- Is
treatment at the Nightmare Treatment Center similar to a standard
doctor-patient relationship?
- What
types of problems are treated at the Nightmare Treatment Center?
- How
is treatment offered at the Nightmare Treatment Center?
- What
treatment is offered for nightmares and disturbing dreams?
- How
much consultation time is needed to learn to control nightmares?
- What
treatment is offered for insomnia?
- How
much consultation time is needed to treat insomnia?
- What
treatment is offered for other sleep disorders?
- How
much consultation time is required to treat these other sleep
disorders?
- How
is payment made for treatment services to the Center for Sleep
Medicine & Nightmare Treatment?
- Will
my health insurance cover any of these treatments?
- Are
there laws pertaining to the practice of telemedicine and distance
medicine which pertain to a patient seeking care from the Center
for Sleep Medicine & Nightmare Treatment?
- What
are the fees for treatment services at the Center for Sleep Medicine
& Nightmare Treatment?
- How
do I begin treatment at the Nightmare Treatment Center?
- Q:
Is treatment at the Nightmare Treatment Center similar to a standard
doctor-patient relationship?
A:
Treatment at the Nightmare Treatment
Center requires that a formal doctor-patient relationship be established. Thus,
patients must make a request in writing (via email) to the Center requesting
treatment services. Until such a relationship is established, medical advice
cannot be provided to patients seeking answers to questions about medical care.
All of your records are kept confidential as in any other doctor's office
although at the Center we will e-mail copies of your records to you for
your personal files or to assist you with discussions with other
health care providers or for reimbursement purposes.
The only major distinction about telemedical treatment is that there is
no availability for a physical examination. And, there is no direct in-person
encounter unless you choose to travel to New Mexico. Videoconferencing over
the Internet may therefore be essential in certain cases where it may be
important to monitor a patient's responses to treatment although telephone
and e-mail communication will often suffice. If a physical examination
is indicated, Dr. Krakow will make appropriate suggestions on what
type of doctor to schedule an appointment with and what type of
physical examination is needed. In many such instances, the most
likely contact will simply be your primary health care provider.
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- Q:
What types of problems are treated at the Nightmare Treatment
Center?
A:
Treatments are offered for nightmares
and other disturbing dream problems, insomnia and other sleep
disorders.
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- Q:
How is treatment offered at the Nightmare Treatment Center?
A:
Treatment is provided through:
1. Telephone and video conferencing
2. On-line through e-mail or ICQ or instant messaging
3. On-site at the Center of Sleep Medicine & Nightmare Treatment
in Albuquerque, New Mexico.
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- Q:
What treatment is offered for nightmares and disturbing dreams?
A:
Nightmares and disturbing dreams
are usually thought of as uncontrollable and unconscious processes
that may occur because of a past traumatic event or for no clear
reason whatsoever. Treatment focuses on gaining a new attitude
about these unwelcome night time visitors - an attitude which
helps you to appreciate that some aspect of your disturbing dreams
may actually be a "learned behavior" or more simply,
a bad habit. The imagery rehearsal technique teaches you how to
literally change your nightmares while you are awake, so that
you will actually gain greater control and more conscious control
over them.
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- Q:
How much consultation time is needed to learn to control nightmares?
A:
Depending upon the severity of the
nightmare problem and whether or not there are other associated
medical and psychiatric problems, the treatment technique is taught
in the range of one to ten hours of consultation time.
If you suffer from chronic nightmares that are accompanied by
only a mild sleep disturbance, such as mild insomnia and no other
serious medical or psychiatric disorders, then imagery rehearsal
can be taught in a one hour consultation with perhaps another
hour of follow-up required a few weeks or months later.
If you suffer from a severe a nightmare disorder associated with
more severe sleep problems, for example, moderate or severe insomnia
and you also suffer from more complex medical and psychiatric
conditions such as depression, post-traumatic stress disorder,
and fibromyalgia, then it is much wiser to pursue a slower, step-by-step
approach that may take ten hours of consultation time, or rarely,
even longer. Such patients may also require more regular follow-up
consultations over the course of several months.
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- Q:
What treatment is offered for insomnia?
A:
Sleep hygiene instruction is a common
tool used among sleep specialists for the treatment of insomnia.
Sleep hygiene will provide you with a number of behavioral tips
that you can employ to regain a normal sleep schedule and to overcome
difficulties with falling asleep and staying asleep.
However, to successfully teach an insomniac the principles of
sleep hygiene, it is critical to connect these behavioral tips
to important underlying beliefs which many insomniacs hold about
their sleeplessness. For example, if I recommend removing a clock
from the bedroom or turn its face to the wall, I can guarantee
you that some people will cure their insomnia simply by doing
so. But, I can tell you with even greater certainty that this
improvement in your insomnia is likely to be lost if you do not
understand the principles behind turning the clock to the wall.
Some sleep specialists might approach their patients with a "Just
do it!" mentality. Instead, I prefer that you become aware
of the simple relationships which you have developed toward clocks
and more importantly time. A rather quick exploration of these
topics will usually lead you to appreciate how it is your view
of time which has led you to think that it is valuable to monitor
your clock if you have trouble falling asleep or if you awaken
in the middle of the night. But once you have learned why you
no longer need to monitor time, then you will find it easier and
more sustainable to remove the clock from the bedroom entirely
or simply turn it to the wall.
I offer this tip as an example, because issues surrounding clocks
are one of the most fundamental dilemmas of most insomniacs. And,
because these issues are almost always at the core of the insomnia
problem, you can gain rapid success by dealing with the clock
problem right from the start of your treatment. Many people in
fact have cured their insomnia just by turning the clock face
to the wall. To reiterate, however, if you do not understand why
you have been watching the clock in the first place and why changing
your attitude about time is so beneficial, then in my clinical
experience, your success with turning the clock will sooner or
later be squandered.
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- Q:
How much consultation time is needed to treat insomnia?
A:
Treatment of insomnia can be combined
with treatment of nightmares in some cases or provided separately
depending upon the patient. Patients with more complex problems
require more time, but overall, most sleep hygiene training only
takes a few hours of consultation time. The keystone of sleep
hygiene instruction is trying out different behavioral tips on
your own after receiving proper instruction. Thus, many insomnia
problems require as little as two hours of initial instruction
with no follow-up consultations required for several weeks or
months.
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- Q:
What treatment is offered for other sleep disorders?
A:
Particular emphasis is placed on
determining whether or not there are other sleep disorders that
could be causing or influencing nightmares. The two most common
disorders to look for are sleep-disordered breathing and sleep-related
movement disorders. Evaluation of these problems starts with learning
more about potential symptoms and behaviors that may indicate
the presence of a physical sleep disorder, such as a breathing
problem, for example, snoring, or a movement problem, for example,
restless legs or leg jerks.
Treatment options for these conditions vary considerably depending
upon the type and severity of the problem.
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- Q:
How much consultation time is required to treat these other sleep
disorders?
A:
Treatment for these sleep disorders
usually requires evaluation at a sleep center. For personal on-site
evaluation, the Center for Sleep Medicine & Nightmare Treatment
is located in New Mexico and works in cooperation with various
sleep laboratory facilities to diagnose and treat sleep breathing
and sleep movement disorders. Testing can be conducted in a lab
setting or it can be conducted in a more familiar environment
such as a local home bedroom or a local hotel room.
For those who do not reside in New Mexico or who do not wish to
travel, the Center for Sleep Medicine will help to coordinate
care with appropriate physicians in your area if sleep testing
is needed.
Depending upon the severity of the problem, treatment for sleep
breathing and sleep movement disorders usually takes one or two
nights of lab testing and anywhere from two to six appointments
with a sleep specialist.
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- Q:
How is payment made for treatment services to the Center for Sleep
Medicine & Nightmare Treatment?
A:
All payments are the responsibility
of the patient receiving services, and all fees for treatment
services must be paid at or before the date of service. If a credit
card is used, then payment can be made on the day of the consultation
at the completion of the appointment. If a check or money order
is the method of payment, it must be received by the Center prior
to the date of the consultation.
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- Q:
Will my health insurance cover any of these treatments?
A:
No direct payments or referrals through
health insurance carriers will be accepted by the Center; however,
you will be provided with physician notes that contain full documentation
of your evaluation and treatment plans. In some instances, you
may be able to use these documents to obtain reimbursement from
your health insurance plan. You are welcome to pursue coverage
for services provided at the Center through traditional means
of primary care referrals, preauthorizations and so forth; however,
there is no need to inform us of this intention as all medical
notes will be provided directly to you in a timely fashion, usually
within 2 working days after completion of any appointment. As
a reminder, all payment for services must be provided directly
from the patient or a responsible party representing the patient
at or before the appointment.
Last, if you require additional sleep disorders evaluation and
treatment, this can usually be handled directly with your local
doctors and your local insurance plan so that your out of pocket
expenses are kept to a minimum.
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- Q:
Are there laws pertaining to the practice of telemedicine and
distance medicine which pertain to a patient seeking care from
the Center for Sleep Medicine & Nightmare Treatment?
A:
The Center for Sleep Medicine &
Nightmare Treatment is located in the state of New Mexico and,
therefore, holds that any encounter with patients occurs under
the jurisdiction of the state of New Mexico. Your locale may perceive
such encounters differently and therefore you are advised to contact
your doctor or your local medical board to determine if there
are any legal constraints that would prohibit seeking care at
the Center.
Given that treatment for nightmares and certain aspects of sleep
disorders represent highly specialized care, there is one safeguard
against any infringement of local medical board laws that can
always be considered. If you discuss your problems with your primary
physician or other healthcare provider, you can request a referral
to the Center for Sleep Medicine & Nightmare Treatment on
the grounds that you have been unable to successfully seek help
for these problems in your area. On a humanitarian basis, if you
require treatment for something which you have been unable to
find treatment for in your area, then it is likely to be perceived
as a reasonable course of action to seek care outside of your
area.
In pursuing such a course, you may simply need to discuss all
of this with your physician who can then send a referral to the
Center for Sleep Medicine & Nightmare Treatment. In such instances,
the Center will maintain regular contact with the referring physician
to apprise him or her of the specialized treatment being provided
to you. In this way, you remain technically under the care of
your primary doctor who has sought additional and temporary assistance
in the management of your care for these sleep-related problems.
If you prefer even greater clarification of telemedicine issues
prior to seeking consultation at the Center, you could write your
local board requesting advice or a ruling about your situation.
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- Q:
What are the fees for treatment services at the Center for Sleep
Medicine & Nightmare Treatment?
A:
All services are billed according
to hourly rates for either direct patient care or administrative
support.
1. Direct patient care time includes consultation time with Dr.
Barry Krakow, a board certified internist and sleep specialist,
preparation of physician notes, and communications with other
healthcare providers and family members as needed on a case by
case basis.
Direct patient care time is billed at $250/hour.
2. Administrative support includes primarily management of case
files including printing, copying, filing and forwarding of physician
notes to patients, health insurance carriers, referring physicians
and so forth by way of snail-mail or fax. Administrative support
time can be radically reduced if arrangements are made to forward
all physician notes and letters electronically.
Administrative support time is billed at $50/hour.
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- Q:
How do I begin treatment at the Nightmare Treatment Center?
A:
To seek treatment services at the
Nightmare Treatment Center, you must take the following steps:
1. Contact Dr. Barry Krakow with a brief e-mail and please clarify
the following three items: (a) nature of the problem for which
you are seeking help; (b) type of consultation interface you prefer
(telephone, email, videoconferencing, ICQ, instant messaging);
and, (c) method of payment.
2. You will receive an e-mail reply to provide you with possible
appointment times.
3. Treatment can usually be started within a month, if not sooner.
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