2023/03/09

Discussion on Digital Health

Online Roundtable Discussion Among Clinical Doctors 【Part 6】

Wearable, Disease management and Patient monitoring, Telemedicine, Sleep disorder, Japan, Digital Therapeutics (DTx), Clinical Doctor

The Third Part: Sleep and Sleep Tech 

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This issue will be the last “Sleep and Sleep Tech” online roundtable discussion with clinical doctors, attended by doctors interested in the current focus on “sleep tech.” The topic will evolve into implementing apps in the medical field, cognitive behavioral therapy, and more. 
(Although the names of specific products and services appear in the text, these are personal impressions and are not intended to guarantee efficacy or endorse specific products. We have no vested interest in any particular company or organization in connection with this article.)

Participants: 

Facilitator: LSMIP Editorial Office

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Implementing Apps in the Medical Field

Facilitator:     In recent years, more people have been using Sleep Tech as a sleep monitor, and I believe that highly conscious doctors can make good use of it and continue to use it. However, it may be difficult for most people to continue without support. I think all cognitive-behavioral therapy with apps is the same, but I expect it to be used more in collaboration with medical care. Are any moves afoot to implement apps into the medical field? (Any apps other than Sleep Tech would be fine.)

Dr. Reina:    I am also very interested in cognitive behavioral therapy apps. Is it an app like this? (Digital cognitive-behavioral therapy app “Awarefy” Awarefy Inc. https://www.awarefy.app/ ) I have never used it, but it looks like it could be applied in various ways, like diet therapy, lifestyle guidance for dialysis patients, diet, etc.

Dr. Nemuruko: We ask SAS (Sleep Apnea Syndrome) patients to download some manufacturer’s specialized apps for monitoring CPAP (Continuous Positive Airway Pressure) therapy.

Dr. Lemon:     It’s not Sleep Tech, but (the world’s first medical device regulatory approval of) digital therapeutic app for Hypertension*1 developed by CureApp Inc. has received insurance approval and is getting much attention, as well as the nicotine addiction therapeutics app.

Dr. Slowly EP:  I have used an app service called ”Join” (Allm Inc.) *2for doctor-to-doctor communication, but not for the patient. But I have heard of the “Apple Watch Heart Study.” https://www.keio.ac.jp/ja/press-releases/2021/2/1/28-77724/ (Keio University Hospital, Keio University School of Medicine, “Clinical Study Using Apple Watch Begins” 2021/02/01)
In the “Apple Watch Heart Study,” you wear an Apple Watch while sleeping, and after waking up, you answer questionnaires on the research application “Heart Study AW” to analyze your ECG while sleeping. I want to do this kind of research.

Facilitator:     Thank you for all the information. We expect the app will soon be used more in the medical field.

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Sleep Tech Startups to Watch

Facilitator:     Could you tell us about any Sleep Tech startups you are interested in?

Dr. Nemuruko: It’s been quite a while since it was founded, but I’m a bit interested in Stanford Professor Nishino’s “Brain Sleep” *3 with its futons and pillows. Then there is Dr. Yanagisawa’s “S’UIMIN” *4 at the university of Tsukuba. The EEG device could be easily attached and seemed highly valued as a simple test.

Dr. Slowly EP:  A sleepwear startup company, “TENTIAL” *5, uses fibers with a warming effect to increase comfort while sleeping.

Dr. Lemon:     Airweave” *6 has been shown in clinical studies to improve sleep quality. I hope we can evaluate the evidence for other products that enhance sleep quality similarly.

Dr. Reina:    I did not know there was evidence for “Airweave”! Yes, it does. Many things are claimed to improve sleep, but it would be nice if the evidence could be shown.

Dr. Nemuruko: I am also an “Airweave” user!

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Cognitive Behavioral Therapy Apps and Preventive Medicine

Dr. Reina:    I am afraid this is of personal interest, but may I return the discussion to the Cognitive Behavioral Therapy App? I am interested in incorporating our medical practices into products such as apps. Still, it would be difficult to do so other than through institutions such as universities or by connecting with companies in some way. It’s not easy enough for a doctor to do it independently.

Dr. Nemuruko: I am interested in that too! It’s a kind of bio-design, isn’t it?

Dr. Reina:    Yes, that’s right.

Dr. Nemuruko: There is a book titled “Healthcare Innovation” written by Dr. Ikeno of Stanford University, and in the book, there is an article about PREVENT Inc., a start-up company created by the Nagoya University School of Health Sciences. The company provides a service called  “Myscope,” and the app is “Mystar”*7. You can check sleep, step count, pulse by Fitbit, and salt intake by a salt reduction sensor. It can be linked to a smartphone app, which can also be used to view learning materials and check medication, and the app can also be used for chat consultations. PREVENT Inc. will link the data to create a health plan for each person and conduct a telephone consultation every two weeks. I don’t know how it reached this point, but it seems based on research results. I would love to do something like this.

Dr. Reina:    Thank you! That’s great. It is precisely the kind of thing I like. The data obtained from this would be a treasure too.

Dr. Nemuruko: This kind of sleep management by specialists using already existing devices (Fitbit, Oura Ring, etc.) seems difficult to cover by insurance, and it would be helpful to collaborate between practicing medicine and industry as a management between outpatient and inpatient. For healthy people, preventive medicine would be received by highly conscious people. It may also be effective for companies to prevent profit loss by improving sleep. Sleep Tech is precious.

Facilitator:     I can feel your thoughts. I think many companies would like to do business with people like you. I believe that cognitive behavioral therapy apps will spread in Japan near future.
Recently, insurance companies have been focusing on preventive medicine. Even if insurance does not cover treatment, I expect that devices and apps will be used to support treatment and health. The companies need to make some sales efforts on that.

Dr. Reina:    I’ve recently heard much about such things from private insurance companies. It may also be effective in preventing profit loss by improving sleep in companies. It seems to go well with your industrial physician certification. I don’t have an Occupational physician, but...

Dr. Nemuruko: That’s right. (I do have an Occupational physician license!). I am currently negotiating with a transportation company to get sleep data from their drivers for my research.

Dr. Slowly EP:  I long for the application to healthy people and preventive intervention, but it seems that the doctor’s side will be the last to become a user.

Dr. Reina:    We must also do something about the doctors’ health. I was shocked to see recently that the average life expectancy of a doctor is 70 years old. Many doctors passed away at a young age when I looked at the list of doctors’ offices.

Facilitator:     This is surprising. Is it because doctors have complex jobs and work night shifts? It is a problem.

Dr. Slowly EP:  What? 70 years old? But it can’t be helped. I know I am living a messy life… Using technology such as Sleep Tech (laughs), I will somewhat resist my fate.

Dr. Nemuruko: That’s scary. Hard work and overnight work that does not even shift time is rampant. Is it the effect of many nights of sleep deprivation? I heard that sleep deprivation increases Alzheimer’s disease.

Dr. Reina:    It is my first time hearing that sleep deprivation increases Alzheimer’s disease. Exercise therapy is the only evidence that has been found to inhibit the progression of dementia, but it also seems to be related to sleep. Sleep is essential. Even young people can die from overwork and sudden death.

Facilitator:     I did not know that either. I understood that good sleep is essential. That is why we have high expectations for Sleep Tech. I can see why everyone is paying so much attention to Sleep Tech.

Dr. Lemon:     Your comments have made me more aware of the importance of sleep. As for myself, the pressing issue is how to combat jet lag. I don’t think we can stop the movement from health care services provided by health insurance to preventive care from now on. Thank you for your continued support.

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