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By: Kent Caylor, RPSGT on March 4th, 2020

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The Changing Face of Sleep Technology, Part 3

history of sleep technology

This article is part three in a four-part series on the ever-changing face of sleep technology. In this article, we’ll address the following questions: What does the future of sleep medicine look like? How will evolving technology change the way sleep studies are done? And, just as importantly, how will economic pressures affect sleep medicine?

The Sleep Lab of the Future


The financial viability of future sleep centers needs to be taken into account. As more home studies are done, more sleep center beds will be empty. What will this do to the sleep center itself? Will some centers be forced to close? And, if they do, where will those patients go? Also, what will happen to the building itself? This change could initially lead to a number of bankruptcies and layoffs, which alone could have a negative impact on the economy.


And although there will continue to be a need for in-lab studies (at least in the foreseeable future), the main revenue might be coming from home sleep apnea tests (HSATs). As the volume of HSATs increase, the volume of in lab studies will naturally decrease. This will ultimately lead to a reduction in sleep technologists, with a reassignment of others to different tasks (more on this in my next article).


This might ultimately lead to more sleep labs set up in hotel rooms with short-term leases, or maybe even clinics that double as sleep labs overnight. Whatever the outcome, sleep centers and technologists need to stay ahead of the game as the move is made toward more HSATs.

 

Will the Canary Die?


(Back in the days of coal mining, miners would use canaries to test for lethal gas.)
Another potential problem sleep medicine faces is how it’s perceived by medical students. The following issues could make sleep medicine less attractive:


• In-lab sleep studies will continue to decrease, which also means a reduction in reimbursements.


• Having just completed four to six years of postgraduate medical school, will students
find another year of sleep training financially worthwhile?


• Because most patients are diagnosed and treated for sleep apnea, there is concern about how intellectually stimulating sleep medicine is perceived.

However, there’s something else to consider. With the increase in HSATs on the rise, the need for telemedicine will likely increase.

 

Telemedicine


With the increasing use of the internet, people are becoming more connected to healthcare services. Thus, in the future, it will become increasingly more common to meet with your doctor via the internet. This will also mean we will have access to more information, which will naturally lead to the possibility of patients becoming more involved in their healthcare.


Additionally, sleep studies should work well with telemedicine, creating a new branch called telepolysomnography, or maybe just telesomnography. You may even be able to have a Type I sleep study in the comfort of your home, with data livestreamed via telemonitor. And while some ofvthe benefits of telemedicine include convenience and saving on healthcare costs, there’s also a downside, such as reduced personal interaction with your doctor.


All this will, of course, be limited to countries with the technology and those with smart homes.

Smart Homes


In a smart home, devices are connected to one another via internet/Wi-Fi. These devices are activated either by voice, motion and/or iPad/smartphone, etc. Any device that uses electricity can potentially be connected to the internet. For example, a lightbulb that can be turned on by an app on your smartphone, or maybe even just motion activated. These devices are part of what has been termed The Internet of Things (IoT). Add artificial intelligence (AI) into the mix and you have a home that will take care of both you and itself. This, of course, has both good and bad implications.


For now, let’s take a closer look at how IoT and AI could work together as they relate to sleep.

 

IoT with AI


Artificial Intelligence takes many forms and is even hard to clearly define. But, for our purpose, any machine capable of learning and problem solving is considered AI. With that, let’s see how this technology could affect future sleep studies.


To begin with, insurance companies continue to push for more home studies; thus, smart homes equipped with AI enabled IoT will facilitate more accurate studies. For example, let’s say you’re set up for a sleep study. Your doctor gives you the equipment and shows you how to apply it. Or, more likely, a sleep tech will be working with your doctor, and they will show you how to apply everything.


Once you’re home and hooked up, your smart bed tracks your movement, while sensors detect the various signals. You could also be supplied with an infrared camera that can be remote viewed via Skype. All the data is then livestreamed to a remote computer, which is either
manned by a sleep tech and/or monitored by an AI device. If there are any problems during the study, you could be immediately alerted and talked through the proper course of action to reconcile whatever the issue is.


There’s already a device on the market that monitors sleep via a non-contact biomotion sensor. There are also apps that connect to your sleep apnea device. The future of sleep studies, at least from a technological standpoint, is alive and well.


However, this technology also raises some serious security and privacy concerns, especially as these tools become more integrated into our lives. With all this information available on the internet, security is going to be an even greater problem than it is today. For instance, imagine someone hacking into your smart home. One security method could involve a more advanced form of biometric authentication using artificial intelligence. Fingerprint, voice and/or face recognition, to name a few, will need to become much more accurate than they are today.

Nanomedicine is another branch of science that hold promise for sleep technology.

 

Nanomedicine


Nanomedicine is the manipulation of individual atoms and molecules to create little “machines” that can be “programmed” to perform specific tasks. The size of these machines are measured in nanometers. And to give you an idea of the size of these machines, consider this: Your fingernail grows at the rate of one nanometer per second, a human hair is 80,000 to 100,000 nanometers thick, and a piece of paper is about 100,000 nanometers thick.


So how does it work? And just how does this fit in with sleep medicine?


Presently, there are nanoparticles (NPs) being designed for introduction directly into the body for diagnostic and therapeutic purposes, including disease prevention. Thus, the way is already being paved for using nanomedicine for both diagnosing and treating OSA, and other comorbidities associated with it. Imagine using “nanobots” to monitor everything from brain waves, to heart rate, and even respiration. These nanobots could be either inhaled or injected, and ultimately eliminated once their function is complete.


However, this does present some toxicological concerns for a number of reasons. One of these is that potential toxicity of a particle increases as the surface area increases relative to overall mass. And, as you can imagine, the smaller the particle, the greater the surface area is relative to overall mass. Also, particles “act” differently at NP size. Therefore, not only safety, but quality and efficacy of nanomedicinal products (NMPs) will need to be established.


And just what will we learn as research continues on the brain?

 

Physical Exercise and Brain Health


The human brain is an amazing organ. We already understand how much better the brain functions during physical exertion/exercise. What will this mean for future generations? As healthcare becomes more prevention focused, it seems likely that insurance companies (already trying to keep costs down) will push even more for fitness programs. 

We already know physical activity has a positive effect on the hippocampus, which is the area of the brain necessary for memory formation. Additionally, the hypothesis is that just as physical activity enhances neurogenesis (creation of new neurons), stress and depression reduces the same. And, of course, without neurons carrying information throughout the nervous system, we could neither think nor feel.


In fact, studies show that people who exercise are less likely to suffer from dementia. And even adolescents who exercise have been shown to make better decisions. Work is continuing with The Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative, and the Human Connectome Project. These projects are aimed at mapping individual brain cells with the goal of capturing complex neural circuit interactions in real time. This research will gain a better understanding of the brain and will aid in the treatment of brain disorders, such as dementia.

 

Sleep Disorders


As research on the brain continues, what new discoveries will be made that will directly affect the treatment of sleep disorders?


EEGs only record those brainwaves emanating from the surface of the brain. There are also brainwaves deep within the brain. Are these also significant? Will further research reveal things about both the sleeping brain and awake brain that we’re missing? And, if so, how could these findings change/improve treatment of various diseases, sleep related and otherwise?


Also, increasing obesity rates may translate into an increase in sleep studies. But again, the demand for sleep technologists could decrease as home studies increase. Along with the move toward more preventive medicine, the role of insurance will also change.

 

Insurance


Insurance in the U.S. has traditionally been focused on curing disease, with an emphasis on quantity of care. Yet, healthcare in the U.S. is not only significantly higher than other developed nations, quality of care is lower than many. In fact, according to the World Health Organization, the U.S. ranks 37th in overall quality of care. Today, health insurance is in a state of flux, and the new focus is on disease prevention, with an emphasis on quality of care.


Also, other positive changes are in the works. For instance, a task force met recently to discuss the future of sleep medicine. Among the various models discussed, the most viable one is the patient-centered medical home model of care (PCMH).


Currently, patient care regarding sleep studies is occasional, with the primary care physician taking on the main responsibility for care management. Under PCMH, responsibility of care becomes more of a team approach, as other medical staff take more active roles. And the goal is a more consistent long-term team management of chronic diseases.

 

The Future Looks Exciting


We don’t know for certain what the future of sleep medicine will be like, but from the looks of present technology, that future looks bright. Although advances in technology will lead to changes in the role of sleep technologists. Therefore, in the next article, we’ll take a look at what that role might look like.


Article originally published in the A2Zzz Magazine Quarter 3, Volume 27