Clinical Manual for Evaluation and Treatment of Sleep Disorders

by Martin Reite, MD; Michael Weissberg, MD; and John Ruddy, MD. American Psychiatric Publishing Inc, Arlington, VA, 2009, 377 pages, $59.00 (paper).

The present volume is a continuation and expansion of a similarly entitled work that was originally published in 1990 and had 2 additional editions. The work has been expanded and rewritten and had a third author, Michael Weissberg, added. It is a comprehensive overview of the field of Sleep Disorders Medicine and is written in a clear, concise, and understandable fashion. It is directed to health-related practitioners and their students who come in contact with patients with sleep-related problems. It serves as an effective orientation to the field both diagnostically and therapeutically and could serve as a reminder to sleep specialists of alternatives when they are faced with difficult diagnostic or therapeutic problems. Unfortunately, it necessarily goes beyond what one could reasonably expect an intelligent layperson to understand.

The book covers the field of Sleep Medicine in some 377 pages divided into 13 chapters and 2 appendices. The first 2 chapters are (1) an orientation to the arena of sleep disorders and (2) an effective overview of sleep physiology and pathology. A caveat is the limited attention given throughout to dreaming, the cognitive state that occurs during sleep.1 The diagnostically oriented chapters, 3 through 9, are organized using the 1979 Sleep Diagnostic System, which is more useful than the so-called more etiologic systems, as it is clinically oriented. These clinical chapters include, in order, insomnia complaints, circadian rhythm–based complaints, disorders of excessive sleepiness, parasomnias, medical disorders and sleep, psychiatric disorders and sleep, and sleep-related breathing disorders.

Much of what these 7 diagnostically organized chapters describe is clinically highly valuable. I found the descriptions in the chapter on circadian rhythm–based complaints of the jet lag syndrome and the phase delay and phase advance syndromes particularly lucid and the treatment recommendations understandable and useful. The chapter on sleep-related breathing disorders provides excellent explanations of the physiologic changes and resultant dangers associated with central and obstructive sleep apnea and the upper airway resistance syndrome. The value of these descriptions of the changes in respiratory physiology that accompany these conditions provide to the nonpulmonologist who sees patients with sleep problems a basis for understanding the disorders and the dangers patients face. The descriptions of sleep and responsiveness in sleep in posttraumatic stress disorder may not capture the fact that such disturbances as movement, arousals, and awakenings occur early in the night and are not REM sleep–related.2

The 2 demographic variables that are related to changes in sleep and to disorders of sleep are gender and age. The next 3 chapters of the Manual are related to sleep problems in children, women, and older adults. These chapters are as well done as the clinical ones and serve to remind the practitioner, no matter of what discipline, that sleep and its disorders are developmental and dynamic processes. The systematic application of behavioral and medicinal treatment of enuresis can facilitate the correction of an embarrassing and distressing experience for both young and older patients. The recognition that the day-night reversal of sleep and wakefulness in the older and often demented elderly is often the final factor that leads to nursing home placement underscores the need to attend to the sleep problems of the elderly.

The last chapter directs our attention to the disruptive effect that many types of drugs have on sleep and the need to take a careful drug history when evaluating patients. One of the appendices provides a comparison of diagnostic sleep-related systems, and the other, a list of handouts for patient education. The proper use of hypnotics may not lead to the serious problems described.3

I would strongly recommend the Manual to all those who are interested in and work with patients who have sleep-related problems. I hope to see the book on the shelf of specialists and nonspecialists. It is readable and valuable and is a great place to start the exploration of a clinical topic in sleep medicine.

References

1. Kramer M. The Dream Experience: A Systematic Exploration. New York, NY: Routledge; 2007

2. Kramer M, Kinney L. Vigilance and avoidance during sleep in US Vietnam War veterans with posttraumatic stress disorder. J Nerv Ment Dis. 2003;191(10):685–687. PubMed doi:10.1097/01.nmd.0000092179.74348.20

3. Kramer M. Hypnotic medication in the treatment of chronic insomnia: non nocere! doesn’t anyone care? Sleep Med Rev. 2000;4(6):529–541. PubMed doi:10.1053/smrv.2000.0122

Milton Kramer, MD

milton1929@yahoo.com

Author affiliation: University of Cincinnati College of Medicine, Ohio.

Potential conflicts of interest: None reported.