Sleep: The Cheapest Medicine

When researchers talk about "sleep debt," it often sounds like metaphor. A study released today makes it viscerally concrete: 60.3% of adults in a large population-based cohort are sleeping poorly. Not occasionally tired—clinically defined poor sleep quality, the kind that accumulates into chronic disease.

The study, conducted in Qatar, identified three independent drivers: smoking, high perceived stress, and poor sleep hygiene. What makes this significant isn't the surprise—we knew these factors mattered. It's the scale. In a rapidly modernizing, high-income country with excellent healthcare access, six in ten adults still can't sleep properly.

This isn't a developing-world infrastructure problem. It's a modernity problem. The same stress patterns, screen habits, and work pressures exist in New York, London, and Singapore. The paper's authors called for "targeted public health interventions," but what does that actually look like? Telling stressed professionals to put down their phones hasn't worked particularly well so far.

Incannex received an R&D Award this week for IHL-42X, an oral medication targeting obstructive sleep apnea. If you've never worn a CPAP mask, this might not register as significant. If you have—or know someone who has—you understand why sleep medicine researchers call an apnea pill the "holy grail."

CPAP machines work. They reduce apneas, lower cardiovascular risk, and improve daytime alertness. They're also uncomfortable, noisy, and require nightly commitment that roughly half of prescribed patients eventually abandon. Insurance companies track CPAP usage; adherence rates are dismal.

IHL-42X combines acetazolamide (a diuretic that shifts blood pH, stimulating breathing) with dronabinol (a synthetic THC that reduces upper airway collapsibility). The combination targets the physiological causes of airway collapse rather than mechanically forcing it open.

The award recognizes potential, not proof. But here's the commercial reality: roughly 936 million people worldwide have obstructive sleep apnea. Even capturing a fraction of the CPAP-intolerant market would be substantial. The device manufacturers know this is coming—which partially explains ResMed's aggressive push into AI and digital health.

The theme at this year's Consumer Electronics Show wasn't subtle: we've moved past knowing you slept badly to actively doing something about it. Three products stood out.

LumiSleep uses real-time EEG to detect sleep onset and plays personalized audio to guide the brain into slumber. It's closed-loop neurofeedback packaged as a headband—the kind of technology that was lab-only five years ago.

NeuroTx WillSleep goes further, using transcutaneous vagus nerve stimulation to treat both insomnia and anxiety. Vagus nerve stimulation has FDA approval for epilepsy and depression; applying it to sleep disorders is a logical (if not yet proven) extension.

Sleepal AI Lamp represents the non-contact approach: radar and thermal sensing for tracking without wearables. Useful for those who find chest straps and headbands counterproductive to actually sleeping.

The shift from passive tracking to active intervention is the story. Your Fitbit told you that you got 5.5 hours of sleep last night. These devices want to make it 7.

A study of over 2,000 seniors published in Neurology found something that should make every irregular sleeper pay attention: fragmented circadian rhythms correlate with increased Alzheimer's risk. But the timing is what matters—these disruptions appear 10 to 15 years before cognitive symptoms manifest.

This isn't about sleep duration—the headline metric most wearables report. It's about sleep regularity. Individuals with weaker daily biological cycles showed faster cognitive decline. The research suggests circadian stability could be a modifiable risk factor for neurodegeneration.

The quote from the study cuts to the core: "Disrupted circadian rhythms are associated with an increased risk of Alzheimer's disease... appearing 10 to 15 years before symptoms manifest."

What this means practically: your sleep-wake consistency might be as important as your total sleep time. The person who sleeps 6 hours at the same time every night may be better off than the person who gets 8 hours on variable schedules. And this is measurable now, with consumer devices, which opens interesting possibilities for early intervention.

At the J.P. Morgan Healthcare Conference, ResMed unveiled "Smart Comfort"—an AI feature that adjusts CPAP pressure settings based on user lifestyle and real-time feedback. CEO Mick Farrell framed it simply: "We are moving from passive monitoring to active, personalized coaching."

The company also launched "Dawn," a digital health concierge covering sleep, nutrition, and exercise. This is ResMed acknowledging that CPAP adherence is a behavioral problem, not just an engineering one. A machine that fits perfectly still gets abandoned if users don't see the value.

Perhaps more interesting was a data point buried in the presentation: higher CPAP adherence among patients taking GLP-1 weight-loss drugs like Ozempic. This makes physiological sense—weight loss reduces sleep apnea severity, which could make CPAP feel more effective. But it also suggests the obesity medications are creating a secondary market for sleep optimization.

ResMed's strategy is clear: if a pill eventually replaces the CPAP machine, they want to be a software and coaching company, not a hardware casualty. The AI pivot is defensive as much as it is innovative.

Researchers at UT Dallas have developed a wearable sensor that measures cortisol and melatonin levels in sweat. Why this matters: these are the hormones that regulate your circadian rhythm, and currently measuring them requires blood draws, typically at specific times, in clinical settings.

The device, developed in collaboration with EnLiSense and validated in Biosensors and Bioelectronics: X, allows continuous, non-invasive monitoring of the body's circadian phase.

The implications extend beyond sleep tracking. Chronotherapy—timing medications to align with biological rhythms—has shown promise for everything from chemotherapy to blood pressure management. But it requires knowing someone's actual circadian phase, which varies significantly between individuals and changes with travel, shift work, and lifestyle factors.

A sweat sensor that tracks melatonin and cortisol in real-time could enable truly personalized chronotherapy. Take your medication not at 8am, but when your body's cortisol curve hits its morning peak—which for a night owl might be 10am.