Sleep Medicine: Essentials and Review

Sleep Medicine: Essentials and Review

by Teofilo Lee-Chiong, Jr, MD. Oxford University Press, New York, New York, 2008, 703 pages, $40.15 (paper).

This comprehensive text is packed with information covering all aspects of sleep medicine. It covers the basics (eg, neuroscience of sleep, respiratory physiology) quite well and describes what is normal, particularly in the context of development (chapters on pediatrics and aging). Chapter 14 ("Sleep in Older Adults") emphasizes that insomnia is rarely due to aging alone, and it contains good information on how disorders such as obstructive sleep apnea (OSA) may have quite different symptoms and implications in the older population than in younger adults.

Chapter 2, "Evaluation of Sleep and Sleep Disorders," summarizes what questions to ask the patient, and it provides useful questionnaires and scales as well as descriptions of common types of sleep studies and when to utilize them. Chapters 3 ("Insomnia"), 4 ("Excessive Sleepiness"), 6 ("Circadian Rhythm Disorders"), and 7 ("Parasomnias and Abnormal Sleep-Related Movements") are organized roughly along the 4 basic International Classification of Sleep Disorders, Revised, categories. The conditions discussed in these chapters are all commonly encountered in psychiatric practice, in particular irregular sleep-wake cycle due to poor sleep hygiene in severely ill patients, and there are increasingly common reports of syndromes suggestive of sleepwalking or REM behavioral disorder.

Where appropriate, separate chapters are devoted to subsets of the 4 categories requiring more extensive discussion (Chapter 5 covers "Sleep-Related Breathing Disorders" and Chapter 8 "Restless Legs Syndrome and Periodic Limb Movement Disorder.") Given the high prevalence of obesity in psychiatric patients, the OSA section is very useful, particularly in its descriptions of neurocognitive symptoms’ overlapping with psychiatric disorders and factors that may increase or decrease the likelihood of treatment. Chapter 8 makes good points about differential diagnosis (eg, restless legs syndrome [RLS] and akathisia can present similarly) as well as common iatrogenic causes of RLS and periodic limb movement disorder and medication treatments for these conditions. Separate chapters on sleep in medical and neurologic disorders are thorough, with classification along organ/ system lines and good physiologic review being particular strengths of the former.

Chapter 11, "Psychiatric and Behavioral Disorders," while excellent overall, does have its limitations. Effects of recreational drugs on sleep warrant considerably more emphasis than they receive here, as do the severity and persistence of the effects of these drugs (and those of alcohol) very long into sobriety. The author astutely identifies sleep disturbance as a risk factor for alcohol relapse but fails to note that few effective treatments are available to this subpopulation, with its increased risk of misuse of medications such as benzodiazepines. Particularly in the public sector, many patients cannot afford the newer nonbenzodiazepine options available, and more discussion of this issue would have been most welcome. I found 2 minor errors: the distinction between bipolar I and bipolar II disorder is confusing, and obsessive-compulsive disorder is classified as a personality disorder rather than as an anxiety disorder. A reference or 2 on the marvelous recent advances in posttraumatic stress disorder psychotherapy would also have been useful.

Chapter 15, "Sleep in Women," contains important information that is not commonly taught in our medical schools, including an excellent description linking physiology of pregnancy to sleep disturbances and relating how common disorders such as OSA may present differently in women. Some issues (eg, the fact that shortened total sleep time just before labor is associated with an increased need for Caesarean sections and that sleep-related breathing disorders are associated with higher prevalence of hypertension and intrauterine growth retardation) might warrant further study given their epidemiologic implications.

One of the best features of the book is Chapter 16, "Medications and Their Effects on Sleep." Tables organized by drug classes (antidepressants, hypnotics, cardiovascular drugs, and others) as well as side effects (insomnia, excessive sleepiness, nightmares, and others) are excellent and suitable as handouts for students and residents.

This book is very well designed as a concise review for the Sleep Medicine Boards—it is densely packed, making liberal use of tables and boxes designed to stand out easily. It contains abundant study questions with brief, clear answers. References are current, abundant, and well chosen. However, it might not be the most practical choice as a guide most psychiatrists could use for finding answers quickly in the office; many answers would require reading the secondary references. Not many psychiatrists are eligible to take the Sleep Medicine Boards, which require formal fellowship training as a prerequisite. The vast overlap between mind and body evidenced throughout Sleep Medicine: Essentials and Review demonstrates the need for more psychiatrists to become certified in sleep medicine and to continue active participation in this multidisciplinary specialty board.

Camellia P. Clark, MD

cclark@vapop.ucsd.edu

Author affiliation: University of California, San Diego, School of Medicine, San Diego, California.

Potential conflicts of interest: None reported.

doi:10.4088/JCP.09bk05750whi

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