Missed Opportunity: The epidemic of poor sleep
There are a lot of ways to save money without going bankrupt in the process, but health care in the U.S. certainly has not lent itself to that sort of thing. Still, there’s a big opportunity to do just that if one demonstrates an interest in sleep, a subject about which there is little evident interest in Washington, D.C., or in the boardrooms of med tech firms.
According to a study by the Rand Corporation, data from five OECD nations suggest that those who sleep less than six hours a night are at a mortality risk that is 13% higher than those who make it to seven hours or better a night. The statement Rand put out in connection with this study states that the GDP in OECD nations sustains a 3% drop on average due to poor sleep, and that the U.S. Centers for Disease Control and Prevention has declared that poor sleep is a public health crisis. But you sure don’t hear a lot about it, do you?
Cost of poor sleep: $411B and counting
The problem is that about one in three Americans are routinely short of sleep, a proportion said to be rising with each passing year. The annual economic hit sustained by the U.S. economy is calculated at $411 billion, the Rand report tell us. In contrast, the National Cancer Institute has estimated that the cost of cancer care next year will slightly exceed $206 billion, while the presumed loss of income in the current calendar year is pegged at $94 billion. That’s a total of about $300 billion.
Lately there has been a fair amount of media coverage of the U.S. federal government’s appropriations for the National Institutes of Health, and rightly so. Depending on which side of Capitol Hill you ask, Congress is looking to add either $2 billion or $3 billion to the NIH budget in fiscal 2020. We’re not here to debate whether additional NIH spending is appropriate, but can we ask whether the priorities for NIH funds are sensible?
In an April 19, 2019, update to NIH spending areas, the agency notes that the allocations for research into cancer rose to more than $6.6 billion in the soon-to-end fiscal year. However, sleep issues will receive only $365 million from the American taxpayer in FY 2019. You don’t have to be a mathematician to see how upside down this is if you’re looking strictly at economic impact.
It should be acknowledged that the mortality numbers for cancer are more stark. The National Cancer Institute recently estimated that cancer claimed about 609,000 lives in the U.S. last year, which admittedly is a much larger toll than can be readily attributed to sleep disorders, but medical science is starting to appreciate the toll imposed by poor sleep on the heart. This doesn’t account for the fact that poor sleep is also associated with metabolic disorders such as diabetes, which in turn feed heart disease.
Sleep; just not very exciting
Obviously, most device makers believe they have more interesting things to do than deal with stubborn things like sleep disorders, and the compliance rate for items and services like CPAP therapy is notoriously low. That’s a fact that payers are well aware of, as was the Office of Inspector General, which cracked down on flimsy billings for CPAP machines in September 2016. Yes, balloon sinuplasty is doing fairly well, but being overweight is also associated with conditions such as obstructive sleep apnea, so there are a lot of things that go into it, many of which are really tough to manage.
Add to that the fact that it’s still fairly difficult to draw a straight line between poor sleep – whatever the cause – and mortality, and the dimensions of the problem become clear. The link is there, though. Just ask any cardiologist or endocrinologist. The evidence base apparently is not, and that’s due in part to the fact that diagnosing sleep disorders has been tricky at best, although digital health seems to be changing that.
Still, it’s tough to gin up a lot of interest in curing the sleep problem, and there are obviously a number of reasons for that or there would be no need to write a blog about it.
It might be pertinent to ask whether sleep research suffers from a blah reputation where biomedical researchers are concerned. One gets the feeling that compared to other lines of research, sleep research is like pulling into the driveway in a 1970s-era station wagon in a neighborhood full of Ferraris and Lamborghinis. The reality is, however, that boring cars take a lot more kids to school and bring home a lot more groceries than the latest super-duper hypercar. One suspects we’re all a bit mesmerized by the glamor and pop of CRISPR and other mind-blowing methods of editing DNA, and after all, if you’re among the best and the brightest, you want to change the world, right?
(Frankly, the world changes us a lot more than we change it if only because each of us is badly outnumbered by the 7.7 billion other inhabitants of planet Earth, but I digress.)
Conversely, if you want to save a national economy a lot of cash, try fixing sleep. After all, if you could take a significant bite out of traffic fatalities, heart failure and diabetes, you might just “bend the cost curve” where Medicare and overall health care spending are concerned. Granted that might not earn you a shiny plaque in the medical science hall of fame like the ones Francis Crick and James Watson have, but what in heck is trivial about saving a $21 trillion economy from a health care spending death spiral?