Effectiveness of Telehealth in Sleep Disorder Treatment

In this first installment of a video series on sleep disorder treatment through telehealth, Rachel E. Salas, MD, MEd, FAAN, FANA, professor, department of Neurology, John Hopkins Medicine, walks us through her experiences addressing sleep issues through telehealth versus in-person consultations.

After switching to 100% “tele-sleep” practice during and following the COVID-19 pandemic, Dr Salas thinks that virtual practice offers many advantages to clinicians treating sleep disorders, including insight to home environment, “sleep witness” access, and accessibility.

Stay tuned for Parts 2 and 3 of this series! In the meantime, visit our Telehealth Excellence Forum for more expert insights on virtual practice.

Psych Congress Network: How effective is telehealth in diagnosing and treating sleep disorders compared to in-person consultations? Are there any limitations to consider?

Rachel E. Salas, MD, Med, FAAN, FANA: I think that sleep medicine has really an opportunity in telehealth for a variety of reasons. One is that we do get insight into the patients’ homes, and sometimes even their work environments. I think that the sleep environment and the environment just at home can be helpful when treating patients, particularly those patients with insomnia or circadian rhythm disorders. So having that insight has been very helpful. In fact, I've made some recommendations based on the environment that I see patients will tell me like this is their bedroom, or this is their workstation. Lighting and things like that may come into play, and I can actually make some more pointed recommendations. So, kind of getting at the precision medicine that we're all trying to do where we're trying to really use evidence-based medicine to treat the patient in front of us. But obviously everybody's different, and I think that “tele-sleep” has really allowed me to better manage my patients with insomnia and circadian rhythm disorders.

The other thing that tele-sleep has really been phenomenal with is allowing what I call the “sleep witness” access. Thinking about in-person visits, a lot of times family members who may have more of the information about the sleep behaviors that the patient is demonstrating may not be able to make it to the patient's clinical appointment. Well, now, with tele-sleep, those family members or friends or bed partners can come into the tele-visit and offer that piece of information. So, I think that's been very helpful.

Another advantage to tele-sleep has really been for our patients with neurological disorders. When you think about patients, for instance, who have Parkinson disease or ALS or multiple sclerosis, they may have increased challenges getting to clinical visits in person. Having the tele-sleep opportunity allows them to meet with a doctor from their own home, which is a more comfortable space. They don't have to leave their space, especially for some of our patients with more advanced neurological disease or disorders. That's been another advantage.

Additionally, when you think of our carbon footprint overall [for medical visits]—getting into car, driving somewhere, maybe even having to pay for parking—and then the time that's involved with getting to a clinical visit in person really can add up for people depending.

So I think that from those perspectives tele-sleep has really been an overall advantage. I will say for me, since the pandemic I have completely turned over to 100% tele-sleep practice. The last advantage that I'll mention is that with someone like with me, I may see some complex presentations of certain sleep disorders like insomnia, or restless leg syndrome, where people come from not only the state of Maryland, but from other states, and sometimes even worldwide, and so by me not having to travel to a clinical space, I can see more patients now  through telemedicine. So for me, it's been phenomenal. I think the proof is in the pudding, where I say that my practice is now 100% tele-sleep.

Rachel E. Salas, MD, MEd, is a professor in the Department of Neurology at Johns Hopkins Medicine, with a joint appointment in the School of Nursing. She earned her medical degree from the University of Texas Medical Branch at Galveston and completed her internship in Internal Medicine and residency in Neurology. After her chief year, she pursued a two-year sleep medicine fellowship in Baltimore before joining the Department of Neurology at Johns Hopkins in 2008. She is board-certified in Sleep Medicine and Neurology. Dr. Salas holds the positions of Assistant Medical Director and Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness.