Careers in Sleep Medicine for Psychiatrists

A reader asks:
I have a question about joining the real world as a psychiatrist and sleep physician. It seems everyone is geared toward pulm/cc guys. I think I will have some benefit with a wife in a gen med practice but only if I open up my own practice. Are there jobs out there for regular shrinks?

The number of pure sleep medicine jobs has decreased over the last several years, but there are some 100% sleep medicine jobs out there that are open to all the underlying sleep medicine specialties. You can find out about these opportunities on the AASM website, the sleep journals, and the websites of recruiting firms like locumtenens.com and MDJobsite.com.

Another possibility is starting your own sleep lab. Check out the ads in Sleep Review for companies that you can hire/partner with to assist in this process.

Another possiblity is taking a psychiatry job with a hospital that has a sleep lab and make it a condition of your employment that you can read (and get paid for) the patients you refer to the lab.

Check out the Sleep forum on the Student Doctor Network for more ideas.

Treating Resistant Insomnia

I posted this on the Medscape message boards today:
I see a lot of pts who have failed the standard hypnotics (Rozerem, Ambien, Ambien CR, Lunesta, Sonata). It's important to screen for secondary causes, including restless legs. If they haven't taken Restoril yet, that's sometimes effective. I have found chloral hydrate effective for short term use (no more than 1 month), for breaking the cycle of insomnia. I have one patient on Xyrem for insomnia (and several who take it for narcolepsy). Before prescribing xyrem, it's important to rule out obstructive sleep apnea. I'll occasionally use Seroquel for insomnia, but only if there is comorbid psychiatric illness. I'll also sometimes use neurontin, but usually only if there are also neuropathic/RLS symptoms present.