Should The Experience of Sleep Apnea Treatment Be Like An Alien Attack?

Loud snoring ruins the lives of millions: the snorers’ as well as those who have to listen to it frequently. However, snoring isn’t just an annoyance. It can hint at a serious sleeping disorder: sleep apnea. Not only does the condition cause frustration in itself, but when looking at the comfort of it, its treatment could be compared to an attack of Aliens. How could digital health help patients who undergo sleep apnea treatment? Are there any ways to get rid of the Aliens?

Almost 1 in 7 people have sleep apnea worldwide

‘Laugh and the world laughs with you, snore and you sleep alone’, that’s one of the troubles with snoring, expressed brilliantly by one of the most influential British writer of the 20th century, Anthony Burgess, most known for A Clockwork Orange. Nevertheless, the curse of loud breathing during the night not only leaves its endurer alone, but it could also signify serious health troubles, such as sleep apnea.

If you snore really loudly and feel tired even after a full night’s sleep, you might have the condition. Its most common type, obstructive sleep apnea – when you stop breathing briefly and repeatedly during sleep due to the relaxation of throat muscles -, sours the life of more than 936 million people worldwide. That estimate – nearly 10 times higher than previous ones – stems from the study entitled Global Prevalence of Obstructive Sleep Apnea (OSA), published in 2018, which was conducted by an international panel of researchers seeking to provide a clear scope of the impact of the chronic sleep-disordered breathing condition. The surprisingly huge number clearly shows that contrary to popular belief sleep apnea isn’t just a disease affecting older, overweight men. It impacts the health of people of all ages, all ethnic and racial groups, and it isn’t gender-specific either.

Source: www.abcnews.go.com

Claustrophobic and uncomfortable

Although the above statistics estimate that almost 1 in 7 inhabitants of the Earth have sleep apnea, a lot fewer people are diagnosed with it. The American company, ResMed, manufacturer of medical equipment for treating, diagnosing, and managing sleep-disordered breathing and other respiratory disorders, estimates that 75 percent of cases of severe sleep disorder breathing remain undiagnosed.

And even if the condition is noticed and examined by a medical specialist, it is not sure that patients undertake the treatment. Sleep apnea is a disease that sticks with the patient for life, and the methods for condition management are, diplomatically speaking, not the most comfortable. Not diplomatically speaking, it’s like constantly enduring the attack of Aliens. That’s because the most commonly used treatment of sleep apnea is the continuous positive airway pressure (CPAP) machine. It means that a patient wears a mask over their nose and mouth at night, which attaches to a machine that provides continuous airway pressure and keeps the nasal passages open. Other sleep apnea treatments include adjustable airway pressure devices and expiratory positive airway pressure, as well as oral appliances to keep the throat open, notes the Mayo Clinic.

While we only have experience with night braces, but that was also like sleeping with ten chewing gums in your mouth every night, we can imagine the inconvenience that sleep apnea patients have to suffer.

Source: www.ctvnews.ca

What can digital health do to help sleep apnea patients?

Due to the inconveniences, we are not surprised that patient adherence to sleep apnea treatment has been so low that it’s basically non-existent. The normal treatment process involves the patient wearing the CPAP device at night, and consults with their doctor several times within a given time period. Healthcare providers have tried using education, apps, and coaching separately to get patients to stick with the program, without much success. While that’s highly detrimental to patients, in the U.S. it also matters to companies seeking reimbursement from the Centers for Medicare and Medicaid Services (CMS). So, how could adherence statistics be raised?

Philips Respironics, a division of Royal Philips that makes CPAP devices, decided to deploy the entire arsenal of digital health and beyond to try to solve the issue: education, apps, motivation, and live coaching in the early days of patients' CPAP use. They call it the Patient Adherence Management System (PAMS), and it involves personalized calls, emails and texts to deliver education, motivational reminders, and support from sleep coaches and respiratory therapists trained in health behavior change, a software for communications with homecare providers to help identify patients struggling with therapy adoption and to personalize coaching, as well as a patient engagement app.

Source: www.bluenovius.com

Better patient engagement means greater adherence

Philips analyzed data from 4383 new CPAP patients who used its program and a control group of 54,455 new patients not participating in PAMS but who were registered with the company's database. The analysis showed that 79.5 percent of the PAMS participants reached the CMS definition of CPAP adherence within 90 days, compared with 63 percent in the standard care control group. The PAMS patients attained nearly 66 percent and 75 percent CMS compliance adherence rates at 30 days and 60 days respectively, compared with 50 percent and 59 percent of patients in the control group.

What does this all mean? Basically, when patients are engaged in their health early on, they can cope with the inconveniences of the sleep apnea device and therapy much better. When they feel taken care of and that’s combined with the right amount of data, they are much more willing to stick to the treatment.

The PWC Consulting Group had a similar experience during their research sponsored by ResMed. Patient compliance with the traditional sleep apnea therapy was fairly low when the patient had to bring his CPAP device to the doctor once every half a year. The doctor downloads the data during the control session and they look at how the patient used the CPAP device during that given time period. PWC found that compliance rates increased when the performance and sleep quality data was transferred from the CPAP device to an accompanying app, and the information was shown to the patient immediately in the next morning. The patient could also share the data with their doctor. The results show that the patient was much more engaged and compliance rates considerably climbed up when the users of the sleep apnea device could immediately see results of the usage.

Source: www.health.harvard.edu

Digital health on the way to make sleep apnea treatment more sufferable

What else could companies on the digital health scene do to make sleep apnea patients’ lives easier? Well, demand would apparently be high for a smaller and less intrusive device. In 2015, the company called Airing started a crowdfunding campaign to raise funds for a ‘micro-CPAP’ device – and received nearly 2 million dollars. Unfortunately, the initiative proved to be a scam, and so far, no company came up with a minimally invasive CPAP device. Although there are successful attempts to ease the pain of sleep apnea patients.

The biggest player on the sleep apnea market, the already mentioned ResMed, for example, has partnered with Alphabet subsidiary Verily to work on sleep apnea, as well as releasing its own connected CPAP devices. Australian company ResApp has developed a technology that can detect sleep apnea based purely on sound with 86 percent accuracy. Fitbit was also reported to aim for the space with their next digital innovation.

Moreover, California-based Beddr has launched Sleep Tuner, an FDA-registered sleep sensor, worn on the forehead, which measures blood oxygenation, heart rate, and sleep position, as well as stopped breathing events. The sensor might be useful to people who already know about their mild to moderate sleep apnea and found the CPAP devices too invasive. These patients might use the Sleep Tuner to understand the impact of sleep position, alcohol consumption, or taking non-prescription medications on increasing their likelihood to have stopped-breathing events.

Source: www.philips.co.uk

All in all, we see incremental hardware improvements in the area of CPAP devices, however, the more important thing is that digital health can significantly improve patient adherence and engagement when it comes to the sleep apnea treatment. We hope that soon enough companies will come up with a less intrusive sleep apnea device, but until then, we are glad to see that digital technologies are raising adherence statistics and saving the good night sleep of thousands. 

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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