The Doctor Is Online: Joseph Krainin, MD, FAASM



Sleep doctor Joseph Krainin, MD, FAASM, founded digital sleep center Singular Sleep, where engineering brings sleep identification and therapy into the masses.

Many of us have experienced the idea, “If I were in charge, I’d do things otherwise. ” But while most of those thoughts don’t sleep doctor Joseph Krainin, MD, FAASM, really turned his vision into reality–for individuals and for both himself across the United States.

With the internet launch of Singular Sleep in November of 2015, Krainin entered new territory. Board-certified in sleeping medicine and neurology, he’d until there traversed a conventional sleeping medication career path, which included stints in academic medicine, private practice, and the private industry. However, with Singular Sleep, Krainin could be accessible for appointments that are virtual just. In the “digital rehab center,” Launched initially in South Carolina and recently relocated to Florida, he uses telemedicine for many consults, diagnoses, therapies, and management.

“We struck the ‘go live’ button to get on Veterans Day 2015. One week later the AASM started its platform. I thought, ‘We& & rsquo;re rdquo; & doomed, & rsquo; Krainin states.

Although not doomed, Singular Sleep did get off to a slow start. “I recall our first sale and becoming psyched. It turned out to be a white sound generator,” he states. “After we took into account shipping, etc and did the mathematics, we realized that we had lost money. ” Loss nonetheless, Singular Sleep currently needed a revenue flow –and it is growing.

Now, three years later, Krainin has a full schedule of individuals each week. Most of the self-referred and primary care providers generally refer the remainder.

Jacqueline Rubio is training manager at Singular Sleep. She manages tasks like maintaining stock, troubleshooting problems, and individual communication for conditions. She’s additionally Krainin&rsquowife. “I haven’t had some misgivings about Joseph’s choice to leave the conventional path of practicing medicine and begin Singular Sleep because the vision that he explained to me was unique, informative, and clearly thought-out,” she states. “His assessment of the current state of its future and medication, along with the extensive amount of planning and self-education he’d undertaken, convinced me that this firm was bound to become successful. ”

As a telemedicine clinic, Krainin can be more flexible than bricks-and-mortar centers in fulfilling patients. Naturally, sometimes people assume that versatility far. “I’t needed to have some bizarre conversations with people who tried to perform the consultation whilst driving,” Krainin states. “Texting while driving isn’t bad enough but doing a video-consultation? ” Perhaps the most extreme case is that a patient who logged in from underneath the wheel of a Tesla. Krainin states, “I started in with my average, ‘You& & rsquo;re going to have to pull over if that conversation is going to continue,’ also he stated, ‘Doc, don’t stress; it’s a self-driving Tesla! ’”

After an appointment, Singular Sleep mails home sleep evaluations into patients as indicated. And for therapy, Singular Sleep has a durable medical equipment arm, which now mails gear for example CPAPs to individuals who want them. Desensitization and Gear troubleshooting is done–”exactly the same manner I did it into my conventional clinic,” Krainin clarifies in person rather than by videoconference. He virtually walks through steps like, “Put the mask on in the evening, if you’re in a relaxed state and watching TV or studying …” He adds, “Cloud-based data acquisition capabilities are revolutionary in PAP management. Forget about carrying smartcard or your machine anywhere. We could see exactly what & rsquo; s moving on by obtaining when a patient is experiencing a problem. Of course, we could even adjust machine settings. ”

Patient Demographics

Singular Sleep team members meet in a conference room. Left to right: Maria Gage, Jacqueline Rubio, Joseph Krainin, and Samantha Collins.

Singular Sleep’s protocols aren’t without controversy. Particularly when it comes to the particular patient populations it diagnoses via home sleep testing (HST)–for example people with comorbidities and children. “At Singular Sleepwe place the power to order the evaluation in their patient’s hands. Patriarchal medicine’s times are allegedly more than but we’re still clinging to some vestiges of this,” Krainin states. &ldquoWe now have information on the website about the reasons why an sleep analysis allow the patients decide what they want to do and might be better in some conditions. ”

At the American Academy of Sleep Medicine’s view, “Research statistics clearly demonstrate that HSATs [home sleep apnea tests] are most accurate in adult patients without a complicating conditions and a heightened chance of moderate to severe OSA. The proof is clear that HSATs may not supply the appropriate information. Because of this, it is crucial to anticipate an HSAT to operate efficiently in all human inhabitants,” states AASM president Douglas Kirsch, MD, who cites a task force of experts who systematically examined literature and graded the evidence for its AASM-approved clinical practice principle published in 2017.1

Krainin states, “From a logical standpoint, it doesn’t make any sense a testing device developed to diagnose sleep apnea shouldn’t be utilized to diagnose the gamut of breathing syndromes. For me, those exclusion standards for HSTs resorted to throwing a fiscal bone to present brick-and-mortar sleep centers if HSTs were eventually accepted into the mainstream. Bottom line: If you want to understand not or if the individual has sleep apnea, which likely accounts for something like 98 percent of all sleep study referrals, then a HST with quality information is going to provide the solution. In 10-15 years, it’s hard to imagine that virtually all sleep diagnostics testing won’t be achieved in your home. ”

AASM’s Kirsch agrees that in the long run more testing for obstructive sleep apnea (OSA) is likely to be performed in your home, but counters, “I expect that laboratory-based polysomnography will nevertheless be required to evaluate patients at risk for OSA who have some other complicated medical conditions in addition to those suspected of having other sleeping disorders. ”

Another contentious market is pediatrics. Singular Sleep offers home sleep testing to children ages 7 and along with the Nox-T3 device. (The Nox-T3 was FDA approved in 2009 for people greater than 2-years-old.) Krainin states , “I’m surprised at the large wait times that a few of these parents face to get their kid into a lab that performs pediatric tests. These kids, and their parents, are suffering. There is certainly a learning curve with getting information that is good but we’ve found a procedure which results in a likelihood of information that is sufficient. We’re upfront within our messaging that the AASM states in-lab studies would be the gold standard for children but also that the AAP [American Academy of Pediatrics] claims that HSTs may be an alternative in some specific scenarios.2 I forecast the AASM will change its song on this topic in the long term future; we’re only ahead of the curve. ”

However, the AASM’s opinion, as articulated by Kirsch, is, “The AASM ardently supports patient-centered attempts to earn sleep medication testing accessible and more convenient. However, diagnostic and therapeutic decisions should be guided by objective proof, and now there is insufficient proof to support the standard utilization of HSATs in children. ” He finds a position paper published in 2017 in which a task force found insufficient evidence comparing HSATs in children into polysomnography, even less evidence readily available in young children and those with comorbidities, and a scarcity of studies evaluating the use of HSAT in the home with detectors applied by means of a caregiver.3 “The task force also was not able to discover literature on the use of HSAT devices which could identify arousals or monitor carbon dioxide to the test of hypoventilation, which is significant information in the assessment of sleep-disordered breathing in pediatric populations,” he states, adding, “I would welcome the publication of information supporting the accuracy of HSATs in pediatric populations, and I expect that sleep apnea screening in the home finally will grow to be a more viable choice for children as diagnostic technologies continues to advance. ”

The market at which Singular Sleep is creating the biggest difference, in terms of number of individuals served, is people in their 50s. Indeed, in 2017an AARP initiative (handled by MedCity News) known Singular Sleep as a healthcare business “ even 50+ Innovation Leader” for bringing innovation into Americans aged 50 and older.

“I’m fond of saying that everyone is on their travel with sleep apnea. Sometimes it takes people decades to proceed forward to ‘action’ stage. In my experiencethis step often happens in the decade due to becoming symptomatic during the day [excess daytime sleepiness] or demonstrating a medical disorder, like hypertension, that’s likely to be associated with sleep apnea,” Krainin states. “This age group is relatively tech savvy, fed up with all the current ‘that is the way we do it ’t always done it like ’ mentality of Big Healthcare, also looking for better, more suitable options. ”

Past Sleep Apnea

In Singular Sleep, Krainin has medicated insomnia, legs syndrome, and circadian rhythm disorders through telemedicine. Cognitive behavioral therapy for insomnia (CBT-I) is “particularly well-suited for this sort of healthcare delivery provided the dearth of competent providers and concentration of these in a restricted number of metro regions,” he states.

Krainin occasionally encounters people who request prescriptions like Provigil or Adderall for narcolepsy (whether diagnosed or not), and he states, “The response is ‘however. ’ For a variety of reasons, prescribing controlled substances isn’t currently part of my clinic. ”

A Way Forward

Consultations are done through videoconference.

Krainin is licensed to practice medicine in more than 40 states. Those licenses are hard-earned. “It turned out to be a burden and added flying into Mississippi to sit to their jurisprudence exam and having to take a course to take a seat Texas’ challenging jurisprudence exam,&rdquo. “The country licensing racket is a bear to deal with. There should be reciprocity between nations. ”

As yet, requiring third party payors isn’t component of Singular Sleep’s strategy. “I wouldn’t state it’s entirely off the desk but getting from the hospital-insurance medical complex was certainly one of my biggest motivators Krainin states. “I had come to feel as though I was only an agent of the insurance providers. This ’s not why we physicians undergo the annoyance of medical school and postgraduate training. ”

Many of the benefits and challenges of running a digital sleep center would be the same as those struck by bricks-and-mortar centers. Singular Sleep clinical director Katie Simms, states , “The most rewarding part of my stance is the expressions I have heard from our patients as soon as they’ve started their therapy for example, ‘My CPAP has been life-changing! ’ & & lsquo;I forgot exactly what it felt like to feel great,’ and ‘My partner has moved back into the sack. ’& & rdquo; A challenging part is assisting patients who are resistant to therapy, such as “perhaps not wanting to wear a mask or sleeping with a machine, or they are ashamed to sleep together with their significant other with the machine and mask,” Simms states, adding, “but because I’m pretty confident and watch daily which they and their significant others will gain in the therapy I do my very best to get them excited about starting therapy as well as the benefits they will derive out of it. ”

Krainin has this advice for other physicians who want to include or boost their use: “Don’t use Skype as it’s not HIPAA compliant! ”

And for Krainin states, “We want physicians. On the whole, we have become passive agents of the machine. Doctors will need to reassert their positions as the captains of the health care team. By growing an understanding of business and economics and getting more entrepreneurial, there is huge opportunity for us to reduce healthcare expenses and improve results while improving our job satisfaction. ”

Sree Roy is editor of Sleep Review.


1. Kapur VK, Auckley DH, Chowdhuri S, et al.. Practice guideline for diagnostic screening for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. JCSM. 2017 Mar 15;13(3):479-504.
2. Marcus CL, Brooks LJ, Draper KA, et al.. Identification and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012 Sep;130(3):576-84.
3. Kirk V, Baughn J, D’Andrea L, et al.. American Academy of Sleep Medicine position paper to its use of a home sleep apnea evaluation for the diagnosis of OSA in children. JCSM. 2017 Oct 15;13(10):1199-1203.

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