Behavioral Sleep Medicine

[Manicsleep]

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Is BSM only for non physicians.
Someone was saying this on another forum. If so when did this happen?

Also, should therapy be directed at sleep hygiene? Or should we only give handouts and say therapy (CBT for example) and sleep hygiene are two separate entities?

Paging Dr. Rack.

 

[danielmd06]

I'm not Dr. Rack obviously but...

At my fellowship, we get trained (modestly) in behavioral sleep...specifically for pediatrics. I see no reason why you COULDN'T do it if you wanted to. Emphasis on the last three words. Certainly, it's within the purview of a psychologist and you could refer to one if you wanted.

Mostly, my clinic for this involves limit-setting and rule-setting type algorithms (and yes, sleep hygiene handouts) with follow-ups in 2-3 weeks to review effectiveness.

 

[michaelrack]

http://sleepdoctor.blogspot.com/2008/03/growing-threat-from-psychologists.html

http://sleepdoctor.blogspot.com/2008/03/behavioral-sleep-medicine-who-should.html

Several years ago there was an attempt by some psychologists to require AASM-accredited sleep centers to have a doctoral level person (phd or MD) certified in behavioral sleep medicine on staff.
I was on the AASM Behavior Sleep Medicine Comm at the time, and was the only physician member of the committee. I fought against this requirement, which never was passed by the AASM board of directors.

Previously both MD's and PhD's obtained the AASM Behav Sleep Medicine Certification. The certificate and exam has been taken over by the old American Board of Sleep Medicine. Here is a list of those who hold the certificate:
http://www.absm.org/BSMSpecialists.htm

The current ABSM Behav Sleep Medicine exam/certification is primarily for non-physicians (primarily psychologists). See paragraph one:
http://www.absm.org/Documents/BSMExamEligibilityCriteria.pdf
I am not sure, but I believe that a non-sleep specialist psychiatrist could be eligible to take this exam.

 

[michaelrack]

Sleep hygiene should be a part of most treatments of insomnia (pharmacological or psychotherapy). In other words, we should be doing things like asking about caffeine use whether we are prescribing ambien or doing sleep restriction therapy.

Sleep hygiene education is a necessary but usually not sufficient component of the treatment of insomnia. If you want to call it "therapy", I have no problem with it. I wouldn't call sleep hygiene education ALONE CBT.

 

[Manicsleep]

Again, I think you are missing the point about sleep hygiene education vs therapy aimed at sleep hygiene.

I am not calling sleep hygiene education "therapy." No psychiatrist would...at least no psychiatrist who knows what they are doing.

 

[watto]

I don't want any MD's to waste their time filling out the application (as I did). I was told by the director of the program that MDs were not eligible. My mentor, who knows some of the committee members personally, wrote letters on my behalf and the word that came down was that MDs were specifically not eligible to sit for the formal exam. Oh well. Felt like a turf thing to me. Which seems odd when people are waving their hands around about the lack of people certified in behavioral sleep med.

 

[michaelrack]

Again, I think you are missing the point about sleep hygiene education vs therapy aimed at sleep hygiene.

I am not calling sleep hygiene education "therapy." No psychiatrist would...at least no psychiatrist who knows what they are doing.

I think I understand what you are saying now. From what you posted in the psych forum, it sounds like you are doing some cognitive work and using some behav techniques on your pts w insomnia- basically doing CBT.

 

[lidocayne]

Interesting. I am an MD, fellowship trained in sleep (along with pulmonary and critical care). After I finished fellowship, my program director asked if I wanted to sit for the BSM exam as well (where I trained was an accredited BSM program as well as AASM, which may be the difference in where watto trained vs where I trained).

I chose not to sit for the exam, only because I did not want to be pigeon-holed in to seeing primarily insomnia patients (which would happen if you were BSM certified). The other sleep MDs would get the OSA (read: PSG generating patients), you'd be stuck with the insomniacs (most of whom don't require a PSG) and as a result your revenue generated would be much lower (and don't let anyone fool you, the revenue you generate is watched, and directly tied to your future compensation).

Knowing I have the knowledge to appropriately treat a patient with insomnia and that I know the nuances of how to treat said patients is a valuable thing to have in your back pocket, but once you hang up that BSM certificate, be prepared to see a paradigm shift in your patient population. Once the word gets out that there is a BSM certified insomnia treating MD, it will dominate your practice (if you don't control the number you're willing to see).

I'd let the PhD's win this 'battle'. See a few here and there to keep your skill set up to date...

 

[bmedclinic]

Dr Rack-
What I heard from a sleep psychologist as of last week is that the AASM is now rapidly moving towards requiring a behavioral sleep specialist for accreditation. Have you heard anything in this regard?

 

[Manicsleep]

Does anyone actually do actigraphy on a regular basis and get reimbursed?

 

[michaelrack]

Dr Rack-
What I heard from a sleep psychologist as of last week is that the AASM is now rapidly moving towards requiring a behavioral sleep specialist for accreditation. Have you heard anything in this regard?

as the sole md on the AASM BSM committee, I fought against this a few yrs ago. the comm was disbanded and I don't know what is happening now.

 

[Bobblehead]

as the sole md on the AASM BSM committee, I fought against this a few yrs ago. the comm was disbanded and I don't know what is happening now.

That would be quite a coup for the psychologists to force their way into every sleep lab in the nation. Let's hope some sense prevails.