There is agreement on a number of important conclusions (1) regarding sleep. These include the following:

The history of sleep medicine is relatively brief but extremely rich. It includes brilliant basic science developed around the world throughout the 20th century until now. Dr. Nathaniel Kleitman, who is regarded as the father of American sleep research, began his work in the 1920s examining sleep and wakefulness and the nature of circadian rhythms (2). In 1953 Kleitman and one of his students, Dr. Eugene Aserinsky, made the landmark discovery of rapid eye movement (REM) during sleep. Another of Kleitman’s students, Dr. William C. Dement, extended Dr. Kleitman’s path of research. Dement described the “cyclical” nature of nocturnal sleep in 1955, and in 1957 and 1958 established the relationship between REM sleep and dreaming (3).

The Sleep Research Society (SRS) was established in 1961 when a small group of sleep researchers met at the University of Chicago to share ideas and data. The host scientists that year were Drs. Nathaniel Kleitman, Allan Rechtschaffen, and William Dement (4). The SRS fosters research from basic sleep research to clinical sleep medicine practice research across the different disciplines in sleep medicine.

Subsequent rapid development of clinical practice in sleep medicine has occurred over the past 40 years. The clinical specialty began in 1970 when Dr. William C. Dement established the world’s first sleep disorders clinic at Stanford University. It was Dr. Jerome Holland, a member of the Stanford group, who first coined the term polysomnography (2). Sleep medicine has expanded to include sleep centers throughout the world.

According to the National Sleep Foundation, a lack of sleep health education and consequent undiagnosed sleep disorders represents a major public health problem. There are a limited number of sleep medicine specialists who provide health care to individuals with difficulties sleeping or staying awake. The integration of information about physiology and pathophysiology during sleep into the overall evaluation of patient health is a cornerstone of modern sleep medicine and should be a part of every routine physical examination. This critical integration of information about sleep does not happen on a broad-enough scale—partly because of a lack of systematic education about sleep in medical school.

The challenge for clinicians and researchers alike is to understand sleep-related changes in physiology and their impact on the quality and quantity of sleep and
consequent impact on waking function. Only recently has there been recognition of the role of healthy sleep for optimal physical and emotional well-being and performance.

The Association of Sleep Disorders Centers (ASDC) was founded in 1976. In 1987, the ASDC changed its name to the American Sleep Disorders Association (ASDA), and in 1999, the ASDA was renamed the American Academy of Sleep Medicine (AASM) (5).

The Association of Polysomnographic Technologists (APT) was established in 1978. It was renamed the American Association of Sleep Technologists (AAST) in 2007. The Board of Registered Polysomnographic Technologists (BRPT) was established as a committee of the APT. In 2000, the BRPT became a separate organization with a primary focus on technologist credentialing. In 2005, the AASM commissioned a Polysomnographic Technologist Issues Committee consisting of educators, clinicians, and technologists. Their goal was to meet the educational needs of sleep technologists. They developed the Accredited Sleep Technologist Education Program (ASTEP) to promote the standardization of sleep technologist education and training and to equip students with the knowledge and skills they need to excel in the profession of sleep technology (6). These programs are AASM accredited and are provided by AASM-accredited sleep centers.

The ASTEP consists of an 80-hour didactic introductory course provided in an AASM-accredited sleep center or affiliated academic institution and an e-learning program consisting of AASM-developed ASTEP online self-study modules completed while the technician completes 18 months of on-the-job training provided by their employer (7). The standards for accreditation of educational programs in sleep technology are available on the AASM website. The AASM began accepting applications for accreditation of ASTEPs in January 2006.

The ultimate educational goal for sleep technologists is formal college-based education in sleep technology. Accredited college programs in sleep technology have been developed across the country. These programs are accredited through the Commission on Accreditation of Allied Health Education Programs (CAAHEP). The Committee on Accreditation for Polysomnographic Technologist Education (CoA PSG) is sponsored by the AAST and the BRPT and comprises nine members (3). The committee’s purpose is to facilitate the accreditation of allied health programs through CAAHEP by establishing standards and guidelines for college programs in polysomnographic technology and reviewing applications for accreditation of such programs.

At the time of this writing, CAAHEP has accredited 45 programs in polysomnography. Some programs offer both a certificate and an associate degree. Currently, there are 25 certificate programs, 17 associate degree programs, 2 bachelor’s degree programs, and 7 accredited online/distance education programs (8). At the time of this publication, there is one master’s degree program in the process of achieving accreditation. This programmatic accreditation process continues to grow until there are enough college programs accredited to meet the educational needs of this field that has grown so rapidly. There is also a distance education program offering an MSc in sleep medicine through Nuffield Department of Clinical Neurosciences at the University of Oxford, UK (9).

Although sleep medicine has its roots in psychiatry and neurology, specialists from many areas of medicine provide sleep health care. Pulmonologists became active in clinical practice of sleep medicine after the initial description of obstructive sleep apnea (OSA) in the mid-1970s. Pediatricians, pediatric neurologists, pediatric pulmonologists, and pediatric psychiatrists also recognize that sleep disorders are common in children. Psychologists play an important role in the care and treatment of sleep disorder patients.

In 2003, the first behavioral sleep medicine board examination was administered to approximately 30 individuals by the AASM’s Behavioral Sleep Medicine Committee. “Following the completion of the 2008 examination cycle, the administration of the certification examination in behavioral sleep medicine was transferred to the American Board of Sleep Medicine.” As of this writing, there were 214 individuals certified in behavioral sleep medicine (10). Sleep medicine is an interdisciplinary field that includes practitioners from internal medicine and its relevant subspecialties including otolaryngology, neuroscience, dentistry, pharmacology, gerontology, and nursing.

There are more nurses serving as health care providers than any other professional group in the United States. Nurses are a valuable resource for advocating healthy sleep as well as promoting the diagnosis and treatment of sleep disorders. They are in a unique position in all areas of medicine to contribute to diagnosis and treatment of sleep disorders because of the amount of contact they have with patients and their ability to educate them. Nurses, nurse practitioners, and physician assistants make excellent case managers for patients suffering from sleep disorders. They have the same problem as all health care professionals: a limited availability of education in the interdisciplinary field of sleep medicine. Courses in sleep medicine are being added to nursing educational programs for both undergraduate and graduate degrees. Unfortunately, this is only occurring on a limited basis.

Education in sleep medicine will expand in time. The traditional order of implementation of a new medical science is that research informs and guides clinical practice. Institutions are slow to incorporate newly
acquired knowledge into curricula. Sleep professionals and the AASM provide critical input into curriculum development and have been instrumental in providing education for the public and the professional sectors as well as supporting legislation for licensure of practitioners.

In June 1996, the AASM was granted a seat in the House of Delegates of the American Medical Association (AMA). In December 2003, the AMA awarded the Resident Recognition of Excellence distinction to the AASM for their efforts with the “Sleep, Fatigue, and Medical Training” conference in October 2001, and the Sleep, Alertness, and Fatigue Education in Residency (SAFER) educational module (11).