By: Mustapha Khemar Ballaho, MBA, RPSGT
For more than five decades, sleep has progressed into the mainstream world such as other things that two to three decades ago would only be deemed as fiction. We have UFC, ubiquitous semi-pro self-made videos, 24/7 news, and robot pets.
The sleep industry has also grown as an independent pillar in assessing overall health. There have been numerous clinical evidences, documentaries, and legitimate lectures that puts a spotlight on sleep as a vital metric in assessing the population’s health, state of healthcare systems, and also on the effectiveness of government spending.
More discoveries in other medical sciences have been lately identified as having links to sleep and the development of diseases such as Alzheimer’s, cancer, and erectile dysfunction.
Succinctly, sleep as a medicine is growing and here to stay as long as there is healthcare. Consequently, sleep is also transforming in various ways from how diagnosis is performed to how studies are read, and what treatments are offered.
In the past, sleep doctors were dependent on overnight polysomnograms to identify sleep disorders. Then home sleep testing (HST) came along after it was improved from being a “screener” device into a reimbursable diagnostic tool for obstructive sleep apnea (OSA) patients. After undergoing home sleep testing, patients can be directly treated with positive airway pressure (PAP) therapy.
Almost two decades later, we now see the emergence of further developments in actigraphy as HST, automation in PAP therapy, and the introduction of implantable devices to treat apneas – obstructive or central. On the same token, we will also soon see a pill to reduce apnea.
But these major developments do not end there because we also see many other forms of therapies such as wearable EPAP devices, genioglossus stimulators, and various oral appliances.
So, what does this mean moving forward to sleep clinicians, sleep operators, and patients? The answers may predominantly hinge on what and how the insurance companies, considerably Medicare, will absorb these developments, and what actions they will take to influence the healthcare system in accepting these new products and services that will surely flood the sleep health market.
Without getting into anecdotes, we know that:
- It is not impossible for smartwatches, smart rings, and other wearables to become “real” diagnostic tools.
- Artificial intelligence has so much data available which can further improve automatic PAP algorithms.
- Insurance companies will further choose to offer cheaper ways to diagnose sleep disorders.
- Patients prefer easier ways to get diagnosed. (and)
- Patients prefer to have the least invasive treatment.
This means that:
- HST devices will be cheaper, lower reimbursement, and more patients will be identified with OSA and non-OSA diagnosis.
- PAP compliance can dramatically improve, dropping OSA patient numbers being titrated in sleep labs.
- HST programs will be seen even in non-sleep practices with very low margins. (and)
- Overall, more patients will be using therapies other than PAP.
In the end, sleep labs will only handle patients with comorbidities. Others will be served at home.