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May 28, 2019

The Future of Sleep Management, a podcast interview with Beddr CEO Mike Kisch

On average, we spend about one-third of our lives asleep, yet modern society has increasingly traded vitally important sleep hours for more awake time to work more and better navigate a highly pressurized and complex world. This is a dangerous trade-off and one that could have serious health implications for people around the world.

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As we look 10 years into the future, what are the challenges we face in understanding the importance of sleep management and how will we better understand and improve our sleep habits and needs? Listen as Beddr Co-founder and CEO Mike Kisch talks with Michael Gale, host of the Forbes Insights podcast “Futures in Focus” on the future of sleep and how we can harness technology to get a better night’s sleep.

Read the full transcript below.

You're listening to Forbes Insights Futures in Focus with your host, best-selling author, Michael Gale.


Michael Gale:

We spend at least 30 percent of our life sleeping. Yet our speaker today Michael Kisch, the CEO and co-founder of Beddr, says we know less than five percent of what happens to us when we sleep, when we get to sleep, when we wake up. That's a lot of time that we're really not aware of what happens. In an average life it maybe a quarter of a million hours of sleep. That means we do not know what is happening to us for an incredible number of days — over 9,000 or over 24 years of our lives.

Mike talks about how we have increasingly substituted vital sleep hours for the purpose of being awake more to work in an increasingly complex and highly pressurized world. Mike talks with me about increased research on the power of sleep and how dangerous this trade off has become between sleep and no sleep. That's something that's sort of well known, however, much of the future is often seen how we handled edge cases now in order to indicate what might be a more general way that we handle bigger populace problems 10 years from now. So Mike's understanding of these edge cases now around sleep are problems we're all frankly having in some way, is a clear indicator of what the future could look like for a much larger population. 

Mike has a very clear pathway for how chronic sleep challenges are being solved. Right now, a combination of technologies, access, and extremely scalable expertise could indicate the way we start to think about solving these challenges. Really it's normal things 10 years from now. Mike talks about the combination of digital technologies, a shift in mindset, and a ripple effect that illustrates what could or could not be possible, combining physical skills with digital measurements for a whole range of sleeping issues going forward.

There are really great insights and lessons from this podcast. I have to think about design for a new world in a very different way. Sleep, frankly, or otherwise. It's sort of like a blueprint example for thriving in a digital world 10 years from now.

Sleep matters as one of those Gordian Knot areas where we have to be able to try to break through the challenges of thinking that have dominated us for the last, 50, 60, 70 years. And in order to be successful, we really have to understand how we prioritize sleep better and differently going forward.

Mike, thank you so much for being with us today. This area of discussion about sleep is a big issue for all of us actually — consciously or unconsciously. Hopefully, we could have a really fun discussion today about what you think the world of sleep will look like 10 years from now.


Mike Kisch
:

Very much looking forward to it.


Michael Gale
:

Let me start with this sort of a side note. We all spend — sometimes not enough — but we all spend about 30 percent of our lives, really everyday, sleeping. But it doesn't seem to be a very large conversation for those conscious hours and it's very clear that we messed up as a species. Walk us through what you think sleep should — and will — look like 10 years from now and why have we messed up so badly about not getting to that world of the future right now?


Mike Kisch
:

Sure. I think historically we just haven't had a really great appreciation or understanding of the importance of sleep. In sort of frenetic times, where people are forced to make trade-offs and to prioritize one thing over the other, sleep was often the thing that people were willing to sacrifice. We've seen that over the course of the last 50 years. We've seen the average time that a person sleeps has declined by almost an hour.


Michael Gale
:

Wow.


Mike Kisch
:

So there's data ...


Michael Gale
:

That's terrible!


Mike Kisch
:

It is terrible but there's lots of data that support that both quantity is decreasing and quality is decreasing as well. I think the biggest fundamental issue is that we just didn't understand it. We didn't place importance on it and it was something people were relatively willing to make a trade-off and not to prioritize in their lives.

I think, moving forward, sleep is very much having a moment. I think we have lots of focus, first on exercise, nutrition, and now we're seeing it on mindfulness. I think people are beginning to view sleep and focus on understanding and improving it as sort of this critical underserved opportunity where you have this massive upside to positively impact almost all aspects of your life. Certainly your physical well-being, as well as your mental and your spiritual well-being. I think the early adopters, more progressive-minded folks, they're now really beginning to place a huge amount of emphasis and priority on understanding and solving any of the traditional sleep issues they have.


Michael Gale
:

Why have we messed it up so badly? Let's go back, past... a world where even television or video function to our great, great grandparents and sort of a late Victorian era, they got sleep. So why have we made this trade? Why a society decided, "Hey, I need another hour. I'll take it from sleep." It's clearly a progressive to care for that sleeping process. It's not one, sort of huge event that's cause it. Why have we not put the brakes on cutting sleep time down?


Mike Kisch
:

It's a really interesting question because I think a lot of people today look at the cellphones, they look at television screens, they look at over caffeination as ... these are the drivers of decreased sleep quality when in reality, the degradation of sleep quality started well before people had smartphones, well before there was the television set in everyone's home, and well before there was a Starbucks on every corner of every street in every town across the world.

I think a lot of it has to do with, particularly in the United States, at the root of our psyche is this idea of we want to be the best. We want to strive to continue to improve. We want to win. There's a machismo that goes along with that where over time, people viewed sleep as almost a way to compete with their coworkers or their neighbor. But it wasn't competing in that “I got more of it,” it was “I need less of it to be successful or more successful than you.” And you've even heard famous people make quotes like "How are you going to compete with me while I'm out getting something done and you're sleeping."

Societally, we had a lot of people who are perpetuating this concept that sleep was bad and it was an inhibitor to your success. I think as we began to learn more about the science behind sleep and the impact it has on our lives, people are beginning to come full circle back to actually the way that I'm going to reach my human potential. One of the ways is I'm going to have to make sure that I'm self-caring and I'm setting aside enough time to get high quality and sufficient quantity of sleep. That's certainly a slow process but it's one that we see under way. There's some very vocal proponents. Jeff Bezos is a great example of somebody who believes that it's in the best interest, it's his fiduciary obligation to the shareholders of Amazon and to his employees to get eight hours of sleep per night because he believes that's what's going to put him in the best position to make the best decisions and to be resilient through the inevitable ups and downs that a public company's CEO goes through.


Michael Gale
:

But if we're going to look at technology as a unicorn or potentially, white knight for this, what's the journey that you see that technology helping us with, that in 10 years from now, when you and I are talking, getting eight hours or seven hours, or nine hours at night is just as obvious as eating or drinking water or putting a seatbelt on? Where are we going to see this journey with technology over time? And how is it going to get us to that point where this no longer becomes this deeply rooted challenge? It's become culturally, really across the world over the last 20 years.


Mike Kisch
:

So one of the challenges is historically when you're trying to help people with sleep issues, it's treated as an acute problem versus a chronic one. Much of the existing sleep medicine system is built around a transactional model. Like, "Oh. You have a problem sleeping, let's get you tested once. We'll get you onto some therapy and then you're out the door.” It's all up to you to figure it out on your own.

The value of technology in this case is that it's present in our lives, and can actually be harnessed for good. What I mean by that is people now have this device with them all of the time, or they have a watch or other types of wearables and these now enable the providing of a relationship-driven model to work with people to consistently support them to actually change behavior and improve the quality and the quantity of their sleep.

The traditional model is capacity-constrained by the fact that you require reimbursement, you have very limited number of experts that you can gain access to. The system itself was built to solve one problem. It wasn't built to really support people on an ongoing basis. Those who have chronic sleep issues, it's very similar to those who have type 2 diabetes, hypertension, mental health issues. These are not things that you could just solve with a pill or with a single visit. These are things that require engagement, active participation on the individual's part, but also easy access to expertise and proven therapies.

This is an area, I also think, technology has huge upside. It can help scale out how we deliver expertise and how we match people to therapies that have been clinically validated to actually help us improve our sleep.

The current systems, while there's technology in them at key points, it's not pervasive or consistent from a foundational standpoint to really allow scale to occur. As a result, about 85 percent of people who have chronic sleep issues, they'll never see a doctor. They'll never be diagnosed. They'll never really understand why they don't sleep well. They'll just assume that, "This is the way it is and this is what I have to put up with and this is the life that's been given to me." I think well-designed technology is really going to help millions and millions of people: help them understand that they do have a problem and it's a problem that can be overcome if they're put in the right types of programs that has been proven to help someone who has a similar situation.


Announcer
:

You're listening to Forbes Insights Futures in Focus with your host, best-selling author, Michael Gale.

Nothing is certain about the future, but you can be more prepared for it by listening to Futures in Focus.

Find this show everywhere fine podcasts are found and subscribe. That way, you'll never miss and episode.

Now, back to the interview.


Michael Gale
:

Generally, I think when we look to the future, we're looking at edge examples. How will these edge cases change the shape of the overall market? So chronic sleep is a great example because it affects a very large niche of the market. It's historically been problematic. There's enough research on it now that says, "It's a problem. You have to handle it." So take that journey from now to 10 years time and walk us through how you believe issues around chronic sleep are going to get sorted by this triangulation of living expertise, ongoing help, and devices. So that somebody sitting here in the morning in 2029 has an exponentially less chance of having chronic issues than they have now.


Mike Kisch
:

Yeah. I think it really breaks into three big categories of evolution. The first one is democratizing access to accurate testing technology. It's allowing almost anyone to basically take a clinically validated sleep test and to be able to gather the necessary data to inform an individual to really understand what's really going on with that person. I think right now, those systems are locked behind the insurer reimbursement wall and the systems just are not designed to not be accessible, like thousands of dollars. They require a lot of clinical expertise involvement just to get people setup to take a test.

The first big evolution is just going to be taking the core aspects of those existing testing modalities and making them inherently scalable, affordable, accessible, and available to any person who suspects that they have a chronic sleep issue.

The second critical area is the population of people who are really expert about sleep is actually quite small. It's a very small specialty.


Michael Gale
:

How big is it?


Mike Kisch
:

It's about 6,000 board certified sleep physicians in the U.S.


Michael Gale
:

That's tiny!


Mike Kisch
:

It's very tiny. Very, very tiny. There's 200,000 dentists to put it in perspective. There's 6,000 sleep physicians. This is a group of people, because they're not very numerous, you almost have to put walls around them to sort of protect them so that they're not overdrawn. I think in the future, those people are going to be scaled out. Their expertise is going to be made available to far more people at a far lower cost than the current system is structured. Part of that is simple things like telemedicine, and enabling the geographic boundaries to be removed from people gaining access to that expertise. Other parts are going to be through artificial intelligence and machine learning where it's basically taking the data and it's being trained by those experts to begin to automate some of the fundamental tasks of helping people understand what's driving some of their sleep issues.

The third critical area is making it much easier for people to get matched to a therapy that has been consistently proven to actually address the problem that they're experiencing and once again, right now, that's very difficult, very expensive. Insurance presents a huge amount of friction in that process. I think we're going to begin to see people gaining access to those therapies in a way that's similar to them going to Amazon and buying a product and it having it delivered to them via Prime over the course of two days.

The system, I think, is going to go through a really, really substantial evolution over the next five to 10 years where anybody can gain access to the diagnostics, the expertise, and the therapies. They’re going to be able to work with people that are going to really treat sleep issues as a chronic problem versus an acute one; who are going to provide them the behavioral support and coaching and guidance that we've seen in other diseases and make a really significant impact on improving outcomes at scale.


Michael Gale
:

So let me ask you a question. It goes back to the funnel effect. If you look at the estimate, least in the United States or the North Americans for chronic sleep issues, what sort of percent of the population, let's say 330 million is affected by this? In other words, they're aware of it or they're not aware of it, but they clearly have chronic sleep issues. Because there's a lot of discussion about people who do night shifts and how difficult their sleep process becomes during the day and there are some really negative statistics about life expectancy for people that work, you know, maybe eight hour days but work them through the night because clearly there's a correlation with sleep deprivation. So what number of the population in the U.S. has these chronic sleep issues?


Mike Kisch
:

So one third of American adults have a chronic sleep issue and the two most likely would be insomnia and sleep apnea. With insomnia they struggle to fall asleep or they'll wake up in the middle of the night and they can't get back to bed. Insomnia really squeezes duration of sleep. And then the other, which is a little bit less well known but it is a condition called sleep apnea. This is where a person stops breathing while they sleep because their airway actually collapses. There's about 50 million Americans alone who have sleep apnea and that of the two is the one that has more long-term health consequences because it's not only about reducing quality and quantity of sleep, but apnea is putting a huge amount of stress on people's cardiovascular system. It's really increasing the likelihood that they're going to have a stroke or some other cardiovascular disease. They're going to have type 2 diabetes.

It's a huge population. Globally, that number easily goes above a billion people.


Michael Gale
:

So one in seven. One in seven and a half.


Mike Kisch
:

Yeah and it's all a guess because there's really no apparatus right now that can screen large populations of people who believe they may have a sleep issue but are uncertain as to what the driver of that issue is.


Michael Gale
:

Because it's actually a higher instance rates in diabetes, which is obviously that and heart disease are, beyond cancer, the two most commonly thought about disease areas. What stopped this happening up to now? Why is this not being solved now? Why are you more optimistic about it in 10 years time than maybe, what would've been 20 years ago?


Mike Kisch
:

I think one of the things that make me most optimistic is the amount of clinical research that has been done that demonstrates the relationship or the linkage between sleep issues and almost everything else related to a physical and mental well-being. I think sleep in and of itself, if it was just, "Oh I had a bad night of sleep," I'm not sure that would have made a massive change in how people think about this, but I think now that we understand what it does to people's blood sugar levels and what it does to their heart rate and how it increases their risk for stroke, how it increases the risk for dementia, how it increases risk for depression. What people on the research and the clinical side are seeing, and consumers are now beginning to become more educated about, is that sleep really is a foundational pillar to our entire health and well-being. If you don't manage your sleep properly, not only will you have short term consequences in that you're tired and your productivity is lower, but there are a range of long term, fairly serious health effects.

This is what's changing people's perspective on the importance of sleep. It's not just, "Oh I'd like to sleep a little bit better." It's now the understanding that, "If I don't get this under control, if I don't address this proactively, I'm going to be at a much higher risk for a range of other medical conditions." I think that's, honestly, probably the biggest driver. And that's both driving the awareness with clinicians, it's driving awareness with consumers, and it's also driving awareness with health systems and insurers. All of those entities play a critical role in the delivery of health care in this country and they all need to be aligned and have a shared set of objectives if we're going to see huge improvement moving forward. I think if you ask representatives from each one of those groups, they would all at this point say that they're really beginning to understand the importance of sleep and its impact on their lives, on their patients, and on their businesses.


Announcer
:

You're listening to Forbes Insights Futures in Focus with your host, best-selling author, Michael Gale.

Nothing is certain about the future, but you can be more prepared for it by listening to Futures in Focus.

Find this show everywhere fine podcasts are found and subscribe. That way, you'll never miss and episode.

Now, back to your host, Michael Gale.


Michael Gale
:

What's the trigger, a year, two, three years from now? What sort of watershed moment needs to happen to make this have a velocity that you're talking about? Or is it just a sort of progressive momentum that picks up over the next five to 10 years that gets us to a better place?


Mike Kisch
:

I think there is already building momentum. People are getting more educated about sleep. People want to play more active roles in their overall health. They're really beginning to put a focus on sleep. We already have all these multifunctional wearable devices, that are being sold in the tens, if not hundreds of millions per year that are adding in sleep tracking or they're adding in sleep disorder detection. You have people buying these products, oftentimes for completely different purposes, but they're getting access to a set of features that are making them aware of the fact that they may be at risk for a condition like apnea, or they're really beginning to understand the sleep duration and their sleep staging that's making them informed and curious consumers. That's driving demand into traditional sleep medicine. More people are going to take sleep tests and talk to physicians and ultimately get on therapy.

I think, as it often happens when consumers begin to exhibit a level of interest in an area, there's a whole bunch of businesses that are rushing to provide services and products to serve those needs. They're working in the yin-yang, back and forth where they're pulling and pushing each other to really drive this market forward and create increased awareness and relevance.


Michael Gale
:

How much of it is generational? The shift between a boomer-dominated world to the one next year where the vast majority of the world's workforce will be millennials? Or is that too convenient an answer to say it's just about age?


Mike Kisch
:

I don't know if age is the way I would segment this. Certainly a lot millennials have poor sleep quality. I'm not sure that today's millennials have much worse sleep than probably I did when I was growing up. I think when we're younger, we don't really think about these things as much and our ability to persevere and bounce back is a lot higher.

When you look in the U.S., I see the biggest sleep issues are at the opposite end of the socioeconomic spectrum. We see shift workers or those working multiple jobs that have very poor sleep. Sleep is just something that they have less of an ability to prioritize because to them it's not the most critical need that they need to address right now. And then the other area that we see lots and lots of sleep issues is at the opposite end, where it's the wealthiest, the most affluent populations, where they have a tendency to be very ambitious, very driven, they're over subscribed, they're multitasking, and they sort of believe themselves to be ...


Michael Gale
:

Infallible.


Mike Kisch
:

Infallible and invulnerable to any issues. The people who have the healthiest sleep happen to typically be middle class, upper middle class. They have a reasonably comfortable life and they have fairly good work-life balance.

I certainly have a lot of passion on helping both groups, but the one that I really do want to help out are those that have less access to the expertise and the solutions that are going to help them get better. I do believe that if they can improve their sleep, it's going to have a follow-on effect in their ability to generate income, their ability through that income generation to better afford a home or rent and food. There's a lot of follow-on benefits that come with actually improving your sleep health.


Michael Gale
:

So if we're sitting here 10 years from now, still talking about sleep, because it's one-third of our lives, what do you hope, or what do you believe will be different about that conversation then than we've been having today?


Mike Kisch
:

I think there won't be any doubt about its importance. People, therefore, will be much more engaged and activated in their desire to tackle it and learn about it and ultimately, solve it. I think that's going to be the first big step.

I think the second one is that on an individual level we are going to know a lot more about sleep. What works best for each person versus general best practices. I think with new technologies, with wearables, with more affordable, accessible diagnostics, everyone's going to have access to technology and products and services that are going to really give them, for the first time, a unique set of insights into their sleep.

I think the final thing that's going to be very, very different is just through all of that data and all of that understanding, not just on an individual level but at a population level, we're really going to have a much deeper grasp on what solutions are most effective and are best matched to each individual. So there will be a degree of personalization that right now doesn't exist, that will exist in the future, and it will be informed by just the sheer number of people who are now gathering data about their sleep. And our ability to process and analyze that data and learn from it can better match people to solutions that stands the greatest chance of helping them out.


Michael Gale
:

Have you seen intrinsic or business interest from the insurance industry? Because I presume at some point if you can say, "Look. This is the one third of the day they spent sleeping and their sleep patterns are infinitely worse or infinitely better than their peers, maybe their premiums are higher or lower." Have these discussions started to happen or is that still some time in the future?


Mike Kisch
:

These discussions are ongoing. Most people in this country are really providing, subsidizing the cost of their insurance. Employers are highly interested in sleep. The reason they're so interested is because they understand the impact of sleep on the performance of their employees. If you're a company in the technology or financial services or transportation logistics industries, your employees making good decisions that advance the company's prospects or mitigate potential risks of accident, there is huge upside there and there's a huge downside from a risk and a cost perspective. So employers are heavily incentivized to be able to help their entire employee population understand and improve their sleep issues.

Conversely, insurers themselves whose customers are these employers, they are now being drawn into that and they're seeing the interest on the employer's side and they're now beginning to understand how they could better insure a large population of people — probably at a lower cost with an improved outcome — if they had a more comprehensive and concerted approach to sleep health.


Michael Gale
:

So probably waking up at 3:30 in the morning and tweeting isn't good for one's sleep patterns?


Mike Kisch
:

No, it's about the worst thing you can possibly do.


Michael Gale
:

So on that note, Mike, this is obviously fascinating because every human being has potential for these challenges. Without you drowning, how can people continue this conversation and find out what you're doing and the company is doing?


Mike Kisch
:

Well, the easiest way is go to our company's website. The company is called Beddr, spelled B-E-D-D-R, and the website is www.beddrsleep.com. Not only can they learn about the product, if that's something that's interesting to them, but there's a treasure trove of content and research that we've accumulated over the course of the last couple of years that we think does a really good job of educating people on the importance of sleep, but also some of the warning signs of when they're getting insufficient sleep or poor quality sleep.


Michael Gale
:

Mike, thank you so much for your time today. Obviously people can connect with you on LinkedIn as well, I presume.


Mike Kisch
:

I do have a LinkedIn profile and I actively respond to people who reach out.


Michael Gale
:

Great! That sounds like a very machine-like answer but Mike, thanks very much for you time today!


Mike Kisch
:

Thank you, Michael! I really enjoyed it.


Michael Gale
:

Get a hold of Mike on LinkedIn and just think about how the future is designed to solve big Gordian Knot challenges that we've really not been able to sort up to now.

Sleep is a great example of that and Mike's discussion today is a perfect illustrator of that potential journey to 10 years from now.

Look, there are less than 6,000 registered sleep specialists in the U.S. for over 330 million people. We can't double or triple or create even maybe 20 percent instantly. That expertise is vital. So getting that expertise in the hands of everybody, when they need it, in the most highly personalized way, is really the fundamental promise of a digitally transforming world. If that was the norm 10 years from now, how much better would the world be?

Listen to Mike's decade forward interview, too, for more insights on his thinking about the wider world of 10 years from now.


Mike Kisch likes to make the complex simple, engaging, and accessible to more people. He is passionate about applying this philosophy to healthcare. Previously, Mike was the founding CEO of Soundhawk, a wearable hearing enhancement company that developed the first connected hearing device. He led the company from concept to commercialization and multi-million dollars in revenue. He holds an MBA from Washington University in St. Louis and a BA from University of Wisconsin-Madison.