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leep medicine is a new specialty in the overall domain of medicine. Since the
discovery of REM sleep by Aserinsky and Kleitmann in 1956, it became more and more obvious that
conventional medicine is considered mainly as "daytime medicine", which is definitely different from
"night medicine". Since then, sleep medicine has been expanded scientifically on a large scale. The
International Classification of Sleep Disorders (ICSD 1990) now makes it possible to diagnose 80
different sleep-wake disorders. Today, more than 90 sleep laboratories in Germany are able to perform
the full differential diagnostic procedure. In 1987, experts in sleep medicine joined together to
found the "Association of Clinical Sleep Medicine" (Arbeitskreis Schlafmedizin) that was converted
into the "German Sleep Society" in 1992.Since it is composed of many different sub-specialties, sleep medicine requires interdisciplinary interaction with regard to diagnostic procedures and therapy. Taking this into account, the board of the society is composed of six representatives covering the areas of internal medicine, pneumology, neurology, psychiatry, psychology and physiology. The active members are organized into 12 different task groups which elaborate and carry out recommendations concerning technical, diagnostic and therapeutic standards. According to a study by the HUK Association, 25% of road casualties on Bavarian highways in 1991 were caused by drivers falling asleep at the wheel. These figures do not surprise experts. On the one hand, other industrialized countries have obtained similar results in their findings; on the other hand experts have known for a long time that health disorders with daytime sleepiness are occurring more frequently than the general public believes. Whereas difficulties with night-work or shift-work happen to be an issue, there is insufficient information available about fatigue with decreased performance in people doing monotonous monitoring and control work. Sleep-wake syndromes, which need to be treated urgently, are present in more than 10% of our population, among them 800 000 patients with obstructive sleep apnea and 25 000 patients with narcolepsy. Only a fraction of these disorders are recognized in time. Every year, indirect costs of up to billions of dollars are caused by sleep disorders which are not diagnosed, and are therefore not treated. A lot of money could be saved with the help of sleep medicine. Early retirements for instance, being very cost-intensive factors and producing costs of up to 300 000 DM p. a., could be avoided. Sleep-wake disorders require special methods with regard to diagnosis and therapy. Only specialized sleep laboratories are able to offer adequate treatment. Although numerous sleep laboratories have been built up in Germany during the last 20 years, patients have to wait at least 6 months because of the great demand. To combat this poor state of affairs many self-help groups have been founded in the recent years by patients with sleep disorders. In 1987, experts in sleep medicine, who are engaged in clinical and scientific research, joined together to found the "Clinical Sleep Centres Association" (Arbeitskreis Klinischer Zentren) that later changed into the "German Sleep Society". In 1984, the Society of Pneumology had already founded a workpackage "Nocturnal Breathing and Circulation Disorders" (Arbeitsgruppe Nächtliche Atmungs- und Kreislaufregulationsstörungen, AGNAK). As scientific representatives of sleep medicine, members of the "Workpackage Scientific and Medical Association" (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) promote the process of putting results from the latest research into practice. This could help to reduce subsequent costs in the social and economic sector, and might possibly help to prevent disasters which can often be put down to sleep disorders. There are many studies proving that excessive sleepiness of the controlling staff is the main cause of accidents, such as in Chernobyl or at Hoechst.
T. Penzel, Universität Marburg
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