It is estimated that 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. The cumulative long-term effects of sleep deprivation and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke. The Institute of Medicine (IOM) Committee on Sleep Medicine and Research concluded that although clinical activities and scientific opportunities in the field are expanding, awareness among the general public and health care professionals is low, given the magnitude of the burden. The available human resources and capacity are insufficient to further develop the science and to diagnose and treat individuals with sleep disorders. Therefore, the current situation necessitates a larger and more interdisciplinary workforce. Traditional scientific and medical disciplines need to be attracted into the somnology and sleep medicine field. Renewed and revitalized commitments to the field from the National Institutes of Health (NIH), academic health centers, private foundations, and professional societies are essential to ensure appropriate public and professional awareness, education and training, basic and clinical research, and patient care. Finally, the fragmentation of research and clinical care currently present in most academic institutions requires the creation of accredited interdisciplinary sleep programs in academic institutions.

Contents

• The National Academies
• Committee on Sleep Medicine and Research
• Board on Health Sciences Policy
• Independent Report Reviewers
• Preface
• Organization of Academic Health Centers
• Acknowledgments
• Summary
  • THE NATIONAL INSTITUTES OF HEALTH LEADERSHIP IN RESEARCH AND TRAINING
  • ESTABLISHING A SUFFICIENT WORKFORCE
  • PUBLIC AND PROFESSIONAL AWARENESS
  • TECHNOLOGY DEVELOPMENT AND ACCREDITATION
  • INTERDISCIPLINARY SLEEP PROGRAMS IN ACADEMIC HEALTH CENTERS
  • PRIORITIES TO ADVANCE SOMNOLOGY AND SLEEP MEDICINE
• 1. Introduction
  • MAGNITUDE AND COST OF THE PROBLEM
  • HISTORICAL BACKGROUND
  • GROWTH OF SOMNOLOGY AND SLEEP MEDICINE
  • CHALLENGES IN ADVANCING THE STUDY OF SLEEP DISORDERS
  • SOMNOLOGY AND SLEEP MEDICINE RESEARCH IN ACADEMIC INSTITUTIONS
  • SCOPE AND ORGANIZATION OF THIS REPORT
  • REFERENCES
• 2. Sleep Physiology
  • SLEEP ARCHITECTURE
  • SLEEP-WAKE REGULATION
  • CIRCADIAN RHYTHMS, THE 24-HOUR CLOCK
  • SLEEP PATTERNS CHANGE WITH AGE
  • REFERENCES
• 3. Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders
  • SLEEP LOSS
  • SLEEP-DISORDERED BREATHING
  • INSOMNIA
  • SLEEP AND PSYCHIATRIC DISORDERS
  • NARCOLEPSY AND HYPERSOMNIA
  • PARASOMNIAS
  • SLEEP AND NEUROLOGICAL DISORDERS
  • SUDDEN INFANT DEATH SYNDROME
  • SLEEP AND MOVEMENT DISORDERS
  • SLEEP AND MEDICAL DISORDERS
  • CIRCADIAN RHYTHM SLEEP DISORDERS
  • REFERENCES
• 4. Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders
  • PERFORMANCE AND COGNITION DEFICITS
  • MOTOR VEHICLE CRASHES AND OTHER INJURIES
  • IMPACT ON FUNCTIONING AND QUALITY OF LIFE
  • ECONOMIC IMPACT OF SLEEP LOSS AND SLEEP DISORDERS
  • REFERENCES
• 5. Improving Awareness, Diagnosis, and Treatment of Sleep Disorders
  • CHALLENGES FACING INDIVIDUALS WITH SLEEP DISORDERS
  • PUBLIC EDUCATION
  • PROFESSIONAL TRAINING AND AWARENESS IS REQUIRED
  • GRADUATE RESEARCH TRAINING IN SOMNOLOGY AND SLEEP DISORDERS
  • OVERVIEW OF MEDICAL SCHOOL SOMNOLOGY EDUCATION
  • OVERVIEW OF SOMNOLOGY IN MEDICAL RESIDENCY TRAINING CURRICULA
  • OVERVIEW OF SLEEP MEDICINE FELLOWSHIP TRAINING
  • DEMONSTRATION OF KNOWLEDGE: BOARD CERTIFICATION
  • NEXT STEPS
  • DATA SYSTEMS FOR SURVEYING SLEEP AND SLEEP DISORDERS
  • REFERENCES
• 6. Ensuring Adequate Diagnosis and Treatment: Access, Capacity, and Technology Development
  • DEVELOPING PORTABLE DIAGNOSTIC TOOLS
  • CHALLENGES TO DEVELOPING AMBULATORY TECHNOLOGIES
  • FUTURE DIRECTIONS
  • REFERENCES
• 7. Opportunities to Improve Career Development in Somnology
  • GROWTH OF THE SOMNOLOGY AND SLEEP MEDICINE FIELD
  • NIH TRAINING AND CAREER DEVELOPMENT PROGRAMS
  • OPPORTUNITIES TO ACCELERATE SOMNOLOGY AND SLEEP MEDICINE CAREER DEVELOPMENT
  • Potential Mechanisms to Improve Training
  • REFERENCES
• 8. Bolstering Somnology and Sleep Disorders Research Programs
  • NIH COORDINATION OF SLEEP-RELATED ACTIVITIES
  • NATIONAL SLEEP DISORDERS RESEARCH PLAN
  • ANALYSIS OF NIH-SPONSORED RESEARCH PROJECT GRANTS
  • NEXT STEPS IN ACCELERATING PROGRESS
  • REFERENCES
• 9. Building Sleep Programs in Academic Health Centers
  • RATIONALE FOR SLEEP PROGRAMS IN ACADEMIC HEALTH CENTERS
  • CONSTRAINTS FACING INTERDISCIPLINARY SLEEP PROGRAMS
  • KEY COMPONENTS AND GUIDING PRINCIPLES FOR BUILDING SLEEP PROGRAMS
  • ORGANIZATIONAL AND FISCAL STRUCTURES FOR SUSTAINING OR EXPANDING A SLEEP PROGRAM
  • ACCREDITATION AND CERTIFICATION ARE ESSENTIAL TO QUALITY CARE
  • NEXT STEPS
  • REFERENCES
• Appendixes
  • A Study Process
  • B Acronyms
  • C Glossary of Major Terms
  • D Congressional Language Establishing the National Center on Sleep Disorders Research, § 285b–7
  • E Sleep Disorders Research Advisory Board Membership
  • F National Institutes of Health Sleep-Related Initiatives: 1994–2004
  • G National Institutes of Health Support of Sleep-Related R01 Grants
  • H Summary of NIH Support of Sleep-Related Career Development Awards
  • I Summary of NIH Support of Sleep-Related R13, R25, P, F, T, and U Grants
  • J Summary of Investment in Sleep-Related Projects at the Top 30 NIH-Funded Institutions
  • K Biographical Sketches of Committee Members and Staff

This study was supported by contracts between the National Academy of Sciences and the American Academy of Sleep Medicine, the Department of Health and Human Services (contract No. N01-OD-4-2139), the National Sleep Foundation, and the Sleep Research Society. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.