Raising Awareness of Sleep Disorders

Sleep Medicine is a relatively new specialty that addresses problems such as excessive daytime sleepiness, insomnia, parasomnias (i.e., sleepwalking), sleep apnea and other sleep breathing disorders. 

Although the defined specialty has only been around for the last 50 years, these problems have been documented for centuries. Consider the fact that we spend roughly 30% of our lives sleeping, and only in these last 50 years have we come to understand sleep medicine the way we do now; I think it is safe to say, we are hardly scratching the surface of this specialty. 

The current understanding of sleep has been possible due to the technology available to us at a given time and in the hands of astute scientists. Very few specialties are as dependent on technology as sleep medicine. Such dependence has had a significant financial impact on the field over the last decade.

For many years we had relied on our current gold standard, the polysomnogram, to diagnose and guide the management of sleep apnea and other sleep disorders. This kind of test involved an overnight stay, with electrodes measuring brain, heart and muscle activity, as well as belts and sensors tracking each breath. This process remains expensive, time-consuming and typically not preferred by patients. 

Home sleep testing changed this landscape by adding the ability to diagnose sleep apnea, one of the most prevalent sleep disorders, in the comfort of the home and for a fraction of the cost. 

This resulted in a seismic shift, primarily driven by consumers and insurers – a shift so significant that many sleep labs across the nation closed as they faced difficulties funding existing lab operations in the new and changing payer environment. The inability to adapt to changes in the technology we use to manage our patients can have a profound impact on our ability to succeed and provide the best and most advanced patient care available.

I believe things are changing again, and in the same way technology has created and molded this field over the years, another seismic shift is coming. This shift is influenced by three very fluid components: current advances in consumer technology, significant advances in sleep medicine monitoring capabilities and a change to value-based medicine by payers.

Over the last decade, wearables and phone apps started to play a significant role in patients’ understanding (and sometimes misunderstanding) of their sleep health, providing real-time access to information regarding their poor sleep habits and quality of sleep. Tech companies continue to improve these devices, which, as of a few weeks ago, are now capable of oxygen tracking. This will allow for even more awareness of potential sleep disorders in patients who may have otherwise felt they were healthy. 

The most common complaint bringing a patient to our clinics is the report by a loved one that they snore too loudly, with patients themselves oblivious to the snoring. This is about to change, too, as patients will soon be warned about such problems by their devices.On the consumer software side, apps are now being used by sleep providers for assistance in the management of insomnia, circadian rhythm disorders and even sleep apnea. 

In addition to the impact of wearables, sleep medicine as a field is also changing dramatically to better incorporate remote physiologic monitoring.The non-invasive ventilation devices we use to treat sleep apnea, such as CPAP and BiPAP, have for years come with integrated modems capable of sending us real-time data on patients’ use of the device, breathing, breathing patterns, response to therapy and therapy information. Initially, this was intended to assist in tracking compliance with CPAP therapy, but has improved to add other data points in the last few years. We now have the capability to track and respond to how our patients are doing with more actionable information and without the need of a patient to visit our clinic. 

Payers have recognized the advantages of using such technology in improving patient outcomes and, over the last three years, have created payment for such services. At the same time, payment for other testing modalities continues to decline.

These capabilities, coupled with telemedicine, have assisted many sleep labs in making it through the difficulties presented by the coronavirus pandemic. And I truly believe this will set apart the best sleep medicine centers of the future. 

A successful sleep center will be able to seamlessly incorporate new aspects of technology to achieve the best care possible at the lowest cost to our patients. The most useful tools I expect to see over the next few years will focus on such integration. It is important to note that most sleep centers will be “stuck” on the ways of the past and will require assistance in transitioning to this new future. 

These changes are, again, a reminder that practically every aspect of sleep medicine is in some way dependent on technology. There will always be opportunities for those willing to embrace it early, as well as for those in the business of helping struggling labs cope with these changes.