An Interview with Barry Krakow, MD on PTSD and Sleep Disorders

Long-term PTSD often co-occurs with independently diagnosable and treatable sleep disorders including insomnia and apnea. Dr. Krakows research suggests that many chronic insomnia patients also have undiagnosed apnea like conditions they are not aware of. He frequently prescribes an imagery technique for treatment of nightmares called Imagery Rehearsal Therapy or IRT. In IRT, patients are taught that nightmares are habitual learned behaviors and therefore modifiable. Patient are then instructed to change their nightmares however they wish and to practice this between sessions. The technique is associated with symptom relief. IRT has no exposure therapy component, but Dr. Krakow does think incorporating one might be helpful. Other sleep disorders are treated using appropriate techniques including use of breathing assistance machines such as adaptive servo-ventilation (ASV), which PTSD patients more readily tolerate than CPAP. Imagery techniques are taught as distraction devices to help patients cope with the discomfort associated with breathing machines. Addressing co-occurring sleep disorders helps PTSD patients rally and cope better during waking hours.