page_title: Sleep medicine
section_title: United States
hierarchical_section_title: Sleep medicine / Training and certification / United States
caption_attribution_description: English: Screenshot of a person in stage N3 sleep.
context_page_description: Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.
  The first sleep clinics in the United States were established in the 1970s by interested physicians and technicians; the study, diagnosis and treatment of obstructive sleep apnea were their first tasks. As late as 1999, virtually any American physician, with no specific training in sleep medicine, could open a sleep laboratory.
  Disorders and disturbances of sleep are widespread and can have significant consequences for affected individuals as well as economic and other consequences for society.
context_section_description: The American Academy of Sleep Medicine (AASM), founded in 1978, administered the certification process and sleep medicine examination for doctors until 1990. Its independent daughter entity the American Board of Sleep Medicine (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 American Board of Medical Specialties (ABMS) was advantageous to the field. Candidates who passed the ABSM exam in 1978–2006 retain lifetime certification as Diplomates of that organization.
  The American Board of Psychiatry and Neurology (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 "grandfathering," 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. Additionally, there are currently four boards of the American Osteopathic Association Bureau of Osteopathic Specialists that administer Sleep Medicine Certification exams. The American Osteopathic boards of Family Medicine, Internal Medicine, Neurology & Psychiatry, and Ophthalmology & Otolaryngology grant certificates of added qualification to qualified candidate physicians.
  Sleep medicine is now a recognized subspecialty within anesthesiology, internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the US. Certification in Sleep Medicine by the several "Member Boards" of the ABMS shows that the specialist:
  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.
  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 fellowship, building on their knowledge of sleep-related breathing problems, rather than the usual twelve-month fellowship required of other specialists.
  Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, 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). The qualified dentists collaborate with sleep doctors at accredited sleep centers and can provide several types of oral appliances or upper airway surgery to treat or manage sleep-related breathing disorders as well as tooth-grinding and clenching.
  Laboratories for sleep-related breathing disorders are accredited by the AASM and are required to follow the Code of Medical Ethics of the American Medical Association. The new and very detailed Standards for Accreditation are available online. 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 all 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.
caption: Polysomnography (PSG) is a multi-parametric test used as a diagnostic tool in sleep medicine.
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