Sleep Medicine

Sleep Medicine begins with a simple but profound statement: “sleep is not an inactive state.” In the subsequent 225 pages, the internationally respected editors and authors then present a thorough review of the full complexity of the science of sleep medicine. Edited by Smith, Comella, and Högl, the book includes sections on normal sleep, sleep disorders, and sleep in specialty areas; in short, nearly all a clinician needs to know and understand when evaluating and treating patients with excessive sleepiness or sleeplessness and the broad array of disturbances that occur during the sleep state.

The book begins with an introduction to the basic neurology of sleep, which serves as a useful prelude to subsequent chapters. The first chapter, “Normal Sleep,” provides a concise review of the development of sleep staging and polysomnography. The basics of polysomnographic acquisition techniques and conventional sleep and wakefulness analysis are then clearly described. A brief review of automatic analysis of sleep and signal preprocessing, including spectral analysis using fast Fourier transform algorithms, period analysis, and transformation into wavelets, along with further reading recommendations, would be useful for some sleep physicians and sleep researchers. The chapter continues with a description of sleep state characteristics throughout life, from newborns to older adults. Readers might find the section on sleep in extreme environments—eg, in polar regions, in the tropics, at altitude, and in space—particularly interesting.

The book contains information that a general clinician might find quite useful and pragmatic. Management algorithms, assessment tools, and questionnaires (chapter 2) are provided. The patient symptom descriptions of cataplexy, sleep paralysis, and hypnagogic hallucination (chapter 5) and the practical review of the basic components of cognitive behavior therapy for insomnia (chapter 6) will likewise be useful to any clinician. A thoughtful overview of the evaluation and treatment of primary and secondary causes of restless legs syndrome and periodic limb movement disorder (chapter 7) is exceptionally well written, as is a detailed review of the epidemiology, pathophysiology, consequences, and treatment of central and obstructive sleep apnea (chapter 8). The synopsis of medical disorders and how they might contribute to risk factors for sleep disturbances is detailed but not daunting and includes a wide variety of disorders (asthma, coronary artery disease, connective tissue and rheumatologic disease). The book also provides diagnostic and treatment recommendations (chapter 11), a useful section on sleep in dementia (chapter 13), and an excellent and intriguing summary of forensic issues in sleep medicine (chapter 14).

The tables and figures are helpful and the references are adequate. Treatment options for obstructive sleep apnea, issues of adherence to positive airway pressure therapy, and ways to improve compliance are clearly outlined in both text and tabular form. Management of the care of persons with obstructive sleep apnea and residual sleepiness as well as assessment of individuals with obstructive sleep apnea employed at high-risk occupations, however, are not adequately addressed. Other limitations include the lack of any substantive discussion on the guidelines of The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (2007) or on ambulatory monitoring; both topics would be important and worthwhile inclusions in any future editions. Other recommendations for future editions include more case examples, separate chapters on women and sleep, and a specific summary chapter to provide quick reference to the effects of medication on sleep and to pharmacological therapy for sleep disorders, which were adequately addressed in each section.

There are 2 types of medical textbooks—those written for the generalist, who needs to know more but has less time to do so, and those written for the subspecialist, who occasionally requires information on a topic with which she or he is less familiar. Sleep Medicine caters to both audiences in a concise, easily readable fashion.