Pulmonology and sleep medicine are distinct specialties, although many sleep physicians have a background in pulmonology due to the overlap between breathing and sleep health. Pulmonology is a subspecialty of internal medicine focused on the respiratory system and its diseases. Sleep medicine is a multidisciplinary field addressing all disorders related to sleep, not just those involving the lungs. A physician must complete specialized, post-residency training to become certified in sleep medicine, regardless of their original specialty.
The Focus of Pulmonology
Pulmonology is the medical subspecialty dedicated to the anatomy, physiology, and pathology of the respiratory system. This includes the lungs, upper airways, chest wall, and respiratory muscles. Pulmonologists diagnose and manage a wide spectrum of disorders that affect a person’s ability to breathe.
Pulmonologists treat chronic inflammatory diseases like asthma and progressive conditions such as Chronic Obstructive Pulmonary Disease (COPD), which includes emphysema and chronic bronchitis. They also handle severe infections like pneumonia and complex conditions like pulmonary fibrosis, where lung tissue becomes scarred and stiff.
Pulmonologists frequently oversee patients in critical care settings, managing mechanical ventilation and respiratory failure. Their expertise extends to diagnosing and treating interstitial lung diseases and pulmonary hypertension. They use diagnostic tools like spirometry and pulmonary function tests to measure lung capacity and airflow. This focus on the mechanics of breathing creates the connection to certain sleep disorders.
The Broad Field of Sleep Medicine
Sleep medicine is a distinct medical specialty that examines biological, psychological, and physiological disorders disrupting the sleep-wake cycle. The field is multidisciplinary, drawing physicians from various specialties including internal medicine, neurology, psychiatry, and pediatrics. It addresses sleep-related issues that extend far beyond breathing problems.
Many conditions treated by a sleep medicine specialist do not involve the lungs. For example, insomnia, characterized by difficulty falling or staying asleep, is a common non-respiratory disorder. Another area is narcolepsy, a neurological disorder where the brain cannot regulate sleep-wake cycles, often leading to excessive daytime sleepiness.
Sleep medicine physicians diagnose and manage sleep-related movement disorders like Restless Legs Syndrome (RLS). They also treat parasomnias, which are unusual physical events that happen during sleep, such as sleepwalking or night terrors. Diagnostic tools include polysomnography (sleep studies), which monitor brain activity, eye movement, heart rhythm, and muscle activity to provide a detailed picture of sleep architecture.
How Pulmonologists Specialize in Sleep Disorders
A pulmonologist is only considered a sleep doctor if they complete advanced training and certification in sleep medicine. This requires completing a post-residency, one-year fellowship accredited by the Accreditation Council for Graduate Medical Education (ACGME). Pulmonology is a common feeder specialty for this fellowship, alongside neurology and internal medicine, due to the overlap in treating airway disorders.
The pulmonologist’s understanding of respiratory physiology makes them qualified to treat respiratory sleep disorders. The most common condition is Obstructive Sleep Apnea (OSA), which involves the physical collapse of the upper airway during sleep. Their expertise in airway pressure management is applicable to treating OSA with devices like Continuous Positive Airway Pressure (CPAP).
Pulmonologists also manage Central Sleep Apnea (CSA), a less common disorder where the brain fails to signal the muscles to breathe during sleep. CSA is often associated with medical issues like heart failure or stroke, requiring a physician with a broad internal medicine and respiratory background. After completing the ACGME fellowship, the physician can seek board certification in Sleep Medicine through the American Board of Internal Medicine (ABIM), formally recognizing them as a specialist.