Book: Insomnia: Principles and Management
Authors: Nava Zisapel
Journal: BMJ (2004)

Sleep—a state marked by lessened consciousness, lessened movement of the skeletal muscles, and slowed-down metabolism—has an essential restorative function and an important role in memory consolidation. It is an orchestrated neurochemical process involving sleep promoting and arousal centres in the brain. Sleep propensity depends on two main factors: the amount of accumulated sleep deprivation and the circadian clock phase enhancing sleep at night.​night.




Figure 1



Eds Martin P Szuba, Jacqueline D Kloss, David F Dinges

Cambridge University Press, £34.95, pp 306 ISBN 0 521 01076 4

Rating: ★★★★




Insomnia is a symptom, resulting from insufficient sleep or sleep of poor quality, with negative effects on subsequent daytime functioning. The prevalence of insomnia increases steeply during the fifth decade of life. People with insomnia often complain of impairments in attention, memory, or concentration, impairments in their mood, feeling depressed or irritable or anxious, and impairments in their ability to function at work, at home, or even at school. They generally have more medical complaints, seek medical care more often, and are more prone to road injuries than people without insomnia.

An enormous gap exists between the prevalence of insomnia and the actual management of people with the condition. While roughly 20% to 30% of adults worldwide get insomnia, less than 50% of them will be diagnosed as having the condition. Patients are hesitant to discuss insomnia with their doctors because they are afraid that their problem will be seen as trivial or indicate a serious illness. Doctors tend to trivialise insomnia because little of their medical training is devoted to it and because they are often unaware that the onset of insomnia may signal a serious condition or an established risk factor for psychiatric illness.

Insomnia: Principles and Management announces the arrival of this complex sleep disorder at the frontiers of internal and sleep medicine. With contributions from highly prominent sleep specialists, this multi-authored volume captures the breadth of the field and introduces a diverse array of up-to-date scientific and clinical data ranging from the diagnosis, prevalence, aetiology, and management of insomnia to the neurobiology of sleep and arousal. It also provides several perspectives on related disorders, such as circadian rhythm sleep disorders in sighted and blind subjects, jet lag, and mood disorders.

The book reviews the various approaches for the management of insomnia, including behavioural approaches, the use of hypnotic drugs aimed at treating sleep quantity deficits, and the use of chronobiotic drugs (biological clock effectors, such as melatonin and its analogues) to improve the circadian control of the sleep-wake cycle. If indeed melatonin plays a role in sleep regulation, either through its chronobiotic, soporific activities or both, we would expect that exogenous melatonin administration will be able to induce sleep during daytime or when the homeostatic drive to sleep is insufficient, and to improve sleep in cases where there is a deficiency in endogenous melatonin. This is indeed demonstrated in blind subjects, delayed sleep phase syndrome, and elderly patients with insomnia in whom melatonin production is diminished.

Another important contribution of this book is the effort to identify where research should be heading. In recent years, the focus of clinically oriented sleep medicine has shifted from sleep quantity to sleep quality, as quality rather than quantity is associated with impaired daytime functioning, anxiety, depression, fatigue, and poor quality of life.

This succinct and informative volume will be useful to both sleep experts and general practitioners alike.