Sleepless Americans Need Better Medical Care

Doctors aren't spotting, treating disorders like insomnia, report finds

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By Amanda Gardner
HealthDay Reporter

TUESDAY, April 4, 2006 (HealthDay News) -- The medical profession is getting a wake-up call to pay more attention to sleep.

A new report released Tuesday by the Institute of Medicine (IOM) laid it out this way: 50 million to 70 million Americans have chronic sleep disorders, such as insomnia, sleep apnea and restless legs syndrome; millions more suffer from less chronic sleep problems; fatigue alone is thought to cost businesses about $150 billion per year in lost productivity and mishaps, and motor vehicle accidents involving tired drivers cost at least $48 billion a year.

Given such numbers, the report said, sleep disorders are grossly undiagnosed, with too few scientists studying the problem and too few health-care professionals tending to patients.

"The report found that the both sleep deprivation, sleep loss and sleep disorders are undiagnosed, and part of the reason is a lack of both public awareness and professional awareness," said Dr. Harvey Colten, chairman of the committee that wrote the report and former senior associate dean for academic affairs at Columbia University Health Sciences in New York City.

"We're recommending intensive education at the K-through-12, undergraduate and graduate levels," he added. "There's also a need for research and development and new diagnostic and therapeutic modalities because the capacity to meet the current demand is not sufficient, never mind if awareness is high enough to warrant an even greater demand."

Experts are hoping the report, Sleep Deprivation and Sleep Disorders: An Unmet Public Health Problem, will give the field a shot in the arm.

"This report comes from a very respected group of scientists, and that is of great importance for sleep medicine," said Dr. Francisco Perez-Guerra, a professor of internal medicine at Texas A&M Health Science Center College of Medicine in College Station and director of the Scott & White Sleep Disorders Center in Temple, Texas. "In my opinion, this will result more than anything else in more basic research, in addition to a reawakening of medical schools' need to teach what they haven't taught."

Until about 50 years ago, Colten said, "sleep was really in the province of poets, not scientists." Then, a series of studies on brain wave activity, as well as heart and lung function, during sleep clearly showed that sleep was not a passive state but "a very complex and active physiological state," Colten explained. Since that time, research and interest have continued to increase -- but not enough.

In 2004, only 54 individuals entered the biomedical research field with degrees focused on somnology, or sleep medicine. This compares with 630 men and women who entered the cancer research arena. Medical students typically get only four hours of instruction in sleep medicine, the report stated.

"Sleep disorders are everywhere in society," Perez-Guerra said. "We know a fair amount, but there's a lot more to know."

The report made a number of recommendations, including launching a multimedia public education campaign geared to everyone from elementary school through to professional education. The authors also called for better technology for diagnosing and treating sleep disorders; for the National Institutes of Health (NIH) to take a more proactive role in integrating sleep medicine into research disciplines; for increased investment in research training and mentoring activities; and for the U.S. Centers for Disease Control and Prevention and the NIH to support additional surveillance and monitoring of sleep patterns and sleep disorders.

"The report will be very important when it comes to justification for research funding for studies on sleep," said Dr. Michael Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City. "The NIH will recognize that there are now starting to be calls for more research in the area of sleep, and it's a wake-up call for medical schools, which have largely ignored issue of sleep."

"We need to get more physicians trained and not just in specialties," Thorpy added. "Every physician deals with patients who have sleep-related problems. Every physician needs more education. We've learned so much about the importance of sleep problems, and the rest of medicine has to catch up."

The American Academy of Sleep Medicine (AASM), which represents more than 5,000 sleep specialists, applauded the report but said in a prepared statement that the IOM "did not go far enough in some of its recommendations to ensure the appropriate growth and development of the fields of sleep science and sleep medicine."

The statement added, "The AASM would have liked the IOM report to call for measures to improve or prevent these problems, specifically work-hour and shift-work limitations, as well as drowsy driving legislation."

More information

For a guide to healthy sleep, visit the National Institutes of Health.

SOURCES: Harvey R. Colten, M.D., professor, pediatrics, and former senior associate dean for academic affairs, Columbia University Health Sciences, New York City; Francisco Perez-Guerra, M.D., professor, internal medicine, Texas A&M Health Science Center College of Medicine, College Station, and director, Scott & White Sleep Disorders Center, Temple, Texas; Michael Thorpy, M.D., director, Sleep-Wake Disorders Center, Montefiore Medical Center, New York City; April 4, 2006, Institute of Medicine report

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