Welcome to Stony Brook Medicine’s Sleep Medicine Fellowship program!
Our one-year, multidisciplinary sleep medicine fellowship is one of the finest learning experiences available for a future sleep medicine practitioner. Our fellowship admits two sleep medicine fellows per year and considers applications from graduates of any three-year residency program. We have graduated fellows trained in internal medicine, neurology, pediatrics, family medicine and psychiatry. When considering our fellowship, one should focus on two important aspects of any learning experience in medicine. First, the structure of the experience, and second, the quality of the experience. In both aspects, the Stony Brook University Multidisciplinary Sleep Medicine Fellowship is exceptional.
The Structure
The one-year sleep medicine fellowship provides every fellow with a full year of exposure to both adult sleep medicine and pediatric sleep medicine. The experience occurs at the Stony Brook University Sleep Disorders Center in Smithtown, New York, and at the Nothport VA Medical Center in Northport, New York. Rather than have a segmented curriculum assembled from rotations through various disciplines, our fellowship exposes each fellow to every discipline, every week of the year. Two-and-one-half days a week are spent in adult sleep medicine and one day a week in pediatric sleep medicine at the University Sleep Disorders Center, and one day a week in adult sleep medicine at the Veterans’ Affairs Medical Center (see the Figure below). Our patient mix is a spectrum from upper income to lower income, from young children to the elderly, at every level of education from pre-school to graduate school and beyond, a cross section of the population of Long Island. In addition, our veteran population includes both individuals whose sleep complaints developed while in-service through psychological or physical trauma / exposure, as well as those whose sleep complaints developed after their service, as civilians.
An important feature of our fellowship is the important role of the fellow in the provision of care in Stony Brook University’s sleep medicine program. In every venue, the fellow is always the first provider to interact with the patient. The fellow obtains the medical history, performs the physical examination, and reviews the available data from previous evaluations before presenting the patient to the attending physician (usually in the patient’s presence). As the year progresses, the fellow is gradually given more freedom to formulate and manage the patient’s care.
One half day per week is dedicated to didactic sessions. The fellowship offers a core lecture series, a monthly journal club (each fellow presenting bimonthly), impromptu sessions with Dr. Gold on subjects the fellows choose, and research.
During the year, each fellow will receive training in a broad range of skills including polysomnography, multiple sleep latency testing and maintenance of wakefulness testing, nasal CPAP titration and prescribing (an area in which we uniquely excel) and home sleep testing.
The Quality
The Stony Brook University Sleep Disorders Center, one of the first such centers in the United States (dating from the 1970’s), is a pioneering institution in the diagnosis and treatment of obstructive sleep apnea (OSA). Our center published the first work connecting OSA to the functional somatic syndromes1,2 and to war-related illness3,4. To explain the connection between OSA and these disorders, we introduced the concept of OSA as a cause of chronic stress5-7, and we continue to be at the forefront of discovery in the clinical management of OSA. Consequently, nearly half of the patients treated for OSA in our program are female, and patients come to us from all over the United States (mostly from the middle Atlantic states) for our expertise. To aid us in our diagnostic and treatment work, our center utilizes questionnaire data not only to quantify sleepiness (the Epworth sleepiness scale), but to quantify fatigue (fatigue severity scale), to quantify stress (the body sensation questionnaire5,7) and insomnia severity (the insomnia severity scale). Some of the manuscripts we publish are case series of some of the unique patients we encounter, described using our unique questionnaire approach to quantifying patient-reported outcomes8,9. Our fellows are the first providers to encounter all these patients and utilize our questionnaires to quantify patient symptoms as well as to organize their thinking around a patient’s diagnosis and response to treatment. In no other program will a fellow in sleep medicine learn in a clinical “research” setting; in a setting where the record of any patient’s history, physical exam, test results and clinical course must be detailed enough for publication. Often, our fellows choose to participate in compiling the data we generate in our clinics for the purpose of reporting a case series5,7. Our fellows learn to function at the high-level characterizing Stony Brook University’s sleep medicine program.
Conclusion
From the discussion above, one can see that both the structure of our multidisciplinary sleep medicine fellowship, and quality of the sleep medicine practice at Stony Brook University provides a unique opportunity for a motivated fellowship applicant. Our graduates go confidently into sleep medicine practices where their unique knowledge and abilities are quickly recognized, leading them to increased opportunities and responsibilities for providing clinical care to patients with sleep disorders. Check out the references below to obtain a more informed opinion about what our sleep medicine fellowship has to offer you!
Gold AR, Dipalo F, Gold MS, Broderick J. Inspiratory Airflow Dynamics During Sleep in Women with Fibromyalgia. Sleep. 2004;27(3):459-466.
Gold AR, Dipalo F, Gold MS, O'Hearn D. The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes. Chest. 2003;123(1):87-95.
Amin MM, Belisova Z, Hossain S, Gold MS, Broderick JE, Gold AR. Inspiratory airflow dynamics during sleep in veterans with Gulf War illness: a controlled study. Sleep Breath. 2011;15(3):333-339.
Amin MM, Gold MS, Broderick JE, Gold AR. The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness. Sleep Breath. 2011;15(3):579-587.
Amdo T, Hasaneen N, Gold MS, Gold AR. Somatic syndromes, insomnia, anxiety, and stress among sleep disordered breathing patients. Sleep Breath. 2016;20(2):759-768.
Gold AR. Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms. Sleep medicine reviews. 2011;15(6):389-401.
Gold MS, Amdo T, Hasaneen N, Gold AR. Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing. Sleep Breath. 2016;20(2):749-758.
Miller P, Iyer M, Gold AR. Treatment resistant adolescent depression with upper airway resistance syndrome treated with rapid palatal expansion: a case report. Journal of medical case reports. 2012;6:415.
Proothi M, Grazina VJR, Gold AR. Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series. Journal of medical case reports. 2019;13(1):252.
Avram Gold, M.D.
Associate Professor of Clinical Medicine
Program Director, Sleep Medicine Fellowship
