For years, Derrick Mosher of Newmarket woke up each morning feeling as though he’d been “slapped in the face with a two-by-four,” even after eight hours of what he thought was sound sleep. His wife complained that he snored, and said she’d witnessed him stop breathing in his sleep. So in November 2012, his doctor ordered a sleep study at Portsmouth Regional Hospital. Mosher, 41, spent the night in the hospital’s sleep center, hooked to wires and sensors from head to chest so technicians could monitor everything from his heart rate and brain waves to muscle activity and breathing patterns.
The study found that Mosher stopped breathing an average of 56 times per night. The diagnosis? Obstructive sleep apnea, one of the most common sleep disorders in the United States, estimated to affect more than 12 million Americans, according to the National Institutes of Health. Poor sleep is often caused by a patient’s medical conditions, such as heart problems, lung diseases, diabetes, and obesity, says Matthew Curley, the medical director at Southern NH Medical Center’s sleep center.
Twenty years ago, sleep studies like Mosher’s were rare. But in the past decade, as doctors and patients alike have become more aware of the dangers of poor sleep—such as heart disease, depression and poor concentration—sleep has become a big business. IBIS World, a market research company, estimates revenue from sleep clinics reached $5.8 billion in 2012, while the American Academy of Sleep Medicine reports that the number of accredited sleep centers in the United States testing for sleep disorders has quadrupled in the past decade, rising from 857 in 2004 to nearly 2,600 in 2014. In NH, nearly every major hospital offers some kind of sleep clinic.
The sleep center at Southern NH Medical Center in Nashua includes five cozy bedrooms, complete with comfortable double beds and TVs and one room with a twin bed for children. Curley says the lab conducts about 1,000 tests a year—meaning on average three of the beds are full every night. That is somewhat fewer than it used to, says Curley, a drop he attributes to new kits allowing patients to test for sleep disorders at home. But he notes lab studies have started to increase in the last few months.
Apart from sleep clinics, the sleep industry also includes pharmaceutical and over-the-counter sleep aids, high-tech mattresses and linens designed to regulate body temperatures and positions, and companies that manufacture sleep equipment, such as masks designed to treat apnea, including Sleepnet in Hampton.
“Sleep is huge. It’s grown exponentially in the last 15 or 20 years,” says Tom Moulton, Sleepnet’s CEO and president, who founded the company in 1997 with a focus on wound care but soon turned to sleep, in part, because the industry was booming, he says. The company makes nasal and full-face masks, employing 25 people and selling its products in more than 40 countries. The masks are used with CPAP (continuous positive airway pressure) machines that control a patient’s air pressure. That is the most common way to treat obstructive sleep apnea.
Sleepnet is a privately held company, and while Moulton declines to share specifics about its financial performance, he says the company has experienced steady growth and is in the process of expanding beyond the home sleep market into hospitals. The company recently launched a line of respiratory masks for hospital patients on ventilators and has more new products in the works. “We’ve got a lot going on with (research and development) right now and a lot of changes coming. We’re pretty excited about that,” Moulton says.
One reason Moulton’s company continues to grow is that both patients and their doctors are focusing more on sleep and its effect on health. Thirty years ago, sleep was rarely an issue doctors discussed with patients, says Matthew Gendron, director of respiratory services at Elliot Hospital in Manchester. But as research emerged showing the effects of bad sleep, awareness of sleep disorders grew. That awareness is a primary driver for the growing sleep industry today, he says.
“The number of patients that have been diagnosed and properly treated has increased,” Gendron says, adding the big change is doctors have focused more on the importance of sleep and its role in health during the past two decades. “Now, everybody knows somebody who has a sleep disorder, and everybody talks about it.”
The Centers for Disease Control has declared insufficient sleep to be a public health epidemic, and estimate that 50 to 70 million U.S. adults suffer from a sleep or wakefulness disorder. Doctors say those numbers may rise as the population ages and obesity rates rise—two major risks for sleep apnea—and as more people become aware of various types of sleep disorders.
A Watchful Eye
At the sleep center at Southern NH Medical Center, patients wear their own pajamas and are encouraged to bring familiar blankets, pillows or even stuffed animals to help them relax. When they’re ready to go to sleep, a specialist attaches a slew of wires to their head and chest to monitor various functions. Then the patient sleeps, as normally as they can, while machines capture all of their activity and a tiny video camera records their sleep.
Elliot Hospital in Manchester conducts its sleep studies at the Homewood Suites near Manchester-Boston Regional Airport. Patients check in like any other hotel guest, can use hotel amenities and receive a complimentary breakfast before they head out in the morning. A technician hooks up the patients to various sensors and then monitors their sleep from another room. The number of rooms the hospital uses fluctuates, depending on patient demand.
“We’ve found it very helpful in decreasing anxiety,” says Gendron of using hotel rooms. “If you think about it, in that clinic setting, what (patients) smell, hear, and see can create a tremendous amount of anxiety, which creates fear and makes it difficult to sleep normally.”
Sleep studies may be growing in popularity, but they aren’t inexpensive. Eric Lindquist, director of respiratory, sleep and EEG at Southern NH Medical Center, estimates that a sleep study in a sleep center can cost upwards of $3,000 or more. While insurance providers generally cover sleep studies, local sleep specialists say insurance companies have been raising deductibles in recent years, and many now require patients to use at-home apnea tests in lieu of a sleep center study at about a third of the cost.
“They’ve (insurance companies) targeted sleep medicine. In the past 20 years there have been a lot of people who have unfortunately abused it and made a lot of money from sleep, and insurance companies are pushing back,” says Dr. Elizabeth Lynch, who runs The Sleep Institute of New England, an independent sleep center in Kingston. She’s seen reimbursements drop 40 to 70 percent in the past few years.
For an at-home study, patients meet with a sleep technician to learn how to hook up their own wires and wear a small console about the size of a large remote control. They perform the study at home and bring the kit back to the lab so sleep specialists can analyze the data. Southern NH Medical Center now has three at-home kits with patients performing 12 to 15 tests per week, says Lindquist. Two years ago, the center only had one at-home kit, but added two more to keep up with patient interest and the increasing mandate from insurance companies to perform at-home tests instead of lab tests, he says.
Insurance companies also appear to be trying to curb costs associated with CPAP equipment, says Lindquist. In the past, patients who were diagnosed with sleep apnea had to come back for a second sleep study to test out a CPAP machine, with a technician continually adjusting the air pressure to find the right setting. Some new CPAP machines automatically adjust the air pressure, however, so insurance companies are requiring patients buy those machines and learn to use them on their own, eliminating the need for a second study.
Mosher, who decided to undergo a sleep study because he’d already reached his annual deductible and knew his out-of-pocket costs would be minimal, now sleeps with a CPAP machine.
Finally, he says, he’s getting the sleep he needs. “I feel so much better in the mornings,” he says. “I wake up more alert than I ever had, and I get through the whole day not needing a lot of caffeine. I still have sleep apnea, but it’s not like it used to be.”