Electronic Health Reporter

By Vik Panda, managing director North America, Dreem.

Rumors had it that Apple wanted to help you track your sleep. Industry watchers said it’s in part about playing catchup with Fitbit and others. Although, Apple has never worried about being second or third, just whether they can be the best.

But when Apple’s big announcement came earlier this month, there was no mention of a sleep tracker.

There is indeed a pressing need for sleep health, but could Apple really have met that need with another tracker? They’ve already acquired Beddit, which is a sensor that fits under your sheet, and Tueo Health, which monitors respiration in sleeping children.

Where would Apple go with a brain wave tracker, or EEG? What about high quality digital coaching? What about data that can propel science? Can they bring an integrated solution forward?

Sleep disorders are a trillion-dollar healthcare problem encompassing a third of the world’s population. In fact, 80 percent of poor sleep is undiagnosed and is untreated. This is in part because diagnosis is perceived as too expensive by individuals – wrongly when you consider the consequence of not getting help – and there aren’t enough trained experts moving through the medical education system to deliver adapted treatments.

A trillion dollars is a big number, but it’s not a real number if no one tangibly feels it, or understands the pain from poor health they feel is because they are not getting the kind of sleep they need or enough of it.

Drug advertisements will focus on the impact that bad health has on spending time with family, but let’s face it, our jobs and our ability to make a living is where health problems can plunge us into panic. Employers also feel the impact of sleep health, and they’re realizing just how important it is.

Sleeping on the job

Before joining a media interview recently, I met Bella Hughes of Shaka Tea in the green room. Bella shared that the trend for companies interested in her caffeine-free tea say their teams are dropping the stereotype of a stimulant-driven workplace. Even in Silicon Valley and its legendary all-nighter coding marathons and pantries stocked with “energy” boosters, the reality is sinking in that focus and results are driven by healthy sleep and conquering sleep disorders.

Why is that?

Forget about the quality of software code and hitting release deadlines. There are 100,000 vehicle accidents per year in the U.S. because of drowsy driving. The rate of breast cancer was 30 percent higher for the women who had worked late shifts. Sleep disturbances lead to up to three-fold higher risks of late onset type two diabetes. Sleeping less than six hours multiplies by 11.5 times the risk to a vaccine failing to provide expected protection compared to sleeping at least 7 hours.

Employers feel the impact in accidents, and costly mistakes. Beyond that, 81 percent of large firms are self-insured. They assume risk for employee healthcare costs, and also the risk of sick employees’ reduced productivity. By providing solutions that help afflicted employees, from caffeine-free Hawaiian tea to technology that does more to address sleep health than just another tracker, employers can improve loyalty and retention.

Through employee benefit programs, distributing directly to employees and managing their benefits, companies know they have a problem with sleep. They can see the drive to buy over-the-counter medications in large quantities. But over the counter therapies have very limited evidence for sleep improvement. Americans spend $41 billion annually on sleep aids and wellness solutions.

But receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death, even when prescribed 18 pills or fewer per year. Thirty percent of medication overdoses involving opioids are linked to drugs commonly prescribed for insomnia.

Despite inducing low-quality sleep, having proven side-effects, lasting health consequences and low treatment efficiency in the long-term, sleeping pills are too often prescribed. That’s changing, in Europe physicians are paid less if they prescribe too many pills. Our own science at Dreem is driven in part by our mission to provide a non-invasive, non-chemical way to address problems with sleep.

Digital for health

Apple may still attempt to address strong demand from a population that already spends large amounts annually in out-of-pocket expenses, and there is a larger opportunity to do better if we look at the combined $1 trillion poor sleep delivers in economic loss, and the $30 billion of unmet need for treatment.

But another Apple tracker may not be enough. The American Academy of Sleep Medicine has published findings that trackers may actually be a problem on their own, not a solution. Alternatively, clinical experts say the more telemedicine and digital solutions are able to mirror and expand what clinicians do in practice, the more they can help.

We need to scale what works in actual sleep labs in a way that brings together the best science we have for disorders today, and through the data we glean from helping people, take science further for all of us.

Recording brain waves with an electroencephalogram (EEG) is important to obtain accurate sleep data. Cognitive behavioral therapy (CBTi) for insomnia has been held out as the standard for therapy, safer than pharmaceuticals. On its own, without high quality tracking, it can be limited. Smarter and scalable technology brings a full comprehensive solution together. It’s not just a brain wave tracker. It’s not just digital coaching. It’s not just being mobile. It’s more than the data and analyzing it. It’s how these integrate.

Professional therapists can integrate these things, but it is difficult to scale with automation, software and digital mobility. A solution that makes an impact must be integrated, and it must scale.

Apple and other companies trying wearables and digital health today need to avoid being like the early days of computer-generated characters in movies. A solution can’t look awfully close to the real thing, like real clinical care, but leave something missing. With high quality comprehensive data sets – in the case of sleep disorders, over a million nights of recorded sleep – we can fully utilize artificial intelligence to design solutions that take what occurs in the clinical setting – personalized high-quality coaching – and help professionals scale it. Therapies can achieve their full promise in a larger community or patients and experts.