Book reviewed this month are ABC of Sleep Medicine by Paul Reading and Menopause: Change, Choice and HRT by Barry G Wren and Margaret Stephenson Meere.
ABC of Sleep Medicine
United Kingdom: Wiley Blackwell, 2013
ISBN 978 0470 659 465, $42.95
Sleep medicine is a relatively new specialty and, as a result, many doctors have not received specific training during their time at medical school. It is, however, increasingly recognised that sleep disorders lead to significant impairments in quality of life and are associated with a range of adverse long-term health consequences, such as increased cardiovascular morbidity and mortality. Despite the availability of effective evidence-based therapies, much of the disease burden from sleep disorders remains undiagnosed and/or untreated. Hence this booklet, from a British neurologist with a clinical and academic interest in sleep disorders, is to be welcomed.
This book follows the easy-to-read format of the popular ABC series of books (part of the BMJ Books Group) and contains a large number of useful summary tables and figures. The first three chapters start with an important background on normal versus abnormal sleep, followed by a clinical perspective on diagnosing sleep disorders and how to evaluate excessive daytime sleepiness, an important presenting symptom of sleep disorders. This is followed by a further four chapters on common sleep disorders, including insomnia and sleep apnoea syndromes. The final four chapters review areas of particular clinical relevance, such as sleep disorders in children and drugs used in sleep medicine. Overall, a good balance of topics is achieved, so that much of the essentials of the field are covered in less than 60 pages.
This book is engagingly written and the author has been able to distil his clinical experience and provide the reader with some nice clinical gems. This book has a very practical emphasis and this helps to demystify a field that can seem esoteric; in effect, complex ideas are well presented in the space available yet without too much oversimplification.
A minor quibble is that some of the figures that necessarily contain detailed information (eg. comparison of hypnograms from a normal individual and one with narcolepsy) do not work well in a small format (unless using a microscope!).
Overall, this is an insightful, short guide to an area of great relevance for the primary care physician.
Dr Nigel McArdle
Menopause: Change, Choice and HRT
Barry G Wren
Margaret Stephenson Meere
New South Wales: Rockpool Publishing, 2013
ISBN 978 1921 878 695, $24.99
The stated aim of this new Australian book is to empower women with ‘the knowledge to make health decisions around menopause’. Dr Wren is a gynaecologist with extensive clinical and research experience in the area. The description of his work given on the back cover is a good indication of the book’s focus. We are told that Dr Wren ‘has worked passionately for 40 years researching the positive role of oestrogen in the solution of menopause’ (my italics). This sentence encapsulates my main criticism of this book, which defines menopause as a ‘hormone deficiency state’ that can be solved by hormone replacement therapy (HRT).
This book starts with some useful information for the lay reader on the anatomy and physiology of menopause. It then goes on to describe health problems that can be associated with menopause, and options for management. Dr Wren devotes quite a lot of time to describing how clinical trials are organised and what constitutes good clinical evidence. He aims to present the information in clear and simple language for the benefit of the lay reader, but the concepts described are complex and technical, and I think readers without extensive research knowledge (including many GPs) would find this information very difficult to understand.
There is a strong emphasis throughout the book on the many potential advantages of HRT, with much less information discussing the potential disadvantages and adverse effects. The problems with the Women’s Health Initiative study are also discussed in great detail. The chapter that discusses complementary and alternative therapies stresses the lack of research evidence associated with these, and the poor quality of the trials that have been done. However, it seemed to me that the evidence for the benefits of HRT was not scrutinised as carefully. For example, several studies are described which suggest that the benefits for HRT could include significant decreased risks of heart disease, bowel cancer and dementia, but the quality of these trials was not considered in detail.
This book does make brief reference to other aspects of the ‘management’ of menopause, such as diet, exercise and paying attention to psychological and social factors that may influence wellbeing at this time in a woman’s life. However, almost all of the case studies describe women who have been severely debilitated by menopausal symptoms and have been ‘rescued’ by HRT.
In summary, I did not think this book was of much benefit to either the lay reader or to the average GP. As a GP, I felt that the book paid little regard for the complex physical, psychological and social factors that often need to be taken into account when a women presents with difficulties around the time of menopause.
Dr Carol Lawson