[Aspects of medical expert assessment of sleep-waking disorders]

Knowledge gained in sleep medicine over the past 10 years has not yet been incorporated into laws for the severely handicapped and pension law. The impact of increased accident incidence of patients with hypersomnia has not yet been recognized in the guidelines for medical diseases in automobile traffic in governmental driving regulations. In preparation for implementation of sleep-wake disorders into medico-legal jurisdiction they must be introduced to the guidelines as a separate medical entity according to the International Classification of Sleep Disorders. Due to different prognoses sleep-wake disorders should be separated into reversible and irreversible disorders. To decide on driving ability, degree of disablement and permanent and total disability therapeutic efficiency should be documented by methods acknowledged in sleep medicine. Professional and nonprofessional drivers and personnel in charge of responsible monitoring should be submitted to regular therapy controls. Degree of disablement or permanent and total disability can only be recommended for patients with symptoms partially or completely refractory to therapy. Accompanying diseases posing a high health risk or those causing sleepiness themselves have to be included in the overall judgement. Sleep specialists have to be nominated as expert witnesses and should furthermore contribute to multiplication of knowledge on sleep medicine for public health officers.