Sleep has become big business, at least for some who have been able to foster a bona fide social movement around the importance of sleep. Ariana Huffington is often credited with bringing the idea of a sleep crisis to the level of concern that previously led to changes in how we think about smoking.
The Rand Corporation has found sleep disorders are costing the U.S. economy approximately $411 billion and the loss of 1.2 million working days per year. Sleep disorders and lack of sleep have been been cited in the Chernobyl nuclear catastrophe, the Exxon Valdez oil spill and the Space Shuttle Challenger explosion.
The sleep movement for those who want to live a healthier lifestyle may indeed be helpful for people in general from a performance perspective, but it’s not enough by far for those with serious sleep disorders.
This awareness of our multi-faceted problem with sleep is important. But it’s a lost opportunity if it raises awareness but does not translate into real solutions, like scalable therapy for insomnia or sleep disorders generally, for people who need help. Wrist-worn wearables and eye cooling masks are not the answer.
To really tap into sleep, as a crucial part of our bodies’ restorative process, we need the gap between clinical sleep therapy and patients to be closed. What we call digital trackers may help, but they may also do more harm than good if they don’t actually track sleep in a scientifically rigorous manner and just add to the stress of sleep for those who need the opposite.
We have a need for more than a tracker, a wearable or an app. We need to think about a platform for sleep health that empowers healthcare professionals to expand sustainably beyond their walls in a way that allows them to succeed both in terms of quality of care, and economically.
Healthcare professionals can deliver the proven resources and clinical expertise to really help people. But not enough people manage to get themselves to an appropriate provider for a number of reasons – including just not being aware of these practices, not prioritizing it in their day despite the need and fear of pills. Nearly 60 percent taking sleep medications report side effects like feeling drowsy, confused, or forgetful the next day, even dozing off while driving.
The sleep movement advanced by celebrities like Ariana Huffington has done a great deal to challenge the myths we have about sleep, and the persistent myth that you can skip it and ignore resulting problems. But the connections between this popular movement and science isn’t strong enough.
These people, with insomnia, a very real illness, for instance, get lost somewhere in the middle — understanding the importance of sleep, but using wearables and gadgets that aren’t clinically proven, taking medications that don’t get to the root causes of their problems or following advice that’s not evidence based.
Those with a specialty in sleep medicine work hard to reach this population, but there are only so many hours in the day, again there is frankly only so much awareness of sleep for healthcare reasons other than sleep apnea, generally.
The American Academy of Sleep Medicine has been working hard at this, launching a telemedicine application called SleepTM and developing partnerships to enable sleep centers and their practices to better scale the help they can deliver.
They can build on this investment. Healthcare professionals with a specialty in sleep medicine should be key elements of the healthcare fabric of their communities and regions, more than they are today.
Wearables to the rescue?
Is this where digital rides to the rescue? That depends.
Wrist-worn trackers don’t even track sleep accurately, especially for people with serious sleep disorders. Your movement in bed or heart beat does not necessarily correlate to how well you sleep. One of the only accurate ways to track is by capturing brain activity via electroencephalography (EEG) sensors, which until recently could only be achieved in a sleep clinic.
To deploy EEG outside of the clinic effectively you need a hardware and software solution that accurately tracks sleep activity through brain activity. Heart rate, respiration and motion are useful, but in addition to EEG. You need to provide relaxation techniques driven by biofeedback. Digital coaching based on cognitive behavioral therapy for insomnia (CBTi) – the only recognized treatment for insomnia — should be a component.
Clinical care standards for telemedicine services and technologies that extend that care should mirror live office visits as much as possible, including aspects of diagnosis and treatment decisions as would be reasonably expected in traditional office-based encounters.
What to do?
We don’t need wearables or trackers, we need a platform at the core.
Clinical judgment should be exercised when determining the scope and extent of telemedicine applications in the diagnosis and treatment of specific patients and sleep disorders. Live interactive telemedicine for sleep disorders, if utilized in a manner consistent with the principles the AASM, should be recognized and reimbursed in a manner competitive or comparable with traditional in-person visits.
Roles, expectations, and responsibilities of providers involved in the delivery of sleep telemedicine should be defined, including those at originating sites and distant sites. The practice of telemedicine should aim to promote a care model in which sleep specialists, patients, primary care providers, pharmacists, and other members of the healthcare team aim to improve the value of healthcare delivery in a coordinated fashion.
Appropriate technical standards should be upheld throughout the telemedicine care delivery process, at both the originating and distant sites, and specifically meet the standards set forth by the Health Insurance Portability and Accountability Act (HIPAA).
Methods that aim to improve the utility of telemedicine exist and should be explored, including the utilization of patient presenters, local resources and providers, adjunct testing, and add-on technologies.
Quality Assurance processes should be in place for telemedicine care delivery models that aim to capture process measures, patient outcomes, and patient/provider experiences with the models employed.
Time for data management, quality processes, and other aspects of care delivery related to telemedicine encounters should be recognized in value-based care delivery models.
The use of telemedicine services and its equipment should adhere to strict professional and ethical standards so as not to violate the intent of the telemedicine interaction while aiming to improve overall patient access, quality, and value of care. When billing for telemedicine services, it is recommended that patients, providers, and others rendering services understand payor reimbursements, and that there be financial transparency throughout the process.
We need to stop talking about wearables and trackers, and talk about care model platforms.
Photo: franckreporter, Getty Images