Abstract
Insomnia: principles and management brings to focus a comprehensive range of clinical and research expertise on the long-neglected problem of insomnia. The book gives a thorough exposition of the different systems for classifying and diagnosing insomnia. Insomnia is conceptualized as either a primary or a secondary disorder. The main cause of primary insomnia is usually an inappropriate activation at or near bedtime, whereas secondary insomnia can be due to a variety of factors including prescription medications, substance abuse, psychiatric and medical conditions, including other sleep disorders (e.g. obstructive sleep apnoea). The book gives a very thorough account of the different forms of insomnia, the causes and the possible medical, behavioural and psychological treatments across the lifespan. Treatment of insomnia is discussed within the contexts of psychological, psychiatric and medical disorders and a limited number of case studies provide useful examples of treatment. The book points out that insomnia has a very high prevalence with up to 20 million Americans suffering from it on any given day and that some 40–60% of people with chronic insomnia also show symptoms of comorbid psychiatric disorders. Importantly, the book reveals that there is often confusion over who should diagnose and treat insomnia. Many people try to self-treat insomnia, often unsuccessfully, and may eventually turn to a general practitioner for advice and treatment. There does not appear to be any consensus with respect to guidelines for general practitioners or other medical specialists about when it is appropriate to refer patients to a recognized sleep specialist. This is unfortunate given that there are proven treatments for insomnia. Although comorbidity may suggest some common pathophysiology, it has become a barrier to the treatment of insomnia because there are few psychiatrists in the field of sleep medicine and sleep disorders specialists (mostly respiratory physicians) may not be prepared to deal with the additional complications of psychopathology. In summary, according to the book there is confusion over who owns insomnia, both from the standpoint of diagnosis and treatment. The book has been written by a team of experts from a variety of clinical and research backgrounds. It has been written in a straightforward manner and includes up-to-date references fromwell-respected scientific journals. At the same time, the book is easily accessible to anyone new to the field of sleep medicine. This book focuses on insomnia as a condition that warrants treatment in its own right, in parallel with the treatment of any other pre-existing psychological, psychiatric and/or medical disorders. The book makes a valuable contribution to sleep medicine and provides a useful reference for psychologists, general practitioners, psychiatrists and any other medical specialists who are likely to treat patients where insomnia is an ongoing issue. The only area that was not covered in the book was the issue of patient compliance to treatment.
This is a particularly important area because most treatments for insomnia fail simply because patients do not adhere to treatment regimens for long enough for them to be effective.