Inside the war for rest and big medicine's new frontier—the sleeping illness sector
Curt Richter had a dozen rats. It was 1919 and as the rest of America held its breath before plunging into the Roaring Twenties, the young Richter began his life's work by observing his rodent subjects. The rats ate, rested, moved, then ate, rested, and moved. What he eventually brought to the scientific community's attention was circadian rhythm—a living thing's intrinsic schedule. For his reward, he became the chosen son of psychobiology, a trailblazer without peer.
Richter's breakthrough was just a single strand in a very long and confusing saga about the discovery of sleep. In previous centuries few records existed of how or why humans slept, much less its value. From the modern conceptualization of the 'biological clock' to identifying the yawn-inducing hormone called melatonin, slow progress is still being made finding out why humans need rest. This was best described by a questing magazine writer who simply declared “the predominant theory of sleep is that the brain demands it.”
Today, scientists feel they have only scratched the surface. Even then, their curiosity has unearthed a trove of medical nightmares.
Among the most insidious is Obstructive Sleep Apnea (OSA), or just plain sleep apnea, first described in a research paper by German doctors Jung and Kuhlo in 1965. Sleep apnea was deemed an exotic condition where the sleeper's breathing was blocked by muscle contractions in the throat.
Unfortunately, further research proved sleep apnea was very dangerous. It occurs when either the nasal or oral airways are blocked during sleep, causing mild suffocation that could last up to a minute. In the course of an eight hour sleeping cycle, this could happen hundreds of times, sabotaging the body's normal functions come morning. It was found out that obese people were more prone to sleep apnea, especially since the fat in their neck and lower jaw can 'recline' and collapse the mouth's soft tissue airway.
After Jung and Kuhlo's breakthrough, it took 14 years before Dr. Colin Sullivan, an enterprising American dentist, channeled his inner-handyman and custom-built what became the first Continuous Positive Airway Pressure (CPAP) machine in 1979. What the CPAP machine did was simply pump a constant stream of air inside the patient's nose and mouth. To his dismay, it was received with skepticism by the medical community.
But in the course of the next three decades, Sullivan's miracle apparatus became the number one product in a booming industry. As the population of North America and Western Europe got older, the elderly demographic proved the CPAP machine's biggest customers. Together with out of control obesity and the precariousness of modern lifestyles, what was a peripheral medical anomaly 50 years ago is now, according to sleep apnea patient Dr. James E. Metz, “...one of the biggest health issues facing our population.”
Almost ten years ago, Cleveland Yu fell asleep behind the wheel. On previous occasions he would collapse, just black out all of a sudden, usually in the afternoon.
At the time he was in semi-retirement after successfully riding the great late 90s tech boom. He also dabbled in angel investing and was putting down seed money for medical start ups. Then his doctor told him he had sleep apnea.
“Because I'm a Type A personality my first inclination was 'Okay let's go for surgery,'” Cleve says. This was UPPP, short for uvulopalatopharyngeal plasty, an invasive procedure where throat tissue is cut to clear the mouth's airway. The problem was in Cleve's case it did not alleviate his condition—and it hurt. A lot. “There are female patients who will tell you it's worse than childbirth,” he shares.
So Cleve resorted to the CPAP machine he uses to this day. He also raised money and together with his wife, a childhood friend-cum-business partner, and a leading Filipino doctor specializing in sleep, launched N2Sleep in 2004. Its name was derived from NREM 2, an early stage in the sleeping cycle. Despite having joined the legion of CPAP dependents, Cleve's background in IT and experience with the medical sector—not to mention his business instincts (“I'm a serial entrepreneur,” he says)—allowed him to spot an opportunity. What if he joined a firm that provided clinics with the equipment and data to treat sleeping disorders like his?
See, beginning in the 1980s when sleep apnea was recognized by doctors and dentists as a serious disorder among a hundred other sleeping disorders, a slow but steady market began to emerge. Metrics are hard to come by at this point, though Cleve himself confidently predicts that it is the “fastest growing field in medicine.” He is correct, because when doctors started using sleep tests to observe patients, a whole ecosystem of devices, procedures, and personnel was needed. Cleve Yu and co's N2Sleep (www.n2sleep.com), describing itself as “...one company to handle everything and provide you with unparalleled support,” services this need. Its growth record has been solid enough that Cleve boasts “I have to turn down offers to buy us every month.”
Yet N2Sleep so far has a bit part in the greater drama of sleep medicine. It is no longer about pills and insomnia and stress. Servicing huge markets in developed countries has spurred demand for research, treatment, and equipment.
Taking the perspective of sleep apnea, since the European Sleep Research Society (ESRS) was established in 1971, more than a dozen other organizations have cropped up to address the illness and its related maladies. Foremost today is the American Academy of Sleep Medicine (AASM) and its sibling the American Academy of Dental Sleep Medicine (AADSM), the National Sleep Foundation (NSF), the Association for the Psychophysiological Study of Sleep (APSS), and the American Board of Sleep Medicine (ABSM).
Sleep apnea itself has grown beyond a respiratory anomaly to a major precursor for life threatening illness. Everything from cardiac failure, psychological problems, and even impotence are being ascribed to it. Worse, its scope has extended beyond the elderly to people as young as their 20s all the way down to infants. Apparently, the consensus is gaps in regular breathing while asleep—at any age—are closely related to numerous diseases.
No wonder an economic news site reported that sleeping related medical-treatment in the United States would be worth US$32.4 billion this year.
Meanwhile, Cleve Yu is eagerly scouting for opportunities here in Asia. He's convinced a lot of people aren't sleeping well. He's right.