Behavioral Sleep Medicine - Current Demand

[CircadianSleep]

Hi All,

Long time admirer, first time poster.

I'm a first year clinical psychology graduate student interested in opinions regarding the current demand for clinical psychologists specializing in behavioral sleep medicine. My future career goals are focused more on clinical work within an academic medical center, so I'm particularly interested in hearing from the clinician perspective.

In terms of academia, there appears to be advantages in being the resident "sleep guy or gal" in the department. At least at my institution, there seems to be a lot of interest from psychology faculty to collaborate on projects exploring the role of sleep in projects spanning neuropsychological assessment, health-related behaviors, PTSD (etc). However, I'm not sure the feeling is mutual at other universities.

My main concern is that BSM is still a relatively new field, and many psychologists (and future employers) may not be looking to hire clinicians with this particular skill set. My current plan is to obtain broad clinical training within health psychology and behavioral medicine as a grad student and obtain BSM certification after internship + clinical postdoc. The fear is that hyper-specializing in BSM may severely limit my career options down the road.

Thanks in advance for sharing your thoughts and experiences.

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[bmedclinic]

Hey,
I'll be brief. I also have a long standing interest with sleep medicine, and did my thesis on a sleep topic.
In academic medicine, the positions are few but the demand is great.
Outside academic medicine, the positions are very very rare. I see a behavioral sleep med "job" outside academic medicine maybe once every few months. And I'm on the BSM listserv, where ironically they post BSM related jobs, but not too often a true bsm job iirc.

For people in private practice, my understanding is that home sleep evals (largely for OSA) killed the market, making many shift their financial models, and forced some bsm types to go into other areas.

 

[deleted343839]

Sleep medicine is not a brand new field. If you peruse academic medical centers with a sleep disorders unit or clinic, you will sometimes find a faculty member (or joint appointee) who is a psychologist. It was once possible to be board certified in sleep medicine as a psychologist, but that's been phased out and sleep specialization has been absorbed into the larger medical specialties (pulm/critical care, psych, etc.).

I think it's wise, as you've already determined, to get broad training and make yourself competitive for a variety of health psychologist positions. Once you can show that you can really help people with insomnia and other sleep disorders, your colleagues will value your skills and yes, you'll become the "sleep guy." Though treating sleep disorders is probably not the only thing you'll do, there are opportunities to build your career in this area.

One last thing - even if you are mainly interested in a clinical career, you'll need to have solid research skills to be competitive for AMC jobs, so make sure to publish and get your name out there even if you mostly want to see patients.

 

[CircadianSleep]

Hey,
I'll be brief. I also have a long standing interest with sleep medicine, and did my thesis on a sleep topic.
In academic medicine, the positions are few but the demand is great.
Outside academic medicine, the positions are very very rare. I see a behavioral sleep med "job" outside academic medicine maybe once every few months. And I'm on the BSM listserv, where ironically they post BSM related jobs, but not too often a true bsm job iirc.

For people in private practice, my understanding is that home sleep evals (largely for OSA) killed the market, making many shift their financial models, and forced some bsm types to go into other areas.

Thanks for the reply bmedclinic. I'm on the BSM listserv as well. Largely research postdoc positions and I haven't seen a true BSM clinical position over the past few months.

If you don't mind sharing, are you in academic medicine doing research on sleep-related topics? It's always helpful for me to get more insight into what professions other clinical psychologists with an interest in sleep medicine have settled on.

 

[CircadianSleep]

Sleep medicine is not a brand new field. If you peruse academic medical centers with a sleep disorders unit or clinic, you will sometimes find a faculty member (or joint appointee) who is a psychologist. It was once possible to be board certified in sleep medicine as a psychologist, but that's been phased out and sleep specialization has been absorbed into the larger medical specialties (pulm/critical care, psych, etc.).

I think it's wise, as you've already determined, to get broad training and make yourself competitive for a variety of health psychologist positions. Once you can show that you can really help people with insomnia and other sleep disorders, your colleagues will value your skills and yes, you'll become the "sleep guy." Though treating sleep disorders is probably not the only thing you'll do, there are opportunities to build your career in this area.

One last thing - even if you are mainly interested in a clinical career, you'll need to have solid research skills to be competitive for AMC jobs, so make sure to publish and get your name out there even if you mostly want to see patients.

Thanks MamaPhD. I'm in a clinical science model Ph.D. program that puts a high emphasis on research and publishing. So, I'll definitely continue to publish. I appreciate this input.

In addition to sleep, I have a background and future clinical interest in hospice / palliative care. There seem to be a lot of relatively unexplored applications of sleep medicine in terminal illness / primary care / hospital settings that I will be writing up as a review paper for publication during my preliminary exams. I'm not sure if anyone on SDN does therapy with grief and end-of-life issues? From what I've looked into so far, it seems the majority of these therapists are licensed social workers rather than Ph.D.-level clinical psychologists, although I could definitely be wrong.

Any additional input on these issues would also be really helpful. Thanks again for the replies so far!

 

[PsyDr]

Back when I was considering an academic career, I emailed dozens of psychologists in non-psych departments. Not an incredible return, but those that answered indicated that their research and networking were key.

 

[deleted343839]

In addition to sleep, I have a background and future clinical interest in hospice / palliative care. There seem to be a lot of relatively unexplored applications of sleep medicine in terminal illness / primary care / hospital settings that I will be writing up as a review paper for publication during my preliminary exams. I'm not sure if anyone on SDN does therapy with grief and end-of-life issues? From what I've looked into so far, it seems the majority of these therapists are licensed social workers rather than Ph.D.-level clinical psychologists, although I could definitely be wrong.

Sounds interesting. End-of-life care is not my main area but I do some of this in my AMC-based practice. I agree with your perception that the predominant front-line mental health providers are social workers, and there are several reasons for this. Happy to chat privately if you want.

 

[Ollie123]

Social work and nursing both do quite a bit of palliative care work. Cancer centers also do a fair amount of this work and can be great places to be as psychologists (usually a good blend of pay, resources and usually not 100% soft money like psychiatry often is).

That said, insomnia is highly comorbid with friggin everything. Heck its a listed symptom for half the bread and butter psychology cases and a side effect of medications used to treat the rest. Plus new research is raising interesting questions about our understanding of cause and effect between the two. If you aren't dead set on making sleep your sole focus (and the risks/limitations that go along with that), you could specialize in pretty much anything else and still do a fair amount of sleep work with some extra training/support.

 

[AcronymAllergy]

Social work and nursing both do quite a bit of palliative care work. Cancer centers also do a fair amount of this work and can be great places to be as psychologists (usually a good blend of pay, resources and usually not 100% soft money like psychiatry often is).

That said, insomnia is highly comorbid with friggin everything. Heck its a listed symptom for half the bread and butter psychology cases and a side effect of medications used to treat the rest. Plus new research is raising interesting questions about our understanding of cause and effect between the two. If you aren't dead set on making sleep your sole focus (and the risks/limitations that go along with that), you could specialize in pretty much anything else and still do a fair amount of sleep work with some extra training/support.

+1000. I can probably count on one hand the number of patients I've seen in the last year who didn't report some degree of sleep disturbance. Of those who were having difficulty sleeping, I'd imagine just about every single one of them could've benefited from BSM-oriented interventions. If you can tack that type of training/expertise on top of something else, I'd imagine you could make yourself very marketable.

 

[bmedclinic]

Thanks for the reply bmedclinic. I'm on the BSM listserv as well. Largely research postdoc positions and I haven't seen a true BSM clinical position over the past few months.

If you don't mind sharing, are you in academic medicine doing research on sleep-related topics? It's always helpful for me to get more insight into what professions other clinical psychologists with an interest in sleep medicine have settled on.

Nope. I love research, but I'm straight up clinical in terms of full time job. I'm transitioning back into full time health psych as we speak. Pain /sleep mostly. I really really really want to get a primary care psych practice up and running, but there are so many barriers, and its really hard to get a foothold in. Where I used to live I had the contacts to potentially make that happen. But I live where I came for postdoc and so not having the same contacts and PCPs that arent as familiar with integrated primary care has set me back a bit. My goal for a primary care psych practice might take a few years, and I might amend my goals to get my ABPP first.

Feel free to PM me and we can chat more. I've also thought about joining a local practice and using them to help me set up a few days of CBT-I work and a few more days of integrated primary care. Twice now I've chatted with local established practices, and I leave uncertain that they truly grasp what I'm going for, and kinda feel like they're agreeing with me to get me to join their practice. And that makes me nervous.

 

[WisNeuro]

+1000. I can probably count on one hand the number of patients I've seen in the last year who didn't report some degree of sleep disturbance. Of those who were having difficulty sleeping, I'd imagine just about every single one of them could've benefited from BSM-oriented interventions. If you can tack that type of training/expertise on top of something else, I'd imagine you could make yourself very marketable.

I'd say 2 in 10 of my patients actually says they are sleeping well, and one of those two usually has sleep apnea and doesn't use their CPAP/BiPAP/Provent and just doesn't know how poorly they actually are sleeping

 

[AcronymAllergy]

I'd say 2 in 10 of my patients actually says they are sleeping well, and one of those two usually has sleep apnea and doesn't use their CPAP/BiPAP/Provent and just doesn't know how poorly they actually are sleeping

Yep, and those rates are (unfortunately) even better than mine. The primary care folks here are pretty great about referral patients for sleep studies if they suspect even a hint of apnea, but treatment adherence can be spotty for various reasons.

And yeah, plenty of folks (myself included, at times) don't realize just how poor their sleep habits actually are, even after reviewing basic sleep hygiene principles during feedback.

 

[CircadianSleep]

These replies are all extremely helpful. Tacking on BSM to more general clinical skills may be a great way to go.

I'm planning on getting practicum experience in an oncology unit (pediatric is the only population offered at my training site), sleep medicine clinic (CBSM clinical psychologist there who I worked with a lot as a post-bac), chronic pain center, and will decide between a general care clinic to get broad training and a VA site to get experience working within the VA system. My advisor highly recommends getting at least some VA experience for my future internship applications. Any input on these tentative decisions would be helpful.

Cancer may provide an ideal mix of my interests in sleep and end-of-life care / terminal illness. Anyone here do practicums or have other experiences working with cancer patients and their families?

 

[erg923]

These replies are all extremely helpful. Tacking on BSM to more general clinical skills may be a great way to go.

I'm planning on getting practicum experience in an oncology unit (pediatric is the only population offered at my training site), sleep medicine clinic (CBSM clinical psychologist there who I worked with a lot as a post-bac), chronic pain center, and will decide between a general care clinic to get broad training and a VA site to get experience working within the VA system. My advisor highly recommends getting at least some VA experience for my future internship applications. Any input on these tentative decisions would be helpful.

Cancer may provide an ideal mix of my interests in sleep and end-of-life care / terminal illness. Anyone here do practicums or have other experiences working with cancer patients and their families?

Veterans don't know how to sleep. I'm convinced they must train it out of you in basic. Yes, get VA experience.

 

[Therapist4Chnge]

My advisor highly recommends getting at least some VA experience for my future internship applications. Any input on these tentative decisions would be helpful.

Solid advice. The VA is the largest single employer of psychologists, they regularly embed psychologists into primary care (prob the best catchment area for sleep disorders), and there is a lot of opportunity to move within the system.

Cancer may provide an ideal mix of my interests in sleep and end-of-life care / terminal illness. Anyone here do practicums or have other experiences working with cancer patients and their families?

Sleep is a huge problem w. multiple pt populations. You can also look at rehab populations (TBI, SCI, etc), which now often includes cancer. There is a split between palliative for terminal cases and acute in-pt rehab for other cases, though in an AMC setting you might be able to see both.

 

[Peacemaker36]

Looks like the demand for BSM is about to increase....
https://www.statnews.com/2016/05/02/insomnia-psychotherapy/

 

[deleted343839]

We'll see. They've been banging that drum for a while now. The evidence is on their side, but most systems aren't prepared to deliver.

 

[Neuro244]

What would be the best route to pursue if I'm very interested in becoming a sleep psychologist. I know one must obtain a Ph.D. in Clinical Psychology, then secure an APA accredited internship. Afterwards, however, how long is a post-doc for someone interested in sleep psychology and BSM?

What would be the step by step process to becoming a sleep psychologist, and what are the anticipated job prospects like if I plan on graduating from the program (will be applying this year), in 2023? What is the current demand for sleep psychologists?

Any foundational information on this path, as well as the best steps to take to increase success, job prospects, salary, and recognition in this field would be HIGHLY APPRECIATED.

Thank you very much, and a steadfast response would be appreciated.

 

[WisNeuro]

I'd be looking to become a clinical psychologist with a specialty in health psychology. Within that, you can focus on sleep stuff, but having the broader health psych training will give you more career flexibility. Not too many jobs for someone who does 100% sleep work, but plenty of jobs for health psychologists who do a fair amount of sleep work.

 

[Neuro244]

I'd be looking to become a clinical psychologist with a specialty in health psychology. Within that, you can focus on sleep stuff, but having the broader health psych training will give you more career flexibility. Not too many jobs for someone who does 100% sleep work, but plenty of jobs for health psychologists who do a fair amount of sleep work.

What exactly does a health psychologist do vs a sleep psychologist? Do they do more CBT/psychotherapy than the typical sleep psychologist?
Also, on a side note, can you pursue neuropsychology in relation to sleep disorders/dreams and things of that nature? I've been thinking up until now of pursuing neuropsychology as I've been doing research on it, but it seems like my research interests wouldn't line up with many of the professors in a clinical Psych Ph.D. program. I'm interested in altered states of consciousness in the realm of REM sleep/non-REM sleep, I'm fascinated by lucid dreaming/dreaming, sleep paralysis, and effects of meditation on sleep and dreaming. Given these interests, I want to do something clinical, and I'm afraid the neuropsych route wouldn't allow me that intellectual/personal satisfaction during my Ph.D. studies. What's your opinion on all this WisNeuro since you're a board certified neuropsychologist?

 

[WisNeuro]

Pursuing a Career in Health Psychology

It's more that sleep medicine as a psychologist practices it, is pretty much subsumed under health psychology. There are some health oriented people on here that may be able to chime in with more nuance than I.

As far as the neuro part, you can do neuro related research with sleep, sure. But, what you describe doesn't need specific neuropsych training to do, it sounds more like general research. Could be clinical psych, but I'd also explore some experimental psych/neuroscience leads if that's what you are interested in. The bigger question would be, what do you want to do as a career? What would your day to day work life look like? That is going to influence which paths you should pursue, to an extent.

 

[Neuro244]

Pursuing a Career in Health Psychology

It's more that sleep medicine as a psychologist practices it, is pretty much subsumed under health psychology. There are some health oriented people on here that may be able to chime in with more nuance than I.

As far as the neuro part, you can do neuro related research with sleep, sure. But, what you describe doesn't need specific neuropsych training to do, it sounds more like general research. Could be clinical psych, but I'd also explore some experimental psych/neuroscience leads if that's what you are interested in. The bigger question would be, what do you want to do as a career? What would your day to day work life look like? That is going to influence which paths you should pursue, to an extent.

I want to be able to do clinical research as well as see patients on a daily basis. I want to have the freedom of being able to fulfill my research interests in graduate school and carry that over into my clinical practice (whether I work for a sleep lab/clinic, interdisciplinary team, VA). The thing with neuroscience Ph.D. is that sure you can do research in that, but your options after graduating at that point are more than likely tenured professorships which from what I've been reading, are extremely rare and have horrible prospects nowadays, and being a researcher. Neither of those have a solid future in terms of job stability, job prospects, salary, and opportunities. I have to find a balance for myself in terms of interest and in terms of something that's practical in the sense that I could practice. Research doesn't pay jack **** (pardon my french), and neither does being a professor. I need a middle ground that allows me to study what I love and makes a decent salary (90-110k). I know that with neuropsychologists, are higher up on the salary scale, and honestly, if I go down that route it's NOT for the money. Sure money is a plus, but I love studying the brain and seeing how people behave. You get paid a decent amount (I live in California) and you study what you like. On a daily basis however, I think sleep medicine would appeal more to me than administering a battery of tests (although I have yet to shadow either one of these fields), but I can only imagine. So overall, I'm looking to be able to pursue my deepest research interests during grad school, but also come out with a clinical job that involves sleep, dreams, consciousness, sleep disorders, and things of that nature. I think BSM through psychology would be the best blend, but please correct me if I'm wrong. The salary of these professionals, however, isn't sustainable (entry level 75k? Am I right or wrong?) in a place like California.

 

[WisNeuro]

For what you want, it sounds like you'll be in a primarily clinical position with an opportunity to do research that is part of that clinical practice. It's going to be hard to find some of the research avenues that you want (e.g., altered states) as they are more experimental and not part of clinical care currently. Also, no one really does dream work anymore. Liek I said, someone who does helath or sleep stuff can chime in, but I have yet to meet anyone who does 100% sleep work. Rather, most psychologists that I interact with who do some sleep work, do it as part of their broader job in health psychology. Not saying those 100% jobs don't exist, just that they are not plentiful.

As an aside, Neuropsychology isn't about just "administering" a battery of tests. We kind of hate it when people say that. Plus, many of us have psychometrists and trainees who do most of the testing. The test administration is like 5% of what it means to be a neuropsychologist.

 

[Neuro244]

For what you want, it sounds like you'll be in a primarily clinical position with an opportunity to do research that is part of that clinical practice. It's going to be hard to find some of the research avenues that you want (e.g., altered states) as they are more experimental and not part of clinical care currently. Also, no one really does dream work anymore. Liek I said, someone who does helath or sleep stuff can chime in, but I have yet to meet anyone who does 100% sleep work. Rather, most psychologists that I interact with who do some sleep work, do it as part of their broader job in health psychology. Not saying those 100% jobs don't exist, just that they are not plentiful.

As an aside, Neuropsychology isn't about just "administering" a battery of tests. We kind of hate it when people say that. Plus, many of us have psychometrists and trainees who do most of the testing. The test administration is like 5% of what it means to be a neuropsychologist.

Right, I apologize if I didn't clarify, because I know that you guys do more than just do assessments. It's not easy becoming a board-certified neuropsychologist, and I'm not saying that you guys are simply doing that on a daily basis. In regards to practicing in sleep medicine, if you're only doing that for a portion of your time, what would you be doing as a health psychologist when you're not focusing on that?

Thanks

 

[PsychPhDone]

Sending @AquaticSunrise13 a PM.

 

[deleted343839]

What exactly does a health psychologist do vs a sleep psychologist? Do they do more CBT/psychotherapy than the typical sleep psychologist?

Breadth versus depth:

Clinical Health Psychology
Sleep Psychology

I want to be able to do clinical research as well as see patients on a daily basis.

Most people who are interested in research and practice find that they need to choose one to be their main professional activity, and can do the other on a lower/less productive level on the side. The reality is it's really hard to do both well at once and sustain that level of performance long term.

So overall, I'm looking to be able to pursue my deepest research interests during grad school, but also come out with a clinical job that involves sleep, dreams, consciousness, sleep disorders, and things of that nature.

Sleep disorders, yes. Everything else, I'm not sure what you could do with that to generate income. As WisNeuro said, dream work is pretty limited (with the exception of treating nightmares related to PTSD).

I think BSM through psychology would be the best blend, but please correct me if I'm wrong. The salary of these professionals, however, isn't sustainable (entry level 75k? Am I right or wrong?) in a place like California.

Salaries vary depending on the type of setting, geographical location, and other factors beyond the specialty. You could have a niche practice treating sleep disorders but this would require: (1) a solid network of referral sources, (2) really knowing what you're doing (which could possibly require leaving California for some period of your training), and (3) having some other skills to generate income when the referrals are slow or insufficient to sustain a full-time practice.