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Pillows on a bed

As anyone who's pulled an all-nighter knows, few of life's pleasures equal a good night's sleep. And as research increasingly shows, getting enough Z's helps you perform better during the day, maintain a strong immune system and rebound from injury.

"Nearly every aspect of physical, emotional and cognitive functioning can be linked to sleep," says behavioral sleep medicine (BSM) specialist Valerie Crabtree, PhD, a pediatric psychologist at St. Jude Children's Research Hospital in Memphis. "It's really exciting to work in an area that is so important to so many different areas of functioning."

The mission of psychologists who specialize in BSM is to help anyone who has difficulty sleeping, including people with insomnia, people with sleep apnea and those for whom illness or pain impedes good sleep. BSM specialists also help parents deal with sleep-related problems that disrupt family life, such as children who wet their beds or teens who stay up all night and sleep all day. To treat their clients, BSM practitioners use specialized behavioral and cognitive techniques that normalize people's sleep schedules and condition them to see their bedrooms as restful places.

New research is illuminating just how damaging sleep problems can be, says BSM practitioner Robert Glidewell, PsyD, a postdoctoral fellow who interprets sleep studies and treats clients at the Lynn Institute of the Rockies, a private, nonprofit research organization.

"Scientists now believe it doesn't matter why you have disturbed sleep," Glidewell says. "If you're not getting enough sleep, you are a higher risk for a whole range of disorders," including hypertension, diabetes, heart disease, anxiety and depression. Indeed, studies show that having insomnia may increase the risk of developing depression and other psychiatric and medical illnesses.

Treating sleep disorders can, therefore, make an enormous difference in people's overall health and mental health-and bring psychologists more fully to the health--care table.


BSM is a tremendous practice opportunity because sleep problems are common--some 10 percent of people suffer from chronic insomnia alone--and top-trained practitioners are not, says Wilfred R. Pigeon, PhD, assistant director of the Sleep Research and Neurophysiology Laboratory at the University of Rochester Medical Center and chair of the American Academy of Sleep Medicine (AASM) BSM committee, which credentials BSM practitioners. Worldwide, there are just 115 certified BSM practitioners, who include psychologists, physicians, nurse practitioners and other health-care professionals.

As a result, the approximately 1,110 accredited sleep disorder centers in the United States are eager to find qualified practitioners, Pigeon says. Clinical psychologists are particularly well-equipped to provide BSM services because they're experts not only in the diagnosis and treatment of psychiatric disorders-which research shows can amplify sleep disorders--but also because of their training in client communication, behavioral assessment and evidence-based treatment, says Michael Perlis, PhD, who directs the University of Rochester's research and neurophysiology lab. Psychologists also are invaluable in sleep-disorder medicine settings because of their facility in program evaluation--a skill that insurance companies increasingly require for reimbursement, Perlis notes.


BSM-certified psychologists work in a variety of settings. Sleep disorder centers may be freestanding or housed in hospitals and medical centers. Psychologists can work there full- or part-time helping patients, conducting research or both. BSM can also be a regular part of a private practice: Some BSM psychologists have built relationships with sleep centers or primary-care practices that refer clients to them, for instance.

BSM-certified psychologists also work in academia, usually in affiliation with university medical centers. Research topics are rich and varied, Crabtree notes: "You can link just about any area to sleep," she says.


Earnings potential in BSM is excellent, especially if you're creative about it, says Perlis. While there are no hard data on salaries, a credentialed psychologist at a sleep center can expect to start at $60,000 to $80,000 a year, he says. You can boost your income by garnering research grants and giving talks. Psychologists also work as consultants, developing and evaluating programs for their effectiveness in treating patients and analyzing insurance-reimbursement rates. A recognized expert who performs a range of these services can earn up to $130,000 a year, Perlis says.

Academic research positions can be financially rewarding too, experts say. If you are connected with a medical center--which many BSM researchers are-expect to make 20 percent to 30 percent more than you would in an undergraduate psychology department, they say.


There are two paths to BSM certification, according to the AASM. One is to obtain 1,000 hours of direct BSM training and experience. The other is to accrue 500 hours of BSM training along with 500 hours of behavioral medicine training, which many psych students receive as a matter of course, Perlis notes. To gain BSM training experience, visit the AASM Web site (see box) for information on fellowship and internship programs, periodic trainings and workshops and the AASM's annual conference, to be held next in June 2008 in Baltimore.

Practitioners also recommend networking with experts, for example by joining BSM listservs (see box) and contacting BSM-certified practitioners in your area for information and training opportunities. That's how Glidewell landed his job.

Once you've finished your hours and after you've obtained your license, you're eligible to take the BSM exam, available once a year at the AASM conference.


Psychologists are drawn to the field because of sleep treatment's high success rates: Several studies show that 70 percent to 80 percent of clients with chronic insomnia, benefit from cognitive behavioral therapy for insomnia or CBT-I. Also attractive is that the treatments lack the side effects of many sleep medications, and they help people improve over time, says Ryan Wetzler, PsyD, director of behavior sleep medicine at Sleep Medicine Specialists in Louisville, Ky. Indeed, a 2005 National Institutes of Health consensus statement cited CBT-I as one of two top treatment choices for the condition, along with the sedative agent benzodiazepine receptor agonists.

"It's incredibly rewarding, because people get better, and they get better quickly," Wetzler says.

BSM practitioners also appreciate the interdisciplinary nature of the work, they say.

"Sleep medicine in general is very supportive and open and welcoming to people of multiple disciplines," Crabtree says. "As a result, psychologists integrate very well, and I've found we tend to be very well-respected and appreciated."

The field's challenging side is that despite the fact that BSM was founded by psychologists, few practice it and those who do often work alongside physicians who may not understand their skills and strengths, says Glidewell. So you may have to sell yourself. For example, he conducts bimonthly dinners and sleep seminars for physicians, educating them on aspects of sleep problems and how he treats them; he also sets up regular lunches with individual physicians to chat about his services.

But this trailblazing aspect appeals to some, who see it as an opportunity to spread the word of a proven treatment.

"While there are obstacles to the practice of behavioral sleep medicine, including a current lack of awareness, they are nothing that can't be overcome," Wetzler says. "I can't think of another area I'd rather practice in."


Tori DeAngelis is a writer in Syracuse, N.Y.

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