Time to Pay Attention to Insomnia?
Adding Insomnia to the Menu of Sleep Disorders can Expand Services Offered by Sleep Testing Facilities
How many sleep apnea patients also suffer from insomnia? And if sleep lab owners could reach out to insomniacs, could they corral a larger market share? Anand Kumar, CEO of Netherlands- based Personal Health Institute international (PHIi), believes the answer is yes. “Sleep labs should consider extending their business model beyond PSGs,” says Kumar, who also serves as CEO at Health Monitoring Corporation (HMC), the exclusive worldwide distributor of PHIi products “Sleep labs don’t see insomnia patients, but insomnia is perhaps even more prevalent than apnea, and just as problematic within society.”
PHIi takes a comprehensive, Internet-based approach to the massive problem of insomnia. Dedicated to the areas of personal health and clinical diagnosis, Kumar believes in a multi- disciplinary approach that features a partnership between experts in areas such as hardware, software, sensor technology, physiology, and behavior. All of these features combine to forge cognitive therapy for insomnia—over the Internet.
Using the knowledge-based software system called Somnio, PHIi models the therapeutic and diagnostic expertise of a sleep therapist. Kumar describes Somnio as a telemedicine solution via the web, a distance model that empowers patients to take control of their own sleep. “Pharmaceutical remedies do work, but studies show that behavioral therapy is more effective in the long run,” says Kumar, a 1971 graduate of the University of California, Berkeley. “There is a shortage of behavioral therapies because behavioral therapies are labor intensive. Using the Internet model, we have been able to make inroads.”
Patients who use Kumar’s Internet-based software can interact via electronic means, and get valuable advice on how to improve their sleep. Patients fill out an electronic diary every day, and input the information where it is ultimately collected and analyzed. “Obviously, you can’t fix the problem of insomnia with a PSG, but you can determine a cause with proper questionnaires and sleep diaries,” says Kumar. “Every week the data is analyzed and patients receive customized therapeutic advice, because every insomnia patient is different.”
Face-to-face therapy is sometimes prohibitively expensive, but done through the Internet, patients can do everything from home. With almost 60,000 readers/visitors to www.somnio.org, the site statistics reflect the growing awareness of insomnia among patients and physicians.
A Third Option
If a patient eschews prescription drugs and face-to-face meetings with therapists, Somnio provides a crucial third alternative. Now patients can go online, stay at home, and pay a nominal fee which is typically far less than a therapist would cost. Results are similar to face-to-face cognitive therapy, but instead patients interact with a computer program. It works, and thanks to Kumar’s wife, Dr. Winnie Hofman, it is a reality.
As vice president of Sales and Business Development at HMC, it is Michael Clark’s job to spread the word to both consumers and sleep laboratories. HMC intends to generate revenue by licensing Somnio to sleep labs, a move that will expand a lab’s market beyond sleep apnea. “US sleep labs are of course focused on sleep apnea patients,” says Clark. “However, insomnia is the most prevalent sleep disorder, and most sleep labs are not prepared to handle it.”
Why do sleep lab professionals rarely know how to deal with insomnia patients? It’s a question of motivation. Right now, there is no reimbursement for testing patients for insomnia. However, sleep labs that buy a Somnio license can get back a major portion of the patient enrollment fee.
Once a lab has the license, HMC can set up the program through a company’s own Web site. “When patients log on, it will look like your Web site, but it is really the Somnio program running in the background,” says Clark. “We license it to the sleep lab for X number of dollars a year, and then we give a large percentage of the money after each patient enrolls back to the sleep lab. Sleep labs benefit because they get another revenue stream. Patients benefit because they come into this program, go through therapy, get treated, and come out at the other end with an 80% chance of being cured of insomnia.”
Beyond Warm Milk
Countless people have suffered from insomnia over the years, and remedies such as warm milk can only go so far. Drug therapies, while effective, are not ideal for everyone. For these people, Somnio offers help based on the most recent scientific knowledge that is tested extensively in clinical practice.
Somnio determines patients’ day-to-day sleep patterns based on answers to questionnaires and a weekly sleep diary. The actual treatment is based on Cognitive Behavioral Therapy, a treatment shown to be effective in a consensus report from the NIH. The treatment has eight sessions, and each session is carefully prepared according to individual needs. The sessions take place online monitored by a certified sleep behavioral therapist.
The treatment plan is prepared on the basis of questions and answers about behavior, feelings, sleep hygiene, and use of sleeping aids. Throughout the eight sessions of the treatment the therapist can monitor changes in sleep patterns with the help of information from the 7-day sleep diary.
The Somnio sleep therapist will:
- optimize sleep patterns;
- optimize sleep behaviors;
- optimize the sleep environment;
- advise on preconceived notions;
- discuss challenges and thoughts; and
- reinforce positive beliefs and thoughts
Somnio was developed by Winni Hofman, PhD, a faculty member of the University of Amsterdam in the Netherlands. Hofman been teaching sleep and treating sleep complaints since 1974. In the decades since Hofman began her work with sleep, awareness has grown exponentially. With more sleep labs opening to address this need, Kumar agrees that it could be the right time to partner with insomnia therapists and expand beyond apnea. “Sleep labs can attract more patients with this and use it as a portal to expanding to apnea,” says Kumar. “We start with a basic screening that patients can do online. It’s a way to attract more patients, develop awareness about sleep, and have a database of prospective patients. Ultimately, a sleep lab can expand its horizons and attract more patients, because most insomniacs have chronic apnea.”
In addition to using Somnio as a marketing tool to attract more apnea patients, physician referrals may also flow toward labs when clinicians hear about the new option. Clark points out that the whole transaction is seamless because cognitive therapy is not involved with Medicare, and does not require a prescription.
The mechanics of Somnio, developed by Hofman and Kumar, are deceptively simple. “They were able to design intelligent algorithms that respond back to people who are entering information, depending upon how they react to a question,” explains Clark. “The question could be asked, and then the answer is given depending upon how they asked the question. It is not replacing therapists, because they still have roles in this.”
Patients answer questions in their own home, and on their own timeframe. Solutions and advice are offered in eight different online sessions; because research shows that eight is the optimal number, one session a week. “After a couple of months of going through this program, it has a remarkably high cure rate,” says Clark. “It’s over 80%, and we have statistics to prove that.”
For more information visit www.MyHealthMonitoring.com
Dr. Winni Hofman and Anand Kumar have studied sleep medicine for over 35 years publishing numerous papers dealing with the consequences and treatment of insomnia. Dr. Hofman is a faculty member of the University of Amsterdam where she is currently teaching advanced sleep medicine courses. Anand Kumar continues to develope advanced software and hardware technology used to monitor multiple physiological parameters.