Barry Krakow, MD is a board certified internist and sleep disorders specialist who has spent over 30 years in medicine in the fields of internal, emergency, addiction and sleep medicine. He has conducted more than two decades of research in the treatment of chronic nightmares and disturbing dreams at the University of New Mexico School of Medicine (1988-1999) and the Sleep & Human Health Institute (2000-current).
Dr. Krakow graduated magna cum laude from the University of Maryland School of Medicine. He was residency trained and board certified in internal medicine and also has ten years of clinical work in emergency medicine. He is a member of the American Academy of Sleep Medicine and the Sleep Research Society and is the former medical director of University Hospital Sleep Disorders Center.
Dr. Krakow has published two books, Insomnia Cures and his most recent, Sound Sleep, Sound Mind, is the first book of its kind to focus on mental, emotional and physical causes to sleep disturbances. Dr. Krakow and his wife, Jessica Kohr-Krakow have also published Turning Nightmares into Dreams, an innovated self-help, audio series and workbook to eliminate bad dreams.
Dr. Krakow is the medical director of Maimonides Sleep Arts & Sciences, Ltd, in Albuquerque, NM as well as the principle investigator of the Sleep and Human Health Institute, a non-profit research facility.
Also, you can find information about his upcoming workshops on his Web sites, which include www.sleeptreatment.com
http://www.nightmaretreatment.com/.
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A psychology podcast by David Van Nuys, Ph.D.
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I always seem to learn something from your interviews, regardless of any initial expectations to the contrary. I have had some sleep issues over the years, but I believe mine were driven by my depression foremost. And, they haven’t been a foremost concernn over the last couple of years.
However, in this interview, I learned something that perhaps should have been obvious on reflection (and has implications far beyond “just” sleep disturbance): my rumination that had been (and still is) central to my depression is most likely a direct result of my UNwillingness to experience my emotions. Rather than experience and truly “feel” my emotions, really process them, I am an extreme avoider. That this leads to rumination and the resultant depression seems blatant on reflection, but was not until I listened to this podcast.
I do not recall anyone ever showing me this connection before. My “racing” mind, my inability to focus, the constant flow of thoughts and worries, are very likely to stem primarily from an unwillingness to experience my emotions of fear, anger, resentment, sadness, frustration, etc. Simply WOW!
NOW what do I do with this knowledge to help myself??
I was not expecting this insight from episode #248 “Sound Sleep, Sound Mind”, but I’m now so glad I listened to it attentively.
Excellent episode Dr. Dave & Dr. Krakow! Thanks so much, AS USUAL!
Wonderful discussion and excellent advice.
Steven, the concept that “racing thoughts = suppressed emotion” should be obvious, but in fact, I believe most of us have grown up in a culture where we did not enroll in Emotions 101 in kindergarten. Instead, we learned to think our way into and out of most of our problems. In my book, Sound Sleep, Sound Mind, we spend a lot of time fleshing out the particulars of the TFI System (thoughts, feelings, and images), and once the individual pays more attention to how much they are over-thinking, it will start the process of beginning to consider feelings (emotions) and mental imagery (the pictures in your mind’s eye).
When I spotted this problem in myself 17 years ago, I started my rehabilitation by inverting Ronald Reagan’s famous debate response to Jimmy Carter: “There I go again,” as I watched a parade of miscellaneous ramblings traverse my mental landscape. Then, I would simply ask myself, “So, what emotion am I hiding from?” Even if you start on the intellectual level only (“thinking about feelings”), you will make progress because your intuition enables you to identify the names of the real emotions being suppressed. Over time, engaging in this process creates enormous opportunity to get to the next level, which is “feeling the feelings.”
I worked with several patients just this week on helping them build their TFI System to produce more balance. Although it is difficult to fathom at the outset, the long-term goal is to not only get past the racing thoughts, but also to get past the tendency to get stuck with a small set of emotions instead developing a broad range of feelings. In session, I explained to these patients that if the only “emotion” words currently in one’s vocabulary are “stress, worry, tension, anxiety, or depression,” then these terms are also likely being used to suppress, avoid, or otherwise negate deeper emotional states like “frustration, anger, fear, or sadness” to name a few. Undoubtedly, some depression is a very deep and deadening experience, but I’m surprised about how many of my patients don’t seem to have much of this endogenous depression; rather, some proportion of their problem is the inability to work with emotions in general.
I believe the above points explain why emotional processing work may be challenging, exciting and intimidating, because on the one hand, it’s great to get rid of racing thoughts and often the insomnia that goes with them, but on the other hand, you have to be willing to commit to a deeper and fuller emotional experience. I’d like to think that more people would accept the challenge, because when you eliminate racing thoughts, it almost always helps insomnia, but there seems to be some proportion of people who prefer sticking with the racing thoughts out of fear of what they might feel.
I have been blessed with the ability to fall asleep on most nights, but many of the people in my depression & bipolar support group are not so fortunate. Your interview summed up some of the observations that I have been arriving at on my own, such as that sleep medications are only a temporary stopgap to be administered on a PRN basis and never for extended periods. I think that many people can benefit from sleep clinics that address the psychological/physical roots of insomnia.
Hi Dr. K, Great show! What about light therapy? Is this part of your holistic approach? If not, why not?
I’m no expert on light therapy, but what I’ve read about it makes me think that for select patients it’s a valuable addition to their sleep program. My only caveat is that I often find that people who allegedly have circadian rhythm disorders including jet lag problems almost always suffer underlying physiological sleep disorders like breathing or leg movement problems. Such individuals often get steered toward circadian rhythm treatments such as light therapy, when what they really need is both light therapy and a fuller evaluation of their sleep in a sleep lab.
I have read both of his books and they are truly amazing!