ABIM Sleep Medicine study guide
ABIM Sleep Medicine · Work through your exam, one topic at a time.
The ABIM Sleep Medicine certification exam is a subspecialty examination for physicians who already hold a primary board certification and want formal recognition of expertise in sleep and sleep-wake disorders. Candidates typically come from pulmonary, neurology, psychiatry, internal medicine, pediatrics, otolaryngology, and family medicine backgrounds, and most have completed a dedicated sleep medicine fellowship or accumulated substantial clinical sleep experience. The ABIM Sleep Medicine study guide has 10 sections and about 3,019 words.
01Normal Sleep and Sleep-Wake Regulation
Sleep is organized into NREM (N1, N2, N3) and REM, cycling roughly every 90 minutes, with N3 front-loaded in the night and REM back-loaded toward morning. N1 is a transitional state with slow eye movements and attenuation of alpha; N2 is defined by sleep spindles and K-complexes; N3 requires at least 20% slow-wave (0.5-2 Hz, 75 microvolt) activity; REM shows low-voltage mixed-frequency EEG, rapid eye movements, and skeletal muscle atonia with preserved phasic twitches.
325 words, about 2 min02Insomnia
Chronic insomnia disorder is difficulty initiating or maintaining sleep, or early-morning awakening, with daytime consequences, occurring at least three nights per week for at least three months despite adequate opportunity for sleep. It is a clinical diagnosis; polysomnography is not required and is reserved for suspected comorbid disorders (apnea, periodic limb movements, or when the history is atypical).
309 words, about 2 min03Sleep-Related Breathing Disorders
Obstructive sleep apnea (OSA) is repetitive upper-airway collapse causing apneas/hypopneas with preserved or increased respiratory effort; central sleep apnea (CSA) reflects absent ventilatory drive (no effort). The apnea-hypopnea index (AHI) grades severity: 5-15 mild, 15-30 moderate, 30 severe.
303 words, about 2 min04Central Disorders of Hypersomnolence
Narcolepsy type 1 (NT1) requires excessive daytime sleepiness plus cataplexy and/or cerebrospinal fluid hypocretin-1 ≤110 pg/mL; narcolepsy type 2 (NT2) has sleepiness and abnormal MSLT findings without cataplexy or low hypocretin. Idiopathic hypersomnia (IH) causes sleepiness without the REM dysregulation of narcolepsy.
268 words, about 1 min05Circadian Rhythm Sleep-Wake Disorders
Circadian rhythm sleep-wake disorders arise from misalignment between the endogenous clock and the external environment or from altered clock function. Key types: delayed sleep-wake phase disorder (common in adolescents), advanced sleep-wake phase disorder (common in older adults), irregular sleep-wake rhythm (dementia, institutionalized patients), non-24-hour sleep-wake rhythm (frequently in totally blind individuals), shift-work disorder, and jet-lag disorder.
295 words, about 1 min06Parasomnias and Sleep-Related Movement Disorders
Disorders of arousal (confusional arousals, sleepwalking, sleep terrors) arise from N3, often in the first third of the night, with amnesia for the event and incomplete awakening. They are more common in children and may be triggered by sleep deprivation, fever, stress, or other sleep disorders (apnea, restless legs).
313 words, about 2 min07Sleep and Medical/Psychiatric Comorbidity
Sleep and medical/psychiatric illness interact in both directions. Depression is strongly associated with insomnia and with REM abnormalities (short REM latency, increased REM density); insomnia is a risk factor for incident depression and an independent treatment target.
313 words, about 2 min08Sleep in Special Populations (Pediatrics, Pregnancy, Aging)
Sleep architecture and duration change dramatically with development: neonates have polyphasic sleep with high REM proportion; slow-wave sleep is prominent in young children; sleep duration declines with age. Behavioral insomnia of childhood includes sleep-onset association type and limit-setting type; management is behavioral (extinction variants, bedtime routines).
294 words, about 1 min09Diagnostic Testing: Polysomnography, Home Sleep Apnea Testing, MSLT/MWT, Actigraphy
In-laboratory PSG records EEG, EOG, chin EMG, ECG, airflow, respiratory effort, oxygen saturation, body position, and limb EMG. It is the reference standard for OSA, central apnea, narcolepsy workup, parasomnias (especially RBD), and periodic limb movements.
315 words, about 2 min10Treatment: Behavioral, Pharmacologic, PAP and Other Devices, Surgical
CBT-I is first-line for chronic insomnia: stimulus control, sleep restriction, cognitive restructuring, relaxation training, and sleep hygiene education. Sleep restriction builds homeostatic pressure by limiting time in bed to actual sleep time, then titrating upward; stimulus control strengthens the bed-sleep association.
284 words, about 1 min