Rise and Shine

It would be impossible to doze through the noise being made recently in the sleep-disorder-products market. What once was a small, overlooked product area is now experiencing booming growth and expectations. Snoring is old news: A greater awareness of sleep disorders has startled physicians, patients and payers awake to the underlying conditions that cause snoring and other problems, injecting a welcome surge of growth that manufacturers are just now settling into.

“A lot of the industry documents indicate double-digit growth — it’s absolutely true,” says Cheryl Richards, sleep product manager for Invacare. “Sleep labs are being put up left and right, and a lot of younger doctors think of sleep disorders and ask [patients] questions about them.”

The momentum in this market is relatively new, according to leading sleep-disorder-products manufacturers. “Five years ago, I would have said sleep disorders were one of the best kept secrets in disease therapy,” says Tim Quinn, vice president of home care for VIASYS Healthcare. Now, he says, “It’s a zoo. I don’t think there’s a faster-growing market in health care today.”

Experts attribute the growth to a greater awareness among doctors and end users of obstructive sleep apnea and of sleep disorders in general. “This market is healthy, with more diagnosis of OSA and greater public awareness,” notes Steve Moore, sales manager for Fisher & Paykel Healthcare.

“From a patient standpoint, the key driver is awareness,” says Rich Kocinski, senior vice president and general manager of the DeVilbiss division of Sunrise Medical. “Five to 10 years ago, significantly fewer people knew about sleep disorders. The exposure in the media, through efforts such as the National Sleep Foundation’s Summit to Prevent Drowsy Driving, has brought sleep disorders to the forefront.”

The link between sleep disorders and other conditions — including congestive heart failure, diabetes, hypertension and even learning disabilities in children — also contributes to growth in this market, experts say. These conditions “are showing up on the radar and being served by the sleep-disorder market,” explains Ron Richard, vice president of marketing for the Americas at ResMed. The market is responding with “robust” growth, he says. “This market is growing at a steady clip and there’s still huge, huge potential.”

Recent research connecting sleep disorders to other serious illnesses has generated a buzz in the market and has ensured a promising future for manufacturers. Media coverage of the diagnosis and treatment of sleep apnea have helped engender recognition among manufacturers, doctors and third-party payers of the potential number of individuals who need sleep-disorder products, says Bob Mogue, executive vice president of sales and marketing for CareFore Medical.

“This market is growing because there’s more interest. It’s word-of-mouth,” says Deidre Christiansen, account manager for SleepNet. “Everybody says, ‘I know somebody with sleep apnea’ and ‘Oh, so do I.’”

Quinn, who credits much of the increase in awareness of OSA to major players in the industry, says a “phenomenal” number of physicians, payers and patients now know about sleep disorders. “Respironics and ResMed did a great job in getting the word out about OSA,” he says. “It’s been an evolution. Five years ago, nobody knew what OSA was.”

But while awareness has evolved, the focus of sleep-disorder-products manufacturers hasn’t changed much from a decade ago. In terms of product development, manufacturers have always had two major concerns: “Compliance and comfort,” says Quinn, “100 percent.”

Manufacturers are constantly seeking new ways to improve compliance, and because patient compliance depends to a large extent on a comfortable product, comfort drives the market, industry leaders point out.

If a patient is comfortable, and therefore compliant, “everybody’s happy,” Mogue says. “The more compliant a patient is, the less a physician will hear about problems, and the home care provider will have to make fewer visits because the patient is happy with [his or her] device.”

And, providers’ profits depend on compliance. “They have to make sure it’s the right product for the right patient the first time around,” Richards explains. Failure to match patients with the best continuous positive airway pressure (CPAP) interfaces for their needs often means the patients won’t maintain their treatment, and this could result in repeated visits to both the provider and the hospital. Complicating things even further for providers is the reality that reimbursement is only likely the first time around — providers find it difficult to justify repeated product changes for a patient to third-party payers.

“The compliance rates for this therapy, combined with the high numbers of patients, will naturally put the spotlight on [the therapy] for the payer community,” Kocinski says. “The measurement of compliance, through tools such as the DeVilbiss eCompliance system, will enable providers to provide better patient management at lower costs, and show their payers the value of their dollars.”

The challenge to manufacturers, then, is to produce comfortable and convenient masks and other nasal interfaces. New products are user-friendly, easier to carry, smaller, and lighter weight, according to their makers. “We’re always concerned with ease of use,” Christiansen says. “Everybody wants something that they can pull out of the box and have it fit the first time.”

For example, manufacturers face pressure to produce a mask that meets a wide range of comfort needs, but this is difficult because of the unique contours of the human face. “There is so much individual variability that it’s hard to find one [mask] to work for a majority,” Mogue says.

The industry has made strides, but because of these challenges the market remains wide open for new contenders, including non-mask alternatives. “This industry is very young on the product development cycle. Non-mask alternatives pop up because people are desperate to try anything to increase comfort and compliance,” Richards says.

Alternatives to CPAPs and nasal interfaces flood today’s sleep-disorder-products market. “There are non-mask solutions — I should say suggestions — but it’s hard to tell what works. There’s a mouth apparatus that pulls the tongue forward, something that clips on the teeth, sprays that numb the back of the throat, and even laser surgery that causes scar tissue in the back of the throat. In some cases, if the patient just loses a little weight it can be better,” Christiansen says.

According to leading manufacturers, the profusion of mostly unproven, often-risky alternatives exist in part because of the flaws or drawbacks to using the traditional mask. “People can be turned off by masks,” Christiansen explains. “If they’re still dating, they wonder how sexy they look with a mask on. Wearing the mask can be uncomfortable if it’s too tight or too loose, or if they don’t maintain it. They’re concerned and not ready for the lifestyle change.”

CPAPs continue to dominate the market, however. “CPAPs always have a fairly large market share: they’re the predominant force out there,” says Joe Krawczyk, national sales manager for Nidek Medical.

Sunrise’s Kocinski agrees, and believes consumers aren’t so much tied to the products as they are to the fact that they have a medical condition. “And the clear choice to treat this condition — OSA — is CPAP therapy,” Kocinski says.

Experts say the presence of alternatives is a good thing for the industry, because it challenges manufacturers to improve nasal interfaces and ensures a wider selection of treatment options for end users. “The CPAP is the gold standard, but it does not work for everyone, so you have to have other modalities,” Quinn says. “With laser surgeries and other oral appliances, it boils down to what’s covered [by Medicare] and what’s not.”

“The market is so big — the problem of OSA and other sleep disorders so pervasive — that it’s hard to have a bad idea,” he concludes.

Experts Interviewed:

Deidre Christiansen, account manager, SleepNet, Manchester, N.H.; Rich Kocinski, senior vice president and general manager, DeVilbiss/Sunrise Medical, Longmont, Colo.; Joe Krawczyk, national sales manager, Nidek Medical, Birmingham, Ala.; Bob Mogue, executive vice president of sales and marketing, CareFore Medical, Olathe, Kan.; Steve Moore, sales manager, Fisher & Paykel Healthcare, Laguna Hills, Calif.; Tim Quinn, vice president of home care, VIASYS Healthcare, Yorba Linda, Calif.; Ron Richard, vice president of marketing for the Americas, ResMed, Poway, Calif.; and Cheryl Richards, sleep product manager, Invacare, Elyria, Ohio.

Zzzzs Could Signal Disease

”Sleep apnea should be recognized as a chronic illness,” says Ron Richard, vice president of marketing for the Americas at ResMed. “Now it’s treated as a subset of other disorders — as a nuisance, more or less.”

By treating that nuisance, people “are trying to get rid of an outward symptom (snoring), thereby ignoring the impact or stress on other organs, such as the heart or the brain,” he says.

Recognizing this link is something manufacturers have stressed for years. That thick, noisy midnight breathing has always been considered a sign of something else, experts say, and while awareness of obstructive sleep apnea and the myriad of conditions linked to snoring has increased dramatically among patients, physicians and third-party payers, manufacturers would like to see that recognition continue to grow industry-wide.

“Consumers who used to accept their disorders now understand [their condition] better, are seeking help and will live longer,” says Rich Kocinski, senior vice president and general manager of the DeVilbiss division of Sunrise Medical. “The research on the long-term effects of poor sleep hygiene demonstrates this.”

Industry leaders seem confident that the market is moving in the right direction. According to Bob Mogue, executive vice president of sales and marketing for CareFore Medical, “There will be continued improvement over the coming five-to-six years and more recognition that snoring may mean a bigger problem.”
— M.G.

Sleep-Disorder Products

Sleep-Disorders Market Geared to Babies and Boomers

Today’s buyer in the sleep-disorder market “doesn’t look like the regular CPAP user,” says Joe Krawczyk, national sales manager for Nidek Medical. Sleep-disorder-products manufacturers used to design products for middle-aged patients, generally men, between 35- and 50-years-old, experts say. But leading manufacturers attest to a recent population change: The market has expanded in both directions to serve an older crowd facing congestive heart failure as well as a younger generation extending to children in diapers and wielding crayons.

“More and more children are diagnosed with sleep apnea,” says Deidre Christiansen, account manager for SleepNet. This increase has been seen especially among “children under 5 pounds and under the age of 2, because of environmental factors and poor health.”

Interest in addressing the sleep-disorder needs of a variety of pediatric patients has been generated recently, notes Ron Richard, vice president of marketing for the Americas at ResMed. “There’s been 20 to 30 percent growth because of studies regarding pediatrics [patients] with ADD [attention deficit disorder] and learning disabilities,” he says. “A high number of those have sleep apnea.” By treating obstructive sleep apnea in children, research has shown “there are [fewer] signs of the learning disability,” Richard says.

While the growth of the pediatric sleep-disorder market is promising for manufacturers, it draws them onto new ground, because most products designed for adults won’t work on children. “Pediatric masks are a very delicate application,” Christiansen says.
— M.G.