the context of iron deficiency, renal failure, and pregnancy. Rapid-eye-movement (REM) behavior disorder is often an antecedent of Parkinson’s disease and Lewy body disease. Hypersomnia is a common symptom in Parkinson’s disease, depression, and various neurological conditions. Similarly, insomnia can occur in the context of various medical and psychiatric conditions and is associated with depression. These patients often require coordinated care across disciplines. As will be described below, interdisciplinary sleep programs provide the best structure to facilitate this type of care.

Inadequate Numbers of Training and Research Programs

Training of health professionals seldom deals with sleep hygiene, sleep loss, and sleep disorders (Chapters 5 and 7). Although there have been some improvements, challenges lie ahead for training of medical, nursing, and pharmacy students. Research opportunities for medical residents, sub-specialty residents, and doctoral and postdoctoral researchers are also limited. Most sleep researchers are clustered in a handful of institutions, according to the grants analysis presented in Chapter 7. Because mentoring is critical to success in clinical or basic research, the concentration of mentors at so few institutions leaves students elsewhere with few opportunities to successfully enter the field, thereby constricting the pipeline of new clinicians and researchers.

Large Body of Knowledge

Given the limited number of sleep experts nationwide and their clustering in a handful of institutions, is there a sufficient knowledge base and need to justify creation of an interdisciplinary somnology and sleep medicine program at each of the nation’s academic health centers? The simple answer is yes. Over the last 25 years, the field has grown to the point that a large base of knowledge now exists regarding diagnosis and treatment. Several recent milestones for the field attest to the achievement of a critical mass of knowledge. Sleep medicine is a medical subspecialty now recognized by the American Board of Medical Specialties. The Accreditation Council for Graduate Medical Education (ACGME) now accredits fellowship training programs. Numerous educational resources, including curriculum, are available from the American Academy of Sleep Medicine. The standard 1,500-page textbook, Principles and Practice of Sleep Medicine, is in its fourth edition. There is also a vibrant body of research, described in previous chapters, on the basic science of sleep and sleep disorders. The number of recipients of National Institutes of Health (NIH) R01 grants in sleep has risen from 100 to 253 over the last 10 years (Chapter 8).



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