By Ritika Sakhuja
New Delhi: Sleep clinics have become increasingly popular in India over the past decade due to a combination of factors, including the rise in lifestyle-related diseases, increasing stress levels, and the growing prevalence of sleep disorders such as obstructive sleep apnoea (OSA), insomnia, restless leg syndrome, and narcolepsy.
However, as per a Global Sleep Survey conducted in January 2023 by ResMed, only 20 per cent of respondents would choose to consult a medical provider, with the vast majority deferring to family or friends (57 per cent) and online information (37 per cent) for advice, creating an obstacle for sleep clinics and effective treatment of sleep disorders.
On the occasion of World Sleep Day, to explore the reasons and the impact of this hesitancy, ETHealthworld spoke to practitioners of sleep medicine to understand the challenges and obstacles that sleep clinics currently face to establish themselves in the healthcare sector due to the lack of awareness amongst masses regarding sleep-related health disorders.
Misinformation, lack of awareness
Long-term sleep deprivation not only dampens the day-to-day quality of life but also enables medical aggravations such as cardiovascular issues and cognitive decline, as has been suggested by numerous studies. In the worst cases, certain sleep disorders can also prove fatal, hence imposing the necessity of sleep clinics.
Expressing the gravity of the situation, Dr Salil Bendre, HOD, Chest and Sleep Medicine, Nanavati Max Super Speciality Hospital said, “Chronic and severe sleep disorders affect millions of Indians, yet the majority remain unaware of the diagnosis and treatment of these conditions. Symptoms such as insomnia, loud snoring, excessive daytime sleepiness, and an inability to establish a consistent sleeping pattern are all too common. Regrettably, these disorders are not given the attention they deserve, causing patients to neglect seeking timely care. Furthermore, the majority of individuals dismiss these symptoms as mere lifestyle problems, compounding the issue.”
ResMed’s global survey is a reflection of Dr Bendre’s comments, as the survey found that 85 per cent of respondents reported satisfaction with their sleep quality, even though the quality of sleep in 2023 has declined by 22 per cent as compared to 2022. More shockingly, 58 per cent of Indian respondents considered snoring a sign of good sleep, unaware that snoring is a potential trigger of OSA and other sleep-related issues.
“We often see patients in our sleep clinic who do not realise that snoring and sleep apnoea are increasingly common causes of hypertension, heart attacks and strokes. OSA is a very common cause of both cardiac and non-cardiac deaths. Snoring is often ignored, as the patient himself doesn’t hear it, or they are embarrassed to admit it, or they feel it’s not important,” informed Dr Shantanu Tandon, Senior ENT Surgeon, Airway and Sleep Apnoea Specialist, Sakra World Hospital.
Only 2 per cent of Indians suffering from OSA consult a physician, as per ResMed’s estimates. Only 21 per cent of males and 24 per cent of females have been tested for sleep apnoea, highlighting the lack of awareness of sleep-related conditions. This calls for immediate action as globally, it is estimated that over 936 million people suffer from sleep apnoea, with 28 million people in India alone.
Misguided ideals enabling sleep disorders
The lack of awareness and misinformation surrounding sleep health often gives way to misguided ideals such as the currently prevailing hustle culture promoting fewer hours of sleep as a sign of hard work, further hampering the advent of sleep clinics. Commenting on this dangerous belief, Dr JC Suri, Chairperson and Founder President, Indian Sleep Disorders Association, and Director and Head, Department of Pulmonary Critical Care and Sleep Medicine, Fortis Healthcare said, “We are one of the many countries that have boarded the bandwagon that frequently equates lack of sleep with success. Scientific data suggests that sleeping less than six hours consistently has a huge impact on health and well-being, there is an increased risk of accidents, developing high blood pressure, heart diseases like coronary artery disease, diabetes, and stroke.”
Subsequently, due to the nonchalance around quality sleep, the masses prioritise their work or leisure over the necessary hours of sleep. “Everyone needs seven to nine hours of sleep daily. However, patients routinely compromise their sleep to accommodate late-night work hours, longer commutes from the office, attending parties or functions and completing household chores. Some even say, why should I sleep eight hours as I feel well with just four to five hours of sleep,” relayed Dr Sudhir Kumar, Senior Consultant Neurologist, Apollo Hospitals, Hyderabad.
ResMed’s global survey participants stated that electronic devices (40 per cent), change of routine (37 per cent), stress (37 per cent), and financial pressures (37 per cent) have caused the decline in their sleep quality, leading to adverse effects such as mood changes, excessive daytime sleepiness, and difficulty in concentration during the day.
Dr Indu Khosla, Paediatric Pulmonologist, NHSRCC Children’s Hospital said, “Screen time causes delayed sleep onset and is a big problem, especially in older children. This results in disorders called circadian rhythm disorders where children sleep late and wake up late, leading to poor growth and immunity.”
Policy regulations to promote sleep clinics
Experts of sleep medicine suggested that government policies will not just boost awareness among the masses by recognising sleep-related health issues as significant, but also help strengthen sleep clinics to provide affordable and quality sleep health services.
ResMed’s commissioned survey revealed that 97 per cent of Indians have encountered a barrier while seeking treatment for sleep issues. “Acknowledging the problem is the first step towards a solution. Sleeplessness must be recognised as a treatable medical condition. Healthcare providers are beginning to launch dedicated clinics for sleep disorders but these are only grossly insufficient. Training programmes for doctors to create a pool of dedicated providers will enhance the attention this area deserves and needs,” advised Dr K Hari Prasad, President, Apollo Group, Hospitals.
Urging that more initiatives need to be taken to promote the integration of sleep medicine into the mainstream healthcare industry, Dr Bendre suggested, “It is unfortunate that awareness of sleep disorders such as OSA often arises only after the untimely demise of a notable celebrity. Sleep health education should be a part of both primary and secondary education for students and their parents alike. Corporate organisations should follow the example of developed countries like Japan, which prioritise the sleep health of their employees.”
Dr Suri contributed, “There is no formal education, certification, or university course in India yet regarding sleep. The doctors are practicing on the basis of their interest or their experience in this field. So there is a lack of standardisation in treatment, despite the fact that more than 30 per cent of Indians have significant sleep deprivation, and are prone to develop health issues.”
He continued, “Another challenge is that the field, to some extent, has been hijacked by the wellness companies that conduct sleep tests through their website without any quality control due to lack of standardisations. And these tests are conducted by untrained technologists due to lack of trained professionals in the field of sleep.”
Practitioners of sleep medicine recommended that the government should encourage private sector investment by offering tax breaks or low-interest loans, provide training and education to healthcare professionals on sleep disorders and treatment options, and develop guidelines and standards for sleep clinics in India to ensure that sleep clinics provide high-quality care and meet certain minimum standards.
“Policy-wise education about sleep disorders needs to be improved in the medical college curriculum. We need to have more awareness about the necessity of healthy sleep habits for the layman on the social media platform,” added Khosla.
Sleep clinics’ modus operandi
Another significant challenge that sleep clinics are facing is the lack of understanding of the services that these clinics offer. Shrouded from common knowledge, sleep clinics often incite doubt and anxiety whenever prescribed to a patient. ResMed’s survey resonates with this doubt as 30 per cent of the Indian respondents expressed that they did not believe that treatment could improve their overall health and sleep-related issues, with 32 per cent expressing concerns about the cost of treatment and 30 per cent fearing the potential results.
In actuality, sleep clinics are very similar to any other department under medicine, offering a range of diagnostic and treatment services for sleep disorders, including sleep studies, which involve monitoring a patient’s sleep patterns and behaviours during a night of sleep, and various therapies such as continuous positive airway pressure (CPAP) therapy for sleep apnoea, cognitive-behavioural therapy for insomnia, and medication for other sleep disorders.
Informing about the operations of a sleep clinic, Dr Koka Rambabu, Sr Consultant ENT Surgeon, Apollo hospital, Jubilee Hills, Hyderabad, illuminated, “Patients are first evaluated with three validated questionnaires which include a questionnaire to the bed partner or witness. This is followed by clinical examination and a flexible nasal-nasopharynx-laryngoscopy on an OP basis. Based on the findings, a sleep study would be done either at the hospital or home. Based on the results, a patient is given options to plan a combined modality of treatments which could include medical, surgical and behavioural enhancements.”
Encouraging the masses to get themselves tested, Dr Ashok K Rajput, Consultant, Pulmonology and Sleep Medicine, CK Birla Hospital, New Delhi urged, “Unfortunately, there is still a lack of awareness around sleep disorders, and many people remain untreated. However, the good news is that treatment is available and can be very rewarding. Those experiencing sleep problems should consult a sleep specialist to prevent hypertension, blood pressure issues, and diabetes, resulting in better overall health.”
Sharing the financial specifications to avail of sleep therapy, Dr Kumar concluded, “Sleep disorders are often treated by non-drug measures and simple medications. The entire cost comes to about Rs 5000. OSA needs a polysomnography test, followed by a continuous positive airway pressure (CPAP) machine in many patients. This could cost anywhere between Rs 5000-75000 depending on the type of machine chosen. However, for surgical treatment, the average cost would be up to Rs 1.8-2 lakhs.”
Practitioners of sleep medicine agreed that a lack of awareness and policy regulations leads to an undeserved decline in the sleep health industry. To tackle the same, experts urged that the government and private associations must step in to educate the masses, increase investments, and recognise sleep disorders as a crucial aspect of healthcare to boost formal training and medical education regarding sleep-related health impairments.