An associated white paper, previous to this one, describes the current institutional infrastructure for academic sleep medicine, its multidisciplinary roots, and related challenges that the field faces in patient care, education, and research. Here we discuss existing approaches to these challenges at some centers, and ideas to maximize the potential that academic sleep medicine has to improve human health, effectiveness of medical care, academic identity, and the likelihood of achieving commonly accepted elements of academic success. Certain features appear to be a recurrent theme for those institutions that have developed existing programs and a recurrent need for others that envision such programs. Key elements identified within this paper include a structure for sleep medicine that includes budgetary responsibility. The institutional reporting structure should recognize sleep medicine as a distinct academic field, with responsibility for defined space, academic appointments, salary control, provision of clinical services across a wide spectrum of sleep-related conditions, and supervision of sleep education. The institutional structure for sleep medicine should permit it to implement research, and also stabilize it with a funds flow that allows reinvestment of those funds into the sleep program. This paper provides an analysis of some existing programs, notes how several have implemented guiding principles from the Institution of Medicine (IOM) report, and describes in more detail some unique programmatic structures, administrative relationships, and financial solutions. The paper also discusses eroding financial support and possible strategies to prevent programmatic instability from ongoing health care funding changes. Finally, this report considers potential ways to improve efficiency of sleep centers and raise awareness of both recognized and "unrecognized" benefits that a sleep center brings to an institution. No doubt exists that the field of sleep medicine is undergoing considerable change, and will continue to evolve. Academic sleep centers must reorganize now if this new field is to maximize its potential for fundamental contributions to public health. The Academic Affairs Committee hopes that through identification of the challenges faced, solutions devised by some programs, and creative visions for the future, both this and the preceding white paper can help advance knowledge in the field, training for future clinicians and investigators, and the practice of sleep medicine. This report is endorsed by the Boards of Directors of the American Academy of Sleep Medicine and the Sleep Research Society.