Who are the Sleep Medicine professionals?
Sleep science relies on professionals from different fields, united in order to increase the quality of life of patients who suffer from sleep disorders. To this end, they are based on the specific skills of their objects of study. In this article we discuss which are the specialties, inside and outside Medicine, that contribute to such a relevant science to human health: Sleep Medicine. Learn more below.
Brief history of Sleep Medicine
Sleep has been described in literature since Hippocrates (460 BC). However, sleep medicine is a relatively recent science. The scientific approach to sleep begins in 1830, with the first descriptions of narcolepsy cases.
The first center focused on the study of sleep was created in 1970, in Stanford, USA, to treat narcoleptic patients. Since then, thousands of study centers dedicated to sleep have been created around the world.
In 1990, the specialty went global due to the elaboration of the International Classification of Sleep Disorders (ICSD), which has the contribution of doctors from all over the world to discuss studies and discoveries related to more than 80 sleep disorders described in the medical literature.
Thus, in just over two decades, an interdisciplinary specialty has emerged whose objective is to increase the quality of life through the promotion of quality of sleep.
An essential biological necessity, sleep is one of the pillars of human physical development and mental functions. Its deprivation causes changes in the biological rhythm and causes countless problems, such as memory loss, irritability, fatigue, mood changes, psychopathological manifestations, among others. Therefore, when there is a change in sleep, the causes must be investigated immediately. This is the purpose of Sleep Medicine.
Sleep disorders require analysis by professionals from different areas, who are able to have an interdisciplinary approach when seeking the treatment choice that best suits each patient. As a result, Sleep Medicine has always been multidisciplinary, since its object can only be understood from multiple perspectives. The area involves pulmonologists, neurologists, otorhinolaryngologists, surgeons, physiotherapists, dentists, among other various specialties that we will see below
A área envolve pneumologistas, neurologistas, otorrinolaringologistas, cirurgiões, fisioterapeutas, dentistas, entre outras várias especialidades que veremos abaixo.
Sleep disorders consist of changes in the rhythm and quality of sleep, whether due to brain, respiratory, anatomical changes or movement disorders.
Currently, to group sleep disorders, the 3rd edition of the International Classification of Sleep Disorders (ICSD-3) is used, which brings them together in the following categories:
- insomnia disorders;
- respiratory disorders related to sleep (obstructive sleep apnea, snoring);
- central hypersomnia disorders (narcolepsy, hypersomnia);
- disorder of sleep-wake circadian rhythm (delayed and advanced stages of sleep, irregular sleep-wake);
- parasomnias (somnambulism, NREM sleep parasomnias, night terror, nightmares);
- movement disorders related to sleep (restless legs syndrome, bruxism); and
- other sleep-related medical and neurological disorders and conditions.
Who are the Sleep Medicine professionals?
Each of the sleep-related pathologies is due to a combination of factors related to breathing, facial shape, psychological state, among others. For this reason, Sleep Medicine is an interdisciplinary area and has several professionals who work in the management of these patients.
In Brazil, Sleep Medicine is very well-structured. In the medical field, after primary education and residency, the professional who opts for the area undergoes a specialization in Sleep Medicine, whose access is made possible through Pneumology, Neurology, Psychiatry, Cardiology, Pediatrics and Otorhinolaryngology.
Professionals from other backgrounds, such as psychologists, physiotherapists, dentists and speech therapists, also contribute to sleep medicine and work with doctors to treat sleep disorders. Next, we will see how each of these specialties and training contributes to Sleep Medicine.
Most sleep disorders are classified as sleep-disordered breathing. Obstructive sleep apnea syndrome (OSAS) is one of the most common complaints among these disorders and is characterized by recurrent upper airway obstruction events, which can be partial (hypopnea) or complete (apnea).
The interruption of air in the lungs results in a drop in oxygen and an increase in carbon dioxide in the blood. As they are directly related to pulmonary and respiratory functioning, pulmonologists are essential in the management of patients with these symptoms.
These professionals assess lung capacity and airways, request complementary exams (such as polysomnography) and refer the patient to the appropriate treatment, in view of the patient’s respiratory situation.
All sleep disorders can cause a decrease in concentration and memory in the long run. The degenerative consequences of poor sleep quality are the subject of a study of Neurology, which assesses how the lack or excess of sleep can interfere with the proper functioning of brain capacities.
In addition, a curious correspondence between sleep disorders and degenerative diseases has been studied in recent years. Evidence from preliminary studies suggests that circadian rhythm disorders, in addition to being a symptom of neurodegeneration, may also be a potential risk factor for the development of Parkinson’s disease, Alzheimer’s disease and related dementias.
Through this association, Neurology is of central importance in the management of patients with these comorbidities, since the neurology specialist will be able to assess, from specific exams, the relationship between the functioning of the patient’s brain and the quality of sleep.
Thus, specialized treatment can cover not only symptoms related to sleep, but also neurological causes and consequences of the patient.
The identification of altered sleep patterns is notable in most psychiatric disorders. Among psychiatric patients, 40% report insomnia, and 46% of patients with hypersomnia meet the criteria for the diagnosis of psychiatric disorders.
About 80% of patients with depression complain about changes in sleep patterns. Initial insomnia is frequent in cases of associated anxious and manic symptoms. In addition, many psychiatric drugs are also responsible for changes in circadian rhythm.
For this reason, the psychiatrist is one of the professionals responsible for treating insomnia, hypersomnia and night terror disorders, examining the patient’s medical history and previous conditions that are risk factors for these maladjustments, in addition to evaluating the use of psychiatric drugs that can interfere with the patient’s sleep patterns.
Patients with cardiovascular diseases have a high prevalence of sleep disorders. Conversely, insomnia and obstructive sleep apnea, in addition to causing symptoms such as tiredness and excessive daytime sleepiness, are also risk factors, especially if associated with systemic arterial hypertension or diabetes mellitus, for problems such as high blood pressure, high cholesterol and arrhythmias.
Thus, in Sleep Medicine, Cardiology is the specialty that assesses the cardiovascular consequences of poor sleep quality. If the patient has risk factors related to cardiac health, he must undergo an evaluation with the cardiologist in order to analyze the treatment options considering the patient’s specificities.
Sleep disorders are very prevalent in the pediatric age group. There is a high incidence of disorders such as sleepwalking, night terror and nightmares in pediatric patients. It is estimated that 30% of children have some sleep disorder, and this prevalence is even higher among children with neuropsychiatric comorbidities.
In addition, sleep disorders also increase the risk of the appearance of a series of metabolic and behavioral changes in this age group, which can lead to attention deficits, mood disorders, weight gain and even changes in neurodevelopment.
Thus, the pediatric doctor has a fundamental role in guiding sleep habits, as well as in the recognition, suspicion and management of possible disorders, as it is necessary to be able to analyze the routine and details of the family environment related to the child’s sleep, in addition to perform a clinical examination that considers the specificities of the child’s circadian rhythm and aspects of child development in sleep.
This specialty has a fundamental role in the treatment of sleep disorders linked to breathing. Respiratory disorders related to sleep, such as snoring and obstructive sleep apnea, are caused by airway obstruction, precisely the object of study in otorhinolaryngology.
For this reason, the physician specialized in otorhinolaryngology is the professional responsible for the diagnosis and monitoring of many patients with complaints of obstructive airway disorders, knowing how to assess whether the problems in question have a surgical indication or whether they respond better to conservative treatments, such as the use of continuous positive airway pressure (CPAP) or intraoral devices.
Nasal and pharyngeal surgeries, as well as mandibular advancement and at the base of the tongue, can solve this category of problem. In case there is a need for surgery, the otorhinolaryngologist is the one who performs this type of intervention.
In addition to medical research, sleep disorders require different treatments that involve everything from the maxillary structure to factors such as the position of the tongue and related comorbidities, for example, mood disorders. We will see, next, what are the other areas of knowledge that work in the management of patients with sleep disorders.
Psychologists are great allies in the treatment of insomnia, night terror and nightmares. Combined with medical interventions, psychology has a fundamental role in the management of patients who suffer symptoms of circadian rhythm, because cognitive-behavioral therapy (CBT), relaxation techniques and sleep hygiene can often reverse the psychological manifestations related to anxiety and psychiatric disorders.
For insomnia, for example, cognitive-behavioral therapy is currently the most indicated treatment in association with pharmacological therapy. CBT consists of helping the patient to restructure his thoughts and modify inappropriate habits in relation to sleep. Often, the technique can reduce or suppress the need for drug interventions in the patient.
The physiotherapist works in different ways in the sleep area, both in clinical practice and in research. They are in charge of the identification and treatment of non-respiratory (insomnia and restless legs) and respiratory disorders. The best known approach to physiotherapy in Sleep Medicine concerns the treatment of obstructive sleep apnea.
From the knowledge of the pathophysiology of the respiratory system, the physiotherapist is the most suitable professional to accompany the treatment with CPAP ventilation equipment, guiding and adapting the patient throughout this therapy.
In addition, the physiotherapist with a specialization in Sleep Medicine is able to perform and read exams such as polysomnography and polygraphy.
Among the most common pathophysiology in sleep disorders are respiratory disorders, such as snoring and apnea.
The cranio-maxillofacial evaluation of the patient is essential for referral to the most appropriate treatment for these disorders, as it provides for the identification of dentofacial changes, very prevalent in patients with obstructive sleep apnea.
Dentists can opt for orthodontic treatments, facial orthopedics, skeletal surgery or make intraoral devices that aim to improve the patient’s breathing conditions during sleep.
In addition, the dentist is the professional indicated for the treatment of bruxism, evaluating the need for making temporary occlusal plaques, applying specific medications for the treatment of bruxism and other treatments.
The relationship between changes in structures and functions of the stomatognathic system in individuals with sleep-disordered breathing is well known by speech therapists.
These professionals are responsible for identifying facial motricity changes, frequent in mouth breathing children and adults with obstructive sleep apnea, and perform a work of muscle and functional adaptation of the breath in order to increase the space in the pharynx and decrease the obstruction of the passage of air. Speech therapy exercises are able to reduce snoring frequency by 36% and its intensity by up to 59%, reduce the rate of awakenings and promote increased tongue strength.
Os exercícios fonoaudiológicos são capazes de diminuir a frequência do ronco em 36% e a sua intensidade em até 59%, reduzir o índice de despertares e promover o aumento da força da língua.
Sleep Medicine: an integrative science
As we have seen, the integration of several specialties is fundamental for Sleep Medicine, since the disorders linked to it are often the cause or consequence of other pathologies studied by these specific areas.
Together, professionals from different areas work in the prevention, diagnosis and treatment of patients and make a difference in promoting the improvement in the quality of life of people who suffer from poor sleep quality all over the world.
Science advances in the development of new treatments for these disorders every day, and this is thanks to the combination of perspectives in sleep studies. The technological equipment that we have today exists due to the union of these areas. Thus, today it is possible to understand sleep more deeply.