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Ethics Commentary: Ethical Considerations in Sleep Medicine
Brandon Peters, M.D.
FOCUS 2014;12:64-67. doi:10.1176/appi.focus.12.1.64
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Author Information and CME Disclosure

Brandon Peters, M.D., Stanford University

Dr. Peters reports no competing interests.

Address correspondence to: Brandon Peters, M.D., Consulting Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, 100 Rowland Way, Suite 300, Novato, CA 94945; e-mail: sleepdisorders@aboutguide.com


As we adopt a forward-looking perspective in the still emerging field of sleep medicine, it is imperative to revisit a set of core ethical principles to serve as a road map in this journey. The foundational concepts of nonmaleficence, autonomy, truthfulness, justice, and beneficence must inform our efforts and guide our actions as we set about to conduct this important work. The primary responsibility of a medical provider is to act in a way that does not cause additional harm to a patient beyond the inherent and unavoidable consequences of a disease process. To avoid potential adverse effects, the judicious use of prescription medications, including sleeping pills, is imperative. Patient autonomy and veracity must be preserved by disclosing the association between REM behavior disorder (RBD) and other neurodegenerative conditions. Distributive justice requires access to basic medical care and fair allocation of resources, including an equal share of public safety, to all members of society. Through education, access to diagnostic procedures, and timely therapy, significant impacts can be made throughout public health. The opportunity for great beneficence exists in the discipline of sleep medicine with a substantial need and effective treatments strengthened by the integral role of technology. Medical care that is founded on these basic ethical standards will ensure continued success as the specialty continues to develop.

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Shakespeare  W:  Sonnet 27, in  The Complete Works of William Shakespeare: Complete and Unabridged . Edited by Well  S;  Taylor  G;  Schoenbaum  S.  NY,  Random House, 1990, p 1195
Gillon  R:  Medical ethics: four principles plus attention to scope.  BMJ 1994; 309:184–188
[CrossRef] | [PubMed]
Roberts  LW;  Hoop  JG:  Professionalism and Ethics: Q & A Self Study Guide for Mental Health Professionals .  Arlington, VA,  American Psychiatric Press, Inc., 2008
Partinen  M;  Hublin  C:  Epidemiology of sleep disorders, in  Principles and Practices of Sleep Medicine . Edited by Kryger  MH;  Roth  T;  Dement  WC.  St. Louis, MO,  Elsevier Saunders, 2011, p 694
Chong  Y;  Fryar  C;  Gu  Q:  Prescription sleep aid use among adults: United States, 2005–2010.  Hyattsville, MD,  National Center for Health Statistics, 2013
Aitken  M:  Declining medicine use and costs: for better or worse?  Danbury, CT,  IMS Healthcare Informatics, 2012
Russo  A;  Miller  K;  Marder  W:  Prescription sleep aid use in young adults,   New York, NY,  Thomson Reuters Research Brief, 2008
Wells  F:  The moral choice in prescribing barbiturates.  J Med Ethics 1976; 2:68–70
Kripke  DF;  Langer  RD;  Kline  LE:  Hypnotics’ association with mortality or cancer: a matched cohort study.  BMJ Open 2012; 2:e000850
[CrossRef] | [PubMed]
Belleville  G:  Mortality hazard associated with anxiolytic and hypnotic drug use in the National Population Health Survey.  Can J Psychiatry 2010; 55:558–567
Hausken  AM;  Skurtveit  S;  Tverdal  A:  Use of anxiolytic or hypnotic drugs and total mortality in a general middle-aged population.  Pharmacoepidemiol Drug Saf 2007; 16:913–918
[CrossRef] | [PubMed]
Mallon  L;  Broman  JE;  Hetta  J:  Is usage of hypnotics associated with mortality?  Sleep Med 2009; 10:279–286
[CrossRef] | [PubMed]
Glass  J;  Lanctôt  KL;  Herrmann  N;  Sproule  BA;  Busto  UE:  Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits.  BMJ 2005; 331:1169
[CrossRef] | [PubMed]
Walsh  JK;  Roth  T:  Pharmacologic treatment of insomnia: benzodiazepine receptor agonists, in  Principles and Practices of Sleep Medicine . Edited by Kryger  MH;  Roth  T;  Dement  WC.  St. Louis, MO,  Elsevier Saunders, 2011, p 905
U.S. Food and Drug Administration:  Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). Safety announcement, 2013. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM335007.pdf
Vertrees  S;  Greenough  GP:  Ethical considerations in REM sleep behavior disorder.  Continuum (Minneap Minn) 2013; 19(1 Sleep Disorders):199–203
Schenck  CH;  Bundlie  SR;  Mahowald  MW:  REM sleep behavior disorder (RBD): delayed emergence of parkinsonism and/or dementia in 65% of older men initially diagnosed with idiopathic RBD, and an analysis of the maximum and minimum tonic and/or phasic electromyographic abnormalities found during REM sleep.  Sleep 2003; 26(Suppl):A316
Postuma  RB;  Gagnon  JF;  Rompré  S;  Montplaisir  JY:  Severity of REM atonia loss in idiopathic REM sleep behavior disorder predicts Parkinson disease.  Neurology 2010; 74:239–244
[CrossRef] | [PubMed]
Schenck  CH;  Boeve  BF:  The strong presence of REM sleep behavior disorder in PD: clinical and research implications.  Neurology 2011; 77:1030–1032
[CrossRef] | [PubMed]
Lamont  J;  Favor  C:  Distributive justice, in  The Stanford Encyclopedia of Philosophy . Edited by Zalta  EN.  Stanford, CA,  Metaphysics Research Lab, Stanford University, 2013. (http://plato.stanford.edu/archives/spri2013/entries/justice-distributive/)
Quan  SF:  Graduate medical education in sleep medicine: did the canary just die? J Clin Sleep Med 2013; 9:101
Belensky  G;  Akerstedt  T:  Occupational sleep medicine, in  Principles and Practices of Sleep Medicine . Edited by Kryger  MH;  Roth  T;  Dement  WC.  St. Louis, MO,  Elsevier Saunders, 2011, p 734
Krishnan  V;  Shaman  Z:  Legal issues encountered when treating the patient with a sleep disorder.  Chest 2011; 139:200–207
[CrossRef] | [PubMed]
Ulmer  C;  Wolman  DM;  Johns  MME (ed):  Resident duty hours: enhancing sleep, supervision, and safety .  Washington, D.C.,  The National Academies Press, 2008, pp 1–322
Taylor  DJ;  Lichstein  KL;  Durrence  HH:  Insomnia as a health risk factor.  Behav Sleep Med 2003; 1:227–247
[CrossRef] | [PubMed]
Pigeon  WR;  Pinquart  M;  Conner  K:  Meta-analysis of sleep disturbance and suicidal thoughts and behaviors.  J Clin Psychiatry 2012; 73:e1160–e1167
[CrossRef] | [PubMed]
Mahowald  MW;  Schenck  CH:  REM sleep parasomnias, in Principles and Practices of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. St Louis, MO, Elsevier Saunders, 2011, p 1083
Mahowald  MW;  Cramer Bornemann  MA:  Non-REM arousal parasomnias, in  Principles and Practices of Sleep Medicine . Edited by Kryger  MH;  Roth  T;  Dement  WC.  St. Louis, MO,  Elsevier Saunders, 2011, p 1075
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