Building sleep programs at academic health centers is not a matter of bricks and mortar. It is a matter of crumbling the organizational walls that separate a variety of traditional scientific and medical disciplines to function more appropriately to meet patient care needs and to facilitate research and training. In this chapter, the committee lays out a vision for each of the nation’s 125 academic health centers to formally establish an interdisciplinary somnology and sleep medicine program. Building sleep programs nationwide will strengthen Somnology and Sleep Medicine as a recognized medical specialty. There is too much at stake—a large patient population, high levels of underdiagnosis, and high public health toll—for inaction.

RATIONALE FOR SLEEP PROGRAMS IN ACADEMIC HEALTH CENTERS

The rationale for sleep programs has been presented throughout this report. This section of the chapter recapitulates those arguments concerning the magnitude of the public health problem and the lack of appropriate education at every level of academic instruction. It also answers the specific question—why is a sleep program optimally interdisciplinary?

Public Health Burden Is High

Chronic sleep loss and sleep disorders are serious and common problems, affecting an estimated 50 to 70 million Americans (NHLBI, 2003). These conditions have a bearing upon nearly every facet of public health— morbidity, mortality, productivity, accidents and injuries, quality of life, family well-being, and health care utilization. Earlier chapters of this report documented the prevalence of sleep problems and their health consequences. Sleep loss and sleep-disordered breathing, for example, are associated with obesity, diabetes, hypertension, cardiovascular disease, and stroke (Chapter 3).

Nearly all types of sleep problems affect personal as well as public health (Chapter 4). The foremost symptom of sleep loss and most sleep disorders—daytime sleepiness—affects performance and cognition. When these functions are perturbed, whether at work, in school, or in the community, serious consequences can ensue. One of the most serious comes in the form of motor vehicle injuries. More broadly, the annual direct and indirect costs of sleep problems reach well beyond $100 billion (Chapter 4).

Most Patients Remain Undiagnosed and Untreated

Most individuals with sleep disorders remain undiagnosed and thus untreated. Two large epidemiological studies, each with thousands of subjects, found that the vast majority, up to 90 percent, of individuals with



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