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Sleep Disorders: Diagnosis and Treatment.
  1. Department of Psychiatry, Park Hospital, Oxford, UK

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    Sleep Disorders: Diagnosis and Treatment. Edited by J Steven Poceta and Merrill M Mitler. (Pp 232; hardback $99.50). Humana Press, 1998. ISBN 0 896 03527 1 .

    “Despite many remarkable advances in the study of disorders of sleep...this knowledge has not been well disseminated to the public nor to the physicians caring for them. Thus, although our knowledge base has increased exponentially, sleep disorders remain a significant and undertreated public health problem.”

    This paragraph from the foreword of this book is undoubtedly true. Recent surveys in the US and UK have shown the meagre content of medical and other professional education about sleep and its disorders. This must mean that many treatment opportunities are lost to the serious disadvantage of the large section of the population who suffer from sleep problems, not least children who are physically ill or have a learning disability.

    A number of recent books have helped to correct these deficiencies. Commendably, this one aims at clinical practice in primary care. This is not the most basic level at which a better understanding of sleep and its disorders is required—public opinion needs informing about which sleep problems should and can be treated. Such sleep problems, however, deserve a knowledgeable approach in primary care, with referral to more specialised services as necessary.

    The 10 chapters include an initial account of the recognition and assessment of sleep disorders, followed by discussion of topics selected (it is claimed) for their special relevance to primary care. The strength of the various chapters is their essentially clinical content with attempts to promote a logical approach to diagnosis and treatment, together with useful case illustrations. On the other hand, the content inappropriately presupposes a familiarity with sleep disorders medicine. This is reflected in the somewhat unbalanced choice of chapter topics which includes “the uses of bright light in an office practice”. Some of the content is pitched at different levels, including at times quite technical and specialised material. The emphasis is clearly on adult sleep disorders with just one chapter on “common sleep problems in children”—the organisation of which could be improved.

    This book is not a particularly satisfactory guide for staff working in the typical primary care setting. Something more basic is required. However, much useful up to date information is provided and, in the last two chapters, important general principles are well stated (although again with an American and essentially adult patient emphasis). These are concerned with the need to improve standards of diagnosis and treatment for sleep disorders, the way such improvement might be achieved, and also the health and economic preventative advantages of doing so. The unlikely sounding Walla Walla Project in the US is described in which primary care physicians were taught the basics of diagnosing and treating sleep disordered patients. This instruction improved accurate diagnosis and treatment significantly. A similar exercise in the UK, involving patients across the whole age range, would be worthwhile.

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