Review of the ESRS course with Prof. Dr. rer. physiol. Thomas Penzel

Interview with Professor Dr. rer. physiol. Thomas Penzel 

What do you feel makes the ESRS certification as European Somnologist so unique? 

The ESRS certification as a European somnologist is internationally recognized. Although the focus is on Europe, the certification is by no means exclusive – it is also available to interested individuals from other countries that have not yet established their own certification in the field of sleep medicine. The current participants from Asia have deliberately chosen the European certification. I’m very pleased about that, because it shows that Europe is being seen as a reference point in this field. 

A particular advantage of the ESRS certification is its interdisciplinary nature. In contrast to the global certification, it is aimed not only at physicians but also at sleep psychologists, scientists, and other professional groups working in sleep medicine. I find this openness and diversity particularly valuable – it makes the ESRS certification a strong and inclusive quality standard in sleep medicine.

Who is the target group for this certification/advanced training? 

Firstly, the certification focuses on physicians, especially those who manage or work in a sleep laboratory. The target group also includes psychologists, because some sleep laboratories – particularly in the fields of neurology and psychiatry – are managed by these specialists. 

Another, albeit smaller, target group includes scientists who wish to confirm their professional qualifications in sleep medicine by a certification. 

It is particularly noteworthy that the European certification also includes medical-technical assistants (MTAs) and other professionals who work professionally in sleep laboratories. For example, this includes nurses with a bachelor’s degree in nursing, as well as nurses who take on specialized roles in the sleep lab. 

How has the perception of this certification changed among professionals in the last few years? 

Over 1,000 professionals have earned the certificate thus far – clear evidence of its success. I observe that the certificate is receiving increasing renown, including internationally. In fact, in some European countries, it is the only certificate that authorizes its holder to work as a somnologist. While in Germany there is also a national certificate, ESRS certification is the only way in the Benelux countries and Scandinavia, for example. This underscores its growing significance and the high position that it has come to hold. 

What role does the certification play in the internationalization of sleep medicine? 

I see a key aspect of internationalizing sleep medicine as establishing a consistent standard of knowledge. That is why I am involved not only in the German certification but also at the European level and internationally with the World Sleep Society. My aim is for certifications to be globally equivalent, mutually recognized, and to create a unified international quality standard in sleep medicine. This is the only way to ensure reliable and consistent care across national boundaries. 

How does the certification specifically contribute to improving patient care? 

I firmly believe that the certification truly enhances patient care. Sleep medicine is an interdisciplinary specialty, encompassing fields such as otolaryngology, which treats sleep apnea, and psychology, which addresses insomnia. Professionals often remain within their respective disciplines. By contrast, the certification demands a comprehensive understanding of sleep medicine, covering all areas rather than just specific ones like insomnia, sleep apnea, or movement disorders. 

That means: To become a somnologist, one must also familiarize oneself with adjacent disciplines. This broadening of one’s knowledge beyond the boundaries of one’s own specialty is a central part of the certification – and ultimately benefits patients. 

Is there an example in your practice in which standardized training has made a significant difference?

Yes, a very concise example can be found in the early days of sleep medicine. At that time, the knowledge about various sleep disturbances was still limited. A typical case concerns the differentiation between sleep apnea and narcolepsy – two disorders whose symptoms are similar but which have completely different causes and treatment approaches. 

In one specific case, a patient with narcolepsy was erroneously diagnosed as having sleep apnea and was given a CPAP device for treatment. That was a clear error in treatment, because the CPAP is not effective for narcolepsy and can even be counterproductive. 

Here it is shown how important it is to have a certified and standardized training program in sleep medicine. It ensures that physicians also recognize rare clinical pictures such as narcolepsy and can treat them correctly. In this way, mistreatments can be prevented and patient safety can be clearly increased. 

How important is continuous training in sleep medicine – and how does the ESRS support this? 

Continuous advanced training in sleep medicine is of prime importance – particularly for specialists who are already working as somnologists and run a sleep laboratory. Even after successful certification, it remains essential for practitioners to make use of new scientific knowledge and developments. 

The European Sleep Research Society (ESRS) offers valuable support. It facilitates a view across national borders and offers quality training options which reflect the latest level of research. 

A particular advantage is its close connection to fundamental research, such as in animal research or theoretical sleep science. As a result, new scientifically based knowledge is introduced at ESRS congresses. 

In addition, the ESRS publishes the Journal of Sleep Research, which comes out every three months and publishes state-of-the-art research results. 

The ESRS also offers various courses and training formats. These formats facilitate a focused advanced training in specific areas of sleep medicine, such as pediatric sleep medicine, new therapy approaches to insomnia or the use of digital applications to support sleep apnea therapy. 

Which current research themes or innovations in sleep medicine do you consider particularly exciting? 

Sleep medicine is currently developing rapidly, and there are some particularly exciting developments. A central research theme is currently the question of what functions sleep fulfils beyond simply rest and recovery. In addition to regeneration and memory encoding, intensive studies are underway to determine whether sleep also has a cleaning effect on the brain. The focus here is on the glymphatic system – a mechanism that may remove such harmful substances as beta-amyloids from the brain during sleep. These substances are associated with neurodegenerative diseases such as dementia. The hypothesis: high-quality sleep could act preventively with respect to dementia. This theme is scientifically state-of-the-art and is under intensive discussion. 

Another exciting field involves technical innovations like wearables. These modern devices, such as the latest Apple watches, not only register sleep duration but also sleep quality. This data offers valuable information and opens new possibilities for individual sleep analysis. 

And, finally, artificial intelligence is also entering the field of sleep medicine. AI is used to efficiently analyze sleep data and link it with information from electronic patient files. This allows a better view of connections between sleep behavior and other diseases – a promising approach to personalized medicine. 

So how do patients in Europe benefit from the cross-border recognition of certification? 

Certification as ESRS Somnologist is recognized throughout Europe, establishing a unified quality groundwork for sleep medicine care. Our goal is for patients in every European sleep laboratory to encounter the same high standard of knowledge and expertise – regardless of whether they are in Germany, Spain, or any other country. If, for example, a German patient visits a sleep laboratory in Mallorca, he can be confident that a somnologist certified in Europe has been trained and tested according to the same standards as in Germany. This harmonization strengthens confidence in cross-border care and improves the treatment quality throughout Europe. 

What differences do you see in sleep medicine between the different countries – and how does the ESRS help bridge these differences? 

The differences are significant. Sleep medicine is well established in Central Europe – particularly in Germany, Switzerland, Austria, the Benelux states and Scandinavia. There it is seen as a professional medical sector and the services are generally covered by the health insurance companies. 

It is quite a different picture in many south and eastern European countries. In those regions, sleep medicine often goes under-recognized. It is barely supported by the health systems and is often only available as a private service. The situation is difficult even in Great Britain – there, too, sleep medicine is mostly financed privately. 

The differences apply to both remuneration and professional recognition. In some countries, the medical use of sleep medicine is still significantly underestimated. One example is Portugal: there, the professional specialty is still in its infancy, with interdisciplinary recognition lacking in many parts of the country. 

The ESRS has set to work there: it is creating a platform for exchange, advanced training and harmonization. Through international standards, certifications and scientific collaboration, it is contributing to reinforcing sleep medicine throughout Europe and closing gaps in the network. 

What motivated you personally to become involved in the ESRS? 

I have been involved in sleep medicine for a long time – a discipline that particularly fascinates me because it is interdisciplinary and constantly developing. It is a comparatively new field of study in which much is happening. My involvement in the ESRS, however, goes beyond my own research and personal interests. 

Why am I involved in the professional society? Sleep medicine is a small field, and the exchange within Germany is often limited – particularly with regard to very specific themes such as the validation of smartwatches or research into the glymphatic system. Conversely, in the ESRS, I find a European platform with a clearly larger community. 

For me, the ESRS means access to a broad network, intensive exchange of knowledge and the opportunity to meet like-minded professionals. This international interchange is very important for my work and my continued personal development. 

How important is collaboration with companies like Löwenstein Medical for the advancement of sleep medicine?

Collaboration with companies like Löwenstein Medical is of central importance for the advancement of sleep medicine. I’ve been active in this field for many years and continually witness the importance of engaging with industry. As doctors and sleep researchers, we deliver patient care and offer practical input – but we don’t create devices for either diagnosis or treatment. This is precisely where Löwenstein Medical plays a role: They implement our suggestions technically and drive innovation forward. Moreover, they play a key role in sharing knowledge, for instance through continuing education and international initiatives. While we usually work at institutions with a limited regional reach, companies like Löwenstein can disseminate knowledge on a regional and even global level. Such synergy is crucial for advancing sleep medicine. 

What technological developments do you see as particularly promising for the future of diagnostics and therapy? 

I am very happy to be allowed to be one of the keynote speakers at the World Sleep Congress in Singapore. My subject: The future of diagnostics and therapy in sleep medicine. I see several technological developments that hold tremendous potential:

1. Artificial intelligence (AI). I feel that AI is the most promising driver of future innovations. We in sleep medicine are confronted by a paradox: we know relatively little about sleep thus far, yet we are already collecting a huge amount of data – from blood values to EEG signals to sleep duration and depth. But most of this data remains unused. AI can help intelligently analyze these quantities of data, and recognize patterns that yield new knowledge about sleep processes.
2. Digitalization and data integration Digitalization allows us to collect and analyze sleep data not only locally but across various locations thanks to cloud systems. This yields a body of data that goes beyond individual sleep laboratories, allowing new research impetus. The future lies in networked analysis – above and beyond institutions.
3. Shift of sleep medicine to outpatient care Classic polysomnography is increasingly being replaced by outpatient care. This puts new demands on data collection and analysis, while also opening up new opportunities – especially in interaction with AI and mobile sensors.
4. Innovative sensory technologies Sensory technologies will play a key role. An example: the body’s core temperature is a central physiological parameter in sleep, but a practical method of continuous measurement has been lacking thus far. New approaches, for example with infrared cameras, could solve this problem. 

Other sensor ideas are also exciting: 

Outpatient CO₂ measurement: Not yet available, but highly interesting for sleep diagnostics. 

Contactless home EEG: A vision that could become reality – for example, for early recognition of microsleep at the wheel. 

Early warning systems for drivers: This is already the subject of intensive research, like at the Fraunhofer Institute, for example. The combination of sensor technology and AI can save lives. 

Because my original field was physics, I often think technically and systematically. To me, a holistic approach is crucial – and I wonder: how can we use technology to practically solve concrete problems? This is why I work closely with computer scientists and involve myself actively in clinical work, rather than only waiting for solutions. 

Thank you very much for this interview, Professor Penzel.