Talking Sleep Defining Well Treated Obstructive Sleep Apnea
Feb 21, 2025
Barry Krakow, a sleep medicine physician known for work on treatment‑resistant insomnia and advanced PAP therapy, discusses measuring success in obstructive sleep apnea beyond simple numbers. He covers switching from CPAP to bilevel/ASV for flow limitation, links between sleep fragmentation and anxiety/PTSD, insurer negotiation for advanced devices, and behavioral tricks to improve PAP tolerance.
AI Snips
Chapters
Transcript
Episode notes
Subjective 'Better' Can Mask Incomplete Treatment
- Many patients on CPAP report feeling 'better' but aren't reaching a true physiological ceiling of normal sleep.
- Barry Krakow found switching to bilevel or ASV often corrected persistent flow limitation and produced noticeably better results.
Personal Turnaround After Switching To Bilevel
- Krakow recounts switching many patients from CPAP to bilevel and watching dramatic clinical improvement.
- He describes personally feeling the difference when he switched from CPAP to bilevel himself.
Retitrate For Flow Limitation Before Increasing Pressure
- Bring patients back to the sleep lab to titrate for flow limitation and expiratory pressure intolerance rather than only raising CPAP pressure.
- Switch to bilevel or ASV when CPAP cannot normalize the expiratory airflow curve.