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Insomnia Principles and Management

Martin P. Szuba, Jacqueline D. Kloss & David F. Dinges (eds)

Specialist Registrar, General Adult Psychiatry, Adamson Centre for Mental Health, St Thomas’ Hospital, London SE1 7EH

Cambridge University Press, 2003, £36 pb, 288 pp., ISBN: 0521010764

Although published by Cambridge University Press, this is a largely American multi-contributor production, with the exception of one chapter author from Brazil and three from Canada. For all that, the book is an impressive ‘teaching text’, taking the reader from the basics to current thinking on insomnia in terms of neurotransmitters and the role of brain structures such as the amygdala in the modulation of arousal.

The subject matter gives practical advice to the clinician trying to manage insomnia in the out-patient department setting, with occasional clinical case illustrations in the body of the text, but also appendices devoted to practical scripts on ‘sleep hygiene’, ‘sleep-restriction’ and ‘stimulus-control’. There will not be many general clinicians who have not struggled to help the persistent complainer of poor sleep. This book gives some of the tools on how to try and help with this problem rationally.

The book demystifies much of the terminology of the sleep disorders specialty. The authors give a clear account of topics such as insomnia due to circadian rhythm disturbances, and the use of hypnotic medications, including melatonin.

The pharmacology of the newer hypnotics (zopiclone, zolpidem, zaleplon) finds a place for discussion, but critically, lacks bite and detail. These drugs are clumped together as ‘non-benzodiazepine sedatives’, but there is clearly more to be said here that is not (e.g. structural differences from the benzodiazepines, interaction with the GABA-A receptor, or benzodiazepine-1 receptor). There is, however, in compensation a useful discussion on dependence risk which will be of interest particularly to prescribers of these drugs.

The book is attractively-covered, handily-sized, light to carry, and packs in an amazing amount into 285 pages (and the print size is not too small either). The book is sparse in terms of illustrations and tables, but generally, and especially given its multi-contributor format, reads clearly and fluently. Each chapter is extremely well-referenced with up-to-date references. A table of abbreviations (given that there are a lot) and their meanings is sorely missed, and there is no glossary of terms, which is a minor inconvenience.

For the introductory reader, there are not many up-to-date books available that can easily match the breadth and reasonable depth of coverage aimed for by this book. It achieves splendidly its aims which in the editor’s words, are ‘to offer state-of-the art, evidence-based reviews of salient clinical issues and research needs in the many areas falling under the rubric of the term "insomnia"’. The book deserves a wide readership, and as it is budget-priced, should get it.

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