Book Review: ‘The Mystery of Sleep’
I was one of the lucky “birthday” winners to receive a free copy of Meir Kryger’s latest book, “The Mystery of Sleep,” at the AAST meeting in Indianapolis last fall.
TMoS is touted as “an authoritative and accessible guide to what happens when we shut our eyes at night.” Indeed, I found the format, tone and relevance of Kryger’s book to live up to the hype.
Unraveling the Mysteries
The format of TMoS creates a distinct educational roadmap that any reader can follow. It starts with a “mystery” in the form of an image and a question. After this is a case study that seeks to answer the question (solve the mystery). Kryger then takes the reader into a section of clinical information that’s applicable to the question raised by the mystery, then returns to the original case study to use this data to solve it.
Teaching Through Story
The tone of TMoS is conversational even as Kryger maintains his sense of authority. He unpacks the mystery in a way that makes sense, using clear examples that illustrate his points.
This may not be beach reading, but it’s worth taking on a plane or reading in the car while waiting to pick up the kids from school. Readers will go away feeling like they just learned from a really effective teacher. If you like reading Oliver Sacks, you will probably enjoy reading TMoS.
The Relevance of Sleep Disorders in the 21st Century
The relevance of TMoS makes it stand out. So many books about sleep written by physicians for the general population tend to stick to the basics. There’s nothing wrong with this approach, but in an age of information overload, readers need a reason to dive in; what they want to learn must directly apply to their lives to be worth the pursuit.
Kryger makes it worth it by focusing on topics in TMoS that often get overlooked in sleep health books. He talks, for instance, about secondhand sleep (the problems that bed partners, roommates and loved ones experience as the result of someone else’s untreated sleep disorders).
Cognitive behavioral therapy for insomnia (CBT-I) makes more than a passing cameo in TMoS, as does advice for beating sleeplessness without medications. I also appreciated “The Thirteen Commandments for Fighting Insomnia.” Let me put it this way: Kryger doesn’t just tell readers to “practice good sleep hygiene.” He gets into particulars, some which may surprise readers.
He also takes on the huge problem of sleep deprivation due to societal demands to live 24/7 lives, both at work and at play. The circadian disparities that teens with delayed sleep phase — but early school schedules — suffer through are addressed early in TMoS. And he’s also worked in the most recent guidelines for getting adequate sleep released by the National Sleep Foundation, which includes the new teen and older adult categories.
Other topics of relevance to people in 2019 include supplement use, energy drinks, dental appliances, transportation concerns (drowsy driving), the link between European swine flu vaccinations and narcolepsy in 2009-2010, and even the impact of social media on sleep.
Special Focus: The Mystery of RLS
Another topic Kryger doesn’t gloss over is restless legs syndrome (RLS), which is common and yet seems to be relegated to the back burner when other sleep problems, like sleep apnea, are present.
It’s nice to see him give RLS the attention it needs; maybe patients who read this section will be more empowered to do something besides take vitamins (which can be a common, though not always effective, recommendation by primary physicians).
This raises a bigger concern: Patients often find fault with medicinal practice these days because they often feel the cost and inconvenience of a live appointment can be offset by self-treatment found online.
Dr. Google is the default for so many people with sleep problems (including RLS), but sometimes self-medication can occur at one’s own peril. Kryger makes a point to discuss the route of self-treatment, while also taking a dive into the wide array of RLS symptom and treatment scenarios that exist. It’s clear he believes an educated patient is an empowered patient.
A Refreshing Look at Women’s Sleep Health
One of the more notable focal points of TMoS is women’s sleep health.
Kryger previously published “A Woman's Guide to Sleep Disorders” in 2004, the culmination of his work treating more than 2,000 women with sleep disorders. Medical research focused on women-specific healthcare concerns is a field that’s far from saturated. His obvious prioritization of women’s sleep health concerns remains a key feature in TMoS.
I found it refreshing that he included discussion about sleep and preeclampsia, for instance. This isn’t something that more generalized books will cover. It’s still an important discussion to have, nonetheless, and Kryger did women’s sleep health a solid favor by including it.
I’m now motivated to pick up his previous work, even if it is 15 years old (hoping he will return and reissue it with new research and updates).
About Meir Kryger
It’s likely you’ve read Kryger’s work during your training in polysomnography school, or through research studies he’s published in all the major journals.
Meir Kryger, MD, FRCPC, is currently a professor at Yale School of Medicine and chief editor of the cornerstone sleep medicine textbook, “Principles and Practice of Sleep Medicine.”
He previously served as director of the Sleep Disorders Centre at St. Boniface Hospital Research Centre; its lab was the first in Canada to study patients with sleep breathing problems. Research from the center has appeared in more than 200 research reports and book chapters.
Kryger specializes in sleep-breathing disorders, especially those with a neurological connection. His lab was responsible for reporting the first use of computer applications to analyze sleep-breathing patterns, which then validated the protocol we now know as the “split-night” study.
Other important developments in sleep breathing disorders can trace their roots to studies published from research originating in Kryger’s labs.
What’s Missing in TMoS
Don’t get me wrong: TMoS covers a huge amount of territory, but there are blind spots or, in some cases, topics he avoided because they are evolving so quickly, with goal posts constantly on the move.
For instance, neuroscience is bringing forth many new genetic theories about the brain, and Kryger might consider boiling these down in a separate book on the latest developments in sleep neuroscience.
Discussions about the ongoing dilemma of health insurance reimbursement could probably use more attention, as patients need to learn more and better ways to practice self-advocacy inside our labyrinthine medical care system (itself a kind of mystery).
Wearables and consumer sleep technology were not a topic in TMoS. Still, this is a topic that needs a bigger platform. People are turning to these options in place of direct medical care, however blindly. Kryger could bring the critical thinking and guidance necessary for such a dialog.
And the opioid epidemic should be a big part of any contemporary book about sleep, given the nightmare of sleep issues that addiction recovery brings, as well as drug interactions and adverse side effects that lead to sleep problems even months after detox. Insomnia, excessive daytime sleepiness and respiratory depression during sleep are all common and undesired results of opioid use, abuse or withdrawal.
Savvy patients who want help with this or other sleep problems can walk away from TMoS feeling more empowered to take charge of their obstacles to good sleep. TMoS prioritizes information, and Kryger’s ideas recognize and serve diverse populations to the benefit of many more readers whose sleep issues may not be taken seriously otherwise.
His writing style is friendly, instructive and pleasant to read. The format of TMoS arises organically from the points he wants to drive home about sleep. He also gives proper attention to contemporary issues about sleep that others haven’t in similar books.
I highly recommend TMoS to anyone who wants to learn about sleep, whether it’s a patient, a sleep medicine student, a healthcare practitioner or a sleep tech looking to stay current with their understanding of sleep disorders in the 21st century.
THE MYSTERY OF SLEEP. ©201, Meir Kryger MD. Yale University Press || ISBN: 978-0-300-23453-4 || 330 pages. Available in audiobook, audio CD, paperback, hardcover and digital versions