Free access to sleep care is now available for people without health insurance in southeast Michigan. Established by a University of Michigan sleep epidemiologist, the new sleep medicine service aims to combat sleep disorders and help reduce poor health outcomes. 

Sleep is a vital function for overall well-being — impacting physical, mental and emotional health. However, many people struggle to get a good night’s sleep.

An estimated 50 to 70 million American adults are affected by sleep disturbances, and one in three adults will experience a sleep disorder at some point in their lives.

“Unfortunately, those who are most susceptible to sleep disorders include low-income working adults, immigrants and refugees,” said Galit Levi Dunietz, Ph.D., M.P.H., an associate professor in the University of Michigan Department of Neurology and Division of Sleep Medicine.

“Medical care is often inaccessible for these underserved groups, and they never receive assessment or diagnosis for sleep disorders. Left untreated, they suffer from severe health consequences.”

Sleep and underserved populations

Dunietz partnered with the Hope Clinic, a nonprofit organization committed to supporting underinsured and uninsured individuals, to provide free sleep care to underserved populations.

With locations in Ypsilanti and Westland, Mich., the clinics are situated in urban areas of the state with diverse communities, including many immigrants and refugees.

The organization provides free medical and dental care, behavioral health counseling and food programs for vulnerable members of the community.

“We aim to provide the most extensive range of free healthcare services possible, but sleep medicine has not been accessible to us in the past,” said Ann Marie Peterson, a medical clinic manager at Hope Clinic.

“There was a critical need for sleep care amongst our patients, which would have been far too expensive for them to receive anywhere else.”

Sleep apnea common

In particular, many patients visiting Hope Clinic were diagnosed with a sleep disorder called obstructive sleep apnea.

Sleep apnea is characterized by loud snoring and frequent pauses in breathing during sleep and can lead to insomnia, daytime sleepiness, high blood pressure, diabetes and heart disease. Obstructive sleep apnea is commonly treated with nightly use of a continuous positive airway pressure device (CPAP), a breathing machine that keeps the upper airway open.   

Without health insurance, evaluation for obstructive sleep apnea and its treatment are inaccessible. Barriers to sleep apnea care include lack of access to a sleep physician, sleep apnea test and CPAP machines.

It’s beyond rewarding to hear them say they’re sleeping better and feel like they can be more proactive in their lives.”

-Galit Levi Dunietz, Ph.D., M.P.H.

 

Right equipment

The sleep medical care at Hope Clinic not only provides free evaluation and treatment for patients at risk of obstructive sleep apnea, but also replaces dysfunctional old CPAP machines, and equipment needed to use it, for individuals with sleep apnea without health insurance.    

To fund the clinical operations of the new program, Dunietz applied for the Community Sleep Health and Public Awareness Grant offered by the American Academy of Sleep Medicine Foundation. The grant funds were used to purchase devices for at-home sleep apnea testing and CPAP machines.

“We send our patients home with a non-invasive, fully portable device to test for sleep apnea,” said Dunietz. 

“It relies on a highly innovative technology and is very convenient for our patients.”

The test is able to identify pauses in breathing or periods of decreased breathing – called apneas or hypopneas, respectively – during sleep based on specific signal patterns, measured in part from the fingertip by recording changes in pulse.

The data from the home sleep apnea testing device is uploaded to the clinic’s cloud server and reviewed by a sleep physician. If the test results are indicative of sleep apnea, the patient returns to the clinic for a consultation with a respiratory therapist who provides the patient with a CPAP machine at no cost.

Dunietz recruited volunteer sleep physicians and respiratory therapists from the U-M and Henry Ford Sleep Disorders Centers to help run the clinics.

Launched in a pandemic

The first monthly clinic took place September 2021 in the midst of the COVID-19 pandemic.

Starting up during a global pandemic presented challenges, but the most concerning issue stemmed from a major recall of CPAP machines, leading to a severe supply shortage.

Dunietz set her sights on local CPAP vendors with existing connections to Michigan Medicine. She convinced them to donate gently used CPAP devices at minimal to no cost, ensuring the clinic could continue to provide treatment.

“The equipment and services Dr. Dunietz has provided is invaluable,” Peterson said.

“She has not only acknowledged the health disparities in our community, but continued to push for change despite all obstacles.”

The free sleep clinic also prioritizes monitoring and follow-up with its patients. The output from the machine tracks use, reporting the number of hours and days per week that it’s active. The data is available to the respiratory therapists and physicians at follow-up visits to Hope Clinic, and can be used to adjust treatment strategies.

“When our patients come back for follow-up appointments, that’s when we know we’re making a real difference,” Dunietz said. 

“It’s beyond rewarding to hear them say they’re sleeping better and feel like they can be more proactive in their lives.”

Although the grant only provided funds for one year, the sleep clinic still operates this year and plans to continue providing care in 2025. 

“The patients we’ve seen at Hope are all suffering from moderate to severe sleep apnea and could not have afforded to receive treatment otherwise,” she said.

“You cannot imagine their excitement. The sleep clinic has had a lower no-show rate than any other subspeciality at Hope Clinic.”

Recently, Dunietz was chosen as a recipient of the 2024 Health Care Equity Research Award by the American Academy of Neurology. The award serves as an official acknowledgement of the success she has had in reducing sleep health inequities for underserved communities.

“I hope that our sleep clinic will serve as a model for others across the country,” Dunietz said.

“I am committed to continuing to provide equitable access to sleep medical care in southeast Michigan.”

Volunteer sleep physicians: Ronald Chervin, M.D., Cathy Goldstein, M.D., Shelley Hershner, M.D., William Palmer, M.D., Ronald R. Gavidia Romero, M.D., Anita Shelgikar, M.D., Qurratul Aine Shamim-Uzzaman, M.D., Punithavathy Vijayakumar, M.B.B.S.

Volunteer respiratory therapists: Rebecca Aiello, Armando Kurili

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