris Warden (18:29.347)
Sure. Okay.

Barry Krakow (18:57.828)
That's how deep the sleep can be when you go in with a PAP machine.

Chris Warden (18:59.362)
Wow. So yeah, in the fire service and it just recently, and I can, again, I can only speak from my experience in my department, but there's, there, you can't, there's probably a fire station in my city that you can go to or can't go to that doesn't have one person on a pap machine sleeping. And it's, it's so common. And I wouldn't have guessed that sleep would have, well, I could guess shift work would affect sleep, but.

Barry Krakow (19:19.556)
Right.

Chris Warden (19:29.315)
Not in the way that we're talking today with the increase in, in PTSD or however that goes, but my mind is just exploding.

Barry Krakow (19:36.804)
Right, well, there's all these factors that, yeah, no, it should, it should. I mean, this is actually in a certain way new, meaning that most people are not talking about this. Most people in mental health are not talking about this. Most people in sleep medicine are not talking about this. The people who talk about this the most are certain...

Chris Warden (19:42.498)
Mm -hmm.

Chris Warden (19:52.098)
Right.

Barry Krakow (20:05.796)
places in the military that were exposed to this problem of chronic nightmares about 15 years ago after the Iraq war. And that opened up a window of opportunity where suddenly it was like, we need treatment for nightmares. Well, once that opened up that window, people began to realize, whoa, there is all this other stuff going on because the nightmares are just the tip of the iceberg. So there's that place. And then there's other people that have

Chris Warden (20:09.122)
Okay.

Barry Krakow (20:35.716)
their own isolated areas. Just recently, back in December and January, I did three hour and a half long weekly podcasts for mental health professionals in Israel, because of course they're dealing with tremendous amounts of PTSD and the soldiers, the first responders, the population, and I talked to them about nightmares, about insomnia, and of course the big one,

Chris Warden (21:01.282)
Mm -hmm. Mm -hmm. Wow.

Barry Krakow (21:04.516)
we just talked about earlier, sleep quality and sleep fragmentation. But that was all new to them. And so, and so even though this stuff has been in the literature, not just for me, but many other researchers for decades, you know how things work in terms of the concept of tipping point. This still hasn't reached the mainstream media. This still has not reached into all kinds of places it needs to be. So the average mental health professional,

Chris Warden (21:30.21)
So, so I am in a position in my department where I get to work with new fellows, ladies and gentlemen, but.

Barry Krakow (21:34.628)
average psychiatrist knows very little about what we're talking about. And so what do they do? They reach for a prescription pad or they offer psychotherapy. And that's the end of that as it relates to sleep.

Chris Warden (21:59.265)
We have this influence on them. And previously up until right now, this conversation I'm having with you, I would typically say, Hey, welcome to the fire service. We're glad to have you. Do you have a therapist? And I'm going to update that and consider saying, do you know how to get sleep? And are you going to go get a sleep study? Because this is like, it's really turning up everything upside down that I've understood to be.

true, obviously. so you're definitely changing my mind on some things. One question I did have for you is at what point do we, do we know we either need a CPAP or like when, when does that individual start saying, Hey, I'm going to take this serious and actually go get a sleep study.

Barry Krakow (22:49.348)
Right. Well, let me plug my book in a way because in life -saving sleep, I talk about the fact that in the current climate, it is not easy to get sleep studies. And it's also not easy to get high quality sleep studies. Nowadays, everything is this thing called home testing. And unfortunately, that has many drawbacks to it.

Chris Warden (22:53.89)
Please do.

Chris Warden (23:10.53)
Okay.

Barry Krakow (23:17.412)
For people with obvious conditions, it's just fine. But you're dealing with people that are a relatively younger population, which means that the chances of showing a sleep breathing disorder, let's say, could be much more subtle. The chances of missing the diagnosis of something like restless legs and leg jerks is higher because you can't find that on a home sleep study.

Chris Warden (23:22.146)
Mm -hmm.

Barry Krakow (23:46.02)
you have to demand to get a sleep study inside the sleep laboratory. So the way I wrote the book was to say, look, the way the world works, there's lots and lots of do it yourself stuff you can do for your own sleep. And so there's a section in there to treat your nightmares. There's a section in there to treat your insomnia with respect to sleep disorder breathing. I have this whole section called early conservative.

Chris Warden (23:46.466)
Right.

Chris Warden (23:55.394)
Mm -hmm.

Barry Krakow (24:14.788)
treatment steps. And I say this because people listening to this get so confused about this idea that they just can't imagine it's true. It's just so hard to digest that so many people could be suffering that they go, well, I don't snore. I say, guess what? Snoring is a useless symptom to evaluate sleep disorder breathing.

Chris Warden (24:18.691)
Mm -hmm.

Chris Warden (24:30.37)
Yeah.

Chris Warden (24:35.33)
Wow.

Barry Krakow (24:44.292)
Only the people that snore loudly, is it helpful? There is tons of people that don't snore, tons, thousands, millions that don't snore, have sleep disorder breathing. You know what they have? They wake up at night to pee. They have a dry mouth in the morning. They have a headache in the morning. They develop high blood pressure. They develop problems with concentration, memory and fatigue. So when you hear all of that, you go, well, they should just go to their primary care doctor.

Chris Warden (24:48.13)
OK

Barry Krakow (25:14.116)
and you know, they'll get diagnosed with depression, get some medications, then they'll get on a high blood pressure medication, you know, and then we're done. No, we're not done because most people don't know that sleep disorder breathing actually causes you to wake up at night to urinate. They don't realize it causes you to have high blood pressure. So this is a really, really big elephant in the room. And yet, having said all that, people still don't believe it. They go, no, there's just no way it could be that big. So what I say,

Chris Warden (25:16.323)
Mm -hmm.

Barry Krakow (25:43.748)
is try early conservative treatments. So for example, you'll love this. If a person goes to the drug store and buys nasal saline rinses, cleans out their nose multiple times a day, I mean, gets it crystal clear, no rhinitis, no allergies, no congestion, no stuffiness, and they do that with nasal saline only, in two weeks, they're gonna come back and say,

Chris Warden (25:43.779)
Yeah.

Barry Krakow (26:13.156)
This is really weird, but I'm sleeping better. Why? Because the nose works. I've got this whole free video on my website, BarryCraycoMD .com. It's called the Nose Nose, N -O -S -E -K -N -O -W -S. And I go through all the things you have to know about your nose that we normalize it. We're so used to breathing. We just normalize whatever we have. Well, it turns out most people have little bits of congestion here and there.

Chris Warden (26:21.552)
Awesome.

Chris Warden (26:39.683)
I unfortunately have a horrible relationship with it and I've gotten a lot better, but it's the only thing that works when I need it to.

Barry Krakow (26:43.556)
and they've already documented in the research literature 20 years ago. Do you know what Flonase is? The steroid nasal inhaler?

Barry Krakow (26:59.204)
Okay, well we're going to talk about that because there's some better versions of it. The best version is called Sensimis. It's over -the -counter. It's like a Flonase. And the research literature already shows that if you use that treatment, nothing else, you actually reduce the severity of your sleep disorder breathing. Again, what did you do? You just treated your nose. So I tell people start with nasal strips on their nose, nasal dilators.

Chris Warden (27:14.211)
Mm -hmm.

Chris Warden (27:24.036)
Mm -hmm.

Barry Krakow (27:29.028)
in their nose. I talk about everything they can do to overcome the congestion. Again, you know, on my website, the free video series, a person does that. Most people will say, okay, I tried these steps and you know what? I'm sleeping better. And now they're going to say, does this mean I have sleep disordered breathing? And the answer is yes. It means you have some degree of it. Isn't it wonderful? I've had people on nasal strips,

Chris Warden (27:34.564)
Yeah, my gosh

Barry Krakow (27:59.044)
they'll do it for a couple of years. They go, no, I feel great. I don't need anything else. And that's, that's okay. Cause that's moving them in the right direction. Other people three months later go, wow, if this is giving me this kind of benefit, well, what would it be like to use a dental device or a pap machine? And so it really gets the curiosity going. And that's why I recommend this so highly because unfortunately the climate and sleep medicine is not friendly.

Chris Warden (28:04.484)
Yeah.

Chris Warden (28:15.364)
Yeah, wow

Chris Warden (28:26.192)
Right? Mm -hmm. Mm -hmm.

Barry Krakow (28:28.292)
There's so many obstacles to care that make it difficult for a person to even get tested or properly tested or get the right equipment. But see, if you've gone and done early conservative treatment and you feel like, man, I want this, you're going to be so motivated that you're going to knock down all the barriers and go, no, no, I want to get a sleep test, sleep test. I want to get my Pap machine. I want to, I want this, I want that. That's how it works when you had a taste.

Chris Warden (28:56.327)
Hmm. So we've, I, I don't, you probably obviously don't know this, but we're literally discussing me right now because I have gone my whole life with congestion. So I started, I learned about Afrin, the steroid one that's probably horrible for us. That works. And that's what I. Okay. So Afrin for me, that's the one that worked. Flownaise didn't work, but Afrin.

Barry Krakow (28:57.892)
of something that is really beneficial for you.

Barry Krakow (29:14.788)
Afrin is not the steroid.

Chris Warden (29:24.582)
It works. So that being said, I even went to. Yeah, please.

Barry Krakow (29:26.82)
So hold on, let me interject. So just a teaser here for people, because you really got to hear this, this is so cool. When a person says, flonase didn't work, and then they had to go to Afrin, that means usually there's either something anatomically wrong with your nose, something that has to be evaluated by an ear, nose, and throat doctor, or more simply, there is a condition, again, very widely overlooked,

Chris Warden (29:37.958)
Okay.

Chris Warden (29:47.174)
Okay.

Barry Krakow (29:55.844)
in many medical professional circles called non -allergic rhinitis. That's non -allergic rhinitis. So everybody's heard of sneezing and itching and getting congested and spring and fall. That's allergic rhinitis. Most people don't know how sensitive the nose is. And it turns out sleep disorder breathing appears to make the nose even more sensitive. And you end up with this condition.

non -allergic rhinitis, where all sorts of stimuli make you either have congestion, runny nose, or stuffiness for which nasal steroids typically do not work that well. And so when somebody comes to us and says, yeah, I use Flonase and it didn't work, we say, well you may have just diagnosed yourself with non -allergic rhinitis. And then we recommend what's called the antihistamine nasal sprays, Astolin and Astapro.

Chris Warden (30:34.28)
Okay, okay.

Barry Krakow (30:55.556)
We recommend another spray called Atrovent. There's another over -the -counter spray that's been out just a few years called XClear Xylitol Nasal Spray. Some people say that will work for non -allergic rhinitis. And so this is this tricky thing. In other words, with non -allergic rhinitis, you don't get to suddenly just say, okay, well, I'm gonna take this pill and I'm done. You gotta work a few weeks to figure out which nasal spray in particular,

Chris Warden (31:01.031)
Yep. I have that one.

Chris Warden (31:09.703)
It works okay. Yeah.

Yeah.

Barry Krakow (31:24.836)
is going to work because it's dealing with a real noticeable sensitivity in your nose. And the people who find that combination and they do it, they go, wow, this is great. I'm breathing through my nose. And that means they're now ready to use a pap machine. Why would I give somebody a pap machine who's horribly congested all the time, which by the way is a risk factor for giving them a very bad sinus infection?

Chris Warden (31:48.2)
Holy cow. Right.

Barry Krakow (31:53.06)
pushing all that junk up into your airway because you never got rid of it beforehand.

Chris Warden (32:00.391)
Holy smokes. So yeah, I did, I've done Afrin, so I need a recommendation for Afrin, me personally, but I'm sure anybody listening could benefit, but yeah, Afrin, and then I went...

Barry Krakow (32:10.468)
No, Afrin is the one that causes other problems. Most people do poorly with Afrin long -term. Afrin has its use in short -term, but you want to go down a different pathway for these different conditions that are affecting the nose. Afrin is rarely, I know one person, he's a friend of mine, he's a doctor, and he actually swears by Afrin. He uses it before he uses his pap.

Chris Warden (32:14.855)
Right.

Chris Warden (32:21.095)
Okay.

Chris Warden (32:37.255)
Hmm.

Okay.

Barry Krakow (32:39.652)
and he's never gotten addicted to it. He's very fortunate. Many people become way too dependent on it and then it produces what's called rebound congestion and they eventually just have to get off of it. Otherwise they're going to drive themselves crazy.

Chris Warden (32:55.401)
So I use it when I get that horrible congestion where my literally I can close one nostril and not breathe out the other one at all. So I've done that, but so I made my way into nasal dilators where I have what not and it holds my, my nose skin up and it doesn't collapse when I breathe. So that's made a huge difference. but now I'm considering, getting tested for a pat machine only because

Barry Krakow (33:03.972)
Right, right.

Barry Krakow (33:09.828)
Great.

Chris Warden (33:25.448)
I really have that, I haven't been diagnosed, but that non -allergic rhinitis, that makes so much sense.

Barry Krakow (33:32.708)
Right, and remember again, you're a young person, you obviously, you know, you're a firefighter, you're fit. So people are gonna look at you and this happens to sleep -ins, well, you couldn't have sleep apnea. Well, what do you mean I couldn't have sleep apnea? They think you have to be overweight, obese, because somehow that's the training, which is incredibly ignorant. The research has been out there for over 30 years.

Chris Warden (33:38.024)
Shift work. Yep.

Chris Warden (33:51.72)
Yeah. Yeah.

Barry Krakow (34:02.307)
that sleep apnea is in your airway. If you are overweight, you can make sleep apnea worse, but it is very rare that obesity causes sleep apnea. It only makes it worse. And so that means lots and lots of people such as myself, you know, slender frame, many, many people. In fact, I have argued previously that...

Chris Warden (34:08.362)
Mm -hmm.

Chris Warden (34:19.337)
Wow.

Barry Krakow (34:30.34)
The majority of people in the world who have sleep apnea are in fact not overweight. They're people who have malformations such as a small jaw or something going on in their airway for whatever reasons, whether it's genetic, whether the way their throat and their facial structure develop, all of these things have so much more importance. And those people constitute a hidden epidemic.

Chris Warden (34:40.233)
Yeah.

Barry Krakow (35:00.452)
of individuals who have sleep disorder breathing. But the caveat, and you'll read about it in my book, Life Saving Sleep, is there's a condition called upper airway resistance, which is a more subtle version of sleep apnea. And here's another barrier. Only maybe one out of three sleep centers in the United States, as one example, recognize that upper airway resistance needs to be diagnosed and treated. Many sleep centers,

Chris Warden (35:10.571)
Hmm.

Barry Krakow (35:30.564)
go around and just say, well, you don't have sleep apnea, you're done. We can't help you. But that's not true. They have to know how to measure these more subtle breathing events, which are incredibly common in younger people and in people who look like they're physically fit, people who shouldn't allegedly have these breathing conditions. And yet if they've got sleep complaints, high blood pressure, waking up at night to pee, cognitive issues, memory, concentration,

Chris Warden (35:40.266)
Sure.

Chris Warden (35:56.682)
sure

Barry Krakow (35:59.268)
If they've got these things, they all get put into the basket. well, you've got PTSD, you've got depression, here's some medication. Okay, maybe, I'm not saying by the way, anything negative about the use of psychotherapy and medications because they do work for people and they're necessary for many people. But that doesn't mean that's the whole story. And the mistake that I think is being made candidly,

Chris Warden (36:19.082)
Mm -hmm.

Barry Krakow (36:26.436)
is there's way too much emphasis on the psychotherapy and the medications early on without taking into account what the heck is going on with a person's sleep.

Chris Warden (36:34.155)
That so again, I'm not trying to make this specifically about me today. so I apologize in advance, but I literally had a double jaw surgery, upper and lower moved. So my upper palate actually got detached from my face and moved forward because my upper jaw was so undergrown. They said when I was young, they said it didn't develop as much. So I had the.

Barry Krakow (37:00.26)
Right. How old were you?

Chris Warden (37:03.114)
so they noticed it, I think when I was like eight or 10, maybe 12, I had the surgery when I was 18, I had the, the molars pre removed. I had like to make space and I like a pattern through my life. And you can ask my mom or my wife or my brother, even I've had sleep. I've had trouble with this, you know, that upper palette nose, mouth region for a long time.

Barry Krakow (37:07.812)
Right? Right?

Barry Krakow (37:25.108)
Right. Yeah, so this is a great, no, no, it's good that this is personal. This is a great story and you should write about it and publish, you know, something on it, your article, whatever, because what you're talking about is whether you know it or not, you had sleep apnea back then. I mean, maybe, you could, yes. And that's what's so remarkable here. So back then, somebody might have said, well, this is cosmetic.

Chris Warden (37:37.61)
Sure.

Chris Warden (37:42.474)
Yeah, and I bet I still do.

Barry Krakow (37:54.756)
Or somebody might've said, well, maybe you'll breathe better. Or somebody might've said, well, if we do this, maybe you'll swallow better. Maybe you'll grow. I mean, yeah, all kinds of things would come up. But if they had tested you at the time, high probability of finding a sleep breathing disorder. Well, fast forward, the average person who gets maxillomandibular advancement surgery over time still ends up

Chris Warden (38:02.378)
They said it was a chewing thing for me. Yeah, yeah.

Chris Warden (38:20.458)
Yeah.

Barry Krakow (38:24.548)
with sleep breathing conditions. Not necessarily right away, but yours was how many years ago?

Chris Warden (38:30.7)
So I had this surgery when I was 18 and it was to correct an, I had an under bite, right? Like where your lower jaw sticks out excessively. probably six years. Like once I went through puberty, it just started to be that way.

Barry Krakow (38:35.748)
Right, sure, sure. How many years?

Barry Krakow (38:46.948)
No, no, no, I mean, how many years ago was the surgery?

Chris Warden (38:50.028)
22. I'm 39 right now. It's 22, 23 years ago.

Barry Krakow (38:53.06)
Yeah, yeah, yeah. So almost 20 years ago. And so what happens is you're already describing certain things. I don't know what the rest of your symptom complaints would be. But when you look into it and you ask yourself about your sleep, remember our not remember. Let me point out that our original research, which occurred in the 1990s, we were working with all these sexual assault survivors, women with chronic nightmares, all in the average age range of

Chris Warden (38:56.108)
Yeah.

Barry Krakow (39:21.572)
mid to late thirties, okay. And we discovered after we did the research showing that we had this nightmare treatment, again, it's in the book, life -saving sleep, it's called imagery rehearsal therapy. We discovered through the years because we kept studying them in different ways for the next five to 10 years after that treatment protocol, we discovered that between 80 and 90 % of 187 women in this protocol had signs and symptoms of sleep disorder breathing.

Chris Warden (39:21.772)
Yeah.

because the study has been raised to the next five years. And we've done some research. We've discovered that between 80 and 90 % of 187 women in the world have signed the gender discrimination act. We actually were able to test approximately 10 % of them. And the big graph shows that every single person who has been tested has been tested positive.

Barry Krakow (39:51.46)
We actually were able to test approximately 10 % of them in a sleep lab or with home testing. And every single person we tested tested positive for a sleep breathing disorder. And so back then in the nineties, we were saying, this is like, this is all coming together now. It's not just nightmares. It's nightmares, it's insomnia, it's sleep disorder breathing. We call it the nightmare triad syndrome.

It's three things. The nightmares are just the tip of the iceberg. It's the red flag waving very brightly that there's something else going on with your sleep. And so we knew that was the case. And so in your situation, you know, a person says, well, I had that surgery fast forward. What do you look back on? Do you say that I had some insomnia over the years? I had some disturbing dreams. Or do you say, no, I'm

Chris Warden (40:44.332)
Ha ha ha.

Barry Krakow (40:49.508)
I'm vibrant, I'm energetic, I've got all the energy I need. So wherever you're in or whether you're between all of that, yes, there's a chance many people after the MMA surgery later on start developing new signs and symptoms of sleep disorder. It's not a definitive cure to the end of time or something.

Chris Warden (41:02.574)
Sure. Yeah, that I don't, I, I looking back, I can't say I ever had anything, but being on shift work and, valuing my fitness, like six years ago, maybe, maybe even longer when I found these nose dilators and I started paying attention to, to my sleep is when I started to try to get more fit, but I couldn't breathe.

out of my nose for a long time of my life. And I, I, I make it a habit. I'm very, very conscious of it now, but to not be a mouth breather, if you will. And I know there's time and place for that. but what is it, what is a sleep disordered breathing? Right. Sleep disorder breathing. What does that look like when you're not asleep? How does that manifest in like fitness or just.

Barry Krakow (41:54.052)
Mm -hmm.

Chris Warden (42:01.581)
sitting around or being alive, not asleep.

Barry Krakow (42:05.252)
If I'm understanding your question clearly, correctly, let me just say, sleep disorder breathing is the single most common cause of what we talked about at the top of the program, sleep fragmentation. If you keep having arousal activity in your brain, because instead of going into deeper sleep, you have a breathing event, then you wake up a little bit for three seconds, 10 seconds, 32 seconds, you don't remember any of that. You just go back to sleep.

Chris Warden (42:16.589)
Okay.

Chris Warden (42:23.981)
Yeah.

Barry Krakow (42:34.628)
And then what do you do? You repeat it again, another breathing event. So sleep fragmentation, the single biggest cause of sleep disorder breathing. And in your age group, some of the things you're going to see are trips to the bathroom at night, memory problems, concentration, attention difficulties, you're at risk for workplace accidents. There's things about your consciousness that you're going to pick up on sooner or later.

Chris Warden (42:34.797)
Right. Mm -hmm.

Barry Krakow (43:02.948)
if in fact you are developing a sleep breathing disorder. Things as simple as your reflexes will change. You'll suddenly notice that, I went to pick up my keys and I dropped them. And you'll go, wait, why did that happen? am I getting older or, you know, was I not paying attention? All of these little things start to show up when cognition is changing. And people after they...

Chris Warden (43:21.74)
Doctor, I literally have told like two or three different people this exact thing. Hey, I can catch stuff now when I drop it, like I'll knock something off a cupboard and I'll grab a glass.

Barry Krakow (43:31.236)
get treatment for sleep disorder breathing, literally say things like, yeah, I actually catch my keys now when they drop.

Chris Warden (43:50.572)
Or I'll drop my keys and I'll, and I've been telling people, I'm like, I don't know what's going on with me, but this is literally happening. So this is probably one of the most profound discussions I've ever had live where it's impacted me.

Barry Krakow (44:02.308)
Well, I'm so glad to hear that, but I'm curious to know whether that's partly because you're using nasal dilators. Because a nasal dilator is what we call an early conservative treatment for either sleep disorder breathing in general, or possibly for upper area resistance. And so that's why I'm so high on people trying it because I've had cases where somebody, this is a funny case.

Chris Warden (44:09.868)
ass.

Chris Warden (44:24.588)
Yeah.

Barry Krakow (44:29.284)
Some person who was very skeptical showed me their watch and said, this injury, my wearable says I'm having all this not, you know, this fragmented sleep. I'm having light sleep. I said, okay, well, you could do a little experiment if you want. You can just put a nasal strip on one night. And the person said, what's that going to do? You know, I said, okay, well, just try it. They put the nasal strip on. They come back the next day. I happen to see this person. They go,

Chris Warden (44:33.196)
Mm -hmm.

Chris Warden (44:43.597)
Yeah. Right.

Barry Krakow (44:58.212)
What was in that nasal strip? I mean, not only did I sleep better, but I looked at my wearable and my wearable said that I got deeper sleep last night. That's magic. How could that happen? So these things, with my own PAP machine, I still use a nasal strip and a nasal dilator with my full face mask, because I actually noticed the difference doing all three.

Chris Warden (45:02.541)
Yo, gosh.

Chris Warden (45:12.301)
God.

Chris Warden (45:19.181)
Yeah. Wow. So I, the, the, gosh, I can't think of the name, but I will put it in the notes and I just want to tell you about the nasal dilator that I wear. is it, you attach two magnets right on your nose and then you have a rigid.

Barry Krakow (45:42.116)
I've heard about that one, right, right.

Chris Warden (45:44.013)
And I've, I use that for motocross. I wear it for hockey. I wear it when I go for like a long run where I want to be calm and not sprint, but I wear it at night. And I remember the first time I wore this at night at the fire department. I think the next morning I was running around with it saying, guys, you need this. This is changing my life. And I didn't, I didn't know that I was doing something. I just, I knew that I had an issue sleeping and I was

Barry Krakow (45:51.3)
Great, great, great.

Barry Krakow (46:12.164)
Right, right, right.

Chris Warden (46:12.717)
Like I'm always trying to solve and you know, there's always room for growth in my life. So, but that is literally one of the things that I found and holy cow, I didn't think I was going to have this conversation today. Like guys out there, you gotta, you gotta get this book.

Barry Krakow (46:24.356)
Well, maybe, please, please, that would be helpful. Give us a good review if you can. The thing is, in your age group, we wonder whether you have the definitive treatment. You know what I mean? Like you're doing all this stuff, clearly getting benefit. And we always say in this field of sleep that the hardest thing to find is your ceiling.

Chris Warden (46:32.75)
Absolutely.

Chris Warden (46:46.798)
clearly.

Barry Krakow (46:53.924)
Like how would you know what the best sleep is for you? You just went from here to here. How would you ever have a clue what's above that? And I've struggled with that concept personally and professionally because I try to explain to people, it's very difficult to sort that out. I've gone through my own episodes where my sleep wasn't where I wanted it for say six months. And then one day I figure out, you know,

Chris Warden (46:56.974)
Right. Yeah.

Right.

Barry Krakow (47:22.948)
This is something to do with the way my chin strap is actually placed on my head and causing an irritation. And it's not really doing the job it's supposed to do. Fix that. And then the next couple of weeks I go, well, that was it. And now I'm sleeping better with my Pat machine. This happens in sleep all the time. You just don't want to do anything other than to say, well, that must be normal. That must be normal. And then you don't like...

Chris Warden (47:46.478)
Right.

Barry Krakow (47:53.156)
think about, well, could it be a little bit better or not? And so you're gonna have a very interesting journey because you may end up getting a sleep study one day and discovering that you do have continued sleep disorder breathing, or it'd be great if you got a sleep study with all your attachments and they say to you, they say, no, you're sleeping great, your breathing's great. That would be very, very interesting.

Chris Warden (47:55.342)
Yeah.

Chris Warden (48:15.694)
Yeah.

Chris Warden (48:19.28)
We're going to have to, maybe we can cooperate and figure this out after we were done with this discussion, but I couldn't agree more. I'm, I am so curious now to, to understand and learn. And, and I think I might've just squeaked out a few more, what I would call performance points, right? Like if I can sleep better, I can do everything better. I'm not kidding. so I'm super excited about that. I was able to pull up the name of that nose dilator that I use and it's the

Intake Premier Nasal Dilator. It's a non -invasive snoring solution.

Barry Krakow (48:52.9)
I've heard of it. I know one person who's also tried and also reported some good benefit from it.

Chris Warden (48:57.968)
Yeah. And I even wore it under my SCBA mask a couple of times at work. And so my correlation at all anecdotal is the longer you can stay nose breathing, the calmer you can remain. When you, as soon as you leave, right? I'm not sure what it is, but I've noted that's the correlation I've come along to.

Barry Krakow (49:14.948)
It is.

Barry Krakow (49:20.324)
So did you read James Nestor's book, Breathe?

Chris Warden (49:24.336)
I might have. I have several breathing books. I don't recall which exactly.

Barry Krakow (49:29.476)
Well, I do recommend that one strongly. It's a very interesting book about breathing. Spends a lot of time talking about nasal breathing, just the way you said it. It came out about five years ago, four or five years ago, James Nestor. And I just had finally a chance to read it just a couple months ago.

Chris Warden (49:33.616)
I might have read that.

Chris Warden (49:46.992)
Well, I will find out if I have read it and I will make sure that gets linked in the description for this podcast. Well, right next to your book and you have another book too, right? And if I recall.

Barry Krakow (50:00.26)
Yeah, yeah, in fact, in fact, I don't know if we're getting here to the close to the end, but I do want to point out a very important closing point, which is I put up in my other larger book, Sound, Sleep, Sound, Mind, that came out about 16 years ago. I ended that book with a very cautionary tale. And I'll say it here because it's funny how you said the thing about, you know, if you get a little bit more performance points and you can do everything better.

Chris Warden (50:07.026)
Yeah.

Chris Warden (50:12.562)
Yeah.

Barry Krakow (50:30.308)
Some people, unfortunately, when they sleep better, they have so much energy, they don't know what to do with it. And I know it sounds funny, but they actually get in trouble. I know of cases of people, I don't want to go into a lot of details, but let's just say per person took that energy.

Chris Warden (50:35.154)
Mm -hmm.

Chris Warden (50:47.314)
Really?

Chris Warden (50:54.322)
Sure.

Barry Krakow (50:58.276)
used it in the wrong way. I'm not talking about violence. I'm talking about, you know, doing something outside of relationships, doing something at work, being just, I don't want to, the equivalent would be saying, making somebody hypomanic and that person not understanding that that then colors your judgment.

Chris Warden (51:02.226)
Okay.

Chris Warden (51:08.018)
sure, sure, sure.

Chris Warden (51:22.162)
Okay.

Barry Krakow (51:24.42)
about what you can do because, you know, human beings, unfortunately, are innately greedy and they want and they want and they want. Once you get back to normal sleep, it's a little bit scary. It was very scary for me in 1998 when I realized that I had been suffering a sleep disorder for 35 years and I suddenly had all this energy. And it was like,

Chris Warden (51:29.49)
Okay.

Chris Warden (51:44.434)
Yeah. I feel you man. Wow.

Barry Krakow (51:53.604)
What is this? For 35 years prior, I wanted to take a nap every day. Now, every single day, it was like, I still have more energy. What am I gonna do with it? Like, do I need to sleep less? I mean, what is going on? It's a very confusing picture. You would think, well, wouldn't it be great to sleep great? And yes, it is.

Chris Warden (52:04.756)
I gotta do more stuff, right?

Chris Warden (52:13.427)
Yeah.

Chris Warden (52:19.539)
man.

Barry Krakow (52:21.412)
But it is a cautionary tale. There are some people who sleep really well. In fact, to show you how this plays out in mental health, it's well known that there are cases of people who are really bipolar and they ended up getting their sleep apnea treated. And that's when they figured out they were bipolar. Before that, they just thought they were depressed. Somebody came along and said, well, you're depressed, man, but let's check your sleep.

Chris Warden (52:35.699)
Okay.

Wow.

Yeah. Okay. Sure.

Barry Krakow (52:51.108)
So they check their sleep, say, whoa, you got bad sleep apnea. Treat their sleep apnea, they're not depressed anymore. Now they're manic. So they actually had a bipolar problem. And it's rare, but it's not so rare that it doesn't happen. It's been reported in the scientific literature a couple of times, and I've heard of cases of it. So there is something about our energy level.

Chris Warden (53:15.699)
Hmm.

Barry Krakow (53:18.66)
that we don't really understand in this modern world because so many of us do have sleep problems. And so we just resort to Red Bull and caffeine and other things. But once you get normal sleep, it's a very interesting experience to live with that. Very interesting. Especially the younger you are to tap into that, it can make a huge difference in your long -term health.

Chris Warden (53:43.891)
You heard it first guys, tap into that. I did have a question for you before we do wrap up about your sleep coaching for high stress profession. Yeah.

Barry Krakow (53:53.572)
Great, great. Thanks. I'll go through all the things that I do for the, my resources. So on my website, BarryCracomd .com, I have a sleep coaching service. It's not something that's covered by insurance. It's, it's designed really for the person who usually has not made the progress they wanted working at another sleep center or working with other doctors where they said, I tried everything for my insomnia and nobody's been able to help me.

Chris Warden (54:05.331)
Mm -hmm.

Chris Warden (54:10.1)
Right.

Barry Krakow (54:24.292)
And they come to me and they say, can you help me build a roadmap to explain why the things I did previously didn't work and what are the things that would probably get me moving in the right direction? Many of those people end up, of course, you know, getting a copy of the new book, Life Saving Sleep, because that actually allows them to refer back to it, you know, over and over again, because, you know, coaching services can be a little pricey for some people.

Chris Warden (54:38.9)
Mm -hmm. Sure, sure.

Barry Krakow (54:50.692)
But nonetheless, in that one hour session or 90 minute session, the average individual comes away with like, I've never heard any of this before. None of my sleep doctors told me this. None of my psychiatrists told me this. And they go, this sounds like an incredible new pathway that I can go down to help myself sleep. So we have the sleep coaching service there. On that website, we also sell other books.

Chris Warden (54:55.188)
Yeah. Great.

Barry Krakow (55:17.604)
and videos that talk about some of the same things we're talking about. And then there's another angle. I have a newer, sub -stack newsletter. It's only been out a couple years. And I update it, you know, a few times a month, sometimes weekly. Often I'll talk about some new research thing that came along that I have some concerns about how it's being interpreted.

Chris Warden (55:23.508)
Okay. Mm hmm.

Barry Krakow (55:45.316)
because the journalists nowadays are very poor at really asking scientists hard questions about the data they're presenting. They're just looking for quotes. They put the quotes in the article and then you're done as opposed to actually saying, well, can you tell me about why this could be wrong or why this could actually help somebody even though you showed it didn't? So it's a big problem in journalism today. They don't really, and that's why of course,

Chris Warden (55:51.095)
Sure.

Barry Krakow (56:15.268)
the world of Substack and podcasts and so forth is replacing a lot of that. People can get very much more accurate information by these kinds of programs. And I'm very pleased I had an opportunity to have this great conversation with you, Chris.

Chris Warden (56:20.598)
Yeah, it's been, it's been very enlightening to say the least. And it, it should, hopefully everybody else gets as much out of it as I have, because this is, this has been a big one for me. But with, with all your experience with workshops going around the world, working at military bases and with veterans in the medical centers.

What would you say is a good way for fire departments to start integrating sleep health into their preventative practices?

Barry Krakow (56:57.924)
It's a tricky question because the first problem is they won't want to. In other words, there might be some people you'll meet, they'll go, well, that sounds interesting. But it's not something that there has to be sort of a buy -in and most of them will say, well, I don't see the buy -in. And you would say, well, wait, but what about all this data about PTSD and workplace accidents? So I just want to point out that...

Chris Warden (57:04.79)
Okay.

Chris Warden (57:18.966)
Right.

Yeah. I get that a lot.

Barry Krakow (57:26.18)
When you try to do stuff like this, it's not unusual to run up against a very large segment of professionals who go, that's very interesting. Right now we've got this other project, get back to me in six months. Of the people who are, yeah, I mean, it's the way it is with so many things that are innovative. But sleep, remember, is very much disrespected. That's the biggest barrier. Sleep is a very disrespected human behavior.

Chris Warden (57:45.62)
Okay. Okay.

Barry Krakow (57:56.548)
And so that already have a strike against you. The second strike against you, of course, is the fact that the people, they're just not interested. They don't have the time. I think the thing that's most useful is if you get somebody's interest, you say, could we have a sleep doctor come and talk to the fire department? Or can we have a sleep center have our firefighters come over to have a tour?

Chris Warden (58:15.443)
Alright. Yeah.

Barry Krakow (58:26.98)
of the sleep center, because it is a very interesting environment. And unfortunately, firefighters and first responders actually show up at sleep centers once or twice a year to pick up a patient who is in having a cardiac arrhythmia. And it does happen. So most firefighters are familiar with sleep centers for that particular reason. But, you know, that level of interaction is probably the first step, getting people to say, would you like to have some education? Because a lot of sleep doctors do like to do that.

Chris Warden (58:35.955)
Mm -hmm.

Chris Warden (58:51.859)
Okay.

Barry Krakow (58:57.028)
They do like to come out into the community and say, yeah, sure, let's have a discussion. And then just like you said, some of those firefighters are gonna go, well, you're talking about me. Maybe I should come to your sleep center. And that doctor is gonna say, this is great, I came here, I got some more patients. So it works that way first before it works to integrate something into your sleep center. Once you start making a connection and more people are say, they're interested,

Chris Warden (59:00.723)
Yeah.

Chris Warden (59:20.563)
Okay.

Barry Krakow (59:24.708)
Hello, Joe over here has a pap and Sally's got a pap. Now everybody's starting to talk about sleep. Now you can do something more internal. It's a lot easier when people have their own personal stake, because then they have something to offer. You know, it's kind of like a 12 step program. Everybody's got something to offer because they've, they've been through it. If you start in with people who know nothing about sleep, they're not going to necessarily want to sit around and talk about it.

Chris Warden (59:29.683)
Okay.

Chris Warden (59:39.667)
Yes.

Chris Warden (59:53.844)
That's a great idea. And I think I'm going to do that the next opportunity I get. This has been the most eye -opening episode I've ever recorded personally. And hopefully, the people listening, all of you guys out there, guys and gals, take something from this and, and just figure out how good you're sleeping, you know, figure that out. And what's a good way for someone to assess their own sleep? Like what do, what do,

Barry Krakow (01:00:23.076)
It's easy. They should wake up in the morning and feel great. If you don't wake up in the morning and feel great, there's always a window. It might take a few minutes to wake up and get out of bed. But if you don't feel great within the first 30 minutes, usually, maybe a few people, it's an hour, without coffee, without caffeine, maybe a little bit of exercise, if you don't feel really good, then you...

Chris Warden (01:00:25.651)
All right.

Chris Warden (01:00:51.379)
Okay. Well, you guys heard it first. Do you feel great when you wake up? If not, it's time to take responsibility for your sleep and stop disrespecting it as we've learned it is so often. after with our discussion with Dr. Greco. Dr. I really appreciate you making time. If you don't mind real quick.

Barry Krakow (01:00:52.644)
Sure, begin to wonder whether there's something going on with your sleep. That simple, that simple.

Chris Warden (01:01:20.755)
Just give us the name of the book again and the best place for people to get a hold of you like your website and then Then we're gonna wrap it up today. But again, I can't tell you how grateful I am to have have you made time for us today

Barry Krakow (01:01:27.332)
thing.

Barry Krakow (01:01:34.5)
I'm so glad that I could be here. Let's start with my Substack. My Substack newsletter is fastasleep .substack .com. My new book is Life Saving Sleep, and that's either at Amazon or wherever books are sold. You can also just put in lifesavingsleep .com. My main, right, thank you. And my main website is Barry.

Chris Warden (01:01:50.772)
I'll put a link in as well. Yes, sir.

Barry Krakow (01:02:01.644)
krakow .com that has some past talks on it. Many of them are free to watch. There's also some videos and books for sale. That's also where you sign up for coaching appointments. Generally has most of my stuff there. And of course a way to contact me, there's a contact form on that website.

Chris Warden (01:02:20.659)
Excellent. Well, again, on behalf of the audience and myself, doctor, thank you so much. anybody out there looking to improve their wellness and take their performance to the next level as we have to invest in our sleep. We have to understand how important it is and

And to reiterate this entire discussion, we need to respect our sleep more. Doctor, thank you so much. It's been a pleasure. I hope you have a great day.

Barry Krakow (01:02:57.636)
You too, great to be with you.