[Sleep medicine services in Germany].

The increase in sleep medicine services has paralleled the increased in nocturnal ventilation therapy in patients with sleep apnea. Even if the sleep medicine expertise did increase in the past, this is not sufficient to cover the increasing demand for sleep medicine services. To serve patients with nonrestorative sleep, a clinical algorithm showing the pathway from the clinical interview to sleep laboratory investigations is available. However, there is a gap in the services offered by family physicians, other medical specialists, and sleep medicine practitioners. For sleep apnea, the diagnostic process and therapy are established; however, for other sleep disorders such as insomnia, parasomnia, movement disorders, hypersomnia, and circadian rhythm disorders, this is not the case. A basic investigation for sleep disorders is attended cardiorespiratory polysomnography, which is not always essential. There is a network of qualified sleep centers for stationary and ambulatory care, but their work is becoming more difficult under increasing health care economic pressure. Sleep medicine needs a solid structural and financial basis to provide good coverage of high quality health care service. New sleep medicine service centers for ambulatory care with a better network structure linked with other medical specialties and with offers for preventive medicine can serve all patients with sleep disorders over long periods of time.