Sleep woes have long been the muse of crooners and scribes. There's nothing like lack of slumber or too much of it to demonstrate emotional turmoil.
Today, we know that sleep troubles hail from more than just emotional hang-ups. There are approximately 80 types of known sleep disorders, with causes ranging from structural airway problems, to chemical imbalances, to lifestyle factors.
Researchers know more about sleep than ever before.
"Our knowledge base about sleep problems, sleep disorders, and treatments has expanded considerably," says Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research, a branch of the National Institutes of Health (NIH). "The number of research results published in medical journals, and the number of publications related to sleep problems have been increasing dramatically year by year."
When the NIH began funding sleep-related studies a decade ago, $60 million was earmarked for research. In 2005, the NIH has directed more than $200 million toward sleep-related investigation.
Yet sleep medicine is still a young discipline. The American Medical Association just began recognizing it as a medical subspecialty this year.
Also, despite growing public awareness of sleep disorders, there are still many people who don't see sleep problems as potential medical conditions.
"They think (sleep problems) might be a character flaw or something you just put up with," says Lawrence Epstein, MD, president of the American Academy of Sleep Medicine (AASM). "The basic thing to know is that there's help out there. There are trained specialists who understand the disorders, and there are very effective treatments."
WebMD asked sleep experts how the average person could navigate the burgeoning frontier of sleep medicine and get help.
The Sleep Medicine Frontier
Help can't come soon enough. According to the AASM, nearly half of Americans have trouble snoozing at some point in their life. The statistic includes problems that may not necessarily be sleep disorders, such as short-term insomnia and sleep deprivation.
Sleep loss can adversely affect concentration, memory, learning, and logical reasoning. The National Sleep Foundation (NSF) places the cost of daytime sleepiness and sleep disorders to the national economy at an estimated $100 billion annually.
The price of catching fewer than 40 winks can truly be great. The good news is that there are more people taking advantage of sleep resources.
"There's been an explosion of sleep medicine utilization in the last 10 years, and that correlates with an increased recognition that sleep disorders are an important part of a health picture overall," says Russell Rosenberg, PhD, director of the Northside Hospital Sleep Medicine Institute in Atlanta.
In 2001, the AASM estimated 1,292 sleep facilities in the U.S. This year, the estimate has grown to 1,822, and that number might be conservative. Kathleen McCann, a spokeswoman for the AASM, says she's heard estimates as high as 6,000 for sleep facilities in the U.S. Yet she considers the AASM survey to be reasonable.
With so much out there, Kathe Henke, PhD, technical director for the Sleep Disorders Center of Virginia in Richmond, worries that many patients don't always tap into the best possible resources for help. Sometimes they may go to sleep labs that do only testing and forgo the comprehensive examination and interview that many well-regarded sleep specialists do.
"People may go for a sleep test, and they have a complaint that sounds like they may have sleep apnea," Henke says as an example. "They have their test done and they find they don't have sleep apnea, but that doesn't mean there isn't some other sleep disorder."
Detecting the Cause
In sleep laboratories where only diagnostic testing is done, problems can be missed and nothing else may be done to identify them.
To get the most out of sleep medicine, Henke recommends seeing a specialist that is certified in sleep medicine by the American Board of Sleep Medicine (ABSM). She also recommends a specialist with sleep medicine as a primary focus, and one that does more than just testing.
Many experts consulted by WebMD agree, but also noted it's important to start out with a visit to a primary care doctor to rule out any other medical conditions. Then, if appropriate, get a referral to a board-certified sleep specialist or to an accredited sleep center.
A Board-Certified Specialist Defined
"Sleep specialists are the health care professionals who are trained to provide the best diagnosis of treatment for people with sleep disorders," says Epstein. "To be a sleep specialist, you must first undergo specialized training. There are now formal fellowship programs for people to devote at least a year to learning about sleep disorders, and then practice it ... with sleep patients."
Sleep specialists become board-certified after they successfully meet experience requirements and pass an examination administered by the ABSM.
Before taking the exam, candidates must complete one year of full-time training in sleep medicine after finishing at least three years of residency training. This means applicants need training in one or more medical specialties such as internal medicine, pulmonary medicine, neurology, psychiatry, or pediatrics.
"Having knowledge from other specialties is a big help," says Epstein. "Sleep covers so much. It has a neurologic basis in terms of the pathways of the brain involved in sleep. We need to know about the effects of sleep on heart and lung function. We need to know how emotional upset affects sleep."
The ABSM examination tests the applicant's general knowledge of sleep-related subjects. In order to pass the exam, candidates must answer questions about physiology, neuroanatomy, biochemistry, pharmacology, endocrinology, psychophysiology, and pediatric sleep disorders, among other subjects.
In short, candidates must demonstrate their breadth of knowledge in medical specialties related to sleep in order to obtain certification.
The American Board of Sleep Medicine will continue to test candidates for board certification until 2007. At that time, the American Board of Medical Specialties (ABMS), will administer the exam. The ABMS is a widely respected nonprofit organization that oversees doctor certification in dozens of medical specialties.
Accrediting a Sleep Center
Another option for people with sleep problems is a visit to a sleep center. But make sure it is accredited, say experts.
"There's a high quality standard and guidelines for care that (centers) have to meet the requirements for, and not all sleep laboratories could meet those criteria," says Rosenberg. "At least you know, at minimum, accredited centers have those criteria."
Sleep centers can be accredited by the AASM or by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The AASM has accredited 893 sleep facilities to date. JCAHO has accredited more than 100 sleep centers.
"The AASM sets very rigorous standards of quality patient care, focusing on comprehensive clinical evaluation and treatment," says Epstein.
JCAHO, on the other hand, asserts it is the nation's oldest and largest standards setting and accrediting body in health care. JCAHO gives accreditations to not only sleep centers, but to hospitals, clinical laboratories, and behavioral health facilities as well.
What to Expect
Most sleep specialists and centers are covered by insurance, although the amount of coverage depends upon the particular insurance, say experts.
On a first visit to a sleep center or specialist, patients can expect to answer questions about sleep history, medical history, sleep problems, emotional status, diet, and exercise habits. Also expect to undergo a physical exam.
It is not unusual for specialists to give patients a sleep history diary to complete prior to the office visit, or to ask, if possible, to bring a bed partner to describe habits during sleep.
Once the sleep specialist has evaluated a patient, he or she might suggest a course of action such as counseling, or suggest further testing. Tests may include a sleep study.
