Sleep telemedicine

Overview

In part due to the limited access and capability of sleep centers, the field of sleep neurology is in a suitable position for real-time, interactive, audio-video telecommunications (telemedicine). The American Academy of Sleep Medicine’s (AASM) Taskforce on Sleep Telemedicine supports telemedicine as a means of advancing patient health, by improving access to the expertise of Board-Certified Sleep Medicine Specialists.

From the use of sleep home monitoring devices to PAP therapy data, technology provides an opportunity to reach sleep patients at their home where they feel safe (specially children or vulnerable adults), as opposed to their traveling to a sleep center.

The American Academy of Sleep Medicine (AASM) provides an implementation guide that suggested two models: Center to Home (C2H) or Center to Center (C2C). The C2H model uses the patient’s own technology (laptop, smartphone, etc.) from wherever they choose to access remotely the sleep specialist. In the C2C model, the patient goes to a nearby location, typically a medical office or clinic where the equipment is located, and is then connected with a sleep specialist. Whatever model is available, having a private telecommunications channel that meets the technical requirements is a requisite (see Table 10.1 ).

Sleep telemedicine diagnostic approaches

Sleep is affected by circadian rhythms, light, backgrounds, sleep patterns, and other environmental variables. The zeitgeber action of light is influenced by interaction between circadian and homeostatic processes, and the opportunity to assess the home sleep environment is valuable to enhance the sleep interview. Nocturnal Artificial Light exposure (NLE) can be harmful by activating the melanopsin system in the retina, which will result in melatonin suppression. NLE can be assessed by asking the patient to show the amount of luminosity generated by their light bulbs. This can be determined by reading the manufacturer’s package, and also by the use of devices that measure luminous intensity or brightness (luxometers); these are also available as smartphone applications. One hundred lumens is equivalent to about 20 watts, and at higher levels, melatonin alterations can be expected. (It should be noted that most interior designers, unaware of the impact of light on sleep and circadian rhythm, recommend up to 2000 lm for a bedroom.) Measures to decrease NLE further include reducing the light intensity of smartphones, TVs, and computers by activating their nighttime modes, and the use of lenses that filter harmful blue light.

Bedroom temperature verification is simply done by inquiring about thermostat temperature settings at night (see Table 10.2 ).