Sleep Medicine: A Guide to Sleep and its Disorders

Abstract

Sleep medicine is a multidisciplinary medical specialty, newly recognized by the American Board of Medical Specialties. Physicians practicing sleep medicine have backgrounds in many fields, including pulmonary medicine, internal medicine, neurology, and psychiatry. Sleep disorders afflict many people and many remain undiagnosed because of lack of clinical recognition of the more than 90 sleep diagnoses. Physicians play a critical role in recognizing sleep disorders and play a key management role in their diagnosis and treatment. Respiratory therapists and polysomnographic technologists also play key roles in diagnosing many sleep disorders, especially sleep-disordered breathing. Respiratory therapists are instrumental in providing therapy for many sleep disorders, by providing nasal continuous positive airway pressure, bi-level positive airway pressure, nocturnal ventilation, and oxygen therapy to patients with sleep-disordered breathing. Because sleep medicine crosses many medical specialties and is a rapidly changing field, it is a challenge to remain up to date, but Shneerson provides a relatively up-todate, concise review of sleep medicine and its more than 90 sleep disorders. Since he is the sole author, the book suffers less interchapter repetition than do multi-author books. The book is divided into 12 chapters.The first chapterdealswithnormal sleep and sleep development. It examines sleep throughout our life cycle and provides a backbone for further discussion in the second chapter, which concerns physiology and control of sleep. The third chapter, “Assessment of Sleep Disorders,” provides a short review of various diagnostic techniques used in sleep medicine. The fourth chapter discusses how drugs impact sleep, including drugs used to treat sleep disorders and the adverse effects of some drugs on sleep. The remainder of the book (Chapters 5 through 12) discusses the many sleep disorders. The book presents the disorders more from a symptomatic standpoint than from a specific disease standpoint. This is appropriate, since patients present with symptoms, not diseases. Chapter 5 examines circadian rhythm disorders. Chapter 6 examines disorders associated with excessive daytime sleepiness. Chapter 7 discusses the complex and often perplexing topic of insomnia. Chapter 8 discusses dreams and nightmares, causes and treatments. Chapter 9 discusses motor disorders, including the parasomnias (motor activities such as sleepwalking, sleep talking, and rapid-eye-movement sleep-behavior disorder). Chapter 10 covers obstructive sleep apnea, which has received much press lately. Chapter 11 discusses central sleep apnea and hypoventilation. The final chapter examines medical disorders and how they can impact sleep. There are 10 appendixes, among which are validated questionnaires that are very useful in the practice of sleep medicine. The author’s key audience is physicians, including sleep specialists, pulmonologists (respirologists), neurologists, psychiatrists, and general/internal medicine physicians who evaluate patients with sleep disorders. Pediatric aspects of sleep are integrated throughout the text, so pediatricians may or may not find this book useful. Although not specifically written for respiratory therapists or nurses, the book may be helpful as a reference. Since this book does not go into detail concerning polysomnography, it is probably not useful for polysomnographic technologists who want specific technical information. Shneerson is from the United Kingdom and has a fine command of syntax and grammar. He provides clear explanations for very complex topics. It is easy to follow his thought processes, because the writing is very clear, concise, and readable. This is a book that you could sit down and read cover to cover. It is not intended to be a reference book on sleep disorders, so it is not heavily referenced, but it provides limited references after each chapter. It is up to date, as evidenced by references to the most recent International Classification of Diseases for sleep disorders. Furthermore, Chapter 4, “Drugs and Sleep,” discusses medications recently released by the U.S. Food and Drug Administration, including pregabalin, ramelteon, and eszopiclone. I think the book’s illustrations will be especially helpful for understanding sleep/ wake mechanisms and pathophysiologic aspects of many sleep disorders, including obstructive sleepapneaandcentral sleepapnea. The author effectively uses tables to describe the differential diagnoses of sleep-related symptoms and differentiate sleep disorders that present with common symptoms. One example is in Chapter 7, “Insomnia,” which examines the various hyperarousable states that can lead to insomnia. In general, the material is well selected and organized. I am most impressed with the author’s ability to present complex topics and concepts in a naturally flowing, easily understood narrative. This is particularly evident in the chapter on the physiologic basisof sleepandwakefulness.Furthermore, the presentation on drugs and sleep is outstanding. It describes drug effects on sleep stages and the circadian rhythm, and discusses pharmacokinetic aspects of specific medicationsandmechanismsofaction.Very few books have examined drugs and sleep in such a concise and well-done manner. Another outstanding aspect of this book is Chapter 9, “Motor Disorders,” which discusses parasomnias, including sleepwalking, sleep terrors, arousal disorders, hypneic jerks, epilepsy, chorea, and tics. For the nonneurologist this section is especially helpful. The statements, in general, are accurate, although sometimes they are simplified for clarity. This book includes only an introduction to polysomnographic methods; it would not be adequate for physicians, respiratory therapists, or sleep technologists seeking to gain expertise in polysomnography. Limited information is provided on sleep-stage scoring and technical aspects of polysomnography, which is covered in only 14 pages. The diagnostic criteria used in the United States are not included. For instance, sleep-disordered breathing in the United Kingdom is often diagnosed without the use of polysomnography. Practice parameters recommended by the American Academy of Sleep Medicine are not described. One example is the diagnosis of narcolepsy. Though the information presented is accurate, different countries have different diagnostic and treatment paradigms for sleep disorders, and this book provides the United Kingdom perspective. An outstanding feature of the book is the extensive descriptions of differential diagnoses of symptoms for many sleep disorders. Chapter 6, “Excessive Daytime Sleepiness,” discusses not only sleep deprivation and its effects, but also other disorders and how they present throughout the life cycle. It gives a complete differential diagnosis, as evidenced by the inclusion of narcolepsy, upper-airway-resistance syndrome, disorders of the pons BOOKS, FILMS, TAPES, & SOFTWARE

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