Effectively communicating sleep awareness can benefit sleep centers, the medical community, and patients.

 Today, the potential for increased consumer awareness in the area of sleep disorders is groundbreaking and the means to help achieve a greater level of patient compliance are becoming more available each day.

This may appear to be an idealistic point of view. To the casual observer, the causes of and solutions for sleep disorders may still be vague. Terence M. Davidson, MD, FACS, professor of surgery, head, and neck surgery, University of California San Diego, and director, UCSD Head and Neck Surgery Sleep Clinic, explains, “There can be more than 15 reasons why sleepiness occurs and often, it is undiagnosed or misdiagnosed.” The National Institutes of Health estimates that more than 12 million Americans suffer from sleep apnea, while only 10% have been treated. Undoubtedly, sleep apnea is a growing area of concern.

A Revived Sleep Disorder Awareness Campaign
One decade after “sleep disorders” first became widely known in the medical profession, the movement is in the midst of change. The heart of this change is due, in part, to the public service push to educate the millions who are unaware that they are afflicted with this condition.

Leading organizations have demonstrated their support of interdisciplinary action between specialties. In February, three organizations, including the American Academy of Sleep Medicine (AASM), the American College of Chest Physicians, and the American Thoracic Society, established a united position to support the independent profession of polysomnography and oppose legislation that would limit its scope. As well, the AASM has been recently recognized by the American Board of Medical Specialties. Results of the latest diabetes study suggest potential support from even more specialists. The University of Chicago College of Medicine released a study that found that type-2 diabetics using CPAP therapy at least 4 hours a night for OSA experienced lower glucose levels. Given the lowered risk factor for late-stage complications of diabetes such as cardiovascular, eye, kidney, and nerve disease, ophthalmologists, cardiologists, and nephrologists now have a greater opportunity to improve quality of care

Third-party administrators may also be stepping up to the plate by providing educational platforms for their insured. For example, Aetna provides a cost-estimator tool to estimate out-of-pocket expenses for sleep apnea.

Specialists, including many ENTs, pulmonary experts, cardiologists, dentists, psychologists, and neurologists, are addressing sleepiness in their practices. Perhaps more important though, the push for sleep disorder diagnosis has come from sleep disorder technicians and those certified by the AASM. Of course, we cannot forget the role of primary care physicians, respiratory therapists, and home health care providers, who have been partially delegated the task of patient education, treatment, and compliance. Not to forget the task of convincing patients to pay cash for some services. Yet, with the multitude of interested parties, there has never been a better time to take public awareness to the next level.

The Challenges
Certainly, there is still much work to be done. Coordination for third-party reimbursement from numerous carriers with differing requirements can be difficult at best. As Ann Guarini, vice president for patient services at Air Products Healthcare, Conshohocken, Pa, states, “It is a difficult balance between cost of equipment, cost of service, and quality care to reach compliance.” In fact, in the state of New York, Medicaid will pay for sleep-disorder treatment, but not for sleep-disorder diagnosis. There are still the fundamental issues of exploring the science behind sleep disorders. There is competition for time in curriculums. In the “Qualitative Assessment of Sleep Laboratory Activity in the United States,” by Tachibana et al published in the Journal of Clinical Sleep Medicine in January 2005, it is suggested that only 29% of laboratories were accredited by the AASM. This indicates that building awareness for sleep diagnosis is needed. Grant funding is only the tip of the iceberg. And as David M. Rapoport, MD, associate professor of medicine and director of research, Department of Medicine, New York University Medical Center, explains, “While we have easy answers for severe sleep apnea, the answers aren’t necessarily easy for mild or moderate sleep apnea. Lifestyle changes, opinions from different physician specialists, and combination treatment plans make diagnosis and treatment an art. And the first step begins with a sleep test.”

Tools for Public Awareness
Today there are tools available to build public awareness and improve the quality of care. The goodwill of a practice focusing on sleep can be demonstrated through participation in hospital committees, recognized boards, and community and public policy endeavors, and ongoing involvement with medical organizations. The presentation of practice credentials and recent studies in a nonpromotional manner can reinforce credibility with patients and physicians in other specialties. The content of presentation information can extend from sleep hygiene and warning signs of sleep apnea to the questions physicians can ask to identify the need for proper sleep disorder diagnosis. Presentations to other physicians and patients might be in the form of open houses, quarterly reports, and letters of introduction. Community involvement with school boards, the AARP, and health fairs can build awareness as well.

According to a qualitative study, there were 1.17 million polysomnograms conducted over the last year, and this number suggests that only a fraction of the potential number of undiagnosed patients has been diagnosed at a sleep center. The seeds for public awareness can be planted in every medical specialty. Reaching out to all specialists with presentations about sleep can help get the word out. It is equally important that the focus of the presentation be limited to a specific area and that the speaker refer the patient to other resources for more information. Such references can help better educate patients so that their expectations are realistic—ultimately, a satisfied patient is key to word-of-mouth referrals. As Edward Grandi, executive director of the American Sleep Apnea Association, explains, “Timing is everything to produce a satisfied patient. The time span between diagnosis, sleep study results, and treatment modality makes a significant difference in the success of the treatment. If the patient is abandoned after receiving the prescription, the likelihood of success is greatly diminished.”

According to statistics, the Internet potentially poses a means to build trust in patients and can help link sleep apnea to other medical conditions. According to Harris Interactive Inc, Rochester, NY, a market research firm, more than 100 million consumers search the Internet for health care information. Another research firm indicated that 63% of consumers say they would switch health care providers if they found credible content, e-mail communications, or scheduling online. Michael Breus, PhD, co-owner of Sleep Center Medicine Institute, Atlanta, suggests, “As more consumers have become interested in learning about sleep apnea online, building and establishing cross links to other resources on practice Web sites can help better educate the patient and build confidence.”

Some sleep centers have dedicated a staff member to locate newsworthy information about sleep. Presentation of information provided by numerous resources can help bridge the information gap.

Advantage vs Downfall
Getting the word out can appear to be a daunting task. Yet, selecting the right terms and listing all necessary information on printed materials or in e-mails can avoid potential miscommunication. Effectively communicating the right message through an on-hold message service, Web site, or interactive video presentation can result in more of the right patients for the practice. Participation in the medical community can lead to more positive reinforcements. The ability to manage the results of these actions is equally important. And while such activities may appear to be an enormous undertaking, the rewards can be far greater. Perhaps it is good timing to continue the National Sleep Awareness Week in your practice for the rest of the year ahead.

Leslie Ranft is a contributing writer for Sleep Review.