All around the world, sleep specialists are facing the same reality: the burden of sleep disorders is growing. And patients increasingly need faster, more flexible access to high-quality diagnostics and treatment.
In Germany, where we are based, the cost of sleep disorders has risen nearly 50% in less than a decade—from €566 million in 2015 to €838 million in 2023.1 As in many other countries, the demand for timely sleep evaluations has grown far beyond the capacity of traditional in-lab models. Despite a highly regarded and well-organized health care system, patients with sleep disorders often encounter significant hurdles in accessing timely diagnostics and care.
Long wait times, overburdened clinics, and limited follow-up support often leave patients struggling for months—or even years—before receiving a formal diagnosis. As pulmonologists and sleep medicine specialists, we have seen these challenges firsthand.
The COVID-19 pandemic further magnified these issues. For several years, patients with sleep disorders were deprioritized as health care systems focused on acute care. Paradoxically, the pandemic also sparked a positive shift. It heightened awareness and demand for remote care solutions, particularly for respiratory and sleep-related conditions.
These trends inspired us to take a bold step earlier last year. We launched DeepSleep, a hybrid sleep laboratory based in Frankfurt, Germany, that blends the rigor of in-lab diagnostics with the accessibility of home sleep testing and remote follow-up care.
Our goal is to bring modern sleep medicine closer to the patient—more flexible, more convenient, and fully aligned with the realities of how people live today. In an increasingly digital and fast-paced world, innovative technologies and new approaches to the delivery of care are reshaping what a sleep laboratory can be.
We feel privileged to be part of this new era in sleep, and we hope our journey will encourage other clinicians to consider alternative approaches and explore new models of care.
A System Under Strain
We have been fortunate to establish a strong foundation of clinical training in sleep medicine at one of Germany’s leading university centers for lung diseases and sleep medicine. We both trained and worked as pulmonologists at the Center for Sleep Medicine and Telemedicine at Ruhrlandklinik, University Hospital Essen.
We have more evidence and growing awareness than ever before that poor sleep is linked to increased risks for serious health comorbidities like cardiovascular risk factors, stroke, dementia, obesity, and mental health conditions, including depression, anxiety, and others. Therefore, we know that gaps in timely diagnosis and ongoing treatment support for sleep disorders have a major impact on overall health and outcomes.
Recent data underscore the magnitude of the problem in obstructive sleep apnea (OSA) alone. A 2024 study in the journal Sleep reported that OSA affects roughly 30% of adults ages 30 to 69 in Germany.2 The retrospective analysis examined nearly 150,000 adults diagnosed with OSA between 2012 and 2022, with a mean age of 58.6 years at diagnosis.2
On average, patients waited nearly two years between undergoing the initial sleep study and finally receiving a confirmed OSA diagnosis.2 Nearly 90% were prescribed positive airway pressure (PAP) as initial therapy, but adherence patterns among nearly 75,000 patients on PAP therapy showed 95.7% were non-adherent within one year of initiation.2
The authors concluded: “This high rate of non-adherence coupled with the lengthy diagnostic delays underscores critical unmet need in the current OSA treatment paradigm.” Their observations mirror exactly what we were seeing.
A Patient-First Hybrid Model
Clearly, patients need more timely diagnosis and ongoing support. However, inpatient diagnostics, in particular, remain technically complex and costly, and typically require significant capital investments, laboratory space, and highly trained staff.
We wanted to make sleep diagnostics more accessible, efficient, and aligned with the needs of today’s patients, but we also have to navigate the often rigid regulatory framework of the German public health care system. We saw a clear path forward using patient-centered, digitally supported sleep diagnostics that have stringent data protection in place.
Because of the cutting-edge tools now available, we are proud to be among the first in Germany to offer patients greater autonomy in managing their health, along with faster access to high-quality diagnostic and therapeutic services for sleep disorders.
Flexibility is key to our philosophy. We offer initial consultations, overnight diagnostics, individualized therapy, and follow-up care—all of which can be provided either in person or remotely, depending on patient preference and medical needs.
After the first touchpoint with the patient online, by phone, or on site, we then schedule an initial consultation to discuss sleep problems in detail. Traditional in-person consultations take place at our outpatient clinic in Frankfurt, and virtual consultations happen via various channels: our website, phone, and soon secure social media.
In-Lab Accuracy at Home
We provide polysomnography (PSG) in strict accordance with the guidelines of the German Society for Sleep Medicine (DGSM) and the American Academy of Sleep Medicine (AASM), but with a modern twist: for most of our patients, the entire process takes place in the comfort of their own home.
State-of-the-art diagnostics allow us to bring the sleep laboratory directly to the patient’s home with self-applied type II PSG testing. We chose a compact, high-precision diagnostic device with forehead-based EEG and EMG electrodes that we can use in the lab or patients can use at home.
For those with more complex cases, we offer traditional in-patient PSG at our sleep lab; however, this service sometimes requires a waiting period because of limited capacity. Most of our patients are good candidates for at-home testing.
We provide detailed setup instructions on our website, as well as a QR code that links to a step-by-step instructional video demonstrating the application process. Our patients have been highly successful completing the test at home, which is consistent with evidence from the literature. In a U.S. multicenter study of nearly 1,000 patients, 85% achieved first-attempt success and 88.6% achieved overall success with self-applied type II PSG testing without technician support.3
Accessibility is often a huge problem in the German health care system due to a shortage of qualified personnel. To ensure that patients have around-the-clock support, we provide direct contact options both to our clinic and the manufacturer’s hotlines and emails for device troubleshooting.
With little disruption to their typical routine, patients sleep naturally at home, complete the testing, and return the device the next day. We schedule a follow-up appointment in advance to review results and plan next steps.
Supporting Patients at Every Step
While advances in technology have made this care model possible, we know that innovation must go beyond technology. It must also reflect a modern, patient-centered attitude, and that’s especially evident in how we handle long-term follow-up and treatment optimization.
Although PAP therapy remains the gold standard for OSA, it’s clear that treatment for OSA is often too narrowly focused on PAP—which is not always suitable or well-tolerated by all patients, particularly younger individuals. Many report that PAP devices negatively impact their quality of life, self-image, sleep motivation, and even intimacy.
Clinical research shows that PAP therapy’s success depends not just on technical precision, but also on long-term patient support and monitoring.4 Studies have proven that as little as four hours of effective PAP use per night can significantly reduce cardiovascular risks.5 But as previously referenced, non-adherence rates can be as high as 95.7% within one year of initiating treatment.2 With patient consent, we offer remote monitoring, allowing for timely adjustments that minimize discontinuation and promote compliance.
We also make it a point to take a personalized and multimodal approach to OSA. We use PSG results to formulate a comprehensive therapy plan for each patient, providing monitoring and regular checkups using telemedicine-based quality controls.
For those with mild-to-moderate OSA, we offer mandibular advancement devices (MADs) as an alternative to PAP, if needed. For patients unable to tolerate PAP or MAD therapy who have moderate-to-severe OSA, we coordinate with surgical and implant specialists to offer hypoglossal nerve stimulation as a third-line treatment.
We support our patients throughout their therapy journey, whether they’re using PAP, MAD, or other interventions. When patients feel guided, heard, and supported, they are far more likely to succeed—regardless of which therapy they use. Using a hybrid model gives us the tools to stay closely connected as patient needs evolve, ensuring that care never stops at the prescription.
The pace of innovation in sleep medicine is giving clinicians opportunities that were unimaginable not long ago, from sophisticated home diagnostics to continuous digital follow-up. These advances allow us to deliver care that is more flexible, more responsive, and more deeply aligned with patients’ lives. My hope is that our journey shows how embracing these tools can reshape what’s possible in sleep care, both in Germany and around the world.
Julija Judickiene, MD, is an internist, pulmonologist, and sleep medicine specialist. Simeon Iwantscheff, MD, PhD, is an internist, pulmonologist, allergologist, and sleep medicine specialist. Together, they cofounded DeepSleep, a hybrid sleep laboratory in Frankfurt, Germany.
References
- German Federal Statistical Office (Destatis). Medical expense statement by disease diagnoses (ICD-10) 2015-2023. Code: 23631-0001. Accessed November 13, 2025.
- Shinde S, Lin X, Yin C, Pettine M, Adam A, Khare S. Patient profiles and treatment patterns for obstructive sleep apnea (OSA) in Germany: a real-world data analysis. Sleep. 2024;47(Suppl_1):A229-30. doi: 10.1093/sleep/zsae067.0536.
- Punjabi NM, Brown T, Aurora RN, et al. Methods for home-based self-applied polysomnography: the Multicenter AIDS Cohort Study. SLEEP Advances. 2022;3(1):zpax011. doi: 10.1093/sleepadvances/zpac011.
- Woehrle H, Ficker JH, Graml A, et al. Telemedicine-based proactive patient management during positive airway pressure therapy: impact on therapy termination rate. Somnologie (Berl). 2017;21(2):121-7. doi:10.1007/s11818-016-0098-9.
- Sánchez-de-la-Torre M, Gracia-Lavedan E, Benítez ID, et al. Adherence to CPAP treatment and the risk of recurrent cardiovascular events: a meta-analysis. JAMA. 2023;330(13):1255-65. doi:10.1001/jama.2023.17465.
