Replies to This Discussion

Permalink Reply by Frank Sanger on October 4, 2009 at 4:27pm

This book will never be topped as an orientation to sleep disorders because it was written by the man who (some would say singlehandedly) turned sleep study into a productive science. Before Dr. Dement, sleep as a subject was almost exclusively in the domain of psychology. The biology and chemistry of sleep were peppered with anecdotes and misunderstandings.

Dr. Dement mixes sound science with a memoir of personal discovery with a mildly suspenseful quest story. A valid criticism of the book is that you must have a strong interest in order to wade through the entire story.Sufferers of obstructive sleep apnea are candidates for such depth of commitment. After all in many cases we owe this man our lives. But even if you have OSA, there is no guarantee that you can stay connected for the whole big story. Very few people have the obsessive enthusiastic passionate curiosity about the intricacies of sleep that Dr. Dement required to advance the science of sleep to a legitimate and life-saving branch of medicine through meticulous studies that span 60+ years.

Sleep apnea is only one of the many disorders we learn about. Someone could make a smaller book for the rest of us by just pulling out the things that Dr. Dement and his students and colleagues discover. If you are not a big fan of science or scientists like I am, this book might put you to sleep.

Permalink Reply by RockRpsgt on October 5, 2009 at 5:37pm

This book is always in my bag. I recommend it to all of my patients. Not only does it cover all of the finer points of sleep, but it is a very easy read.

Permalink Reply by RockRpsgt on October 30, 2009 at 7:57pm

http://www.clinicalpsychiatrynews.com/article/S0270-6644(05)70747-5/fulltext

We've all heard that the Exxon Valdez was run aground in 1989 by a skipper who had been drinking. Given the magnitude of the oil spill in Alaska's Prince William Sound, the story of the unfortunate skipper has lived with us for many years.

In “The Promise of Sleep” (New York: Delacorte Press, 1999), William C. Dement, M.D., and coauthor Christopher Vaughan tell us the real story: The third mate—not the skipper—was in charge, and the third mate, having had only 6 hours of sleep in the previous 48, ordered the helm to starboard without noticing that the autopilot was still on. Addled by what Dr. Dement refers to as “sleep debt,” the third mate twice failed to heed warnings before he noticed, too late, that the autopilot had prevented his course correction from taking effect.

Dr. Dement, who almost single-handedly established the study of sleep as an area of scientific research and the treatment of sleep disorders as a medical specialty, wrote this book for the general public, but it has a great deal to say to physicians, especially those in primary care and psychiatry.

How common is sleep deprivation? Dr. Dement believes that fully half of us mismanage our sleep enough to negatively affect our health and safety. “I have observed people staggering through their lives in a daze,” he writes, “misunderstanding the roots of their sleepiness, or not even recognizing that they are sleepy.”

The electric light, the demands of modern life, and the seductions of late-night television, e-mail, and other distractions have increased our national sleep debt to the point where driving while drowsy causes at least as many accidents as driving while intoxicated. In a survey by the National Sleep Foundation, 23% of a random sample admitted falling asleep while driving in the past year.

In his 50-year career, Dr. Dement has made too many contributions to sleep medicine to tally here. He identified and named rapid eye movement (REM) sleep as well as the four stages of non-REM sleep. He determined that most dreaming occurs during REM. He pioneered all-night polysomnography for the diagnosis of sleep disorders, and he has been a tireless promoter of proper sleep hygiene. An excellent medical politician, he has made enormous efforts to recruit and educate new researchers, new clinicians, and new advocates in the difficult field of sleep disorders.

The key to better sleep in today's world, he says, is to reduce our sleep debt to manageable levels. When we don't sleep long enough, the brain keeps an exact accounting of how much sleep is owed. And that sleep debt may be collected any time. He tells one story of a physician who actually fell asleep while using a stethoscope to listen to a female patient's heart. She was startled and very upset when his head fell onto her naked breast.

It turned out that the physician had obstructive sleep apnea and was waking 50 times an hour throughout the night. At the time (about 25 years ago), the only treatment for this very common disorder was tracheostomy because continuous positive airway pressure (CPAP) had not yet been developed. The physician underwent the surgical procedure and has led a productive professional life ever since.

Sleep debt, whether caused by apnea, insomnia, or a stressful life, often masquerades as a psychiatric disorder. Adults are misdiagnosed with treatment-resistant depression, and children receive mistaken diagnoses of attention deficit disorder.

Dr. Dement tells the story of a high-achieving Silicon Valley executive who had been fired because of poor performance and whose irritability had cost him his marriage. Diagnosed with bipolar disorder, he'd been taking lithium for 5 years. Despite taking sleep medication at bedtime, he came to the clinic complaining of severe insomnia and daytime blackouts. Dr. Dement found him pacing around the waiting room and, once inside the exam room, the patient complained, “I just can't sit still.”

The diagnosis was restless legs syndrome. People with this syndrome suffer uncomfortable and sometimes painful feelings in the limbs that create an irresistible desire to move them, causing difficulty sleeping. The person may flex, stretch, and cross the legs to ease the discomfort. The feelings may be relieved, but may return minutes later. As many as 1 person in 10 may suffer from this disorder.

Psychiatrists know that hypersomnia and insomnia can both be manifestations of psychiatric disorders. Most cases of insomnia we see are also cases of depression. Considering that depression is one of the most common disorders in medicine and that it is serious, disabling, and too often lethal, I would have hoped for a longer exposition of Dr. Dement's ideas about the diagnosis and treatment of depression, especially because psychiatrist David J. Kupfer, M.D., had success in using latency of REM sleep as an indicator of the outcome of therapy.

This may be too much to ask when one considers that the book is already an excellent aid for both patients and physicians, containing detailed recommendations for determining one's own sleep debt and devising a strategy to repay it.

According to Dr. Dement, 40% of the population suffers from some level of sleep apnea, and at least half of those have clinically significant symptoms. Yet, how many physicians consider that out of every five patients walking through the door, one is likely to have this disorder?

Permalink Reply by RL on February 11, 2010 at 2:40pm

Great review Rock, and Frank too. I just ordered this book, will add comments once I read it.

Permalink Reply by J Adams on March 7, 2010 at 1:43pm

I am working with Bill Dement and actually the focus now is on home sleep studies (yes it's his company) with proper screening to decide who can be tested at home or will need an in lab study. The problem has been that the sleep medicine community has created a scenario in which every conceivable sleep disorder is used as a rationalization to have an in lab study. But if you look at the percentages OSA is the primary issue (75% +) associated with sleep apnea and the vast majority of these patients (if screened correctly) are excellent candidates for a home study. I think the disconnect in the sleep medicine community has been a fear of losing ones job and/or loss of income which is why there are so many games now being played on the credentials side (AASM driven). What needs to be realized is that the home sleep business will actually very soon play a major role in validating the need for an in lab study as well as provide increased diagnosis for a far greater number of people which will increase everyones ongoing care business (plus let's not forget the job here is to diagnose and then provide good outcomes). Plus, with more screening and steerage from the MCO's, VA hospitals, DOT trucking mandates and primary care there will be more business (for in lab appropriate patients) than you can imagine.

We are not your competition and actually will play a key role in ensuring the long term viability of the sleep lab.

Frank Sanger said:

This book will never be topped as an orientation to sleep disorders because it was written by the man who (some would say singlehandedly) turned sleep study into a productive science. Before Dr. Dement, sleep as a subject was almost exclusively in the domain of psychology. The biology and chemistry of sleep were peppered with anecdotes and misunderstandings.

Dr. Dement mixes sound science with a memoir of personal discovery with a mildly suspenseful quest story. A valid criticism of the book is that you must have a strong interest in order to wade through the entire story.Sufferers of obstructive sleep apnea are candidates for such depth of commitment. After all in many cases we owe this man our lives. But even if you have OSA, there is no guarantee that you can stay connected for the whole big story. Very few people have the obsessive enthusiastic passionate curiosity about the intricacies of sleep that Dr. Dement required to advance the science of sleep to a legitimate and life-saving branch of medicine through meticulous studies that span 60+ years.

Sleep apnea is only one of the many disorders we learn about. Someone could make a smaller book for the rest of us by just pulling out the things that Dr. Dement and his students and colleagues discover. If you are not a big fan of science or scientists like I am, this book might put you to sleep.

Permalink Reply by Mary Z on March 7, 2010 at 2:24pm

Dr. Dement does indeed write a fine book. I had to put it down for a while as it follows the history of his research and I might learn something (or try to) that he later finds out is not the case. It does seem more like a textbook to me. I need a bit clearer head to appreciate it, and maybe need to take notes, or read it twice. I got Dr. Parks book for Christmas, but haven't read it yet. I'm looking forward to it. I can't believe how the science of sleep study seems to be growing by leaps and bounds since I've been on the forum. At home sleep studies only seemed to be an idea then, not they are a reality for many.
Mary Z.

Permalink Reply by Steven Y. Park, MD on February 22, 2011 at 9:24am

I just finished reading it and found it an invaluable read. It's a layman's sleep medicine curriculum. Sadly, many of his warnings and recommendations go unheeded, even over 10 years after he wrote his book.