Sleep therapy growth at inflection point

Sleep therapy is expanding across new channels, technologies and care settings, creating more ways than ever to diagnose and treat obstructive sleep apnea – and giving providers new opportunities to shape the patient journey, despite its growing complexity, industry experts say.

“Demand remains strong because obstructive sleep apnea continues to be significantly underdiagnosed, but the pathway into therapy is changing rapidly,” said Robin Randolph, senior vice president of sales and marketing at sovaSage.

Patients may still come through a physician referral or sleep lab, but they may also start with a home sleep test, wearable alert, GLP-1 conversation, virtual care visit, direct-to-consumer program or online research.

For HME providers, the funnel is wider, but harder to support.

The pathway is no longer linear

James Dragatsis, senior executive advisor and partner at ACU-Serve Corp., says the old pathway is evolving into a distributed ecosystem with multiple entry points, including primary care, cardiology, endocrinology and weight-management clinics.

Boone Lockard, vice president of HME, Respiratory & Wellness for VGM & Associates, says providers should prepare for less reliance on traditional sleep lab referrals and more partnerships with digital health companies, while delivering faster setup and onboarding.

Competition no longer looks familiar

Carlos Nunez, M.D., chief medical officer for Resmed, says the competitive landscape has changed dramatically.

“Pre-pandemic, we knew what the competition looked like for CPAP,” he said. “It looked like us. It was companies like Philips and Fisher & Paykel, making other devices. Now, the basis of competition is things like, mind share on social media. It’s pharma. It’s big tech. It’s players that don’t look like us. We can’t compete against your mask because you don’t make a mask.”

But the North Star continues to be that CPAP remains the gold standard, says Nunez. The opportunity is turning awareness into treatment.

More access, but persistent friction

Home sleep apnea testing has made diagnosis faster, more convenient and less expensive than in-lab testing, Dragatsis says, but the patient experience still has weak spots.

Nunez saw that firsthand when his 85-year-old mother was diagnosed with sleep apnea. Her physician initiated a home sleep test, avoiding a long wait for a sleep lab appointment, but the first test failed because it was too difficult to set up.

“We need to continue to make the patient journey scalable and friction free,” he said. “It’s still too difficult.”

A patient with health alerts from a watch or sleep data from a ring may not understand why diagnosis, setup or follow-up feels disconnected once they enter the health care system.

The critical window isn’t setup – it’s what comes next

Providers can make an impact by treating the earliest stretch of therapy as a critical intervention window, not just a handoff after delivery, says Lockard.

“HME providers have a significant opportunity to improve outcomes by focusing on the first seven days of therapy through rapid setup, AI-driven mask fitting, proactive onboarding, and segmented adherence programs that provide long-term targeted support based on patient risk,” he said.

Lockard says early support matters because patients can lose momentum quickly, whether from delays in therapy initiation, complex insurance processes, a poor first mask experience or a lack of ongoing patient engagement, especially among asymptomatic individuals.

The risk is treating patient management as a short-term compliance event, says Randolph.

Organizations focused heavily on scaling tend to focus on setup and the initial compliance window, then reduce engagement after reimbursement milestones are met. The result can show up later in lower resupply utilization, weaker referral performance and lost long-term value.

“One of the biggest misconceptions in sleep therapy is that adherence problems are primarily technology problems,” Randolph said. “In reality, many adherence failures are engagement and behavior challenges. Patients may struggle with motivation, anxiety, comfort, education, or simply feeling disconnected after setup.”

AI can identify problems – but not solve them

As patient volume grows, AI is becoming a necessary way for providers to spot trouble earlier, whether through mask-fitting tools, adherence-risk prediction or automated outreach.

But stakeholders point to a limit: Finding the problem is not the same as fixing it.

Randolph says many adherence failures are behavioral and emotional –  tied to anxiety, comfort, motivation or education.

“The future of patient management will likely not be defined by AI alone,” she said, “but by hybrid engagement ecosystems where artificial intelligence and human intervention work together.”

The provider as the connective tissue

As sleep therapy becomes more decentralized, HME providers have an opportunity to connect the pieces.

“HME providers should position themselves as the operational and patient-support backbone of sleep therapy,” said Dragatsis. “The provider that can effectively bridge clinical care, technology, and patient engagement will create significant value.”