Sleep Medicine in Clinical Practice

The study and treatment of sleep disorders is a young, rapidly expanding specialty, with board certification, accredited treatment centers, and research journals. Combining aspects of psychiatry, neurology, and pulmonary medicine, it deals with an important human function largely ignored until the discovery of rapid eye movement (REM) sleep (1). Half a century later, hundreds of sleep laboratories offer diagnostic studies, and scores of accredited sleep disorder centers provide both diagnosis and ongoing treatment for insomnia, obstructive sleep apnea, narcolepsy, and other sleep-related illnesses.

The authors’ stated audience for this compact volume includes trainees, practicing sleep physicians, and academic training programs, and they hope to spur interest in those outside the field. They reflect their own practice at the Mayo Clinic; for example, they describe a night in their sleep laboratory that differs in some interesting details from the procedures of other accredited centers. Their overview is organized into four sections: Basics of Sleep Medicine, The Sleepy Patient, The Patient Who Cannot Sleep, and The Patient With Excessive Movement in Sleep. In this general approach lie both the strengths of this book and its weakness.

As a short textbook, Sleep Medicine in Clinical Practice is a useful addition to the available general literature, suitable both as an overall introduction and as a quick reference for busy practitioners. It covers the diagnostic categories within the current (soon to be revised) International Classification of Sleep Disorders, some very briefly. Clinical norms, often adjusted by age group, will help the general physician interpret sleep study reports. Illustrative clinical vignettes are well placed and helpful, fleshing out the diagnostic entities. Charts, tables, and line drawings illustrate key topics and provide examples of polysomnographic studies. Useful clinical algorithms show how to reach clinical diagnoses and treatment decisions.

The authors’ effort to provide a wide overview of sleep medicine, however, ultimately limits the book’s usefulness. Rare and unusual diagnoses are covered, but the same succinct approach is applied to common disorders. For example, the authors describe recurrent (periodic) hypersomnia and catathrenia (nocturnal expiratory groaning), illnesses the average clinician will probably never encounter. Sleep apnea, both obstructive and central, makes up the bulk of clinical work, comprising perhaps four of every five referrals to a sleep center, but receives only 50 pages of compact description, roughly one-eighth of the book. Restless legs syndrome and periodic limb movement disorder, two other common entities, receive even less space. Insomnia is better covered, with separate chapters devoted to causes, clinical approach, and management, but it too receives less attention than its high incidence merits: 17 pages. The coverage of delayed sleep phase and other disorders of circadian rhythm is also thin.

For a reference source, this book’s index is only adequate. For example, although tobacco use and its effect on sleep are mentioned in several chapters, the index has no listing for tobacco, smoking, or nicotine, and nicotine use is not included in the discussion of substance abuse and sleep. Cited references are listed at the end of chapters, but for those seeking additional sources a bibliography would be useful, and this book has none.

In short, Sleep Medicine in Clinical Practice is a useful introduction to an exciting medical field, but readers looking for greater depth of clinical information will need to go elsewhere.