Sleep medicine is at a critical point. Demand is rising, the science is expanding, and too few specialists are available to meet the need. The U.S. has just 7,500 board-certified sleep specialists to serve a population of 325 million—many of whom have sleep disorders with complex comorbidities that require ongoing, individualized care.1
The world of sleep medicine is not only broad enough to include physicians, nurse practitioners (NPs), and physician assistants/associates (PAs), it’s going to need to rely on all of them. These advanced practice providers (APPs) are not new to health care, but their role in sleep medicine is rapidly evolving and increasingly essential.
APPs are helping expand access, deepen patient engagement, and bring a more holistic approach to care. Yet despite their growing presence, APPs remain underutilized in many sleep settings. That gap represents both a challenge and an opportunity. As sleep medicine continues to evolve, expanding the role of APPs may be one of the most practical—and immediate—ways to meet patient needs.
A Historical Need in Health Care
The NP and PA roles were birthed to meet the growing needs of health care during a time of necessity. In 1965, President Lyndon B. Johnson signed the Social Security Amendments that created Medicare and Medicaid.2 Within the three years of being signed into law, the passage of these amendments expanded health insurance coverage to roughly 20 million people.3 The pre-existing shortage of physicians struggled to keep pace with this surge of newly insured individuals—undeniably straining the health care system.
The very same year that Medicare and Medicaid were born, NP and PA education programs enrolled their first students. Loretta Ford, EdD, RN, PNP, NP-C, CRNP, and Henry Silver, MD, launched the first NP program at the University of Colorado.4 And Eugene A. Stead Jr., MD, of Duke University Medical Center, developed the PA program model, based on the fast-track training program used for physicians during WWII.5-6
Roles that began as a solution to a workforce shortage quickly became a backbone in all fields and settings of medicine. While primary care was the initial focus, APP practice has expanded into nearly every specialty over time—including cardiology, neonatology, oncology, psychiatry, endocrinology, and pulmonology.7 Sleep medicine, by comparison, is a newer frontier.
Feeling the Strain of Continued Shortages
Shortages in health care providers continue to pose problems for Americans today. According to the most recent U.S. Bureau of Labor statistics, NP and PA growth in this country are projected to reach 35% and 20%, respectively, by 2034—far outpacing the projected 3% growth for physicians during that same time period.8-10 This increasing demand for APPs not only speaks to the quality of care provided and the affordability of education, but also the flexibility of the profession to meet the needs of the ever-evolving landscape of health care.
Sleep medicine is also feeling the strain of the continued shortage crisis. A 2011 survey conducted by the American Academy of Sleep Medicine (AASM) found that only 40% of responding AASM-accredited sleep centers employed an advanced practice registered nurse (APRN) or a PA in predominantly clinical roles.11 A majority reported that these APPs had clinical responsibilities conducting new patient evaluation and follow-up, but less than half reported research or administrative responsibilities.11
The conditions routinely managed by APPs included sleep-related breathing disorders, insomnia, or movement disorders, with little to no involvement of APRNs and PAs in hypersomnias, parasomnias, and circadian rhythm disorders.11
Fast forward to 2026, it’s evident that more research is needed on the role of APPs in sleep medicine as care models have shifted over time. Although these survey results are more than 15 years old, they highlight an ongoing issue: APPs are underutilized in sleep medicine, and the full potential of those who are in the sleep workforce remains untapped.
The APP Advantage
Effective care in sleep medicine goes far beyond diagnosing a condition. In addition to clinical knowledge and skill, it requires a patient-centered approach that is sensitive to how a person’s daily routines, environment, mental health, and social context contribute to their sleep.
That kind of care takes time, curiosity, compassion, and flexibility—and that’s exactly where APPs shine. In fact, it’s integral to their training. In addition to clinical education in pathophysiology, pharmacology, and physical assessment, APPs are trained in providing community/population-based care that is culturally competent. They consider the broader context of a patient’s life: their culture, family dynamics, and even socioeconomic status. They look at what’s happening outside the exam room, not just inside it. This training encourages APPs to integrate a patient’s emotional, social, spiritual, and physical needs into care, rather than focusing on the disease state alone.
Beyond their formal education, the clinical experiences many APPs bring to their roles add meaningful depth. NPs typically develop a strong human-centered approach to care through their initial experiences in nursing, which often begin at the bedside. PAs build similar skills and patient rapport through prior health care positions such as medical assistants and emergency medical technicians that place them in the direct line of patient care. Those experiences shape how APPs interact with and care for patients and their loved ones. They transition from the role of assisting the patient in the health care setting to being a key decision-maker in their diagnosis and treatment.
In sleep medicine, that can make a meaningful difference. APPs are interested in why a behavior exists—not just what a person’s bedtime is, but why. Not just whether a patient uses continuous positive airway pressure (CPAP) therapy, but what’s getting in the way of better adherence. As “tedious” as these questions may be, they are essential to providing patient-centered quality care in sleep medicine.
An Untapped Opportunity
APPs are well-positioned to help fill critical gaps in sleep medicine. Their contributions can extend beyond direct patient care to include providing leadership in administrative roles and even helping influence health care policy. Expanding their scope—both in terms of conditions managed and responsibilities assumed—represents a significant opportunity for the field. While the current management trend may be focused on sleep-disordered breathing, continuing this practice is a missed opportunity for health care as a whole. APP education and training positions them to be highly capable of managing all complex sleep disorders.
This is especially important as sleep medicine continues to evolve—and we gain even more understanding about the impact of sleep on holistic health and every organ system in the body. More providers are needed to manage the patient load, and they are needed now. APPs present one of the best solutions to this problem without compromising the quality of health care but rather enhancing it.
Multilevel support is essential to make this possible, and that’s why we launched the Sleep Medicine Advance Practice Provider (SMAPP) Foundation in 2025. A nonprofit dedicated to amplifying the role of APPs in sleep medicine, SMAPP strives to empower APPs through educational programs, resources, and community-building to help connect those who might otherwise be practicing in silos.
By fostering a “by APPs, for APPs” model, SMAPP aims to strengthen the field. The goal is not just to make sure APPs are present in the clinic, but to elevate their impact—as clinicians, leaders, and contributors to research and health care policy.
To learn more on how to get involved or about upcoming initiatives, please contact info@smappfoundation.org or visit smappfoundation.org.
By Heidy Merius, RN, DNP, NP-C, Maggie Lavender, MSN, APRN, FNP-C, and Cecile Martin, FNP-BC, MS, RN
Source: SleepWorld Magazine May/June 2026
References
- American Academy of Sleep Medicine. Telemedicine. Accessed March 3, 2026. https://aasm.org/advocacy/initiatives/telemedicine.
- Berkowitz E. Medicare and Medicaid: The past as prologue. Health Care Financ Rev. 2005;27(2):11-23.
- National Archives and Records Administration. Medicare and Medicaid Act (1965). Accessed February 19, 2026. https://www.archives.gov/milestone-documents/medicare-and-medicaid-act.
- Historical timeline. American Academy of Nurse Practitioners. Accessed February 16, 2026. https://aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp/historical-timeline.
- History of the PA profession. American Academy of Physician Associates. Accessed February 16, 2026. https://aapa.org/about/history.
- 6. Miller L. The birth of the physician assistant. U.S. National Library of Medicine. November 15, 2026. Accessed February 16, 2026.
- Nurse practitioners: Shaping the future of health care. Penn Nursing. Accessed February 19, 2026. http://nursing.upenn.edu/nhhc/nurse-practitioners-shaping-the-future-of-health-care.
- Nurse anesthetists, nurse midwives, and nurse practitioners. U.S. Bureau of Labor Statistics. August 28, 2025. Accessed February 23, 2026. http://bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm.
- Physician assistants. U.S. Bureau of Labor Statistics. August 28, 2025. Accessed February 23, 2026. https://bls.gov/ooh/healthcare/physician-assistants.htm.
- Physicians and surgeons. U.S. Bureau of Labor Statistics. August 28, 2025. Accessed February 23, 2026. https://bls.gov/ooh/healthcare/physicians-and-surgeons.htm.
- Colvin L, Cartwright A, Collop N, et al. Advanced practice registered nurses and physician assistants in sleep centers and clinics: A survey of current roles and educational background. J Clin Sleep Med. 2014;10(5):581-7.
