How to Get a Sleep Study

Show Intro and Sponsor Shoutouts 0:00

Lights out. Welcome everyone once again to another episode of Sleep Tech Talk of the E-Sleep Podcast with your hosts and friends, Emerson Kerr, Robert Miller, and me, Dr. Gerald George Monikerode. Folks, we have an exciting episode as always, but just wanted to let you all know that we thank you so much for each and every one of you. Thank you for listening to the show and making it the success that it is. We couldn't have done it without you, thank for all the likes, all subscriptions, especially all the shares and don't forget there is a comment section here and if you have any questions any thoughts please sure to drop it down in the comments at the same time we also want to give a huge shout out to the sponsors who helped us on this journey and keep us going even now so thank you so much to sponsors folks please as you're listening be sure and check them out with that being said Robert what's going on today a word from our sponsor MedBridge Healthcare MedBridge Healthcare is a leading provider of sleep lab management services and home sleep apnea testing.

Medbridge partners with hospitals, healthcare systems, and medical academic institutions to offer comprehensive, fully integrated services for sleep disorders. Sleep Tech Talk is brought to you by Fisher and Pike. Fisher & Pike Health Care is the leader in CPAP mass design and innovation for over 20 years. Their unique technologies have benefited millions of OSA patients through their top CPAP masks.

Dr. Rifkin's Sleep Medicine Background 1:44

These advancements continue to further enhance patient experience and outcomes. Hey, hey. Thanks, Jerry. We have Dr. Daniel Rifkin with us today with Ognomi, the sleep telehealth provider. And we're excited to have him with this today. Dr Rifken, thanks for joining us. It's absolutely wonderful to Can you tell our audience a little bit about yourself and how you got into the world of sleep medicine and what maybe gave you the idea around developing an online sleep telehealth practice? Sure. Well, it's a pleasure to be here.

Thank you guys for the invitation and you have a great podcast. Really enjoy it when I listen to it. Kudos to you all. I know we only have 20 minutes for a podcast and I'm not sure I could fit in my entire journey in 20-minutes, but I'll try to give you shortened version. Basically, I'm a sleep medicine physician, and I've been practicing sleep medicines for over 25 years. It all started during my residency. I am a neurologist by training. Way back when, when I was in residency, sleep wasn't really on the radar screen.

Even in medical school, too many lectures on sleep, we didn't learn about sleep medication. But I had one attending, they called me a firm attending when we would do our outpatient visit. We basically would see a patient, then call the attending in, and the attend would ask about sleep. As neurologists, we would say headaches, sleepiness, pain syndromes, nondescript dizziness. All kinds of problems. To have a doctor ask you about sleeping, I'd say, why are you asking about asleep? He would uncover sleep apnea, insomnia, other problems that we just really need to see.

In neurology, as you know, we deal with a lot of neurodegenerative problems where patients don't necessarily get better. We treat patients to more healers, I guess you'd call us, where we help them with their journey. But when you treat someone with the sleep problem and you fix their sleep problems, they're super grateful. He was really the only attending that was getting baskets of apples, you can tell them from the Northeast, for thank you gifts and different things like that because wives would come in and say, I have my husband back.

Thank you. He's a better father. It's he's the better husband and all these really neat stories that I could tell you again, we don't have the time, but it piqued my interest. There was a gentleman by the name of Edwin Manning who ran a sleep center here in the Buffalo area. I was in Rochester at the And I was able to do a month long internship with him and from there it all began and I went on to a fellowship at the University of Michigan under Mike Aldrich and Ron Chirving. And from there came back to Buffalo and I've been here ever since I had a really large sleep practice, a bunch of labs.

And it was during that time that I was kind of doing the lab thing, seeing tons of patients, really loving what I do. I'm still super passionate about sleep. But I love to treat sleep patients and, I still treat them even in my current job. You know, but I kind got a little older. My kids stopped wanting to play with me after dinner. So I looking for something to do, I decided to go back to school for a master's of public health. It was really during that time that I recognized what I was doing treating individual patients in a local area was neat and fun.

But when you start studying the ramifications of untreated obstructive sleep apnea from a population health perspective, I mean, it's astounding. I recognize that, man, I cannot tackle this disease. People have to live close to sleep doctors or close-to-sleep centers. So I don't know if any of you have ever done any graduate work, but typically you'll bring your own expertise into projects and different things like that. That's why I really started to think about it. What I learned during this training is that although patients or people may not even have running water in their home or sanitation in our home,

Building Ognomi and Learning from the Startup Journey 5:49

they have a smartphone. And so we started to think about how can we find patients with sleep apnea or how patients would sleep Apnea find us through a smartphone. And that's basically what led to the birth of agnome. the telehealth space. That's awesome. We certainly know that access to care is probably, because of the demand today from a sleep health perspective, you were ahead of a curve just a little bit though. I think in developing an online tele-health platform, and especially, I guess it would have been a lot more simple to try to do it on a regional level, but you had this vision of national sleep tele health service.

Can you tell us a bit about that? Yeah, even more nationally. We're really interested in going international. I mean, we want to be able to provide that access to care for people that don't have it. And I know, especially in developing nations. where untreated obstructive sleep apnea will have just a huge impact on health systems even if left untreatable because of the non-communicable diseases that will come from that. Untreated sleep Apnea like diabetes, heart disease, stroke, all those problems there.

We want to go worldwide. That's our goal and hopefully we'll get there, but for now we started off regional in New York State. And now we're moving towards the whole country. We're in 50 states now, and hopefully we'll go international sometime next year. Sleep Tech Talk is sponsored by React Health. Within our Luna PAP device line, each offering is FDA approved, encompassing CPAP, APAP bi-level and bi level ST models. Our thoughtfully selected array of PEP interfaces and accessories complement our LUNA PAPP device lines while accommodating diverse patient requirements.

As Robert said, you were very pioneering in this in a lot of ways and the explosion of your company has been fantastic. What were some of the learnings or maybe surprises along the way that really shaped Ognomi into what it is today? No, that's a great question. Emerson know the surprise for me because and we've changed our model a little bit as we developed right so at first I thought okay I want to open up access to telehealth care for all sleep doctors so we actually built a platform from the ground up.

That really takes into account all the workflows all of the pathways all that pain points that people would experience in the telehealth space, and we tried to offer it to sleep medicine physicians, actually that was our first sort of model that we try to put together and. Uh, it was great. And, and I thought, wow, this is terrific. People are really going to love this. Sleep doctors are going love because I love it and on the sleep doctor. So, you know, lesson number one, know your audience and know product and, talk to your potential customers before you build a product.

Right. so it turns out that although physicians love the product to switch from the current product they're on and to try to go through that whole pain of change into a different EMR. You know the sales cycle was too long and we signed our first strategic partnership that said okay that's great and you have these these really neat ideas, but you need to grow a lot faster than you're growing to meet our capacity. And so that's what kind of shifted us from selling our product. There are still about four or five practices that use Agnomi, but then we started to build out our own physician base and provider base so we could meet the capacity.

So that was the first learning and something for anyone with a startup. Really do a little research ahead of time with the market you're going after before you build it. So, you know, the very first question I should probably should have asked you is, what does agnome mean, can you give us the meaning behind the name. That's another great question and everyone asked that and because everyone hates the main because they can't really pronounce it is that I know me is it

Patient Impact and Insurance Access 9:52

on me. So I can already think of my first commercial is going to be some say agnome, you say Agnami, like one of those kinds of things. But yeah, it's a crazy name, but it comes from the word physiognomy, which is the Greek term for diagnosis based on facial feature and expression. So it is a little bit of a play on the telemedicine space. Oh, that's awesome. That's really cool. I just wanted to make a comment. It was interesting to hear the previous bit of conversation, Doc, when you started talking about the product development and rollout, you did not sound like an MD nor an MPH.

You sounded like a MBA. So I wanted just to put that out there. And that is the other hysterical part about all this because I am truly a doctor. I mean, before I started building agnome and building software and working in software development, I could download an app. That's about how much computers, the kind of computer skills that I had. But talking with people and reading as much as I can and getting advice just kind led me to where I am to understand these types of things. So for anyone out there that's interested in pursuing anything that you're not an expert in per se, there are so many people in the startup space and the whole ecosystem that just want to help you.

You just need to reach out and ask and they're incredibly generous with their wisdom. They are designed to consistently deliver performance, stability, comfort, and minimalism. To learn more, visit fpcare.com forward slash curiosity. Are you a sleep tech looking for new opportunities? Well, MedBridge Healthcare is one of the largest employers of sleep technologists and they are growing. If you are a Sleep Technologist interested in a new position, potential paid relocation, or looking a career advancement, consider a Career with Medbridge Healthcare.

Now, back to the show. You shared that when you were first in practice, some of the life-changing moments that you saw with wives happy about their husbands. When you look at Ognomi now and what it's grown to, what sort of story stands out to you that really continues to keep that fire burning within you, that it reminds you of why you're doing what you are doing? You know, I could probably give you one every week. That's what's so neat about this because when I first started seeing patients through telehealth I always thought it was about access to care living close to A particular sleep medicine physician.

I mean, i'm in Western New York and it can get pretty rural so people have to drive one hour or two hours to get to a larger city that might have a sleep center or something like that. But then I started to see patients with more social determinant issues. Like I saw a single mom with three kids that had worked a job and just couldn't get out of work and spend that 30 minutes to drive in to You know, hearing those kind of stories where it's not just proximity or or geo geo geographics. It's also the social determinants where people might not have that kind have access to cars and different things like that so that that those kinds of things stand out, but it It's opening up that access and then people having that change of life experience and every sleep person on that.

I'm sure everyone listening to this podcast even has a story about a life changing patient, a patient that had a live changing moment. We have a really neat video right on our website that you can call it a testimonial, but it was a patient that just couldn't say enough about how his life had changed. And we're like, we need to capture this somehow. So if you want to hear the one story that still resonates with all of us at Agnomi, it's there on video.

Focus on Sleep Apnea and Evidence-Based Telehealth 14:02

That's great. Dr. Rifkin, I know that one of the challenges, you know, it seems like for new entrants into the sleep telehealth space, the easy button is a cash model, but you have been committed to being able to utilize or allowing a patient to use their insurance. Can you give us just a little quick, some insight as to what that has looked like to you? Because I it's probably still a challenge even today. Yeah. Well, it's really daunting to kind of set up these entities that can take insurance throughout the country.

But again, there are experts out there that I can help you. It's, really one of those things where you can do it, but then once you dip your feet into that little water there, you know, can you drown pretty quickly. So you're always getting new contracts, you are always talking with payers, your always trying to get your providers credentialed in all these different places. But again, it's about that access to care. People want to use their insurance to their healthcare. Not everyone can afford self-pay, especially the cost of sleep care, not only the sleep testing and diagnostics, but also the therapy.

There are definitely people that can. They are wonderful concierge sleep practices out there that really give the same kind of care that we do, but we give it to everyone, whether you can afford it personally or need your insurance to pay for it. But we, again, it's all about, our mission is about opening up the access to care. And we know insurance is going to play a big role in that. So that's why we put a lot of eggs in the basket. Doc, being a sleep specialist and a neurologist, is there any specific area within the sleep medicine space that you like to focus on?

Well, in agnome, we're truly a sleep apnea vertical because it's sort of the easiest, I would say sleep telehealth disorder where REM sleep behavior disorder or narcolepsy, a good neurological exam is important. If we see someone in agnome that has something like that, we'll work with a brick and mortar partner to try to make sure they get either PSG or in-person neurology examination. But we work was sleep apnea because that's the big disease that affects a billion people in the world and we want to tackle that.

Because we're all trained in sleep, you know, see all the sleep disorders that we can deal with. We can do with insomnia. some CBTI. We work with other CBT companies where we can refer out that are virtual first. Um, we. Can deal with the parasomnia as much of the time, unless it's REM sleep behavior disorder. And we, can deal, with some of this circadian dysrhythmias, you know, things that don't require in person evaluation. So, and, that's what. You know, someone that's a sleep medicine physician that has been practicing for a really long time.

I miss seeing the narcolepsy patients and I missed seeing some of these really interesting RBD patients or other neurologically based sleep disorders. But it's funny, I still see them. They present thinking they have sleep apnea or they present, thinking that something else and like, you know. it's really this and we need to have you see this guy. So I don't miss it enough to go back, but those are all really interesting diseases to continue to work with. You know, one of the things that we talk about a lot on here is how technology is changing sleep.

It's changing everything. But when you think of sleep and, you know in particular, whether it's the diagnosis or the therapy or, the new pharmaceuticals, we talked about it on our latest show that they were super present as you saw at sleep 2025. How do you see agnome changing and evolving with these advancements in technology and medicine around sleep apnea? Yeah, and I'm a big fan of evidence-based medicine, right? So I never like to see the technology get ahead of the science. So I truly rely on a lot of my colleagues and my academic colleagues in the sleep medicine space to drive how we care for patients.

So when we built Ognomi, we thought about bringing that evidence-based brick and mortar care into the virtual space. Although we use AI, it's more for workflow things and stuff, but the actual patient-physician interaction, still very old school, patients are still seeing a provider, we're still discussing disorders, were still talking about evidence-based care and evidence based therapies and following patients through that journey. So although technology is going to help facilitate that type of care right now, the evidence base AI therapies in different things, I should say waiting for the to start incorporating AI to that actual patient interaction and different things like that, we're gonna have to wait and see, but I'll always let science reign.

I'm still a huge believer in science, so. Dr. Rifkin, before Jerry starts to cut us off, which I feel like it's happening just about any time now, Oknomi has had the opportunity to partner with some really large players in the sleep medicine space. Can you talk a little bit about that?

Partnerships, Closing Remarks, and Where to Find Ognomi 19:38

Sure. And again, it's because of just the quality of care that we provide and the full soup to nuts journey that offer patients. We work with a lot of large partners in the sleep medicine space. I should also give the caveat that, we have no financial relationship with them in terms of our doctors getting paid or incentivized to give any kind of therapy. whether a patient comes from BreastMed or Inspire or Lilly or anyone else, it really doesn't matter. What's best for the patient is what we'll do.

And we've had other partners that weren't so thrilled with that idea. We have to make sure that our partners are mission aligned, where they want what's the best of the patients, because it's what WE want, what is best as the provider in agnome. that shared decision-making is what drives the care. So the partnerships that we've been able to develop really fall into the just, again, opening up access, open up that top of funnel and just kind of getting more patients diagnosed with sleep apnea, bringing that awareness to the table because still 80% of patients remain undiagnosed.

It's great for everybody. Just based on those numbers, just getting people into that sleep-apnea journey. Doc, we're really, really close to time, just like Robert had mentioned earlier. But before we close, is there anything else that you'd like to mention before close and where can people find you, more information about you and about agnomy sleep? Sure. You can always reach out to me. Just look me up in LinkedIn. I'll absolutely connect with you. But you can go to agnome.com. And that's just our general website that'll give you some information about agnomia.

We like to partner with physicians. we like partner to with brick and mortar sleep centers because we send a lot of patients for PSG in their area where they live. So yeah, we would love to hear from you and to learn more about what you're building. And I will say the last thing I want to say is just if you are in the telehealth space or if your in just the innovation and sleep medicine space, look me up and give me a shout. I would just love sit down and spend a little time and hear about your building, offer any kind of advice I can give because I was given so much advice to get us to where we are and I just want pay it back.

That's how I learned that. Oh, that's really fantastic to hear. Thank you so much, Doc. We appreciate you. My pleasure. Thanks for having me, guys. Most definitely. And folks out there, thank you for joining us once again on this episode. Huge shout out to each and every one of you, we couldn't do this without you! We want to say thanks for all the likes, all of the shares, and all subscriptions. Please continue to do that! And to our sponsors, a huge shout out to each and every one of you. Thank you so much for allowing us to continue to grow.

And until next time, we say, lights on. Be sure to check out our clinical sponsor, Sleep Review Magazine. More details in show notes.