October/1999
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HARVARD MEDICAL SCHOOL Reviewed by Lynne Lamberg |
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Many people sleep poorly, but few seek help from their doctors. Surveys show most troubled sleepers think their problems aren't important enough, the doctor is too busy, or that nothing can be done. Books such as this one, a hefty tome from one of the nation's leading universities, published with much fanfare, could help validate sleep complaints and convince both physicians and the public to take sleep difficulties seriously. Said to reflect the expertise of 7,000 Harvard physicians and other health professionals, this book is advertised as "the first health guide written specifically to empower readers in the era of managed care." It is a snapshot of state of the art knowledge and treatment of a wide variety of illnesses at the start of the twenty-first century. This is an impressive book, clearly-written, consistently edited, and targeted at the motivated general reader. It is beautifully designed, loaded with photos, drawings, and charts, as well as colored headlines, text boxes, and appealing graphics. It's attractively priced, costing less than a single visit to most doctors. Its coverage of sleep, however, falls short. An early chapter, Take Charge of Your Health, urges readers to follow eight key health practices: eat a healthy diet, exercise, do not use addicting substances, engage only in safe sex, have regular medical checkups, prevent injury, manage stress, and get immunized. Despite solid research showing that lack of sleep plays a key role in workplace injuries and errors, boosts traffic fatalities, and undermines mood, some of it done by Harvard researchers, "get enough sleep" did not make this list. The book offers an overview of how the body works, with 21 detailed color illustrations. These explain basic processes, including how you see, hear, digest food, circulate blood, and feel pain, even how your kidneys work, and how you fight bacterial infections. What happens when you sleep is not among them. The book devotes about 7 pages each to sleep problems in adults and in children. It also offers a brief report on sleep in seniors, and scattered mentions of disturbed sleep in many illnesses. There is a symptom chart on drowsiness, steering readers to further reading according to their specific complaints. Perhaps the most substantive reporting on sleep is that on sleep in young children. Richard Ferber, author of Solve Your Child's Sleep Problems, and a member of the Harvard faculty, provides a clear step-by-step guide to teaching your baby sleeping skills. This section also discusses sleep issues from birth through age four. The adolescent health chapter details "normal changes to expect" in puberty. It devotes about a half-page to tattoos and body piercing. But it does not cover shifts in adolescents' biological clocks that prompt them to stay up later and thus need to sleep later, and to need more sleep than younger children. At a time when high schools across the nation are exploring the possibility of starting later to accommodate teenagers' sleep needs, this is a significant omission. Indeed, this topic is an evolving and important one on which parents would welcome a balanced overview from a reliable source. The terms "biological clocks" and "circadian rhythms" do not appear in the book's index, again curious, considering Harvard's eminence in this area. In the chapter on sleep and sleep problems in adults, the most thorough report focuses on sleep apnea, with useful illustrations explaining what goes wrong, what causes snoring, and how treatment with continuous positive airway pressure helps. Brief reports describe insomnia, narcolepsy, restless legs, and other disorders. The Health in Seniors chapter offers sleep hygiene advice for older persons, and advises against using sleeping pills. There are a few mistakes, e.g., "REM sleep is necessary to feel rested." In fact, people taking medications that suppress REM sleep often report sleeping better. Shift workers are told that rotating forward around the clock is better "than working the day shift, night shift, and evening shift on successive days." Rotating on successive days in either direction would be onerous. In the U.S. workers typically spend five to seven days on a shift. In Europe, workers may rotate every two or three days, and then get several days off. A novel feature of this book is a free companion web site to provide continuing updates, http://www.health.harvard.edu/fhg. While there are no plans to put the entire Family Health Guide online, the site already includes a short interactive symptom guide to sleep problems. Expanded coverage of the nature of sleep and its disorders belongs there, too.
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