Sleep medicine and management is a medical subspecialty focused on diagnosing and treating sleep disorders. Sleep disorders are common and can have significant long-term consequences if left untreated. For example, sleep disorders increase the risk of heart disease, stroke, type 2 diabetes, and obesity.
Differences Between Sleep Medicine and Neurology
A neurologist is a medical doctor with specialty training in diagnosing and treating diseases or functional problems of the brain, spinal cord, peripheral nerves, and muscles. Neurologists also diagnose and treat disorders of the autonomic nervous system — the part of the nervous system that controls the bodily functions that happen without you thinking about them, such as your heartbeat, breathing and digestion.
Neurologists treat a wide variety of disorders, including stroke, brain and spinal tumors, headaches, epilepsy, Parkinson’s disease, Alzheimer’s disease, and other memory disorders, multiple sclerosis and muscular dystrophy.
Not all neurologists are sleep medicine specialists. To become a board-certified sleep medicine specialist, a neurologist must complete a one-year fellowship in sleep medicine following their neurology residency.
In addition, not all sleep doctors are neurologists. Doctors from a number of other clinical backgrounds may also complete a sleep medicine fellowship and become board-certified sleep specialists.
Specialized Training in Sleep Medicine
Sleep physicians, sometimes called somnologists, may come from a variety of different clinical backgrounds but all have training in sleep medicine. “The earliest sleep doctors were pulmonary doctors, because it was thought to be a more breathing-related problem,” says Brijesh Malkani, MD, neurologist and sleep medicine specialist, and Castle Connolly Top Doctor at Mount Sinai Hospital in New York. “As time went on, there was far more understanding and greater awareness of the other specialists and expertise that can be brought into sleep medicine.”
Doctors who may have additional training in sleep medicine include:
- Family physicians
- Internal medicine doctors
- Otolaryngologists (ear, nose and throat, or ENT, specialists)
To receive board certification in sleep medicine, these doctors must complete medical school and residency, followed by a one-year sleep medicine fellowship that includes both research and clinical training. During that time, they learn about the bodily processes involved in normal sleep as well as how those processes go wrong in sleep disorders. They also gain the skills needed to diagnose sleep disorders and develop treatment plans for patients of all ages.
Sleep medicine and management specialists may practice in a variety of settings, from primary care practices to dedicated sleep disorder centers. In treating patients, they may collaborate with a wide variety of health care professionals, including other doctors, nurses, physician assistants, sleep technologists and respiratory therapists.
Other health professionals who provide patient care for sleep disorders include sleep psychologists, who have training in treating insomnia and sleep-related behavior issues, and dentists, who create and fit dental devices used to treat sleep apnea.
The Sleep Medicine/Body Connection
Sleep medicine and management treats your whole body, including your pulmonary (lungs), respiratory (breathing), endocrine (hormones), muscular, and nervous systems. It also treats your mind, as getting poor sleep or not enough sleep can affect your mental health.
“When you think about the psychological impact of sleep, if you’re tired every day, if you’re drowsy, it certainly can affect your mental health,” says Dr. Malkani. “It can precipitate feelings of depression.”
Sleep Specialists Treat a Broad Variety of Medical Conditions
Sleep specialists have advanced training in a variety of sleep disturbances and disorders. Some of the most common conditions they treat include:
- Bruxism (teeth grinding)
- Central sleep apnea
- Circadian sleep disorders, including non-24-hour sleep-wake rhythm and shift work
- Night leg cramps
- Nightmare disorder
- Obstructive sleep apnea (OSA)
- REM sleep behavior disorder
- Restless legs syndrome
- Sleep terrors
- Sleepwalking (somnambulism)
- Sleep & Snoring Disorders
- Sleep Disorders
- Sleep Surgery
- Sleep Disorders-Pediatric
- Sleep Disorders in Cancer Patients
- Sleep Disorders/Apnea
Sleep Medicine Tests, Procedures, and Surgeries
The tests your sleep doctor may recommend will depend on the type of sleep problems you are having. These include:
Blood tests: Your doctor may want to check for conditions that can interrupt your sleep — for example, a thyroid problem.
Sleep log: This is a diary in which you record information such as when you go to bed at night, when you wake up in the morning and how sleepy you feel during the day. This can help diagnose insomnia.
Sleep inventory: This is a detailed questionnaire that covers your health history as well as your sleep patterns.
Sleep study, or polysomnogram: This is an overnight study in which you sleep in a lab. You’ll be connected to sensors that monitor your stages of sleep, body movements, oxygen levels, and breathing patterns. How sleep studies are conducted can vary depending on the type of disorder being diagnosed. For example, if the evaluation is for sleep apnea, patients are observed as they sleep overnight. If narcolepsy is suspected, patients sleep and wake in the lab for a series of naps.
Based on your diagnosis, your sleep specialist may recommend one of these treatments or procedures:
Cognitive behavioral therapy for insomnia (CBT-I): This is a type of therapy that helps you identify the thoughts and behaviors that may be contributing to your insomnia and learn new strategies to improve your sleep.
CPAP – continuous positive airway pressure: Used to treat sleep apnea, this device keeps your airway open by delivering a steady stream of air through a hose to a mask that you wear to sleep at night.
Medications: If you have insomnia, your doctor can determine whether — and which —medication is the best sleep aid for you. It may be sleeping pills, also called hypnotics, that you use for a short period of time. In some cases, medications that treat other problems can also help you sleep. Medications may also be prescribed for other sleep disorders, including restless legs syndrome, narcolepsy, and REM sleep behavior disorder.
Oral appliance: If you have sleep apnea and can’t tolerate a CPAP machine, a dental sleep specialist can create a device (similar to a sports mouth guard or retainer) you wear in your mouth at night. The appliance holds your tongue or jaw in the correct position to prevent your airway from being blocked while you sleep.
Sleep hygiene: This involves developing a set of beneficial habits that you practice regularly in order to improve your sleep. Habits can include creating a pleasant sleep environment, getting enough exercise and exposure to natural light, and avoiding stimulants such as caffeine and nicotine near bedtime.
Surgery: There are several different surgical approaches for sleep apnea and snoring. They include:
- Hyoid suspension: The doctor connects the U-shaped bone in the front of your neck (the hyoid bone) to your Adam’s apple or suspend it from your lower jawbone to help keep your airway open.
- Hypoglossal nerve stimulator: An electrode is attached to the nerve that controls your tongue muscles and a pacemaker is used to stimulate them while you sleep to keep your tongue from blocking your airway.
- Radiofrequency volumetric tissue reduction (RFVTR): Energy waves are used to shrink and tighten tissues in and around your throat. Used more often for snoring than for sleep apnea.
- Septoplasty and turbinate reduction: These are surgical approaches that improve air flow by opening your nasal passages. Septoplasty straightens out a bent or “deviated” septum (the divider between the two sides of your nose). Turbinate reduction trims down or removes the curved bones inside the walls of your nasal passages.
- Uvulopalatopharyngoplasty (UPPP): The surgeon removes and repositions excess tissue in the back of your throat to widen your airway. UPPP may be combined with surgical procedures on other parts of your airway to increase the chances it will help your sleep apnea.
- Weight loss surgery: If you are obese and have sleep apnea, the weight loss from bariatric surgery may improve your sleep apnea as well as reduce other health risks.