There are at least four reasons why a sleep clinician should be
familiar with rating scales that evaluate different facets of
sleep. First, the use of scales facilitates a quick and accurate
assessment of a complex clinical problem.In three or four minutes
(the time to review ten standard scales), a clinician can come to a
broad understanding of the patient in question. For example, a
selection of scales might indicate that an individual is sleepy but
not fatigued; lacking alertness with no insomnia; presenting with
no symptoms of narcolepsy or restless legs but showing clear
features of apnea; exhibiting depression and a history of
significant alcohol problems. This information can be used to
direct the consultation to those issues perceived as most relevant,
and can even provide a springboard for explaining the benefits of
certain treatment approaches or the potential corollaries of
allowing the status quo to continue.
Second, rating scales can provide a clinician with an enhanced
vocabulary or language, improving his or her understanding of each
patient. In the case of the sleep specialist, a scale can help him
to distinguish fatigue from sleepiness in a patient, or elucidate
the differences between sleepiness and alertness (which is not
merely the inverse of the former).Sleep scales are developed by
researchers and clinicians who have spent years in their field,
carefully honing their preferred methods for assessing certain
brain states or characteristic features of a condition. Thus,
scales provide clinicians with a repertoire of questions, allowing
them to draw upon the extensive experience of their colleagues when
attempting to tease apart nuanced problems.
Third, some scales are helpful for tracking a patient s
progress. A particular patient may not remember how alert he felt
on a series of different stimulant medications. Scale assessments
administered periodically over the course of treatment provide an
objective record of the intervention, allowing the clinician to
examine and possibly reassess her approach to the patient.
Finally, for individuals conducting a double-blind crossover
trial or a straightforward clinical practice audit, those who are
interested in research will find that their own clinics become a
source of great discovery. Scales provide standardized measures
that allow colleagues across cities and countries to coordinate
their practices. They enable the replication of previous studies
and facilitate the organization and dissemination of new research
in a way that is accessible and rapid. As the emphasis placed on
evidence-based care grows, a clinician s ability to assess his or
her own practice and its relation to the wider medical community
becomes invaluable. Scales make this kind of standardization
possible, just as they enable the research efforts that help to
formulate those standards.
The majority of "Rating Scales in Sleep and Sleep Disorders:100
Scales for Clinical Practice" is devoted to briefly discussing
individual scales. When possible, an example of the scale is
provided so that readers may gain a sense of the instrument s
content. Groundbreaking and the first of its kind to conceptualize
and organize the essential scalesused in sleep medicine, "Rating
Scales in Sleep and Sleep Disorders:100 Scales for Clinical
Practice" is an invaluable resource for all clinicians
andresearchers interested in sleep disorders.
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