Trains, Planes, Automobiles & Sleep Apnea

I travel quite a bit with my work. Last year, I flew over 100,000 miles with just one airline and spent more than 100 nights in various hotel rooms around the world. And no, traveling is not all that’s it’s cracked up to be.

Many years ago I thought that a job requiring extensive travel would be glamorous and exciting. I never anticipated all the changes that would impact traveling post-9/11. And that’s not to mention time zone changes and sitting in a small, uncomfortable seat for hours on end with the only reward a bag of peanuts and a soft drink — if you’re lucky!

On the bright side, I get to meet a lot of interesting people through my travels. Conversations usually flow into areas of work and family. One question I am often asked is, “What kind of work do you do?”

Five years ago my response was labored and well-thought out, since few people in the general public knew much about the growing problem associated with sleep apnea. People would relate to sleep apnea by joking about their uncle or brother-in-law who “snored like a freight train.”

I would go through a detailed explanation to a fellow passenger describing as best I could in non-technical, non-threatening terms the life-threatening nature of sleep apnea and the simple, non-invasive treatment that was available. Usually, I would hear the following polite reply: “Oh, that sounds interesting, but I could never have something like that.”

But over the past couple of years it seems like someone has let the cat out of the bag on this silent but deadly disease. Recently, when a conversation with a fellow traveler led to the inevitable question about what I do for work, I tried a new approach I learned from a friend in sleep medicine. I simply told the gentleman I worked in the medical industry for a company that develops products to treat sleep suffocation.

Immediately he told me that he had been diagnosed with a sleep disorder and now wears a “funny little breathing mask with a machine attached to it that blows a gentle breeze” into his lungs. He went on to say how much better he feels and that he has a new lease on life. He said his wife now also gets a good night’s sleep since he isn’t tossing and turning and snoring, which previously had kept her awake and often forced her to sleep in another part of house.

In addition, he now feels well enough to drive a few hours to see his grandkids. Before being treated, he was afraid to drive more than 30 minutes for fear of falling asleep at the wheel. I felt relieved to finally find someone who knew what my work was all about without having to go into a long, drawn-out discussion.

Today, I am pleased to say that over the last two years this experience has been repeated many times. In fact, it’s gotten to the point that when I mention the field of work I am in related to sleep medicine, I now have people telling me more about the topic than I was aware.

People are getting passionate about finding a solution to their health issues. It seems now that the news of sleep disorders is spreading rapidly, thanks to increased awareness by the media. Over 200 million impressions have surfaced on the topic in the last 24 months.

Sleep disorders are one of the most researched areas on WebMD, as well as other popular Web sites. The secrets of getting a better night’s sleep are being touted in several new books sold at national bookstores, and the benefits of treating sleep disorders is well-documented in newspaper articles, magazines and clinical journals.

So why is everyone so concerned about sleep apnea? Sleep is something we all have in common. We all must rest or our lives quickly become miserable and we suffer a multitude of side effects. Getting good sleep is critical to living a healthy life rather than suffering from the symptoms and/or comorbidities associated with sleep apnea.

The friend I mentioned who refers to the disorder as “sleep suffocation syndrome” is a physician at Stanford and has spent more than 30 years working in the field of sleep medicine. He refers to sleep-disordered breathing as “death by a thousand nicks,” because the damage suffered by the patient occurs over many years, much like smoking. After years of experiencing apneas and shunting oxygen from major organs such as the heart, brain and kidneys, a patient is at significantly increased risk of hypertension, heart disease, stroke and diabetes.

With sleep apnea, it’s like that old saying, “Pay me now or pay me later.” But paying later usually comes with higher interest rates and costs a lot more.

By improving earlier detection and screening for sleep apnea, the health care system can potentially save billions of dollars over the next decade. In the case of treating SDB, it’s difficult to argue facts in terms of economics benefits. The average cost savings in real dollars is estimated to be $2,000 per patient per year, according to published articles in Sleep, the official journal of the American Academy of Sleep Medicine and the Sleep Research Society.

In addition, several of the comorbidities directly linked to SDB are also listed in the top 10 categories of highest percentage of dollars allocated for treatment and diagnosis of a disease. Considering the high prevalence of sleep apnea in these costly health conditions, it is clear that sleep apnea is associated with significant health care costs (see the accompanyint table).

In fact, it is arguable that each dollar spent diagnosing and treating patients for sleep problems provides one of the best returns in our health care system. A recent article from a trucking company that tracked health care cost pre- and post-treatment for sleep disorders found that the company saves on average $540 per month.

This is compelling data and translates into savings in terms of dollars and in terms of lives lost either in single or multiple vehicle accidents.

Another question I often get asked, primarily by market analysts, is, “Why is everyone so concerned about sleep apnea?” And my reply is pretty simple: People are concerned because millions are affected either directly or indirectly by this chronic and debilitating illness.

The treatment is safe, non-invasive and produces great results when used properly. Rest is also something we all need — there is no replacement for a good night’s sleep. Additionally, the trends in the field of sleep look very positive for a number of reasons:

• Increased awareness in the public as well as medical specialties
• Improvements in the technology (smaller CPAP devices, heated humidification, more comfortable masks and new algorithms that address complex patients)
• Better overall education on the topic and understanding how to treat the disease
• Screening for sleep apnea has increased in hospitals and clinics to reduce risk associated with sleep disorders

Advances being made in the area of patient interfaces as well as devices appear to be reaching a new benchmark. We can expect further improvements in convenience and comfort, size reduction and feedback provided to the patient and the clinician so they can better manage this chronic disease process.

This trend is being driven by patient and physician demand, as physicians are increasingly looking at sleep apnea patients’ overall health rather than treating their conditions as isolated issues.

Another trend is the increasingly important role that patient education and management plays in the equation; these are both critical elements in assuring adherence to therapies such as CPAP. Providing patients options and educating them in terms of self-managing their chronic disorders has proven to pay back dividends to the health care system. This model is well documented in the areas of diabetes, asthma and COPD.

Many published articles from leading clinicians state that by properly educating patients at the start of CPAP therapy and providing regular follow-up during treatment, HME providers can help patients adhere to their therapy, ultimately leading to better patient outcomes and lower costs to health care insurance payers. Therefore, patient service can be viewed as a critical investment in the home health care industry.

Many of the leading sleep centers now have a multidisciplinary approach to treating their sleepy patients. They often employ a variety of medical specialists who can provide expertise and options for patients suffering from snoring and excessive daytime sleepiness, restless leg syndrome, narcolepsy and insomnia.

Patients being treated in this type of model may see an ear, nose and throat physician, a dentist and a pulmonologist to find a solution for their sleep disorder. Medical silos are being broken down and replaced with an open-minded approach that seeks better protocols or pathways to improve treatment and patient care.

A good example of this cooperative effort was a conference hosted last September by the American College of Chest Physicians to discuss issues surrounding the sleep industry. Invited attendees included representatives from manufacturers, sleep physicians, patient support groups, home care providers and payers. Of specific focus was aftercare and setting new standards for managing patients being treated for sleep disorders.

As for the future, I am very encouraged by the trends we are seeing in the area of sleep medicine. I see better communication on the topic among medical professionals, support groups and home care providers.

Sleep apnea is quickly becoming a national concern due to the impact it has on safety, health care expenses and the overall decline in quality of life for patients who suffer from this chronic disease. Creating standards to address aftercare issues, improvements in screening and new treatment options will decrease overall health care expenses related to sleep apnea as well as its associated comorbidities. These decreases are estimated to be in the billions of dollars.

The next time I am on a plane or traveling somewhere, I bet I will meet someone who is living a much better life based on getting treated for his or her sleep disorder, and I won’t have to struggle telling them what type of work I do.

The secret of getting a good night’s sleep is spreading, and this should make all of us proud of the work we do.

Ron F. Richard is senior vice president of strategic marketing initiatives for ResMed Corp., Poway, Calif. He may be reached at [email protected].