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Commentary

Veterans Cannot Afford to Delay Sleep Issues and Neither Can America


December 10, 2020

By: Dr Melissa Lim, chief medical officer and Co-Founder, Somnology and Patrick Yam, CEO and Co-Founder, Somnology 

Melissa S Lim, MD, FCCP, FAASM, chief medical officer and co-ounder, and Patrick Yam, CEO and co-founder, both at SomnologyIt shouldn’t come as a surprise that trauma and post-traumatic stress disorder (PTSD) are correlated to the development of sleep problems. In fact, it’s been highlighted that self-reported increases in sleep issues with PTSD can occur anywhere from 2 to 45 years after the traumatic event.  

There are many unknowns related to why witnessing or experiencing a traumatic event may cause symptoms, including issues with sleep health, decades later. But the reality is that these two issues, often linked, are highly prevalent in America: 70% of individuals with PTSD also have co-occurring sleep problems.  

For the veteran population specifically, these numbers can be even worse. And the long-term impact to overall health and wellness can be significant. 

Shifting the Mindset Around Sleep

The problem rests with how the health care industry has traditionally viewed sleep health—a benign secondary health problem rather than an urgent health epidemic that requires attention.

Ignoring sleep health has severe long-term implications as demonstrated by alarming statistics. Lack of sleep elevates the risks for heart disease, diabetes and other chronic diseases. Drowsy driving causes an estimated 300,000 motor vehicle accidents each year.  

Delaying treatment for sleep issues will simply “punt” the problem and contribute to rising and unsustainable health care costs, which are expected to reach between $299 billion and $433 billion in 2020 alone. Consequently, the imperative to solve sleep issues is clear, and it must be solved quickly. 

Our veterans deserve better. They deserve access to the most scientific sleep diagnostic tools, expertise and treatment options regardless of where they work and live. They need providers who are committed to addressing barriers to optimal sleep health and solutions that are tailored to their specific needs.  Somnology’s telehealth sleepcare platform extends its care to include veterans in rural communities to provide them needed care without the necessity to drive and attend appointments.

Understanding Barriers to Optimal Sleep Health

Unfortunately, many of the best diagnostic treatment options—for veterans and civilians alike—fall short.  

For example, many people assume wearable sleep tracking applications will suffice when addressing sleep issues. But these apps, which track the duration, cadence and quality of sleep, can’t diagnose major clinical issues and aren’t the complete remedy to correcting one’s sleep disorder. They are not typically equipped with alerts that result in physician follow ups, so problems identified by the device frequently go unchecked.  

The polysomnogram, or laboratory sleep study, is more comprehensive than a wearable, but it is not a realistic option for most Americans. There are only 2,700 accredited sleep centers in the United States, and 7,500 board-certified sleep physicians who can oversee sleep studies. While populous states like California and Texas have 500+ sleep physicians, more rural states often have fewer than 100. This results in long waiting lists for patients. The time delay from referral to treatment can take up to 180 days, during which a patient’s other health issues can escalate.

Also, even if a health plan covers most of the cost to administer a sleep center analysis, which can cost up to $5,000 per industry estimates, the 10 or more hours a veteran spends away from home for just one night of analysis limits a physician’s insights into the nature of sleep over time. Sleep is dynamic and apt to change depending on one’s environment and stress levels. A single night’s sleep test may be extensive, but it’s not necessarily all that’s needed to diagnose a patient holistically.  

And the reality is that diagnosing a sleep disorder is only the first step. Finding the right treatment plan and follow-up care for the patient can take a lot of trial and error, and veterans must have solutions that are tailored specific to their needs.  

The bottom line is that a successful outcome hinges on having a continuous, personalized solution—one that offers the right diagnostic tools to assess the sleeping problem, the right care team with experience in treating sleep disorders, and ongoing patient engagement.

Improving Veterans’ Health Through Sleep Science

The good news is that most veterans don’t need costly sleep studies to see improvement in their daily lives and sleep quality.

Somnology sleep experts have seen more than 1,000 U.S. veterans, ages 20 to 89, improve sleep health through a comprehensive approach that brings together the power of continuous sleep monitoring and ongoing professional consultation. In 2019, our medical team provided veterans with wearable sleep-assessment gear that enabled them to self-monitor symptoms while in the comfort of their own homes. While they slept, the wearable device collected sleep data and transmitted it to an integrated sleep care platform known as “SLaaS,” or sleep lab-as-a-service—which then dispatched data to sleep specialists across the country.  

Following the data collection process, the specialists set up appointments to meet remotely with veterans through a telehealth network. During these ongoing, periodic consultations, the specialists helped individuals understand the nature of their sleep issues, including the correlation of sleep with any other medical conditions (eg, PTSD, substance use). The specialist would then implement a treatment plan tailored to their specific clinical needs and lifestyle considerations. 

While this intervention is still relatively new, it has already saved the U.S. Department of Veterans Affairs an estimated 50 percent in sleep-diagnostic costs, while helping a greater number of veterans receive specific treatments for their exact issues.

And while this is just one promising study, it’s an important one that can serve as a model for veterans organizations throughout the country.

If anyone deserves the best that sleep science has to offer, it’s the men and women who are of service to our country. Improving sleep health for veterans will have a positive impact on other health outcomes—so our health care leaders should do whatever they can to implement solutions that help our nation’s veterans live heathier, more well-rested lives.  

 

Melissa S Lim, MD, FCCP, FAASM, is the Chief Medical Officer and Co-Founder of Somnology

Patrick Yam is the CEO and Co-Founder of Somnology

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