How clinicians get certified in behavioral sleep medicine

The question I get asked most by clinicians

Do I need to do a fellowship?

Clinicians ask me this constantly. Physicians, psychologists, therapists, all wanting to know how to get real training in sleep without starting their careers over.

So I asked Dr. Daniella Marchetti, a clinical psychologist and behavioral sleep medicine specialist, to walk through what the certification actually involves. She works at the Miami VA and runs a private practice devoted to sleep disorders.

What behavioral sleep medicine certification means

The Diplomate in Behavioral Sleep Medicine, or DBSM, means you have completed enough training and supervised exposure to be considered a specialist in the evaluation and treatment of sleep disorders, looking at the behavioral, psychological and physiological factors that interfere with sleep.

The older name for it was the CBSM. DBSM is the current one.

Who is eligible

There is a degree requirement first. You need a graduate level degree in a health related field from an accredited institution.

You do not have to be a psychologist. A social worker, or anyone with a graduate level health degree, can qualify.

You also need to be licensed in your own field.

The standard track

The standard track means a postdoctoral fellowship, one to two years, at an accredited behavioral sleep medicine training program.

There are only about 17 of these in the United States, and they are competitive. As Dr. Marchetti put it, it is a small world, and all the sleep people know sleep people.

Most standard tracks can be completed in a year, because the postdoc is fully devoted to behavioral sleep medicine. Some, including a well-known one at Stanford, run two years because of a research component.

The alternate track

This is the route for clinicians who cannot relocate, which is why Dr. Marchetti took it herself.

The alternate track is 500 hours of training under someone who already holds a CBSM or DBSM. If you are not yet licensed you work under their supervision. If you are licensed, those hours are consultation.

The 500 hours break down like this:

• 120 hours of didactics. At least half must be in behavioral sleep medicine, 30 can be general CBT, 15 in mental health assessment, and another 15 in any combination of those.
• 250 hours of direct clinical care, of which 150 are direct patient care in CBT-I, with at least one hour of consultation per week.
• The remaining hours can combine didactics and clinical experience, including sleep research, teaching a course, or presenting on sleep.

She completed hers in a year, alongside other clinical responsibilities, because her mentor referred cases to her from the sleep clinic. How fast it goes depends heavily on the opportunities where you are training.

There is an exam at the end. It is offered twice a year, in the fall and the spring, and recertification is every five years.

What you actually learn

It is worth saying that CBT-I is not the whole of it.

CBT-I itself has two components: changing what the patient does around bedtime, including the time in bed window, and challenging the maladaptive sleep cognitions that come with it. Sleep anxiety. Conditioned hyperarousal. Patients who have come to dread going to bed because they already know how the night ends.

Beyond that, a behavioral sleep medicine program covers nightmares, including imagery rehearsal therapy. Hypersomnolence, including adherence and strategic napping in narcolepsy. And a great deal of sleep apnea work, particularly CPAP adherence.

That last one matters more than it sounds. Wearing a mask every night is aversive, there is a learning curve, and patients are often handed a machine and told to figure it out.

This range is the reason the training is worth having. Many patients who are struggling with sleep have more than one thing going on: apnea and insomnia together, or a circadian component that also needs addressing.

If you are not eligible for DBSM

There are many sleep programs and online certifications aimed at coaches and non-licensed practitioners. Dr. Marchetti’s advice is buyer beware. Some are genuinely good. Some are not.

Check that a program is evidence based and taught by people with real credentials.

One red flag I would add: whoever is teaching the program should know what CBT-I is. If they have never heard of CBT-I and they are teaching you about sleep, that tells you what you need to know.

The same caution applies to what patients are hearing. There are a lot of voices talking about sleep online without the training behind them, and it is confusing for clinicians and far more confusing for the patient trying to find help.

Clinical pearls

• You do not need a sleep medicine fellowship to get real behavioral sleep medicine training.
• Two routes to DBSM: a postdoc at one of about 17 accredited programs, or the alternate track of 500 supervised hours.
• Eligibility is a graduate degree in a health related field plus licensure, not a psychology doctorate specifically.
• The alternate track can be completed in a year if your training site gives you access to enough sleep cases.
• The exam runs twice a year, and recertification is every five years.
• For non-licensed practitioners, evaluate any sleep certification on whether it is evidence based and whether the instructor knows what CBT-I is.

Sleep training is one of the few additions to a practice where the results show up quickly. CBT-I is generally not meant to exceed six to eight sessions, and patients who have been struggling for years tend to notice the change inside that window.

If you’d like a place to start before committing to certification, our free clinical sleep mini-course for practitioners covers the basics.

Disclaimer: This information is for educational purposes only and is not intended to replace individualized medical advice, diagnosis, or treatment.