Sleep Is the New Vital Sign

During the past 18 months, there has been an explosion in the use of remote care modalities, and many things once relegated to the health care vernacular—such as telehealth, remote patient monitoring and virtual care—are now household terms.   

Along with the rise in popularity of remote care platforms, there has been a deeper understanding of the benefits of measuring the data points that make up traditional remote patient monitoring platforms, such as blood pressure, weight and heart rate.

Those in the remote patient monitoring (RPM) space have also seen something percolating on the horizon for a while now—the idea of sleep as a clinical marker.

Why? Well, really, it’s a trifecta of factors:

1. Consumer demand has accelerated broader awareness for sleep data;
2. The technology for monitoring sleep has gotten better; and
3. Poor sleep is now widely recognized as a primary indicator for developing or exacerbating chronic conditions.

Consumer Demand

Sleep has been having a moment in the health tech market for some time now. Wearables manufacturers—from fitness trackers to smartwatches to rings—discovered years ago that they could provide consumers with sleep data based on their heart rates and body movement during resting hours.

For consumers, seeing patterns of light and deep sleep, and even points of waking in the night that they might only vaguely recall, was a true technological breakthrough—and immensely exciting. Or at least it was at first.

According to New York Times technology journalist Brian X. Chen, “[the] excitement ended there. Ultimately, the technology did not help me sleep more. It didn’t reveal anything that I didn’t already know, which is that I average about five and a half hours of slumber a night. And the data did not help me answer what I should do about my particular sleep problems. In fact, I’ve felt grumpier since I started these tests.”

Chen also realized he isn’t alone: a study from Rush University Medical College and Northwestern University’s Feinberg School of Medicine found patients complained about sleep data collected by apps and devices from Nike, Apple, Fitbit and others. Their research cautioned that sleep-tracking tech could provide inaccurate data and even worsen insomnia when people became obsessed with getting a perfect night’s rest.

But it’s likely that the “grumpiness” with the data points is tied to another aspect related to consumer-driven health and wellness devices: The data points don’t
tie back to actionable insights to help make people healthier or show an actual impact on other health markers, such as blood pressure or weight.

And that is what the industry could start to see in the very near future: As sleep weaves its way into more formalized remote patient monitoring platforms, there will be a marrying of sleep data points with more traditional data points. This will allow health care providers to have a much more robust picture of patient health in order to make recommendations for improved patient outcomes.

Technology Advancement in Sleep Monitoring

Sleep monitoring isn’t new—in fact, sensors have been used to study sleep for decades. The gift that longevity has given the industry is the development of a gold standard by which to measure all other sleep monitoring devices against—polysomnography (PSG) paired with clinical evaluation, both of which are typically accomplished in a laboratory or other professional setting.

But becaue a lab setting is neither a practical nor inexpensive way for consumers and their health care providers to discover more about their sleep patterns, there has also been a steady influx of investment into the sleep monitoring technology space.

In fact, according to some reports, parts of the sleep health industry have grown at more than a 15% compound annual growth rate for the past several years—with no signs of slowing down. This has resulted in a bevy of smaller, less obstructive and more portable devices, including:

• Bed sensors
• Smartwatches and fitness trackers
• Mobile phone sensing
• Wi-Fi and radio-signal approaches

While those new technologies hold immense promise for consumers and their health care providers to be able to extract valuable insights from sleep patterns, what they lack is the key ingredient needed to be used in a health care setting: a demonstrated alignment against the validated PSG gold standard.

Unless a device has been satisfactorily tested against polysomnography, no physician in the world would risk making a patient assessment based on the data. I expect more manufacturers will start making the move to clinically test their devices against PSG and market them based on adherence to that standard.

Sleep as a Clinical Marker

With demand and technology firmly moving into place, the final piece of the puzzle can be more fully explored, and that is the demonstrated link between sleep and an array of chronic health conditions.

According to the recently released position statement from the American Academy of Sleep Medicine, “Current data supports the importance of healthy sleep for cognitive and mood function, as well as cardiovascular, cerebrovascular and metabolic health. Chronic insufficient sleep was found to be associated with increased morbidity and mortality, while extending nightly sleep duration in these patients was associated with health benefits.”

If sleep is a primary component in caring for people with chronic conditions, then monitoring the quality of a patient’s sleep is the first step toward being able to give health care providers the information they need to make better decisions when it comes to care plans.

But providers and patients can’t do that without also creating the ability to analyze the data on the back end. No physician wants to receive individual sleep graphs for 278 patients every day.

What physicians do want is a single dashboard that provides them with a clear picture of how every one of their patients is doing. Maybe that’s a sleep score that’s combined with early morning weight and then measured against parameters set by the physician for their patient set, much like what we see with traditional remote patient monitoring dashboards.

With the demand for sleep monitoring coming from consumers, and the technology advancements that can be validated against gold standards such as PSG, providers simply need to connect all the dots to be able to take sleep and use it to give them the same type of insight they get from other clinical markers.

The world of RPM is about to get bigger—with data sets that include a lot of Zs.