Book Review for Sound Sleep, Sound Mind:
7 Keys to Sleeping Through the Night

Barry Krakow, M.D.
Hoboken, N.J.: John Wiley & Sons, Inc., 2007, XXXpp.
US $24.95, hardcover
http://www.wiley.com

In order to understand and to repair sleep disorders, the over-arching consideration is the interaction of one’s mental, emotional, and physical states. Dr. Krakow draws upon his extensive background as sleep researcher and as sleep disorder therapist to help readers understand the mental, emotional, and physical issues that produce insomnia, nightmares, and un-restful sleep. Importantly, he helps readers understand that the quality of their sleep deserves as much consideration as the quantity. He then provides a series of mental exercises, with accompanying mnemonics to aid in their implementation, which allow people to pinpoint thoughts, feelings – both physical and emotional -- and images which prevent them from entering, and remaining in, satisfying, sound sleep. Finally, he presents a crucial discussion of physical problems which lead to fragmented sleep and the treatments available for their resolution. As you read, look for some whimsical word play and for instructions on using your socks to help determine if you have a physical disorder that interrupts your sleep quality.

This book will put you to sleep . . . though not while you’re reading it.  Self-help books for sleep disorders tend to focus on either “mental” or “physical” approaches to the problems of insomnia and of un-restful sleep. This outdated, mind-body split is laid to rest in this ambitious book which integrates current information on the development, diagnosis, and treatment of sleep disorders from both a psychological and a physical point of view.

Barry Krakow, M.D., draws upon his extensive experience in research and treatment of sleep disorders as well as in internal and emergency medicine to develop a sleep disorders model that integrates mental, physical, and emotional components.  He leads the reader through a series of mini-lessons, or “keys,” to an understanding the mind/body nature of their sleep disturbance, and to the development of systematic procedures for tackling each dynamic which hinders their ability to slip into a sound, uninterrupted sleep.  Throughout, he provides mnemonic cues for the procedures, and reinforces the lessons in each chapter with a closing “Pearl” which elucidates the chapter’s points. It’s easy to feel crotchety when sleep-deprived, and Barry’s occasional sly play on words provides some levity.

Much information written for the lay person who is trying to solve sleeping problems has a relatively narrow focus.  Use of mental imagery, control of the environment and pre-sleep activities, physical relaxation approaches – all are useful in and of themselves, but are likely to fall short of delivering optimum results when used in isolation. More than anything else, the multiple examples of the inseparable relationships among physical and mental states and sleep patterns set this book apart and make it a comprehensive guide based on the best current scientific evidence.

What, then is proposed for the reader’s journey to slumberland? Krakow sets the stage for Sleep Dynamic Therapy® (SDT) by examining the signs, symptoms, and consequences of poor sleep quality.  Recognizing that most persons are accustomed to thinking of their sleep problems as getting too little sleep, he provides a self-rated “Sleep Misery Index” to illuminate the connections between poor sleep quality and other physical/mental and emotional problems. Since the ability to rate one’s own sleep quality is the critical step to success in solving sleep problems, he reviews ten barriers that can interfere with gaining a clear picture of sleep quality, including the “Catch 22” of dulled mental capacity and judgment which proceed from disrupted sleep patterns. Once the reader is securely focused on improving sleep quality rather than sleep quantity, the process of learning to slow down the body and mind can begin.

Notably, Dr. Krakow teaches the reader how to investigate the quality of sleep they are achieving rather than to get caught up in the idea that they simply need a greater quantity of sleep. He accomplishes this through both didactic information about brain and body processes during various stages of sleep and through a number of self-administered quizzes, allowing the reader to evaluate his/her sleep problems by gaining  an understanding of poor sleep quality and related waking problems.

A variety of techniques are used to help the reader assimilate key information. At the end of each chapter, a “Pearl” is presented; these give practical suggestions which help integrate and implement the information presented in the preceding pages. Information which might ordinarily be relegated to footnotes and therefore overlooked is presented in highlighted boxes labeled “Snooze Flashes.”  “Warning” boxes point out possible mistakes or dangers to be heeded. For example, there is a caution about putting infants to sleep on their stomachs, even though sleeping prone provides relief for some adult cases of sleep disordered breathing.

The final third of the book is an invaluable resource for the many sleep disorder sufferers who, not matter how well they follow procedures for mental and physical preparation for sleep, do not achieve adequate relief.  Dr. Krakow gives clear explanations of the signs, symptoms, and consequences of sleep disordered breathing and limb movement disorders. He includes quizzes and information which will help the reader screen him/herself for the possibility of physical disorders affecting sleep quality, and provides instructions for various activities which will either improve sleep quality or which will point strongly to the need for a sleep laboratory evaluation and medical assistance.  Finally, he prepares the reader to participate in a sleep lab study, and to understand the possible benefits from mechanical, surgical, or chemical treatment. Particularly, he gives detailed and reassuring information about what to expect from CPAP therapy, including examples and tips from his personal experience.

This book is dense with information, much of which may be new to the reader. There are a number of skills to learn and practice which are simple in themselves, but which can be frustrating if not learned well and sequentially.  Perhaps the best approach is to read the whole volume through once, to get a basic overview and to assuage one’s curiosity as to what will be presented. Then, go back and systematically work through the assessment tools and exercises. Individual readers will find some steps take less time to learn than others, but most persons should expect significant improvements in their sleep quality within four to six weeks. Given that sleep problems may have plagued them for years, this is a relatively small time investment.  For those who are alerted to the likelihood of sleep disordered breathing and limb movement disorder problems, the clear and sympathetic descriptions of surgical, mechanical, and chemical treatments may give them the courage to get effective treatment for what can be truly life-threatening conditions.

Dr. Krakow is a board certified sleep disorders specialist, and is currently Medical Director and Principal Investigator of the Sleep and Human Health Institute, Medical Director for Maimonides Sleep Arts and Sciences, Ltd., and founder of the Nightmare Treatment Center, all in Albuquerque, New Mexico. He also is Medical Director for three additional New Mexico sleep laboratories, and Adjunct Associate Clinical Professor of Emergency Medicine & Psychiatry at the University of New Mexico Health Sciences Center. Treatment of chronic nightmares and disturbing dreams through cognitive-behavioral methods has been a major research focus for him, and his training and experience in internal and emergency medicine positions him well to bridge the disciplines of sleep medicine, psychology, and psychiatry.

Reviewed by: Linda Dutcher, Ph.D
                    Santa Fe, NM