Review by M Mamelak, MD
Gregory Stores is Professor of Neuropsychiatry at Oxford University.
In this succinct and informative volume about sleep disorders in
children and adolescents, Professor Stores hopes to offer a guide
that will be useful to both experts and lay people alike. He specifically
aims to address the needs and questions of parents faced with sleep
problems in their children. In this regard, he has succeeded admirably.
Stores has a broad and thorough knowledge of his subject matter,
he writes clearly, and he provides numerous case histories to illustrate
the more technical aspect of his presentation.
Stores begins by providing a history of the field of sleep disorders
in children and adolescents. He identifies children at high risk
for these disorders; namely, children with certain physical or psychological
problems, including learning disabilities. He then reviews developing
information about the effects of persistent sleep disturbances on
development, citing studies that have linked early-onset sleep apnea
and slow-wave sleep abnormalities with diminished growth or failure
Stores reviews the normal physiology of sleep and its distinctive
features in children and adolescents. He outlines a protocol for
taking a sleep history that is attentive to gathering information
about the childs 24-hour sleep-wake schedule, sleep rhythms,
and sleep hygiene. He observes that, for daytime functioning, the
duration, continuity, and timing of the childs sleep are the
most important aspects. He inquires whether the sleep environment
is satisfactory and conducive to sleep. He then offers examples
of treatment approaches for sleep disorders, emphasizing the importance
of relaxing bedtime routines. Surprisingly, however, Stores writes
that using a pacifier to help an infant settle may be unhelpful,
because the child may lose contact with it during the night; he
notes that many infants cry when they awake during the night but
that from about age 6 to 12 months most are capable of returning
to sleep without needing their parents attention. Conversely,
however, many parents have discovered the marvellous power of a
pacifier and welcome the relief gained, if only for a few hours,
by popping the pacifier back into the infants mouth!
Stores lists the factors to consider in sleepless children at different
agescolic in infancy, poor bedtime routines and poor limit-setting
in early childhood, difficulty getting to sleep and parasomnias
in middle childhood (age 4 to 12 years), and the use of recreational
or illicit drugs and the development of psychiatric disorders in
adolescents. Up-to-date references are given for the use of melatonin
to treat sleep problems in children with neurodevelopmental disorders.
Excessive daytime sleepiness, although less common than sleeplessness,
is recognized as a clinical problem that can interfere with behaviour
and performance during the day. Poor sleep at night and irregular
sleep-wake schedules are often the cause of daytime sleepiness.
However, sleepiness during the day may also betray emotional problems
and depression. Conversely, late nights in the absence of any emotional
pathology may also impair alertness during the day. It is particularly
common for adolescents to delay their bedtime and consequently to
have trouble getting up in the morning. Such adolescents may be
good sleepers, but they live in their own time zone. They suffer
from the so-called delayed sleep-phase syndrome. This
syndrome usually develops in children with a stimulating family
environment at bedtime and, in adolescents, as an adaptation to
a late-night lifestyle. Stores describes the use of chronotherapy
to treat this often-recalcitrant sleep disorder, as well as the
use of bright light in its management. Finally, he provides a knowledgeable
presentation of the pathophysiology, clinical manifestations, and
treatment of 2 unique causes of excessive daytime sleepiness in
children: obstructive sleep apnea and narcolepsy.
Stores closes his clinical survey of sleep disorders in children
with a discussion of the parasomnias. Here, he provides a helpful
summary of the clinical manifestations and management of such frequently
encountered sleep-related disorders as bruxism, rhythmic movement
disorder, sleepwalking, sleeptalking, and sleep terrors. He describes
the treatment approaches developed for enuresis and, specifically,
behavioural approaches that include rewards for a dry night and
conditioning by means of an alarm system. He also recommends the
short-term use of desmopressin.
Stores concludes his textbook by drawing attention to the need
for wider dissemination of information about sleep and its disorders
and for more clinical research about their epidemiology and their
relation to the common medical and psychiatric disorders of childhood.
He is concerned that so little is known about the effects of disturbed
sleep on childrens cognitive functions, mood, and behaviour.
His emphasis on this issue brings the study of sleep back into the
mainstream of psychiatry.
This is an excellent book. However, at US$39.95, it may be too
expensive for parents and a lay audience.
*Reviewer Rating Scale/ Échelle dévaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé