#449: 9.2 million people can't sleep... and the NHS isn't ready

0:02There are 10.8 million people with sleep apnea. 85 % are currently undiagnosed. So 9.2 million people in the UK currently living with undiagnosed sleep apnea. It's about to be the next ADHD autism assessments where the waiting lists are four, five, six years and it becomes a sort of source of embarrassment in the NHS. It has to change. There's no kind of standard sleep medicine training in this country and there should be.

0:30Hey everybody, this week I have Tom from ThetaSleep with me. Tom, welcome to Health Tech Podcast, how are you doing mate? Thank you very much for having me, yeah really well. Really looking forward to this, listening for a very long time, it's very nice to be coming on and sharing the story. Thank you mate, appreciate you saying that. Yeah, I always say the same thing when people say that, which is that I've honestly got no idea who listens to this podcast beyond the odd person at an event who comes up to me and says, like oh i listen to podcasts and it's so funny because um so like our 30 day numbers on on this podcast we get around like seven eight hundred downloads in the first like month or so of a podcast and then over time that'll creep up to like sometimes like two thousand or or even over that so it sometimes creeps up like super high so there's a lot of people that do listen and and 50 percent of my downloads are like back catalogs it adds up to somewhere like 10 to 10 12 downloads months sometimes but i've just got no no idea who does that i was expecting like oh well not expecting but i hoping sometimes like all my dms are full of people with questions or like all this sort of stuff it's like oh no i think people just listen to it and they're like yeah enjoy it yeah nice nice part of the podcast you know yeah exactly exactly cool mate yeah delighted to have you on dude um there sleep's a funny one isn't it it's like is it is it nhs stuff sleep is it private sector sleep is it my problem is it the nhs's problem if i'm not sleeping is that anyone's problem other than mine like should i go like yeah there's a lot of people in that in in that world um i also know that uh you well you induced sleep as an anesthetist as did i for quite a long time So you manipulated consciousness for a living, which we can definitely talk about as well and compare some stories there.

2:23So there's loads we can talk about, man. Why don't you start with your story? Because I've not heard your story end-to-end before, so I don't actually know kind of how you got here. I know you're an esoteric and all that sort of stuff. But yeah, let's start with that. Yeah, how I got to where we are now as anaesthetic and sleep medicine doctor and one of the co-founders and our chief medical officer at ThetaSleep. so my story probably gets you know vaguely interesting after about f2 or so i reckon you know medical school f1 f2 very standard medic life medic time when you say that though were you were you the sort of person that always thought they might leave was that ever on your radar were you one of the people in doing interviews at investment banks in third year of uni like any of that or were you straight down the line i'm gonna do my exams i'm gonna be a consultant was that just your path yeah was was straight down the line was was always like doing lots of stuff was always super super busy got you know like crazy involved in all uni sports and did loads of other stuff on the side more because i i had to i did stacks of tutoring i was at medical school at ucl and to afford living in london i had to do stacks of tutoring so like super busy calendar super busy you know running all that stuff doing all the stuff i did in various societies but it was never like academic particularly other than the odd the odd project here or there and it was never there was never some big picture goal at medical school or like it was always you know i really enjoyed the stuff at medical school i really enjoy life as a doctor and i haven't it was very like the stuff i'm doing now has been very whole factor rather than push back to your point at the beginning of like whose problem is sleep like that is ultimately why probably i am where I am at the moment is like it's just something that has not been appreciated enough in the public health system and what we do in the NHS in the public consciousness and despite sleep disorders clinical sleep disorders affecting more than 10 million people in the UK you know how many people do you know who are consultants in sleep medicine there are there are not many at all there are not many no and and it wasn't until the sleep medicine journey kind of came along that sort of really found that kind of passion area and realistically I fell into it I in my F2 job I had a respiratory job at Barts in East London which just so happened to be on the sleep and ventilation team there and loved it they were great people it was a great job learned so much was super interested in what kind of seemed like and is in many places unfortunately still now a niche topic and then just can i just jump in a sec so so sleep and ventilation team at bart's was that an inpatient yes it was that was an inpatient team so i mean mixture of both like i was that was my first introduction to sleep apnea clinics which is a lot of what we focus on at theta sleep now but they had both the outpatient sleep clinic which year was kind of standard sleep apnea referrals and then inpatient home ventilation so you know severe copd chronic hypoventilation neuromuscular disorders obesity hypoventilation syndrome and that stuff was super like the physiology and the the science and the pathology around that was was super super interesting so absolutely love that as well and that's where the kind of interest in sleep began you know what happens during sleep and breathing and then taking it taking it from that interesting i imagine it's probably i mean it's it's an education for me i mean i feel like this is one of those things that i should know like why don't i know why don't i know that there's an inpatient sleep and ventilation team i think probably just goes to show like i just did this like really generic dgh education through medicine yeah i would have i would have never known like half of these specialties even existed um so it is it's fascinating for for me that that that even does exist and also sleep attached to respiratory is a funny one as well i obviously understand that as a as an anesthetist obviously sleep apnea being a big reason for that obviously it's probably the number one issue therefore it goes there but sleep is a a new what i'm even thinking now is that a neurology thing like in isolation it's a it's a it's a neuro process yeah and and that is it's part of the problem to be honest with you is like the how the way sleep medicine services are set up and run in this country and they're so fragmented and i experienced this when i was in a respiratory sleep team so as a respiratory sleep team you focus on sleep apnea because it's what you know it's what you treat it's what you know it's lots of cpap or it's lots of non-invasive ventilation it's kind of you know the the real wheelhouse of respiratory physicians but then you've got a lot of psychiatrists or gps will do insomnia work and then you've got your neurologists who will do the more kind of sub-specialist tertiary sleep stuff so parasomnias your sleepwalking etc central disorders of hypersomnias like narcolepsy but they're also fragmented and that's part of the problem is you know you don't you you learn it when you're in your training there's no kind of standard sleep medicine training um in this country and there should be and that's been part that kind of i've had to navigate that and do other bits like a european exam and other bits and pieces but it leads to these fragmented care pathways that means that patients don't present with sleep apnea you know they present with a sleep problem so you have to be able to manage their insomnia their restless legs their other potential problems that they're coming with which you just aren't taught if you're in a kind of standard rls would go into there as well yeah yeah yeah and you're just not taught it if you're in a bog standard like as you said dgh sleep clinics and there are more now because there has to be because the referrals are just absolutely skyrocketing but the kind of wraparound knowledge of sleep medicine just you know we don't teach people enough in medical school in training in all of this stuff this is fascinating because this is i would say an area where modern modern public health that's basically being delivered by clinical content creators, influencers, the Brian Johnsons of the world, you know, for good or for bad or whatever.

8:43But modern discourse is that there are a few pillars that will do the majority of incredibly good preventative healthcare and keep you healthy, nutrition, exercise, and sleep. And so you can completely see how a modern mentality of sleep being incredibly important does not line up with how the healthcare system has evolved since the 40s when it was set up in the UK. Because I imagine in the 40s, we didn't have nutrition and sleep as the biggest pillars of health. I mean, sleep's only appeared in the last probably 10 years or so, hasn't it? It wasn't that long ago that it was bad, Javon, all this stuff, which I think is fortunately gone now.

9:33But that point is a really interesting, important one. And it kind of comes with its own double-edged sword because it's often seen as just a kind of health behavior. And clinical sleep disorders are so heavily underdiagnosed. So best estimates would suggest in the UK, there are 10.8 million people with sleep apnea. 85 % are currently undiagnosed so 9.2 million people in the uk currently living with undiagnosed sleep apnea and i think people just see bad sleep as like potentially fixed by good sleep health good sleep hygiene avoiding caffeine and all these things where there are so many people whose sleep is ruined by sleep apnea or insomnia who can't access the care or you know don't know about it because the public health messaging isn't there.

10:23And all of that needs to change in the long run. And hopefully, you know, will change, as you say. It has to be, if we care about preventative healthcare, it has to be a pillar of the preventative healthcare kind of ethos and how we try and tackle it. Well, you can see how supply and demand isn't going to match up because with that more public education and people knowing that it's something that they need to correct, they're obviously going to seek that. And so we're in the bit now of transition of hold on a minute we've got an extremely high and growing demand but very little supply and actually to your point this goes right back to well actually we're not we're not teaching medical students this and you know no no shade thrown at like anyone that's like setting this stuff up but why would that why would they because it's not been a thing for that long so but we're not we're not teaching it to medical schools properly or students properly we're not so we don't have training program systems for it properly therefore you know i'm thinking back to my health education england days if you want to set up and change uh consultant numbers in something well that's a process that takes 10-15 years because actually medical students need to know that that's even available in order for them to start pointing themselves at it you need to increase training numbers and then you need to train them for that many a year and then you get the consultants and And then you get the specialists and then the clinics and then the private practice.

11:48And so actually to fix a problem for the country, that's going to take a while, isn't it? And it needs, you know, I would love to see a world in which eventually you can get a CCT in sleep medicine. You can't over here. In the States, you can board certify as a sleep physician as well as other stuff. I think in Australia, you can do the same. Yeah. Yeah. And as I said, you can do, so there's a European exam, a somnologist exam, which is nice. I get to call myself a somnologist these days. It's an amazing word. Which is a much better professional title than Anita Tits. But we don't have it in the UK.

12:22The British Sleep Society do lots of great stuff around trying to think about how we can educate people better. But it has to just be a bigger focus of public funding, public interest of how we do this properly. And it will have to be because as we care increasingly about diagnostic waiting times and referral streaming times, sleep studies, i.e. the diagnostic for sleep apnea, referrals for sleep studies have increased by 140 % in the past four years. It's the fastest growing diagnostic test in the DMO1 data set by far and away, like twice as fast as anything else. The numbers are still reasonably small, 200 ,000, 250 ,000 per year, which if we're trying to reach nine and a half million, it's going to take a while.

13:03But it is rapidly growing and changing the way we approach these things has to come because it's about to be the next ADHD autism assessments where the waiting lists are four, five, six years. And it becomes a sort of source of embarrassment in the NHS. So it has to change. economically as well because we have to talk about this stuff and this might lead us on to i know i interrupted you we've gone on a big tangent here in the middle of your story economically speaking the the kind of you know we have to do it for public health there's way more public interest in it it's a pillar of health now we know that we understand that we know it can do a public health job therefore there's so many knock-on effects there are people living with sleep apnea that's currently undiagnosed insomnia uh parasomnias all this sort of stuff like and therefore there are things that are building up they are becoming more of a burden on the on the system also they are obviously experiencing uh morbidity themselves and we want to fix both of those things but thinking about it from a systems perspective getting the roi on that stuff like what is how quick is that how quick how direct is that roi because what i'm thinking here is you know if If we as a healthcare system commit to this and we want to see change, there's not sloshes of money that we can be like, oh, with this war chest that we've got, let's just put a few hundred million into this.

14:29Let's wait five years and then that will start paying back. Unfortunately, we're not in that position. So are there in-year ROI savings if you were to zoom out to a systems view? Is sleep so direct there that we can actually see those changes and avoid? because i imagine diabetes and things starts building up as well like all like chronic conditions cardiovascular like all these chronic conditions like delirium even if people have got infections and they're older and they're not sleeping they'll wake up confused and i imagine i've sort of answered my own question there yeah but you're quite right and yes short answer yes there is with with sleep so i was chatting on um the on the nhs app team recently about how sleep should be part of the preventative agenda and talking about that you know the triple dividend of preventative health care with productivity with um health care spending and chronic disease etc as well so as let's start with a dollar yes it's the short answer to that question is yes there is a there is a quick return on it and i was chatting to someone at nhs england recently about sleep as a potential of you know tackling this triple dividend of preventative health care in that it targets long-term health conditions and reduces them.

15:42It reduces healthcare spending and improves workforce productivity. So there's great data that shows sleep is probably one of the most single important things that affects your productivity at work and in people, as we've all experienced. I'm laughing just because, as you know, I've got a one-and-a-half-year-old that his sleep sucks and so must be irritating for him. But certainly I have, I don't mean this sincerely, right? I'm completely understanding. And by the way, it's worse for my wife because she has been feeding him in the middle of the night and the rest of it. But I am understanding in a way that, in a slightly different way than we understood it than we did when we did night shifts.

16:28I'm understanding the chronic buildup of sleep debt and what that means for productivity, irritability, my immune system, by the way. Because also having a one-year-old, they're just vectors for disease. Then your sleep, it all knocks on. So I'm really understanding that in a new way, I would say. um and having an appreciation that when i take my situation and i extrapolate it because i'm not saying that you know a bit of a bit of disturbed sleep from a one-year-old is i mean everyone goes through it so that's kids so it's not a huge issue but like i get it when you can extrapolate that yeah yeah and it is you're right every single aspect of our physical and mental health is impacted by sleep i'm also in that that stage of of young children and sleep deprivation we yeah congrats man thank you yeah it certainly uh changed my own state and it's genuinely though it's given you that like as as a doctor in sleep medicine it gives you the perspective of what people are feeling like when they are chronically sleep deprived and it's just imagine that feeling and you're right you know sleep is a wonderfully dynamic process it's not an on-off switch it's you know incredibly well the the sleep homeostasis in itself incredibly interesting you know we we recover from sleep deprivation when you've got it for a short period of time, for example, and with kids being born, you know, everyone has kids goes through that.

17:53It's not, doesn't impact you in the long term. But there are so many people who are currently living with chronic sleep deprivation from clinical sleep disorders who just every day have that impact on their physical, mental health, their productivity. And it does, to your question on what is the impact, sleep apnea, we know increases your risk of heart disease, diabetes, strokes, obesity, dementia and treating it there is good data that shows if you treat it you reduce long-term healthcare spending there's data out of the states that shows there was a big um group that looked at kind of professional drivers big truckers dry and screening and treat them sleep apnea and you reduce you reduce healthcare spending if you identify and treat sleep disorders and you improve productivity and you improve long-term health and happiness so like it does have it does have a our investment i think is kind of circling back to the beginning is it's just something we haven't known enough about or put enough time and effort into understanding and we are increasingly doing that and i do you know the mood music is very positive and i do think that will be changed that's great and so thinking about then where where there's a supply and demand issue entrepreneurs are going to be flocking and there is going to be interest right and so where there's those that that mismatch there's always some level of opportunity uh to make impact to make money to make um to put something in place that can solve a problem so um with that in mind like pick up pick up on your story then so um you yeah sleep medicine exams european exams that are qualified then then where does your mind go thinking about solving problems and setting up a company all of the kind of area of interest i had throughout my i did a master's in sleep meds which i finished last year and again focused the research in that was all was around actually potential of smartphone based diagnostics for sleep apnea all with this vision of like how do you do this properly how do you do this at scale in the scale that we need um and then that was sort of the driving one of the driving ethos is to bring together the right people at the right time to to found theta sleep and do what we're doing now and the beauty i think of sleep medicine from a supply and demand perspective and and in the nhs when we're looking at all the 10-year health plan things when we're looking at going digital first and preventative and at home is few things lend themselves so well to being done in this way you know if you take sleep apnea which does ultimately have a single diagnostic test a sleep study which 30 years ago you had to go into the laboratory have a polysomnogram be wired up with all the wires on the head, bands on the chest and abdomen.

20:32We don't do that anymore. We don't do that in the UK. We've got much better novel diagnostic approaches. The best place to diagnose and treat sleep disorders is in your own home. And the infrastructure exists to do that. The diagnostics can be done at home. The treatment can be done at home. Telemedicine, video conferencing, telephone calls. What was missing is the kind of technical and clinical infrastructure to knit that all together and that's that's the problem that we then went out to try and solve is building that technical and clinical infrastructure to bring all of those innovations into the patient's homes so that you can deliver at-home sleep medicine that's better faster cheaper more accessible all of those things that we need when there is a massive supply and demand issue i love this so and you'll know this because because i saw that you're one of the first subscribers but this is exactly the thing that I was writing about with pigeon insider, the sort of new layer to health tech pigeon, shameless plug, et cetera.

21:29And that's what you know as well. I was, I was honest at the beginning and I was saying I'm a long time, long time listener because I have indeed one of the first subscribers, you know, I wasn't just talking about it. Absolutely. Absolutely. But yeah, I, I, I honestly think that it's, I think it's fascinating. I think it's absolutely fascinating that you have nice approved treatment pathways for something and yet no clear definition of who and how it's diagnosed by and where it's diagnosed is it a dentist is it a gp is it secondary care is it after an inpatient sleep study and our patients like who who can do this stuff and then what are the interventions and how do they get them and i wrote about the example in dentistry of smile direct club that was like billions in value and they were doing this like remote um like remote dentistry stuff basically like invisalign stuff maybe and and all that side of the all that side of the world um but they removed the clinician completely and they had an amazing scale then it ultimately collapsed because it needs a clinician in the loop but it but but in doing all the research for that i found there's these mandibular devices that only dentists can subscribe but and that's 0.5 percent of the of the clinical base and it's and it's like these mandibular devices can can significantly improve sleep apnea but they don't a lot of those don't they don't even know they can prescribe it and actually GPs don't know they can prescribe it.

23:12So GPs don't refer them to that. So there's this thing that exists, but there's no clinical infrastructure to link a nice approved device that to your point would help millions of people and just no clear clinical infrastructure to actually make that happen. I found that absolutely fascinating that that exists. Yeah, yeah. And it's also the funding for when you specifically reference that point on mandibular advancement device on devices on MADS, which as you say, it's been in the NICE guidance for years, but patients can't access them, partly because no one has set up the clinics to do it and partly because the tariffs in dental sleep medicine just can't cover the costs that are needed.

23:53So it's exactly, you say, it's a whole system-wide thing, which again, for us with what we're doing with these sleep is super interesting because it just means that, you know, we are growing in what we're doing. We want to be in that place where we are taking GP referrals from anywhere over the country and we are delivering the right diagnostic test for the right patient at the right time in their home and getting them the right treatment you know that truly personalized care and when you sit in the middle as the clinician in the loop sitting in the middle you can innovate at the speed that's required because you don't have the you know cumbersome procurement issues that a single dgh has a sleep clinic does when they own four five home sleep tests which all cost them 5k a pop and they never can scale more than that because they don't have the budgets for it whereas all of this stuff that is now available to be able to be used which makes the pathway better and cheaper is there which just makes it obviously a super super exciting time that we can now do that for patients 100 and exactly what i said before about where there's a supply and demand issue that's exactly where technology should be and that's exactly where it can help because that's where the scale of technology can actually solve a problem make a difference and great okay can you walk me through starting this can you walk can you just like let's zoom in on turning an idea into reality because i think this is important i think there are more examples of what we're talking about here of supply and demand issues you mentioned adhd testing is another one um there's there's gonna be many many more of these i'm interested in how a clinician with i believe so far no business experience that you've mentioned in terms of setting anything up goes about solving this problem and then run into kind of where theta sleep is now and what it looks like and and let's talk about the the you know clinician journey the patient journey all that sort of stuff but first of all let's go like turning an idea into reality how did you go about that yeah and it's a it's it's one of those that you know it's the right people at the right time and you get lucky with the people that the the co-founders that we've got with the business and a huge part of it anchors on so we're a founding team of five which big big founding team interesting but but necessary for what we do you know for all of the different bits together to make it happen and it probably the sort of the genesis for what we're doing theetiously came at this two things at the same time one was conversation i was regularly having with my brother who's our chief exec at theta sleep um whose background is in tech startups who built co-founded an ed tech startup which as you can imagine went big during the pandemic because it was all virtual tutoring and software um and then had left that was always interested in you know tech for you know how you can use tech to solve interesting problems how software does a good job and then the health tech space is then interesting from that perspective so we spoke to him we he and i were speaking for this is sort of april of 2024 probably easter time april 2024 um and at the same time i had just met our medical director a guy called dr david dawson who is a consultant anesthetist who has worked in sleep for 20 25 years and set up multiple sleep services and is like a genuine pioneer of sleep medicine in this country and of doing remote sleep medicine so he his anesthetic sleep story is is wonderful he is he gave he was you know sedation for a procedure gave someone a bit of midazolam a bit of opioids and they just stopped breathing for hours and hours and hours he's like what what's going on here what's happened you know inquisitive anesthetist whilst i was going on turns out this guy has sleep apnea this is 25 years ago um you know does some reading understands it finds out that you know it can be weight related this patient was overweight not everyone with sleep apnea is overweight it's a massive um incorrect public health message that is the case we can come on to that later but this this chat did did have that problem um and david spoke to him he lost weight six months later he's saying you've changed my life i used to fall asleep in the boardroom my sleep apnea is better you know i feel like a new man which which happens with sleep when you treat sleep apnea either with weight loss or with things like CPAP people have a genuinely kind of yeah they describe it as life-changing but I so I I met Dave at a similar time because there are not that many anesthetists who have got an interest in sleep medicine and we really connected over sleep anesthetics trying to do things differently how you can manage this problem of scale and the issue of all of these ideas that you know I might have had running around in my head Dave probably had running around in his head Will had our other co-founders had is I always thought well this isn't possible because you need senior medics you need people with commercial background and you need tech guys to bring this all together and I didn't really see how I was going to be able to do that and then fortunately we just had the right people at the right time so got everyone together in a room Dave is a senior medic I'm kind of sitting in the middle knitting a few bits and pieces together a colleague of Dave's from another venture John who's our commercial director has got you know all the supplier relationships from working in sleep for a number of years.

29:09We've got Will from a kind of product design, tech background, building startups. And then a mate of his from uni is a very, very talented developer. Ollie is our CTO. So then just, you know, can build everything that we ask him to build in a very quick and beautiful manner, which is then just, you know, it's finding the right people to be able to tackle the problem that it comes. It would never have, it would have been one of those things that I was probably, would have been sat as a frustrated nhs commission in 25 years saying there is there is an easy way to do this differently but trying to bring the right people i just it's so hard to bring the right people together in the room i think it is and actually for five co-founders to just get on is yeah yeah also tricky and challenging i mean it helps that you obviously with your brother well does it helps it with your brother it obviously does uh i'm joking but yes that it's tricky for so many reasons also thanks for saying luck as well because I actually did a talk um last week was it last week or this week anyway I did a talk recently um and it was about my career journey and it was for uh resident doctors and I think it's really as I get older and particularly as I run a business for longer and longer and you see cycles of how the market's moving I'm starting to really identify really identify how lucky I have been and for whatever reason it was really front of mind when I was writing this talk and I actually wrote it with that in mind and I've never done this before and it's incredibly humbling and I would love to I record so much stuff on this podcast that like what i've already said like what's going to cancel me has already been said by me in a previous episode i've said this more times but like i reckon i've attributed to genius maybe not genius but i've definitely attributed to genius what was luck at least privately to myself yeah i've 100 i've 100 done it because what i did in this talk when i was writing it I went through my career journey and I went super granular of like, what could you sensibly attribute to complete luck?

31:37And by that, I mean like 90 % plus luck of like beyond I was in the right place. There was like eight specific points of like, if I'd not been in that WhatsApp group and I wouldn't have got that message, I wouldn't have done the accelerator at digital.london, which means I wouldn't have run accelerators and I wouldn't have known the position was marketing that they needed and I wouldn't have started something. There was like eight of these moments of complete randomness, bumping into Tony Young in Shoreditch of all places and him going like, who are you? What are you doing? Like, why are you talking about this stuff?

32:11Because I feel similarly. Like, that's quite interesting. Like, that led to me working at NHS England and did some stuff with the clinical show. There's so much luck involved in this game that I have 100 % attributed it to like, will I increase the surface area for luck which is which is also a which is true a fair point I think yeah to give myself some credit of like yeah okay there's definitely bits in there but I don't know it's just just the mood I was in about feeling super grateful of like where I've been and and you know experiencing a very difficult market by the way very difficult to make money at the moment very difficult to get revenue and there's so much changing because of AI But anyway, I say all that just to say I appreciate you saying luck because I think it's also the survivorship bias is real for a lot of people.

32:59And I think the way that often we as people that have particularly left medicine, and that's what I liked about how you said it there as well. I think people that have left medicine can often sort of either glamorize it or attribute things that it is just like you can have a 10 out of 10 execution, but still not have the luck bit and therefore not have the opportunity. And I think that's so real, you know? Yeah. Yeah. It is fundamental, I think, to anything that goes well, isn't it? Like to your point, I think you can increase your surface area, you know, stay busy, stay inquisitive, do as much as you can, but you never know where that's going.

33:34And she said the number of points where I've been, you know, all of my, my sleep medicine stuff, which, you know, you could have gone, yeah, 15 years ago, I looked and saw sleep was going to become a really big problem and thought I'd be really interested. That's nonsense. I fell into a two job that happened to be in sleep and thought, God, this is interesting. And then just went and did more. Was lucky with the right people. I've been talking of like, of navigating, working in medicine, working in the NHS. I've still got a training number in anesthetics. I am going back to my anesthetics training shortly.

34:02and I have been so lucky with how well I've been supported by my training program director, by the head of school at London School of Anesthetics, by like all of that support around it has been genuinely really, really, really good. That is lucky actually. I was just going to say that is quite lucky. I only say that just because I know the experiences of many medics that try and do in inverted commas extracurricular stuff that you know makes impact and all the rest of it that definitely don't have that tpd experience that's um that feels rare yeah yeah i think yeah it is it is luck um dr ruth bedson who's the training program director of northwest london stage one anesthetics amazing um absolutely here she's yeah they were all great everyone was super supportive i think amazing part of that is is probably also because a lot of this was in sleep medicine and and my my routine did come through perioperative sleep apnea screening detection treatment so there was always a like hook but you know i've been yeah so so fortunate with how well supported i've been by by everyone in my nhs training as well as all of the fortunate stuff outside of it as well that's great and i hope that is a blueprint as well for people and i think it should be i think it's still i was chatting someone the other day of saying you know chatting to people now about the pros and cons of medicine and there are obviously a lot of cons.

35:27There's obviously a lot of disenfranchisement, disillusionment with training and there are lots and lots and lots of problems. Do not get me wrong. But the fact that now you can once in a training program and that is a lot easier said than done, of course, but when you're in that training program, the fact it is so flexible to go less than full-time, to take time out. You know, you used to, not that long ago, you had to have significant caring responsibilities for them to even look at your less than full-time application. but now you can go 60 you can go 80 for for reasons that include you know just doing interesting stuff outside of work or because you want to and the the flexibility that that offers and what you can then go and do with that time in a really de-risked manner because you've still got your day job that you're falling back on is phenomenal and it's amazing that you can do that now like you know i've talked to mates who are non-medics where not now as i've sent out to there and full-time and the rest on this but when i was 80 60 you know imagine going to your your consulting job and saying sorry lads i'm only going to turn up three days a week and i'm going to work on my own thing two days you know like that is that is amazing that we get that it's a really good point yeah that's a really really good point before we talk about theta sleep um can you talk to me about the decision to go back into clinical medicine having been out having done what you've done been part of building a business i think it's interesting because obviously the business sounds like it's very tied actually to to obviously the sector and things that you'll be doing to some extent um so it's not as if you're going into a random full-time job there's nothing to do exactly that must be part of it but can you yeah are you are you how are you thinking about that are you worried in any way are you apprehensive have you de-skilled yeah yeah yeah yeah certainly so there's certainly all those roads i mean i have kept up the odd locum shifts i'm hoping when i go back i've still oh perfect ability not to uh not completely forgotten how to give a safe anesthetic but you know time will tell i have the i have a recurring dream i'm not joking i have a recurring dream and it's probably once a month i would say that i'm just on bog standard but i'm just doing like i'm doing an anesthetic like i'm in the anesthetic room it always starts with me in the anaesthetic room and i'm first step i'm just oxygenating and it's this classic like orthopedic lma like it's it's a usual it's like it's like an easy one but honestly month by month as this goes on i'm getting worse and worse more and more behind everything's like i'm like the conveyor belt's getting quicker and quicker and i'm getting further and further behind and i'm forgetting things and yeah not not not ideal so the odd locum shift i imagine is an absolute lifesaver there preventing that reality yes has been has been useful to keep keep the hand in but yeah i mean as you say like part of it is i think there is massive benefits so again i've been very well supported partly because now child care responsibilities and with with everything they're doing outside of work i'm going back at 50 which again is very fortunate i can go back at 50 and it's a true 50 it is a true yeah yeah it's a true 50 and actually and how do do they do that do they do that of a 50 of a single week or is it can you do that yeah i've got my rotor for the from the placement i'm in from may through to feb i've i can see what that is at 100 and i just pick 50 of the days that i can't you pick yep yeah yeah more more more luck in the in the story yeah i think the the places where i've had less than full time again this could be a london bubble thing again super super fortunate but have been a case of you get your rota and then you say you know you have to take 80 or 60 or 50 and you just take 50 of those days out of it which means caring responsibilities you can do which means the days where i need to be around for the business the standard meetings or you know the check-ins we've got customers etc i can work around that so yes i am apprehensive yes there's a lot of moving parts but that all of that stuff is very well supported and there's a great synergy i think trying to deliver innovation in the nhs as a as a doctor in the nhs yeah keep also being a practicing doctor in the nhs is is such a benefit to understand the system because i think people take you more seriously and we have a big focus on pre-operative sleep apnea and what we do as well like you know we are we're founded by anaesthetists from a clinical perspective perioperative sleep apnea is a big problem so So keeping a hand in with that and supporting central NHS customers in that space is great.

40:02Yeah, it's going to be an interesting return. Part of it is at this stage, you know, just don't close any doors. Because sleep medicine doesn't exist, because you can't CCT in sleep medicine. I can't. I love the clinical work I do. I still do, obviously, clinical sleep medicine in our telemedicine clinics that lead to sleep. but if I didn't go back to my anesthetics at the moment I think you would I would be in a very strange kind of limbo place as a medic and and it's it's there are so many benefits to going back and it keeps all the doors open and it I tried to keep extending it for as long as possible and I was very fortunate again I had a full kind of just over 18 months out which they were good at giving me but eventually I said no no you know either you aren't coming back and you're not serious about wanting to continue and be a consultant or you need to come back and i said no no i want you know both both are important to me i want to be able to do both um so kind of a bit of a no-brainer in that way amazing especially really funny because i remember when i um when i was on the way out of anesthetics one thing i did say out loud on multiple occasions is that i would work 50 percent of if i could work 50 percent of the time for 50 percent of the pay i would do it and that would actually be appropriate if i could find a way of doing that obviously there was no there was no way of doing that at the time um i think that's a wonderful way to stop the brain drain and to stop to stop people leaving and all the rest of it and you're right it's an incredible opportunity that other jobs just won't give you like yeah it's yeah almost impossible to get that yeah for a particularly similar salaried role and all the rest of it god why are you striking guys like honestly i'm joking i'm joking for the record i'm joking i know why you're striking if you're talking things that could get one counted on this podcast a good topic to to achieve the final yeah i have no sympathy what are you talking about again legal reasons that's a joke and social reasons that's a joke um yeah no super interesting man and like fair play for for getting the system to work for you and taking your opportunities and all the rest of it to set this up so let's talk about these theater sleep then so let's go end to end do the elevator pitch or whatever it is however you want to explain this but what I'm super interested in is I'm really interested in like what like the system problem it solves and thinking about what's the clinician journey using ThetaSleep what's the patient journey as they experience ThetaSleep like those two things are really interesting to me so yeah what's the opportunity what's the solution and what are those journeys of the people going through it yeah so I guess kind of the best way to understand what we do is think about that typical patient journey and then our patient journey so the typical patient journey for someone let's take sleep apnea referrals because it's the obvious one and it's the one that's clearest as to what is what is done what is spent what the wait list are etc so you go to your gp and you are snoring or you're sleepy or whatever you've got the symptoms of sleep apnea and you're referred into the local secondary care clinic for sleep apnea now depending on where you are that could be hundreds of miles away because in some parts of the country there is no sleep clinic um wherever you are the likelihood is you are going to sit on a very very very long waiting list for your sleep study to be done which is the first point in the journey now the traditional um the traditional journey will exist as you get the referral you then are in your the clinic with the consultant with the registrar whomever but they tell you our sleep history it's pretty standardized the sleep history that you often take from people um and then you're going to have a sleep study done because it's so prevalent sleep apnea you're going to and you've been referred for it you are going to have a home sleep study done often though you have to go in and out of the hospital to pick up the sleep study equipment so you have to travel and you have to take time off work take time off your caring responsibilities whatever it is all of the carbon footprint you know everything go into the hospital pick it up take it home most places use what's called respiratory polygraphy sleep studies which are sort of a stripped back version of the complicated psg so it's still bands around the chest bands around the abdomen oxygen probe um you know quite uncomfortable stuff but but huge amount of data that you capture off it you take that home you wear it you bring it back you hope that the data is captured okay because if it hasn't you're repeating that journey again and you don't know until it's there um and then that that result sits in a big queue to get scored and reported then you have the follow-up appointment clinic to discuss the results and start treatment so mixture they should be reported by appropriately trained clinicians which is either physiologists and clinical scientists with the right qualifications or often respiratory registrars respiratory consultants who can score and report them yeah yeah yeah um and then you wait for your your clinic appointment that you have which often is telephone but can be face-to-face and then if you need treatment so if you need cpap treatment for example which is the traditional therapy for sleep apnea which i'm always at pains to say is not a massive loud machine by the bed with a darth vader mask or a bame or whatever you want to call it all of these terrible public images are so damaging for sleep apnea a lot of them we normally use nasal masks first line they're quite lightweight they sit under the nose little machine by the bedside which blows air in to stop you from stopping breathing which is obviously what's happening with sleep apnea and again you're often going in and out of the hospital to get that set up to get the mask fitted etc that whole thing by the way it's wild that i didn't know that as well I feel like, again, when you say CPAP, of course, I'm an anaesthetist.

45:32I think of that type of CPAP. Yeah, and it's a real public health issue. It really is. There are so many people who, there's a stigma around CPAP, right? People assume it's this big, ugly mask. It's disrupting your bed partner. It's not sexy. It's not like... A hundred percent. Do you know what I was going to say as well there? I was thinking my dad snored. My dad snored for a long time. And I'm sure that there's probably some level of sleep apnea going on, ex-smoker, like all that sort of stuff. I was actually thinking that one barrier to him getting that would be the assumption that it's those things.

46:20And that's because actually my, my grandma went onto home oxygen and then obviously died shortly after because she had quite severe emphysema slash COPD. And it's almost like a signal that you're not, you're not coming back from this. This is not this massive piece of like cumbersome equipment is now like, I mean, what that does to your sort of personal identity as well of like, now I'm someone that's medicalized horrendously, that can't live and breathe without this massive equipment and you're right that's my perception of it maybe that's tied to anesthetics i don't know but like that if you're saying that's the public perception then yeah that i can completely i can completely get it and and there's there's nuance to it like in my family that's how it would be perceived definitely so so i've got the live explanation of it like i've lived explanation so my dad has right he is now right on and he's it uses it very very well he's had it for years and right initially was a one of these patients who didn't engage in therapy and he said to me you know i'm not interested in that i don't want to look like i've been on intensive care that was his description that was his description and it wasn't until we were doing what we were doing with theta sleep and i i myself was like i need to know what the patient experience is like here i need to get a c-pack machine i need to wear it for a few nights i need to be able to explain to people what it feels like and i got the the first line device that we would prescribe lightweight nasal mask wore it for three four nights was fine sent pictures of it and said look at look at this it's quite straightforward and then dad engaged with therapy and has now been on it and uses it phenomenally well and i'm sure feels so much better for it and you know reducing all his long-term health risks feels better in the day feels more alert like it and that's happening up and down the number of people i speak to who are like oh i don't really want to get diagnosed i really don't want that mask and And you're like, it's such a doubt.

48:12And it's in popular culture is that it is like an ugly, cumbersome, bad bit of kit as well. That's really interesting. Some of the work that we do is with clinical content creators. It's a sort of a talent management side of some of us that we've been doing for a little while. And so I might have a little word about a potential public health campaign here. Yeah, we've spoken a lot of value. yeah we've spoken a lot about it interesting as we're talking like so the example that we give right is or we've spoken about internally you take viagra before newman etc came on the market and started putting these funny adverts on that kind of made erectile dysfunction an acceptable thing and sort of a cool thing and you take a pill and you get better like when that happened the floodgates opened like you can't quite do the same but there needs to be some public health messing around making cpap cooler and just knowing that you know you sleep better every night for with this device when it works well and like the and it doesn't it's not perfect for everyone it's complicated therapy that needs support and that's obviously a big part of what we do and how you use digital tools to improve adherence and make it better as yeah i could talk about that for hours but just the like blanket i do not want to use this because i've got this image in my head that it is uncomfortable it's going to piss off my bed partner that's going to all of this stuff is so damaging and it's in pop culture it's in everywhere so yeah would let's let's definitely explore that let's let's talk definitely this might be a stupid question is sleep apnea reversible with c-pap so can you do you end up coming off the mask because i feel like that's another misconception as well that you're on it for life yeah so often people are on c-pad therapy in the long run they are sometimes on cpap therapy for life which is sometimes unappealing but there are other things that we do with sleep habits that people are on for life and never bat an eyelid about you know i wear an eye mask and earplugs every night yeah i'd be lost without them some people will will mouth tape for example and they'll wear that every night like there are things that we do to improve our sleep every night sleep cpap is not this the other thing cpap is not the only therapy for sleep apnea so we mentioned weight before in people who have obesity and sleep apnea you can sometimes reverse it with weight loss therapy and it's where glp1s are an interesting therapy for sleep that is interesting obviously you stop them the weight comes back on it it generally comes back but there are other treatment options so we mentioned mandibular advancement devices some patients have positional sleep apnea which you can treat with positional devices there are more surgical options available like doing kind of interesting medtech hyperglossal nerve stimulation is a therapy that is increasingly available on the nhs so it's a changed environment again that's what's fun being that a clinician sitting in the middle is there's all these innovators in diagnostics and there's all these innovators in treatment and we get to like help people access those and facilitate those and bring those innovations to them um so yeah i guess or we've we've digressed for very good reasons into um yeah the theta sleep our journey now is yeah so the whole thing we did is is how can you how can you tell them well take take the hospital completely out of it and how can you deliver the right the diagnostic and therapeutic journey for the patient that is not just a one-size-fits-all answer so patient gets referred into us anywhere in the country same same level of care as it should be um we they get onboarded onto our digital platform where they can access education on sleep apnea and sleep disorders, where they give us a focused sleep history.

51:50So all that stuff you'd usually cover in that first clinic appointment, remove that first clinic appointment, capture that digitally and get them to schedule a sleep study to do at home. And we use the full range of diagnostic devices. So we use traditional studies when they're needed. So we spoke about RLS before. If you've got RLS, you want to look for limb movements during your sleep and that needs the traditional devices, restless leg syndrome for those yes sorry and um and uh also needs the the monitors on the leg to look for limb movements overnight there are some patients who need this traditional test but others can use novel diagnostics as we we bracket them there's a nice guide i'm from 2024 about these novel diagnostics they're approved for sleep apnea use they're not for everyone and you have to have a degree of clinical decision making to decide who can get that and we use clinical decision and support tools in our platform to work out what is the right sleep study for you to have at home what are those tools so mixture of stuff the three in the nice guideline from 2024 is why it's called a watch pat device which is uh it's got a watch as you can imagine and it's got a peripheral arterial tonometer which is the pat part of it which sort of can act as a tonometer like pressure like it works right with um measuring blood flow through the finger as a surrogate for around the tech behind it yeah tech behind all of them is so interesting and i could yeah yeah very very boring and nerdy about all that stuff as you can imagine um so watch past one of them um sunrise is another one which is something that sits on the jaw and measures your mandibular movements to look for a proxy of sleep apnea and acupebble is the other one which is a device which sits on the neck and measures that is a superb name

53:38yeah and they're great devices when used for the right patients and we will work out who is suitable for which device and but but before the clinic appointment we will capture that all digitally and we'll make sure that the patient gets the right diagnostic at home we've also got importantly non-digital pathway so all the stuff that's captured on our platform we can post out to people education content we can use our support team to get on the telephone to the patients and capture all the data so you know so we're not excluding key part of any of any digital health innovation yeah and then it means that the clinic appointment comes up and that patient has had the education they would normally have they have had the right sleep study for them the clinician has got all of the information on our so we've built the sleep medicine specific electronic health records that captures all the days from the patient so everyone is then in that clinic appointment clued up ready to go and actually talk about what the sleep problem is i spent my life in sleep clinics going through sleep apnea is a condition where you stop breathing during your sleep and you spend 10 of the 15 minutes 20 minutes you've got explaining the same stuff and it means that patients come ready to go everyone has a better experience we can deliver better personalized care and get to the bottom of what's going on with someone's sleep whether it's sleep apnea or something else and then if they need treatment again sticking with sleep apnea for the sake of argument cpap device we get that delivered to them in their home set up education training done remotely and we monitor their adherence dynamically so we pull the data of the cpap devices onto our platform so we can intervene when patients are struggling in the first few weeks cpap adherence is a real problem we know it's a big problem we know So in this country, it's about 50 % of devices don't get used.

55:29And you can tell in the first two weeks to 30 days. So that is the time where you need to intervene. And by getting that data and being able to intervene quickly, that's what we do. So our whole model is just how can you, essentially, how can you take all the innovations that everyone else is doing, deliver the right stuff to the right patient and knit it all together with the platform, with the pathways and with the clinicians. Brilliant. How do you get paid? so nhs clear tariffs for um sleep medicine and for sleep studies um so there are there are tariffs for all of the aspects of the sleep medicine journey and we deliver below those tariffs so we deliver our service at about 60 percent of the tariffs so each new patient that we see saves money for an icb saves money for a commissioner if it's private again just you know self-pay um comes in but yeah the nhs for sleep that's what makes sleep apnea the important kind of gateway into doing this sleep medicine the whole sleep medicine journey better because there are clear tariffs there's a clear problem and my hope in the next five years is we've got enough volume of patients and delivering the care for enough people that we can then not just do sleep apnea but we can deliver the best sleep medicine journey for anyone so for insomnia for other things the insomnia market is changing soon which is great and then there's how can you do all of the other sleep disorders better and still in the home-based model brilliant brilliant what are your constraints to scaling this then the the biggest challenge as we scale and as we grow will be the clinical workforce there's always clinicians in the loop we're still having those clinical appointments we don't want to automate that um there's a lot you can do beforehand there's a lot you can do afterwards but that like appointment in clinic with a doctor who's ready to talk to you about your sleep is super important um and it's then recruiting enough clinicians into the into the service but the benefit for us really is it's not like and we speak to various kind of nhs trusts who are struggling to recruit into their local area because you can only recruit within a 30 mile radius our doctors who work for us can be anywhere in the uk like our patients can be anywhere in the uk and they can work evenings they can work at different times so actually recruiting the workforce to do that is not going to be a massive problem but that's that's the one thing that won't scale with the devices with the tech etc is needing the clinicians but once we get to that problem where we need hundreds thousands of clinicians we're we're we're in a good place you're laughing because you're so profitable by that point anyway that yeah yeah exactly exactly exactly it's it's incredible man like honestly like huge congrats to you i think it it's like I said before it's it's an area of huge uh potential arbitrage supply and demand it's just supply and demand like genuinely and the the thing for me the demand is going absolutely nowhere other than increasing genuinely just because of what we now know scientifically about sleep and how those messages are now reaching the public you look at all of the prevention conversations that are happening and the fact that sleep is just getting more and more and more popular as this demonstration of of like luxury almost or having your shit together or whatever it's like the fact that you can sleep eight hours is like perceived as some sort of luxury and and it's sought after and it's it's desirable and it's no longer a flex to be like oh I work and I don't sleep.

58:58Like all of these things is, it's just pointing us in a direction of, of you seemingly having quite a lot of first mover advantage here and clearly so much clinical understanding of, of how to set this up. The fact that it is set up the fact that you understand the pathways and all these things, and you're connected into tech. The co-founding team is interesting to me as well because of the, the, the spread of skills and knowledge that you have. It, it seems, it, it seems like you're in a, in an incredibly good position to, That's fair. Very kindly to say. Well, no, no. I mean, it's not kind. It feels like a genuine, it feels like a real opportunity.

59:36Because also because of the tariffs as well, like reaching profitability isn't something that is going to be like that much of an issue. It's not a huge volume required to get there. This is the thing. From where we currently are to where we need to be, to reach that is not far at all. That's the thing. And so in terms of like your sort of raising journey, like you're raising money to achieve scale quickly rather than out of necessity so it's almost like you're picking your level of like how big you want this to be to some extent and that's based on obviously your ability to raise money so did you guys have you raised the seed around to get this off the ground are you looking at the next well where whereabouts are you in your kind of raising journey and your even your desire to do that you might not want to i don't know but yeah where are you yes so so we did a small sort of very pre-seed kind of close angels friends family network yeah in just seis stuff correct in feb last year that we did raise with seis um which gave us the the year and a bit to build the platform do all the compliance get the version one out the door you know be able to deliver a service to patients that we are now delivering and in that first year was then get more patients coming through the door so we then saw last year we saw a total of just over 400 patients mixture of nhs and private patients in the model, showed it worked, proved the revenue that we can generate through it, etc.

1:01:00And we are raising again now, actually. We're doing a 500k round this summer, EIS approved. EIS, yeah, nice. From a mixture of angels, angel syndicates, kind of smaller funds who are interested in the journey and really believe in what we're doing and understand the market. And it's the main purposes of that. As you say, we can just go on the go slow here and grow slowly with what we're doing. And the overheads are low. You might get overtaken by competitors and blah, blah, blah. Yeah. So it's how can we, it's raising that money to essentially accelerate the sales and the product. So get into more of the NHS conversation we want to be in, which as we know are very slow.

1:01:39Really scope out that direct to consumer market, which is growing because there are so many people who are sat on waiting lists and wanting to do something about it. and spec out all of the product things we want to be able to do to deliver that kind of perfect sleep medicine experience for patients so yeah exciting year ahead really as we as we're on that journey fantastic what i will say as um we've talked about this before like i we jess and i did our first angel investment uh into booby biome and so looking at things through that lens i just want to say like it's it's incredibly kind of uh reassuring when you're at that earlier stage ticket size but yet you're investing in something that isn't oh i've got this idea i'm going to use the money to build a product the product's already there the revenue is already there the process the system the business model is already up and functional and it's within a market where the demand is only increasing the supply looks in no danger of of exceeding where it is anytime soon so yeah i i will just say it is an incredibly appealing situation if we weren't already cleared out because of our previous investment uh but i obviously know a few people that i can um that i can send your deck to and stuff and obviously there's people listening that yeah if there is anyone who fits that bill who'd be interested in chatting then i would would love to chat to them um yeah linkedin's probably the best place to find me perfect is is yeah and always interested to talk to anyone in that space.

1:03:17Perfect. Dude, this has been an absolute pleasure. Thank you so much. I've genuinely really enjoyed it. I've learnt a load that I probably, half of it I should have already known, but I've learnt a heck of a lot about sleep medicine, what you guys are up to, and I'm super excited to keep following your journey, man. Thank you very much for having me on. You're very welcome, man. As you say, I think LinkedIn's probably the best place to find you. Tom Chambers, spelled exactly how it sounds for anyone listening. But yeah, it's been a pleasure, Tom. I'll see you out and about. Yeah, thanks so much for having me.

1:03:46It's been really nice coming on. And yeah, we'll talk sleep medicine on how to do it better with anyone for as long as they want. So thank you for giving me the opportunity to do that for the past hour also. You're very welcome, sir.