Telemedicine’s Place in Sleep Disorder Care, Tackling the Greatest Unmet Needs

Michael J. Thorpy, MD

This is a 2-part interview. To view part 1, click here.

Among the many changes to clinical care throughout the COVID-19 pandemic, arguably none was bigger in the neurology specialty than the adoption and acceleration of telemedicine. While the integration of telemedicine reached heights never before seen, some questioned what its long-term use would look like once the pandemic was over and the option to see patients in-person became available.

For Michael J. Thorpy, MD, telemedicine has been a revelation of sorts to treat patients with sleep disorders. He told NeurologyLive that treatment options such as digital cognitive behavioral therapy programs can become more prominent due to the greater accessibility that telemedicine provides. While new medications have entered the field, Thorpy believes that tailoring treatment options, especially combination treatment approaches, is still the greatest challenge within the space.

In part 2 of this interview, Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center, provided his thoughts on the integration of telemedicine and its overall positive effect throughout the pandemic, as well as thoughts on some of the greatest current unmet needs for those with sleep disorders.

NeurologyLive: How has care for sleep disorders changed throughout the pandemic? What advantages has telemedicine brought to the space?

Michael Thorpy, MD: The pandemic had a major impact upon medical care for patients, both those who have had COVID-19 and those who haven’t. It has affected their care so much as they haven’t been able to have access to their usual clinicians in the same way. What we’ve done is move towards telemedicine so that most of our interactions with patients are virtual through means of either phone contact or video contact. It’s been a 2-edged sword for the patients.

They’ve had to learn technologies and the use of computers, which is obviously is not a major problem for our younger patients with sleep disorders, but for our older patients, it’s been a bit of a trial and difficulty. But, as time goes on, they’re becoming more comfortable with the new technologies thus making our interaction with them easier. Patients used to have to travel to the physician’s office, which would take a lot of commuting time, particularly [for my patients] as I am in New York City, where it takes patients sometimes nearly an hour to travel to the office. Then they must wait for their appointment and have an hour commute back again. Again, that’s a lot of time.

With telemedicine, the interaction can be limited to 15 to 30 minutes or so. It’s much easier for the patients. Because of that, it’s really improved the management particularly for patients with narcolepsy. What we’ve found is that these patients often require a lot of interaction in treating them and managing their medications. There’s a lot of polypharmacy now. With telemedicine, we can adjust medications, and we can easily follow up with patients within a matter of days or weeks to make changes and adjustments. From the patient’s point of view, it’s actually worked out to be very advantageous and they can have greater contact with a physician, whereas in the past we were reluctant to have to bring a patient in the office and spend several hours of their day having to do that office visit.

There have been some good things and some bad things. There are other areas where it’s not so good. With some patients, we have technological problems and difficulty communicating with them with telehealth. That’s been a bit of a problem. Overall, it’s been a positive experience for those who can communicate with their physicians by telemedicine because of this better interactive communication.

Will telemedicine have as prominent of a role going forward?

Telemedicine is here to stay. There were a lot of questions about once the pandemic is over whether we were going to revert to previous methods of handling patients, but I don’t think that’s the case. Certainly, many patients still need to be seen in the office for physical examinations and things like that, but for other patients, once that information is obtained, it’s a matter of adjusting medications or producing behavioral treatments. I think telemedicine is going to play a bigger part. There are more programs available and as patients become more [comfortable] with the technology, they’re able to utilize some of these digital-like cognitive behavioral programs for the treatment of insomnia. The whole role of technology is going to play a bigger part. Hopefully, it will also lead to newer ways to help and diagnose as well—such as new technologies get developed that interact with the computer and can provide information. Everything is leading in the direction of improving clinical care for patients and making access to clinical care much better as well.

What is the greatest unmet need in treating patients with narcolepsy or other sleep disorders?

We still have a long way to go with many of the sleep disorders, particularly insomnia. We certainly have new medications available to us, which is good, but we know that there’s no 1 drug that suits all patients. We need to have a variety of medications available to us. Being able to select the right medication for the right drug is still not easy when it comes to insomnia. Oftentimes it’s a trial-and-error process. Many patients have tried numerous medications before they find something effective. We still have a long way to go with insomnia.

In the last few years, we’ve found that cognitive behavioral therapy and behavioral therapies in general have been a big advantage for patients with insomnia. We certainly combine that with any pharmacological treatment that we might undertake in these patients.

Still, with the medications we have a long way to go before we can tailor the right medication to the specific patient. The unmet need is personalized medicine, where we can focus in and choose the right drug without having to go through a trial-and-error process for many patients. There are many things in the narcolepsy area that re very exciting because we have a lot of new drugs coming available to us. But now, the unmet need is understanding how do we use these medications? How do we combine them? For many of these patients, they require polypharmacy and getting the right combinations for these patients is an area we need more information on.

Transcript was edited for clarity.