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class="vector-toc-numb">3.1</span> <span>Worldwide</span> </div> </a> <ul id="toc-Worldwide-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Africa" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Africa"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Africa</span> </div> </a> <ul id="toc-Africa-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Asia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Asia"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Asia</span> </div> </a> <ul id="toc-Asia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Europe" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Europe"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Europe</span> </div> </a> <ul id="toc-Europe-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_States" 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class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" 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href="https://ca.wikipedia.org/wiki/Medicina_del_son" title="Medicina del son – Catalan" lang="ca" hreflang="ca" data-title="Medicina del son" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Schlafmedizin" title="Schlafmedizin – German" lang="de" hreflang="de" data-title="Schlafmedizin" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Unemeditsiin" title="Unemeditsiin – Estonian" lang="et" hreflang="et" data-title="Unemeditsiin" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%99%CE%B1%CF%84%CF%81%CE%B9%CE%BA%CE%AE_%CF%84%CE%BF%CF%85_%CF%8D%CF%80%CE%BD%CE%BF%CF%85" title="Ιατρική του ύπνου – Greek" lang="el" hreflang="el" data-title="Ιατρική του ύπνου" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Medicina_del_sue%C3%B1o" title="Medicina del sueño – Spanish" lang="es" hreflang="es" data-title="Medicina del sueño" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%BE%D8%B2%D8%B4%DA%A9%DB%8C_%D8%AE%D9%88%D8%A7%D8%A8" title="پزشکی خواب – Persian" lang="fa" hreflang="fa" data-title="پزشکی خواب" data-language-autonym="فارسی" data-language-local-name="Persian" 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.hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For drugs which induce <a href="/wiki/Sleep" title="Sleep">sleep</a>, see <a href="/wiki/Hypnotic" title="Hypnotic">hypnotic</a>. For drugs which bring about a reversible loss of <a href="/wiki/Consciousness" title="Consciousness">consciousness</a>, see <a href="/wiki/General_anaesthetic" title="General anaesthetic">General anaesthetic</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical specialty</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><caption class="infobox-title" style="padding-bottom:0.25em;">Sleep medicine</caption><tbody><tr><th scope="row" class="infobox-label" style="padding-top:0.185em;line-height:1.15em; padding-right:0.5em;">System</th><td class="infobox-data" style="line-height:1.3em;"><b><a href="/wiki/Respiratory_system" title="Respiratory system">Respiratory system</a>, <a href="/wiki/Cardiovascular_system" class="mw-redirect" title="Cardiovascular system">cardiovascular system</a>, <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a></b></td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.185em;line-height:1.15em; padding-right:0.5em;">Significant <span style="padding-left:1px;">diseases</span></th><td class="infobox-data" style="line-height:1.3em;"><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a>, <a href="/wiki/Sleep_apnoea" class="mw-redirect" title="Sleep apnoea">sleep apnoea</a>, <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a></td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.185em;line-height:1.15em; padding-right:0.5em;">Significant <span style="padding-left:1px;">tests</span></th><td class="infobox-data" style="line-height:1.3em;"><a href="/wiki/Sleep_study" title="Sleep study">Sleep study</a></td></tr><tr><th scope="row" class="infobox-label" style="padding-top:0.185em;line-height:1.15em; padding-right:0.5em;">Specialist</th><td class="infobox-data" style="line-height:1.3em;">Sleep medicine physician</td></tr></tbody></table> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1257001546"><table class="infobox"><caption class="infobox-title">Sleep Medicine Physician</caption><tbody><tr><th colspan="2" class="infobox-header">Occupation</th></tr><tr><th scope="row" class="infobox-label">Names</th><td class="infobox-data"><a href="/wiki/Physician" title="Physician">Physician</a></td></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Activity sectors</div></th><td class="infobox-data"><a href="/wiki/Medicine" title="Medicine">Medicine</a>, <a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a></td></tr><tr><th colspan="2" class="infobox-header">Description</th></tr><tr><th scope="row" class="infobox-label"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;">Education required</div></th><td class="infobox-data"> <ul><li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a> (MD)</li> <li><a href="/wiki/Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">Doctor of Osteopathic Medicine</a> (DO)</li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a> (MBBS/MBChB)</li></ul> </td></tr></tbody></table> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Sleep_diary.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Sleep_diary.svg/225px-Sleep_diary.svg.png" decoding="async" width="225" height="170" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Sleep_diary.svg/338px-Sleep_diary.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Sleep_diary.svg/450px-Sleep_diary.svg.png 2x" data-file-width="287" data-file-height="217" /></a><figcaption><a href="/wiki/Sleep_diary" title="Sleep diary">Sleep diary</a> layout example</figcaption></figure> <p><b>Sleep medicine</b> is a medical specialty or <a href="/wiki/Subspecialty" title="Subspecialty">subspecialty</a> devoted to the diagnosis and <a href="/wiki/Therapy" title="Therapy">therapy</a> of <a href="/wiki/Sleep" title="Sleep">sleep</a> disturbances and <a href="/wiki/Sleep_disorder" title="Sleep disorder">disorders</a>.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The rapidly evolving field<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for <a href="/wiki/Board_certification" title="Board certification">board certification</a> in some countries. Properly organized, minimum 12-month, <a href="/wiki/Postgraduate" class="mw-redirect" title="Postgraduate">postgraduate</a> training programs are still being defined in the United States.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In some countries, the sleep researchers and the <a href="/wiki/Physician" title="Physician">physicians</a> who treat patients may be the same people. </p><p>The first sleep <a href="/wiki/Clinic" title="Clinic">clinics</a> in the United States were established in the 1970s by interested physicians and <a href="/wiki/Allied_health_professions" title="Allied health professions">technicians</a>; the study, <a href="/wiki/Diagnosis" title="Diagnosis">diagnosis</a> and treatment of obstructive <a href="/wiki/Sleep_apnea" title="Sleep apnea">sleep apnea</a> were their first tasks. As late as 1999, virtually any American physician, with no specific training in sleep medicine, could open a sleep <a href="/wiki/Laboratory" title="Laboratory">laboratory</a>.<sup id="cite_ref-Collop_6-0" class="reference"><a href="#cite_note-Collop-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Disorders and disturbances of sleep are widespread and can have significant consequences for affected individuals as well as economic and other consequences for society.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The US National Transportation Safety Board has, according to <a href="/wiki/Charles_Czeisler" title="Charles Czeisler">Charles Czeisler</a>, member of the Institute of Medicine and Director of the <a href="/wiki/Harvard_University_Medical_School" class="mw-redirect" title="Harvard University Medical School">Harvard University Medical School</a> Division of Sleep Medicine at <a href="/wiki/Brigham_and_Women%27s_Hospital" title="Brigham and Women's Hospital">Brigham and Women's Hospital</a>, discovered that the leading cause (31%) of fatal-to-the-driver heavy truck crashes is fatigue related (though rarely associated directly with sleep disorders, such as sleep apnea), with drugs and alcohol as the number two cause (29%).<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Sleep_deprivation" title="Sleep deprivation">Sleep deprivation</a> has also been a significant factor in dramatic accidents, such as the <a href="/wiki/Exxon_Valdez_oil_spill" title="Exxon Valdez oil spill">Exxon Valdez oil spill</a>, the nuclear incidents at <a href="/wiki/Chernobyl_disaster" title="Chernobyl disaster">Chernobyl</a> and <a href="/wiki/Three_Mile_Island_accident" title="Three Mile Island accident">Three Mile Island</a> and the explosion of the space shuttle <i><a href="/wiki/Space_Shuttle_Challenger" title="Space Shuttle Challenger">Challenger</a></i>.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Scope_and_classification">Scope and classification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=1" title="Edit section: Scope and classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Sleep_disorder" title="Sleep disorder">Sleep disorder</a></div> <p>Competence in sleep medicine requires an understanding of a plethora of very diverse disorders, many of which present with similar <a href="/wiki/Symptom" class="mw-redirect" title="Symptom">symptoms</a> such as <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">excessive daytime sleepiness</a>, which, in the absence of volitional <a href="/wiki/Sleep_deprivation" title="Sleep deprivation">sleep deprivation</a>, "is almost inevitably caused by an identifiable and treatable sleep disorder," such as sleep apnea, <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a>, <a href="/wiki/Idiopathic_hypersomnia" title="Idiopathic hypersomnia">idiopathic hypersomnia</a>, <a href="/wiki/Kleine-Levin_syndrome" class="mw-redirect" title="Kleine-Levin syndrome">Kleine-Levin syndrome</a>, menstrual-related <a href="/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a>, <a href="/wiki/Idiopathic" class="mw-redirect" title="Idiopathic">idiopathic</a> recurrent stupor, or <a href="/wiki/Circadian_rhythm_sleep_disorders" class="mw-redirect" title="Circadian rhythm sleep disorders">circadian rhythm disturbances</a>.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Another common complaint is <a href="/wiki/Insomnia" title="Insomnia">insomnia</a>, a set of symptoms that can have many causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis. </p><p>ICSD, <i>The <a href="/wiki/International_Classification_of_Sleep_Disorders" title="International Classification of Sleep Disorders">International Classification of Sleep Disorders</a></i>,<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> was restructured in 1990, in relation to its predecessor, to include only one code for each diagnostic entry and to classify disorders by <a href="/wiki/Pathophysiologic" class="mw-redirect" title="Pathophysiologic">pathophysiologic</a> mechanism, as far as possible, rather than by primary complaint. Training in sleep medicine is multidisciplinary, and the present structure was chosen to encourage a multidisciplinary approach to diagnosis. Sleep disorders often do not fit neatly into traditional classification; <a href="/wiki/Differential_diagnoses" class="mw-redirect" title="Differential diagnoses">differential diagnoses</a> cross medical systems. Minor revisions and updates to the ICSD were made in 1997 and in following years. The present classification system in fact follows the groupings suggested by <a href="/wiki/Nathaniel_Kleitman" title="Nathaniel Kleitman">Nathaniel Kleitman</a>, the "father of sleep research", in his seminal 1939 book <i>Sleep and Wakefulness</i>. </p><p>The revised ICSD, ICSD-R, placed the primary sleep disorders in the subgroups (1) <a href="/wiki/Dyssomnias" class="mw-redirect" title="Dyssomnias">dyssomnias</a>, which include those that produce complaints of insomnia or excessive sleepiness, and (2) the <a href="/wiki/Parasomnias" class="mw-redirect" title="Parasomnias">parasomnias</a>, which do not produce those primary complaints but intrude into or occur during sleep. A further subdivision of the dyssomnias preserves the integrity of <a href="/wiki/Circadian_rhythm_sleep_disorders" class="mw-redirect" title="Circadian rhythm sleep disorders">circadian rhythm sleep disorders</a>, as was mandated by about 200 doctors and researchers from all over the world who participated in the process between 1985 and 1990. The last two subgroups were (3) the medical or psychiatric sleep disorder section and (4) the proposed new disorders section. The authors found the heading "medical or psychiatric" less than ideal but better than the alternative "organic or non-organic", which seemed more likely to change in the future. Detailed reporting schemes aimed to provide data for further research. A second edition, called ICSD-2, was published in 2005, followed by a third edition (ICSD-3) in 2014 and a text revision (ICSD-3-TR) in 2023.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>MeSH, <i><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">Medical Subject Headings</a></i>,<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> a service of the US National Library of Medicine and the National Institutes of Health, uses similar broad categories: (1) dyssomnias, including narcolepsy, apnea, and the circadian rhythm sleep disorders, (2) parasomnias, which include, among others, <a href="/wiki/Bruxism" title="Bruxism">bruxism</a> (tooth-grinding), <a href="/wiki/Sleepwalking" title="Sleepwalking">sleepwalking</a> and <a href="/wiki/Bedwetting" class="mw-redirect" title="Bedwetting">bedwetting</a>, and (3) sleep disorders caused by medical or psychiatric conditions. The system used produces "trees," approaching each diagnosis from up to several angles such that each disorder may be known by several codes. </p><p>DSM-IV-TR, the <i><a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a>, Fourth Edition, Text Revision</i>,<sup id="cite_ref-Bonds_18-0" class="reference"><a href="#cite_note-Bonds-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> using the same <a href="/wiki/Diagnostic_code" class="mw-redirect" title="Diagnostic code">diagnostic codes</a> as the <i><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">International Statistical Classification of Diseases and Related Health Problems</a></i> (ICD), divides sleep disorders into three groups: (1) primary sleep disorders, both the dyssomnias and the parasomnias, presumed to result from an endogenous disturbance in sleep–wake generating or timing mechanisms, (2) those secondary to mental disorders and (3) those related to a general medical condition or substance abuse. </p><p>Recent thinking opens for a common cause for <a href="/wiki/Depression_(mood)" title="Depression (mood)">mood</a> and sleep disorders occurring in the same patient; a 2010 review states that, in humans, "single nucleotide polymorphisms in <i>Clock</i> and other clock genes have been associated with depression" and that the "evidence that mood disorders are associated with disrupted or at least inappropriately timed circadian rhythms suggests that treatment strategies or drugs aimed at restoring 'normal' circadian rhythmicity may be clinically useful."<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=2" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A 16th-century physician wrote that many laborers dozed off exhausted at the start of each night; sexual intercourse with their wives typically occurring in the <i>watching period</i>, after a recuperative first sleep.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Anthropologist" title="Anthropologist">Anthropologists</a> find that isolated societies without <a href="/wiki/Electric_light" title="Electric light">electric light</a> sleep in a variety of patterns; seldom do they resemble our modern habit of sleeping in one single eight-hour bout.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Much has been written about <a href="/wiki/Dream_interpretation" title="Dream interpretation">dream interpretation</a>, from biblical times to <a href="/wiki/Sigmund_Freud" title="Sigmund Freud">Freud</a>, but sleep itself was historically seen as a passive state of not-awake.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>The concept of sleep medicine belongs to the second half of the 20th century. Due to the rapidly increasing knowledge about sleep, including the growth of the research field <a href="/wiki/Chronobiology" title="Chronobiology">chronobiology</a> from about 1960 and the discoveries of <a href="/wiki/REM_sleep" class="mw-redirect" title="REM sleep">REM sleep</a> (1952–53) and sleep apnea (first described in the medical literature in 1965), the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the US, and in many western nations within the two following decades, clinics and laboratories devoted to the study of sleep and the treatment of its disorders had been founded. Most sleep doctors were primarily concerned with apnea; some were experts in narcolepsy. There was as yet nothing to restrict the use of the title "sleep doctor", and a need for standards arose. </p><p>Basic medical training has paid little attention to sleep problems;<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> according to Benca in her <a href="/wiki/Review" title="Review">review</a> <i>Diagnosis and Treatment of Chronic Insomnia</i> (2005), most doctors are "not well trained with respect to sleep and sleep disorders," and a survey in 1990–91 of 37 American <a href="/wiki/Medical_school" title="Medical school">medical schools</a> showed that sleep and sleep disorders were "covered" in less than two hours of total teaching time, on average.<sup id="cite_ref-psychservices_24-0" class="reference"><a href="#cite_note-psychservices-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Benca's review cites a 2002 survey by Papp et al. of more than 500 <a href="/wiki/Primary_care_physician" title="Primary care physician">primary care physicians</a> who self-reported their knowledge of sleep disorders as follows: Excellent – 0%; Good – 10%, Fair – 60%; and Poor – 30%. The review of more than 50 studies indicates that both doctors and <a href="/wiki/Patient" title="Patient">patients</a> appear reluctant to discuss sleep complaints, in part because of perceptions that treatments for insomnia are ineffective or associated with risks, and: </p> <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote"><p>Physicians may avoid exploring problems such as sleep difficulties in order to avoid having to deal with issues that could take up more than the normal allotted time for a patient.<sup id="cite_ref-psychservices_24-1" class="reference"><a href="#cite_note-psychservices-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup></p></blockquote> <p>Also, an editorial in the American College of Chest Physicians' (<a href="/wiki/Pulmonologist" class="mw-redirect" title="Pulmonologist">pulmonologists</a>') journal <i>CHEST</i> in 1999 was quite concerned about the <i>Conundrums in Sleep Medicine</i>. The author, then chair of her organization's Sleep Section, asked "What is required to set up a sleep laboratory? Money and a building! Anyone can open a sleep laboratory, and it seems that just about everyone is."<sup id="cite_ref-Collop_6-1" class="reference"><a href="#cite_note-Collop-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> On the <a href="/wiki/Accreditation" title="Accreditation">accreditation</a> process for sleep laboratories, she continues: "This accreditation, however, is currently not required by most states, or more importantly, by most <a href="/wiki/Insurance" title="Insurance">insurance</a> carriers for reimbursements... There is also an American Board of Sleep Medicine (ABSM) that certifies individuals as sleep specialists. This certification presumably makes those individuals more qualified to run a sleep laboratory; however, the certification is not required to run a laboratory or to read sleep studies." Her concern at the turn of the century was: </p> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote"><p>Not all patients with <a href="/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a> have sleep apnea, and other diagnoses may be missed if the physician is only trained to diagnose and treat sleep apnea. Also, when a physician runs a sleep laboratory, they are "assumed" to be a sleep expert and are asked to evaluate and treat all types of sleep disorders when they are not adequately trained to do so.<sup id="cite_ref-Collop_6-2" class="reference"><a href="#cite_note-Collop-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></p></blockquote> <p>In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the <a href="/wiki/Imperial_College_Healthcare_NHS_Trust" title="Imperial College Healthcare NHS Trust">Imperial College Healthcare</a> Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians."<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> The Imperial College Healthcare site<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> shows attention to <a href="/wiki/Obstructive_sleep_apnea" title="Obstructive sleep apnea">obstructive sleep apnea</a> syndrome (OSA) and very few other disorders, specifically not including insomnia. </p> <div class="mw-heading mw-heading2"><h2 id="Training_and_certification">Training and certification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=3" title="Edit section: Training and certification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Worldwide">Worldwide</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=4" title="Edit section: Worldwide"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The World Federation of Sleep Research & Sleep Medicine Societies (WFSRSMS) was founded in 1987. As its name implies, members are concerned with basic and clinical research as well as medicine. Member societies in the Americas are the <a href="/wiki/American_Academy_of_Sleep_Medicine" title="American Academy of Sleep Medicine">American Academy of Sleep Medicine</a> (AASM), publisher of the <i>Journal of Clinical Sleep Medicine</i>; the <a href="/wiki/Sleep_Research_Society" title="Sleep Research Society">Sleep Research Society</a> (SRS), publisher of <i>SLEEP</i>; the Canadian Sleep Society (CSS) and the Federation of Latin American Sleep Societies (FLASS). WFSRSMS promotes both sleep research and physician training and education. </p> <div class="mw-heading mw-heading3"><h3 id="Africa">Africa</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=5" title="Edit section: Africa"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Colleges of Medicine of South Africa (CMSA) provide the well-defined specialty Diploma in Sleep Medicine of the College of Neurologists of South Africa: DSM(SA),<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> which was first promulgated by the Health Professions Council in 2007.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The newly formed South African Society of Sleep Medicine (SASSM) was launched at its inaugural congress in February 2010.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> The society's membership is diverse; it includes general practitioners, <a href="/wiki/Otolaryngology" class="mw-redirect" title="Otolaryngology">ENT</a> surgeons, pulmonologists, cardiologists, endocrinologists and psychiatrists. </p> <div class="mw-heading mw-heading3"><h3 id="Asia">Asia</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=6" title="Edit section: Asia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>WFSRSMS members in Asia include the Australasian Sleep Association (ASA) of New Zealand and Australia and the Asian Sleep Research Society (ASRS), an umbrella organization for the societies of several Asian nations. </p> <div class="mw-heading mw-heading3"><h3 id="Europe">Europe</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=7" title="Edit section: Europe"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The European Sleep Research Society (ESRS) is a member of the WFSRSMS. The Assembly of National Sleep Societies (ANSS), which includes both medical and scientific organizations from 26 countries as of 2007, is a formal body of the ESRS. The ESRS has published <i>European Accreditation Guidelines for SMCs</i> (Sleep Medicine Centres), the first of several proposed guidelines to coordinate and promote sleep science and medicine in Europe. </p> <div class="mw-heading mw-heading3"><h3 id="United_States">United States</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=8" title="Edit section: United States"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Sleep_Stage_N3.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Sleep_Stage_N3.png/250px-Sleep_Stage_N3.png" decoding="async" width="250" height="181" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Sleep_Stage_N3.png/375px-Sleep_Stage_N3.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/95/Sleep_Stage_N3.png/500px-Sleep_Stage_N3.png 2x" data-file-width="840" data-file-height="609" /></a><figcaption><a href="/wiki/Polysomnography" title="Polysomnography">Polysomnography</a> (PSG) is a <a href="/wiki/Parametric_model" title="Parametric model">multi-parametric</a> test used as a <a href="/wiki/Diagnostic_tool" class="mw-redirect" title="Diagnostic tool">diagnostic tool</a> in sleep medicine.</figcaption></figure> <p>The <a href="/wiki/American_Academy_of_Sleep_Medicine" title="American Academy of Sleep Medicine">American Academy of Sleep Medicine</a> (AASM), founded in 1978, administered the certification process and sleep medicine examination for doctors until 1990. Its independent daughter entity the <a href="/wiki/American_Board_of_Sleep_Medicine" title="American Board of Sleep Medicine">American Board of Sleep Medicine</a> (ABSM) was incorporated in 1991 and took over the aforementioned responsibilities. As of 2007, the ABSM ceased administering its examination, as it conceded that an examination process recognized by the <a href="/wiki/American_Board_of_Medical_Specialties" title="American Board of Medical Specialties">American Board of Medical Specialties</a> (ABMS) was advantageous to the field.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Candidates who passed the ABSM exam in 1978–2006 retain lifetime certification as Diplomates of that organization.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/American_Board_of_Psychiatry_and_Neurology" title="American Board of Psychiatry and Neurology">American Board of Psychiatry and Neurology</a> (ABPN), and the corresponding boards of Internal Medicine, of Pediatrics, and of Otolaryngology (ear, nose and throat, ENT) now administer collectively the Sleep Medicine Certification exam for their members. Each board supervises the required 12 months of formal training for its candidates, while the exam is administered to all of them at the same time in the same place. For the first five years, 2007–2011, during "<a href="/wiki/Grandfathering" class="mw-redirect" title="Grandfathering">grandfathering</a>", there was a "practice pathway" for ABSM certified specialists while additional, coordinated requirements were to be added after 2011. The ABPN provides information about the pathways, requirements and the exam on its website.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Additionally, there are currently four boards of the <a href="/wiki/American_Osteopathic_Association_Bureau_of_Osteopathic_Specialists" title="American Osteopathic Association Bureau of Osteopathic Specialists">American Osteopathic Association Bureau of Osteopathic Specialists</a> that administer Sleep Medicine Certification exams. The American Osteopathic boards of <a href="/wiki/American_Osteopathic_Board_of_Family_Physicians" title="American Osteopathic Board of Family Physicians">Family Medicine</a>, <a href="/wiki/American_Osteopathic_Board_of_Internal_Medicine" title="American Osteopathic Board of Internal Medicine">Internal Medicine</a>, <a href="/wiki/American_Osteopathic_Board_of_Neurology_and_Psychiatry" title="American Osteopathic Board of Neurology and Psychiatry">Neurology & Psychiatry</a>, and <a href="/wiki/American_Osteopathic_Board_of_Ophthalmology_and_Otolaryngology" title="American Osteopathic Board of Ophthalmology and Otolaryngology">Ophthalmology & Otolaryngology</a> grant certificates of added qualification to qualified candidate physicians.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Sleep medicine is now a recognized subspecialty within <a href="/wiki/Anesthesiology" title="Anesthesiology">anesthesiology</a>, <a href="/wiki/Internal_medicine" title="Internal medicine">internal medicine</a>, <a href="/wiki/Family_medicine" title="Family medicine">family medicine</a>, <a href="/wiki/Pediatrics" title="Pediatrics">pediatrics</a>, <a href="/wiki/Otolaryngology" class="mw-redirect" title="Otolaryngology">otolaryngology</a>, <a href="/wiki/Psychiatry" title="Psychiatry">psychiatry</a> and <a href="/wiki/Neurology" title="Neurology">neurology</a> in the US. Certification in Sleep Medicine by the several "Member Boards" of the ABMS shows that the specialist: </p> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote"><p>has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake–sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></p></blockquote> <p>Pulmonologists, already subspecialists within internal medicine, may be accepted to sit for the board and be certified in Sleep Medicine after just a six-month <a href="/wiki/Fellowship_(medicine)" title="Fellowship (medicine)">fellowship</a>, building on their knowledge of sleep-related breathing problems, rather than the usual twelve-month fellowship required of other specialists.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>Sleep dentistry (<a href="/wiki/Bruxism" title="Bruxism">bruxism</a>, snoring and sleep apnea), while not recognized as one of the nine <a href="/wiki/Dentistry" title="Dentistry">dental specialties</a>, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the AASM, and these dentists are organized in the Academy of Dental Sleep Medicine (USA).<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> The qualified dentists collaborate with sleep doctors at accredited sleep centers and can provide several types of <a href="/wiki/Mandibular_advancement_splint" title="Mandibular advancement splint">oral appliances</a> or upper airway surgery to treat or manage sleep-related breathing disorders<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> as well as tooth-grinding and clenching. </p><p>Laboratories for sleep-related breathing disorders are accredited by the AASM and are required to follow the <i>Code of Medical Ethics</i> of the American Medical Association. The new and very detailed <i>Standards for Accreditation</i> are available online.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Sleep disorder centers, or clinics, are accredited by the same body, whether hospital-based, university-based or "freestanding"; they are required to provide testing and treatment for <i>all</i> sleep disorders and to have on staff a sleep specialist who has been certified by the American Board of Sleep Medicine and otherwise meet similar standards. </p> <div class="mw-heading mw-heading2"><h2 id="Diagnostic_methods">Diagnostic methods</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=9" title="Edit section: Diagnostic methods"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Pediatric_polysomnogram.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a6/Pediatric_polysomnogram.jpg/250px-Pediatric_polysomnogram.jpg" decoding="async" width="250" height="167" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a6/Pediatric_polysomnogram.jpg/375px-Pediatric_polysomnogram.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a6/Pediatric_polysomnogram.jpg/500px-Pediatric_polysomnogram.jpg 2x" data-file-width="1024" data-file-height="683" /></a><figcaption>Pediatric <a href="/wiki/Polysomnography" title="Polysomnography">polysomnography</a></figcaption></figure> <p>The taking of a thorough <a href="/wiki/Medical_history" title="Medical history">medical history</a> while keeping in mind alternative <a href="/wiki/Medical_diagnosis" title="Medical diagnosis">diagnoses</a> and the possibility of more than one ailment in the same patient is the first step. Symptoms for very different sleep disorders may be similar and it must be determined whether any psychiatric problems are primary or secondary. </p><p>The patient history includes previous attempts at treatment and coping and a careful medication review. Differentiation of transient from chronic disorders and primary from secondary ones influences the direction of evaluation and treatment plans.<sup id="cite_ref-Cataletto_40-0" class="reference"><a href="#cite_note-Cataletto-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/Epworth_Sleepiness_Scale" title="Epworth Sleepiness Scale">Epworth Sleepiness Scale</a> (ESS), designed to give an indication of sleepiness and correlated with sleep apnea,<sup id="cite_ref-Johns1991_41-0" class="reference"><a href="#cite_note-Johns1991-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> or other questionnaires designed to measure <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">excessive daytime sleepiness</a>, are diagnostic tools that can be used repeatedly to measure results of treatment. </p><p>A <a href="/wiki/Sleep_diary" title="Sleep diary">sleep diary</a>, also called sleep log or sleep journal, kept by a patient at home for at least two weeks, while subjective, may help determine the extent and nature of sleep disturbance and the level of alertness in the normal environment. A parallel journal kept by a parent or bed partner, if any, can also be helpful. Sleep logs can also be used for self-monitoring and in connection with behavioral and other treatment. The image at the top of this page, with nighttime in the middle and the weekend in the middle, shows a layout that can aid in noticing trends </p><p>An <a href="/wiki/Actigraph" class="mw-redirect" title="Actigraph">actigraph</a> unit is a motion-sensing device worn on the wrist, generally for one or two weeks. It gives a gross picture of sleep–wake cycles and is often used to verify the sleep diary. It is cost-efficient when full polysomnography is not required. </p><p><a href="/wiki/Polysomnography" title="Polysomnography">Polysomnography</a><sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> is performed in a sleep laboratory while the patient sleeps, preferably at his or her usual sleeping time. The polysomnogram (PSG) objectively records sleep stages and respiratory events. It shows multiple channels of <a href="/wiki/Electroencephalogram" class="mw-redirect" title="Electroencephalogram">electroencephalogram</a> (EEG), <a href="/wiki/Electrooculogram" class="mw-redirect" title="Electrooculogram">electrooculogram</a> (EOG), <a href="/wiki/Electrocardiogram" class="mw-redirect" title="Electrocardiogram">electrocardiogram</a> (ECG), nasal and oral airflow, abdominal, chest and leg movements and blood oxygen levels. A single part of a polysomnogram is sometimes measured at home with portable equipment, for example <a href="/wiki/Oximetry" class="mw-redirect" title="Oximetry">oximetry</a>, which records blood oxygen levels throughout the night. Polysomnography is not routinely used in the evaluation of patients with insomnia or circadian rhythm disorders, except as needed to rule out other disorders.<sup id="cite_ref-Cataletto_40-1" class="reference"><a href="#cite_note-Cataletto-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> It will usually be a definitive test for sleep apnea. </p><p>Home Sleep Tests (HST) or Home Sleep Apnea Tests (HSAT) are types of sleep studies that can be performed in a patient's home to identify obstructive sleep apnea. HSTs are performed at home in the patient’s usual sleep environment and thus are more representative of their natural sleep than staying overnight at a lab, where patients often experience “first night syndrome” <a rel="nofollow" class="external autonumber" href="https://academic.oup.com/sleep/article/47/10/zsae179/7731374">[1]</a> These devices are increasing in utilization due to their convenience and cost effectiveness and the fact that many insurance companies now require them instead on a polysomnography. </p><p>There are two main types of devices, Type III which includes four or more channels and can confirm if a patient has sleep apnea based on what is recorded. Type IV devices have two to three channels and are used more for screening patients before an in-lab study. <a rel="nofollow" class="external text" href="https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=227&ver#:~:text=Type%20III%20monitors%20have%20a,or%20ECG%2C%20and%20oxygen%20saturation/">CMS guidelines</a>. HST is not useful for other types of sleep disorders such as parasomnias or narcolepsy. </p><p>A <a href="/wiki/Multiple_Sleep_Latency_Test" title="Multiple Sleep Latency Test">Multiple Sleep Latency Test</a> (MSLT) is often performed during the entire day after polysomnography while the electrodes and other equipment are still in place. The patient is given nap opportunities every second hour; the test measures the number of minutes it takes from the start of a daytime nap period to the first signs of sleep. It is a measure of daytime sleepiness; it also shows whether <a href="/wiki/REM_sleep" class="mw-redirect" title="REM sleep">REM sleep</a> is achieved in a short nap, a typical indication of <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a>. </p><p><a href="/wiki/Medical_imaging" title="Medical imaging">Imaging studies</a> may be performed if a patient is to be evaluated for neurodegenerative disease or to determine the obstruction in obstructive sleep apnea.<sup id="cite_ref-Cataletto_40-2" class="reference"><a href="#cite_note-Cataletto-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p><b>Sleep <a href="/wiki/Questionnaires" class="mw-redirect" title="Questionnaires">Questionnaires</a></b>: There are some validated questionnaires in sleep medicine such as: </p> <ul><li><i><a href="/w/index.php?title=Tayside_children%27s_sleep_questionnaire&action=edit&redlink=1" class="new" title="Tayside children's sleep questionnaire (page does not exist)">Tayside children's sleep questionnaire</a></i>: A ten-item questionnaire for sleep disorders in children aged between one and five years old.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup></li> <li><i><a href="/wiki/Children%27s_Sleep_Habits_Questionnaire" title="Children's Sleep Habits Questionnaire">Children's Sleep Habits Questionnaire</a></i><sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup></li> <li><i>Cleveland Adolescent Sleepiness Questionnaire (CASQ)</i>: There are 16 items to measure extreme sleepiness during the day in adolescents aged 11–17 years old.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup></li> <li><i><a href="/wiki/Munich_Chronotype_Questionnaire" title="Munich Chronotype Questionnaire">Munich Chronotype Questionnaire</a> (MCTQ):</i> Assesses the timing of sleep.</li></ul> <div class="mw-heading mw-heading2"><h2 id="Treatments">Treatments</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=10" title="Edit section: Treatments"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Normison.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3c/Normison.jpg/220px-Normison.jpg" decoding="async" width="220" height="126" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3c/Normison.jpg/330px-Normison.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3c/Normison.jpg/440px-Normison.jpg 2x" data-file-width="2499" data-file-height="1429" /></a><figcaption>Normison (<a href="/wiki/Temazepam" title="Temazepam">temazepam</a>) is a <a href="/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepine</a> commonly prescribed for <a href="/wiki/Insomnia" title="Insomnia">insomnia</a> and other <a href="/wiki/Sleep_disorders" class="mw-redirect" title="Sleep disorders">sleep disorders</a>.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>When sleep complaints are secondary to pain, other medical or psychiatric diagnoses, or substance abuse, it may be necessary to treat both the underlying cause and the sleep problems. </p><p>When the underlying cause of sleep problems is not immediately obvious, behavioral treatments are usually the first suggested. These range from <a href="/wiki/Patient_education" title="Patient education">patient education</a> about <a href="/wiki/Sleep_hygiene" title="Sleep hygiene">sleep hygiene</a> to <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> (CBT). Studies of both younger and older adults<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> have compared CBT to medication and found that CBT should be considered a first-line and cost-effective intervention for chronic insomnia, not least because gains may be maintained at long-term follow-up. Sleep physicians and psychologists, at least in the US, are not in agreement about who should perform CBT nor whether sleep centers should be required to have psychologists on staff.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> In the UK the number of CBT-trained therapists is limited<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> so CBT is not widely available on the <a href="/wiki/National_Health_Service" title="National Health Service">NHS</a>. </p><p>Behavioral therapies include progressive relaxation, stimulus control (to reassociate the bed with sleepiness), limiting time-in-bed to increase sleep efficiency and debunking misconceptions about sleep.<sup id="cite_ref-Bonds_18-1" class="reference"><a href="#cite_note-Bonds-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Pharmacotherapy" title="Pharmacotherapy">Pharmacotherapy</a> is necessary for some conditions. Medication may be useful for acute insomnia and for some of the parasomnias. It is almost always needed, along with scheduled short naps and close follow-up, in the treatment of narcolepsy and idiopathic hypersomnia. </p><p>Chronic circadian rhythm disorders, the most common of which is <a href="/wiki/Delayed_sleep_phase_disorder" title="Delayed sleep phase disorder">delayed sleep phase disorder</a>, may be managed by specifically timed bright <a href="/wiki/Light_therapy" title="Light therapy">light therapy</a>, usually in the morning, <a href="/wiki/Dark_therapy" title="Dark therapy">darkness therapy</a> in the hours before bedtime, and timed oral administration of the hormone <a href="/wiki/Melatonin_(medication)" class="mw-redirect" title="Melatonin (medication)">melatonin</a>. <a href="/wiki/Chronotherapy_(sleep_phase)" title="Chronotherapy (sleep phase)">Chronotherapy</a> has also been prescribed for circadian rhythm disorders, though results are generally short-lived. <a href="/wiki/Stimulant" title="Stimulant">Stimulants</a> may also be prescribed.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> When these therapies are unsuccessful, counseling may be indicated to help a person adapt to and live with the condition. People with these disorders who have chosen a lifestyle in conformity with their sleeping schedules have no need of treatment, though they may need the diagnosis in order to avoid having to meet for appointments or meetings during their sleep time.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Cpap-example.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Cpap-example.jpg/220px-Cpap-example.jpg" decoding="async" width="220" height="125" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Cpap-example.jpg/330px-Cpap-example.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Cpap-example.jpg/440px-Cpap-example.jpg 2x" data-file-width="2085" data-file-height="1188" /></a><figcaption>CPAP (<a href="/wiki/Positive_airway_pressure" title="Positive airway pressure">positive airway pressure</a>) machine</figcaption></figure> <p><a href="/wiki/Continuous_positive_airway_pressure" title="Continuous positive airway pressure">Continuous positive airway pressure</a> (CPAP), Bilevel Continuous Positive Airway Pressure (BiPAP), or similar machines can be used nightly at home to effectively manage sleep-related breathing disorders such as apnea. In milder cases, oral appliances may be effective alternate treatments. For mild cases in obese people, weight reduction may be sufficient, but it is usually recommended as an adjunct to CPAP treatment since sustaining weight loss is difficult. In some cases, upper airway surgery, generally performed by an otolaryngologist/head & neck surgeon or occasionally an oral and maxillofacial <a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">surgeon</a>, is indicated.<sup id="cite_ref-Cataletto_40-3" class="reference"><a href="#cite_note-Cataletto-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> The treatments prevent airway collapse, which interrupts breathing during sleep.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> A 2001 study published by <a href="/wiki/Hans-Werner_Gessmann" title="Hans-Werner Gessmann">Hans-Werner Gessmann</a> in the Journal of Sleep Medicine and Sleep Psychology found that patients who practiced a series of electrical stimulations of suprahyoidal tongue muscles for 20 minutes a day showed a marked decline in sleep apnea symptoms after two months. Patients experienced an average of 36% fewer apnea episodes after successfully completing the treatments.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p><p>According to the National Cancer Institute (NCI), about 50% of cancer patients have trouble sleeping. Difficulty sleeping can include Restless Leg Syndrome (RLS), sleeping that is fragmented, or insomnia. Some reports show that up to 80% of patients who are undergoing cancer treatments experience some form of insomnia. One of the significant reasons for sleeping problems is stress, uncertainty, and fear. Other patients have difficulty sleeping directly due to their treatments while others experience pain that affects sleep quality. Other factors include diet and less than optimum sleeping conditions. Cancer has also been shown to be a cause of increased sleep apnea, which adds to the potential issues. </p> <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=11" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/American_Academy_of_Sleep_Medicine" title="American Academy of Sleep Medicine">American Academy of Sleep Medicine</a></li> <li><a href="/wiki/Noise_health_effects" class="mw-redirect" title="Noise health effects">Environmental noise health effects</a></li> <li><a href="/wiki/Polysomnographic_technician" class="mw-redirect" title="Polysomnographic technician">Polysomnographic technician</a></li> <li><a href="/wiki/Reversed_vegetative_symptoms" class="mw-redirect" title="Reversed vegetative symptoms">Reversed vegetative symptoms</a></li> <li><a href="/wiki/Sleep_study" title="Sleep study">Sleep study</a></li> <li><a href="/wiki/Sundowning_(dementia)" class="mw-redirect" title="Sundowning (dementia)">Sundowning (dementia)</a></li> <li><a href="/wiki/White_noise_machine" title="White noise machine">White noise machine</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.ama-assn.org/specialty/sleep-medicine-specialty-description">"Sleep Medicine Specialty Description"</a>. 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Medscape medical news<span class="reference-accessdate">. Retrieved <span class="nowrap">2008-08-04</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidelines+Issued+for+Management+of+Circadian+Rhythm+Sleep+Disorders&rft.pub=Medscape+medical+news&rft.date=2007-11-05&rft.aulast=Barclay&rft.aufirst=Laurie&rft.au=Charles+Vega&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F565320&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASleep+medicine" class="Z3988"></span></span> </li> <li id="cite_note-55"><span class="mw-cite-backlink"><b><a href="#cite_ref-55">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKayumovGregory_BrownRipu_JindalKenneth_Buttoo2001" class="citation journal cs1">Kayumov, Leonid; Gregory Brown; Ripu Jindal; Kenneth Buttoo; Colin M. Shapiro (January 1, 2001). <a rel="nofollow" class="external text" href="http://www.psychosomaticmedicine.org/cgi/content/full/63/1/40">"A Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effect of Exogenous Melatonin on Delayed Sleep Phase Syndrome"</a>. <i>Psychosomatic Medicine</i>. <b>63</b> (1): <span class="nowrap">40–</span>48. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00006842-200101000-00005">10.1097/00006842-200101000-00005</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11211063">11211063</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:33330589">33330589</a><span class="reference-accessdate">. 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The findings to date regarding melatonin treatment of DSPS are promising but limited.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Psychosomatic+Medicine&rft.atitle=A+Randomized%2C+Double-Blind%2C+Placebo-Controlled+Crossover+Study+of+the+Effect+of+Exogenous+Melatonin+on+Delayed+Sleep+Phase+Syndrome&rft.volume=63&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E40-%3C%2Fspan%3E48&rft.date=2001-01-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A33330589%23id-name%3DS2CID&rft_id=info%3Apmid%2F11211063&rft_id=info%3Adoi%2F10.1097%2F00006842-200101000-00005&rft.aulast=Kayumov&rft.aufirst=Leonid&rft.au=Gregory+Brown&rft.au=Ripu+Jindal&rft.au=Kenneth+Buttoo&rft.au=Colin+M.+Shapiro&rft_id=http%3A%2F%2Fwww.psychosomaticmedicine.org%2Fcgi%2Fcontent%2Ffull%2F63%2F1%2F40&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASleep+medicine" class="Z3988"></span></span> </li> <li id="cite_note-56"><span class="mw-cite-backlink"><b><a href="#cite_ref-56">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://dspsinfo.org/">"DSPS – Delayed Sleep-Phase Syndrome"</a><span class="reference-accessdate">. Retrieved <span class="nowrap">2008-08-04</span></span>. <q>But while the treatments may be effective for some people, a large proportion of DSPS sufferers are not able to achieve and maintain a normal sleep–wake schedule.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=DSPS+%E2%80%93+Delayed+Sleep-Phase+Syndrome&rft_id=http%3A%2F%2Fdspsinfo.org%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASleep+medicine" class="Z3988"></span></span> </li> <li id="cite_note-57"><span class="mw-cite-backlink"><b><a href="#cite_ref-57">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDagan_YAbadi_J2001" class="citation journal cs1">Dagan Y; Abadi J (November 2001). "sleep–wake schedule disorder disability: a lifelong untreatable pathology of the circadian time structure". <i>Chronobiol. Int</i>. <b>18</b> (6): <span class="nowrap">1019–</span>27. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1081%2FCBI-100107975">10.1081/CBI-100107975</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11777076">11777076</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:22712079">22712079</a>. <q>Patients suffering from SWSD disability should be encouraged to accept the fact that they suffer from a permanent disability, and that their quality of life can only be improved if they are willing to undergo rehabilitation. It is imperative that physicians recognize the medical condition of SWSD disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chronobiol.+Int.&rft.atitle=sleep%E2%80%93wake+schedule+disorder+disability%3A+a+lifelong+untreatable+pathology+of+the+circadian+time+structure&rft.volume=18&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1019-%3C%2Fspan%3E27&rft.date=2001-11&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A22712079%23id-name%3DS2CID&rft_id=info%3Apmid%2F11777076&rft_id=info%3Adoi%2F10.1081%2FCBI-100107975&rft.au=Dagan+Y&rft.au=Abadi+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASleep+medicine" class="Z3988"></span></span> </li> <li id="cite_note-58"><span class="mw-cite-backlink"><b><a href="#cite_ref-58">^</a></b></span> <span class="reference-text"><i><a rel="nofollow" class="external text" href="http://www.emedicine.com/neuro/topic419.htm#">Obstructive Sleep Apnea-Hypopnea Syndrome</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></span> </li> <li id="cite_note-59"><span class="mw-cite-backlink"><b><a href="#cite_ref-59">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFH.-WRS" class="citation journal cs1">H.-W, Gessmann; 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Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. Chapter 5 (full text): <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK19963/">Improving Awareness, Diagnosis, and Treatment of Sleep Disorders</a>,</li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sleep_medicine&action=edit&section=14" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://aasm.org/">American Academy of Sleep Medicine</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output 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movement (REM)</a></li> <li><a href="/wiki/Non-rapid_eye_movement_sleep" title="Non-rapid eye movement sleep">Quiescent sleep</a></li> <li><a href="/wiki/Slow-wave_sleep" title="Slow-wave sleep">Slow-wave</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Electroencephalography" title="Electroencephalography">Brain waves</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alpha_wave" title="Alpha wave">Alpha wave</a></li> <li><a href="/wiki/Beta_wave" title="Beta wave">Beta wave</a></li> <li><a href="/wiki/Delta_wave" title="Delta wave">Delta wave</a></li> <li><a href="/wiki/Gamma_wave" title="Gamma wave">Gamma wave</a></li> <li><a href="/wiki/K-complex" title="K-complex">K-complex</a></li> <li><a href="/wiki/Mu_wave" title="Mu wave">Mu rhythm</a></li> <li><a href="/wiki/PGO_waves" title="PGO waves">PGO waves</a></li> <li><a href="/wiki/Sensorimotor_rhythm" title="Sensorimotor rhythm">Sensorimotor rhythm</a></li> <li><a href="/wiki/Sleep_spindle" title="Sleep spindle">Sleep spindle</a></li> <li><a href="/wiki/Theta_wave" title="Theta wave">Theta wave</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sleep_disorder" title="Sleep disorder">Sleep disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Oral_and_maxillofacial_pathology" title="Oral and maxillofacial pathology">Anatomical</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bruxism" title="Bruxism">Bruxism</a></li> <li><a href="/wiki/Mouth_breathing" title="Mouth breathing">Mouth breathing</a></li> <li><a href="/wiki/Sleep_apnea" title="Sleep apnea">Sleep apnea</a> <ul><li><a href="/wiki/Catathrenia" title="Catathrenia">Catathrenia</a></li> <li><a href="/wiki/Central_hypoventilation_syndrome" title="Central hypoventilation syndrome">Central hypoventilation syndrome</a></li> <li><a href="/wiki/Obesity_hypoventilation_syndrome" title="Obesity hypoventilation syndrome">Obesity hypoventilation syndrome</a></li> <li><a href="/wiki/Obstructive_sleep_apnea" title="Obstructive sleep apnea">Obstructive sleep apnea</a></li> <li><a href="/wiki/Periodic_breathing" title="Periodic breathing">Periodic breathing</a></li></ul></li> <li><a href="/wiki/Snoring" title="Snoring">Snoring</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dyssomnia" title="Dyssomnia">Dyssomnia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">Excessive daytime sleepiness</a></li> <li><a href="/wiki/Hypersomnia" title="Hypersomnia">Hypersomnia</a></li> <li><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a></li> <li><a href="/wiki/Kleine%E2%80%93Levin_syndrome" title="Kleine–Levin syndrome">Kleine–Levin syndrome</a></li> <li><a href="/wiki/Narcolepsy" title="Narcolepsy">Narcolepsy</a></li> <li><a href="/wiki/Idiopathic_hypersomnia" title="Idiopathic hypersomnia">Idiopathic hypersomnia</a></li> <li><a href="/wiki/Night_eating_syndrome" title="Night eating syndrome">Night eating syndrome</a></li> <li><a href="/wiki/Nocturia" title="Nocturia">Nocturia</a></li> <li><a href="/wiki/Sleep_state_misperception" title="Sleep state misperception">Sleep state misperception</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0; line-height: 1.15em;"><a href="/wiki/Circadian_rhythm_sleep_disorder" title="Circadian rhythm sleep disorder">Circadian rhythm<br />disorders</a></div></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Advanced_sleep_phase_disorder" title="Advanced sleep phase disorder">Advanced sleep phase disorder</a></li> <li><a href="/wiki/Cyclic_alternating_pattern" title="Cyclic alternating pattern">Cyclic alternating pattern</a></li> <li><a href="/wiki/Delayed_sleep_phase_disorder" title="Delayed sleep phase disorder">Delayed sleep phase disorder</a></li> <li><a href="/wiki/Irregular_sleep%E2%80%93wake_rhythm" class="mw-redirect" title="Irregular sleep–wake rhythm">Irregular sleep–wake rhythm</a></li> <li><a href="/wiki/Jet_lag" title="Jet lag">Jet lag</a></li> <li><a href="/wiki/Non-24-hour_sleep%E2%80%93wake_disorder" title="Non-24-hour sleep–wake disorder">Non-24-hour sleep–wake disorder</a></li> <li><a href="/wiki/Shift_work_sleep_disorder" title="Shift work sleep disorder">Shift work sleep disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parasomnia" title="Parasomnia">Parasomnia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nightmare_disorder" title="Nightmare disorder">Nightmare disorder</a></li> <li><a href="/wiki/Night_terror" title="Night terror">Night terror</a></li> <li><a href="/wiki/Periodic_limb_movement_disorder" title="Periodic limb movement disorder">Periodic limb movement disorder</a></li> <li><a href="/wiki/Rapid_eye_movement_sleep_behavior_disorder" title="Rapid eye movement sleep behavior disorder">Rapid eye movement sleep behavior disorder</a></li> <li><a href="/wiki/Sleepwalking" title="Sleepwalking">Sleepwalking</a></li> <li><a href="/wiki/Sleep_driving" title="Sleep driving">Sleep driving</a></li> <li><a href="/wiki/Sleep-talking" title="Sleep-talking">Sleep-talking</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Benign phenomena</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dream" title="Dream">Dreams</a> <ul><li><a href="/wiki/Lucid_dream" title="Lucid dream">Lucid dreams</a></li></ul></li> <li><a href="/wiki/Exploding_head_syndrome" title="Exploding head syndrome">Exploding head syndrome</a></li> <li><a href="/wiki/Hypnic_jerk" title="Hypnic jerk">Hypnic jerk</a></li> <li><a href="/wiki/Hypnagogia" title="Hypnagogia">Hypnagogia</a> / <a href="/wiki/Sleep_onset" title="Sleep onset">Sleep onset</a></li> <li><a href="/wiki/Hypnopompia" title="Hypnopompia">Hypnopompia</a></li> <li><a href="/wiki/Sleep_paralysis" title="Sleep paralysis">Sleep paralysis</a></li> <li><a href="/wiki/Sleep_inertia" title="Sleep inertia">Sleep inertia</a></li> <li><a href="/wiki/Somnolence" title="Somnolence">Somnolence</a></li> <li><a href="/wiki/Nocturnal_clitoral_tumescence" title="Nocturnal clitoral tumescence">Nocturnal clitoral tumescence</a></li> <li><a href="/wiki/Nocturnal_penile_tumescence" title="Nocturnal penile tumescence">Nocturnal penile tumescence</a></li> <li><a href="/wiki/Nocturnal_emission" title="Nocturnal emission">Nocturnal emission</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Treatment</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_diary" title="Sleep diary">Sleep diary</a></li> <li><a href="/wiki/Sleep_hygiene" title="Sleep hygiene">Sleep hygiene</a></li> <li><a href="/wiki/Sleep_induction" title="Sleep induction">Sleep induction</a> <ul><li><a href="/wiki/Hypnosis" title="Hypnosis">Hypnosis</a></li> <li><a href="/wiki/Lullaby" title="Lullaby">Lullaby</a></li></ul></li> <li><a href="/wiki/Somnology" title="Somnology">Somnology</a> <ul><li><a href="/wiki/Polysomnography" title="Polysomnography">Polysomnography</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Sleep medicine</a></li> <li><a href="/wiki/Behavioral_sleep_medicine" title="Behavioral sleep medicine">Behavioral sleep medicine</a></li> <li><a href="/wiki/Sleep_study" title="Sleep study">Sleep study</a></li> <li><a href="/wiki/Melatonin" title="Melatonin">Melatonin</a></li> <li><a href="/wiki/Neuroscience_of_sleep" title="Neuroscience of sleep">Neuroscience of sleep</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Daily life</th><td class="navbox-list-with-group navbox-list navbox-even hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bed" title="Bed">Bed</a> <ul><li><a href="/wiki/Bunk_bed" title="Bunk bed">Bunk bed</a></li> <li><a href="/wiki/Daybed" title="Daybed">Daybed</a></li> <li><a href="/wiki/Four-poster_bed" title="Four-poster bed">Four-poster bed</a></li> <li><a href="/wiki/Futon" title="Futon">Futon</a></li> <li><a href="/wiki/Hammock" title="Hammock">Hammock</a></li> <li><a href="/wiki/Mattress" title="Mattress">Mattress</a></li> <li><a href="/wiki/Sleeping_bag" title="Sleeping bag">Sleeping bag</a></li></ul></li> <li><a href="/wiki/Bed_bug" title="Bed bug">Bed bug</a></li> <li><a href="/wiki/Bedding" title="Bedding">Bedding</a></li> <li><a href="/wiki/Bedroom" title="Bedroom">Bedroom</a></li> <li><a href="/wiki/Bedtime" title="Bedtime">Bedtime</a> <ul><li><a href="/wiki/Bedtime_procrastination" title="Bedtime procrastination">Procrastination</a></li> <li><a href="/wiki/Bedtime_story" title="Bedtime story">Story</a></li></ul></li> <li><a href="/wiki/Biphasic_and_polyphasic_sleep" class="mw-redirect" title="Biphasic and polyphasic sleep">Biphasic and polyphasic sleep</a></li> <li><a href="/wiki/Chronotype" title="Chronotype">Chronotype</a></li> <li><a href="/wiki/Circadian_rhythm" title="Circadian rhythm">Circadian rhythm</a></li> <li><a href="/wiki/Comfort_object" title="Comfort object">Comfort object</a></li> <li><a href="/wiki/Dream_diary" title="Dream diary">Dream diary</a></li> <li><a href="/wiki/Microsleep" title="Microsleep">Microsleep</a></li> <li><a href="/wiki/Nap" title="Nap">Nap</a></li> <li><a href="/wiki/Nightwear" title="Nightwear">Nightwear</a></li> <li><a href="/wiki/Power_nap" title="Power nap">Power nap</a></li> <li><a href="/wiki/Second_wind_(sleep)" title="Second wind (sleep)">Second wind</a></li> <li><a href="/wiki/Siesta" title="Siesta">Siesta</a></li> <li><a href="/wiki/Sleep_and_breathing" title="Sleep and breathing">Sleep and breathing</a></li> <li><a href="/wiki/Sleep_and_creativity" title="Sleep and creativity">Sleep and creativity</a></li> <li><a href="/wiki/Sleep_and_learning" title="Sleep and learning">Sleep and learning</a></li> <li><a href="/wiki/Sleep_and_memory" title="Sleep and memory">Sleep and memory</a></li> <li><a href="/wiki/Sleep_deprivation" title="Sleep deprivation">Sleep deprivation</a> / <a href="/wiki/Sleep_debt" title="Sleep debt">Sleep debt</a></li> <li><a href="/wiki/Sleeping_while_on_duty" title="Sleeping while on duty">Sleeping while on duty</a></li> <li><a href="/wiki/Sleepover" title="Sleepover">Sleepover</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" 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