An Epidemic of Sleepless Nights

In the darkest days of COVID-19, no one was getting much sleep.    

Even those without diagnosed sleep disorders found that the stress of the pandemic—coupled with changing routines, new financial and psychological worries,  a penchant for “doom scrolling” and even altered sleeping quarters in some cases—made it hard to get a good night’s rest.

In fact, some 70% of people worldwide said they were experiencing new sleep challenges in the past year, according to Philips’ annual sleep survey, which queried 13,000 adults in 13 countries about their attitudes and behaviors around sleep. The Amsterdam-based company released the results of its annual survey on World Sleep Day in March.

“A year since the start of the pandemic, sleep issues loom large,” the report accompanying the survey reads. “Unsurprisingly, sleep worsened during the past year.”

Of those surveyed, 60% reported that the pandemic had directly affected their ability to sleep well, and 43% said they were struggling with waking during the night.

The impact shouldn’t be surprising: According to Rachel Manber, director of Stanford University’s Sleep Health and Insomnia Program, the two main factors for worsened sleep are changes in stress levels and changes in sleep behaviors.

“In general, worries and anxieties tend to have a negative impact on sleep,” she said in an interview published on the university’s website. “Distraction and other strategies people use to deal with the stress during the day are not helpful when they go to bed at night.”

CPAP Patients Are Struggling

What does stand out from the survey, however, is that the impact on those with sleep apnea was significant.

Only 18% of respondents reported routinely using their CPAP device during the previous year—a decline from the 36% reported in 2020’s survey. The proportion of those who had never used their prescribed CPAP climbed from 10% in 2020 to 16% in 2021.

Those who discontinued their CPAP therapy in connection with COVID-19 cited a range of reasons, from financial challenges to limited access to supplies. Dr. Teofilo Lee-Chiong, Philips’ chief medical liaison, said that everything from supply chain pressures to fears of going to doctors’ offices may have kept people from getting the treatment that they needed.

“If they had difficulty with their current mask, it was very difficult to provide them with a service, to allow them to choose another mask,” he said. “Everything was disrupted.”

At the same time, the survey found, 57% of those living with sleep apnea had never been prescribed CPAP at all. Lee-Chiong said that was likely because of shifts in the medical establishment in response to the pandemic.

“We didn’t have any personal protective equipment when you’re having a test, so a lot of labs were closed,” he said. “A lot of physicians were reassigned to the emergency room, to the intensive care unit. So, resources-wise, it was very limited.”

HME Can Help

The good news, Lee-Chiong said, is that home medical equipment (HME) providers can play a key role in ensuring that CPAP users get appropriate care both as the public health emergency continues and after it ends.

“They are not an isolated service. They are really part of the service of providing care and they have expertise that is unique; they have things that they can do that I cannot do in my clinic,” he said.

In some cases, he said, they may know their patients more intimately than physicians do, especially if they have visited them at home. And HME providers may be the first to get alerted if something isn’t working with CPAP therapy—which they should then document and pass on to the medical team.

They can also advise patients about their options if they’re simply unable to get the supplies they need in time. For instance, Lee-Chiong said, many CPAP masks are actually designed to slightly outlive their published life span. That means that if a reorder has been delayed due to either patient inaction or supply difficulties, it is better to continue to use an older, well-functioning and properly cleaned mask than to abstain from therapy, he said. The same goes for filters—an older filter, as long as it is clean and not torn, is better than none.

Meanwhile, it can help to realize that, even as the pandemic seems to recede, customers still may need extra time or prompting to reorder supplies.

HME providers can also work closely with other members of the care team to ensure that their patients have access to everything they need—and as few obstacles to therapy as possible.

“At the end of the day, they are the patient advocate, they have to work for the patients,” Lee-Chiong said. “And because of that, then there are certain things that they have to do beyond just providing the supplies.”

“Is there anything wrong with the patient experience?” he continued. “I think they ought to consider sharing that with the medical team. And if they’re unhappy with the reimbursement, … then they should come together and advocate for better access for the patients.”

Heading Online for Sleep Help

More than half of survey respondents (58%) were willing to seek help for their sleep issues via telehealth services, although many hadn’t done that yet. Seventy percent, however, said they thought it would be hard to find a sleep specialist through a virtual program.

Lee-Chiong said, however, that sleep-related telehealth could improve the quality and efficiency of care and provide better health outcomes. In fact, using more technology in conjunction with sleep apnea care would allow providers to work closely with patients whatever setting or phase of life they are in.

“This year’s survey results confirm what we’ve known to be true for a while: with the right solutions, care doesn’t have to be defined by a place, but instead by the needs of the individual and his or her condition,” Lee-Chiong said. “The tools required to deliver telehealth efficiently and reliably already exist, and the interest from consumers is apparent, particularly in the face of COVID-19.“

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