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
by Marjory Garrison

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

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

“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

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

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

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

“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,

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

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.