Dr. Ravindra Mehta on Why India Still Treats Sleep Medicine as a Luxury
By Arunima Rajan
Dr. Ravindra Mehta is an established clinician, researcher, and teacher in the field of pulmonology (respiratory/chest medicine), interventional pulmonology, critical care (intensive care), and sleep disorders medicine. He is the only doctor in the country who is American Board certified in interventional pulmonology. In an interview with Arunima Rajan, he talks about the evolution of sleep medicine in India.
Where are you from and why do you do what you do?
My name is Dr. Ravindra Mehta. I am a physician by training and went on to pursue several subspecialties, including ICU medicine, chest medicine, sleep disorders, critical care, and pulmonology. I trained in both India and the United States, completing most of my subspecialty training in the U.S. For the past two decades, I have been practicing in India and currently run an outpatient centre, Vaayu Chest and Sleep Specialists, which focuses on chronic respiratory diseases and sleep medicine.
What drew you to the field of sleep medicine?
What drew me to sleep medicine, however, was its deep connection to pulmonology. Around 70% of sleep medicine still revolves around sleep apnoea, and since "apnoea" literally means the absence of breathing, the field naturally overlaps with respiratory medicine. That is how pulmonologists became a major part of sleep medicine, especially when it comes to managing sleep apnoea. During my training in the U.S., sleep medicine was just gaining recognition. The links between sleep apnoea and other conditions were becoming clearer, and it struck me how something that takes up one-third of our lives influences almost every aspect of health. When I realised India did not yet have a dedicated subspecialty in sleep medicine, I decided to train in it and return home to help build it here. It has been a rewarding journey, integrating sleep medicine across disciplines, whether general medicine, respiratory care, intensive care or cardiac sciences. Wherever you look, sleep plays a vital role
What is sleep medicine?
The simplest way to understand it is to look at what we do naturally. Mother Nature has designed certain rhythms that govern how we function, and one of the most important is the cycle of wakefulness and sleep. Sleep is an integral part of life; whether you like it or not, it’s something you have to do.
Think of sleep as the phase when everything in the body is reconstituted. During the day, our systems get exhausted, and at night they reboot. To put it in modern terms, it’s like your computer’s RAM getting overloaded during the day and resetting at night. That’s when the body rejuvenates what has been depleted and rests the parts that need repair. There are billions of processes happening in the body during sleep, many of which remain a mystery even with today’s advanced supercomputers and emerging quantum technologies. Simply put, sleep is a restorative, rejuvenating, and uplifting part of life that allows you to function effectively the next day. Within that sleep phase, countless complex mechanisms occur. The study of those mechanisms has become a science in itself, known as sleep medicine. When I first trained in this field, people often joked, “So you teach people how to sleep?” But over time, the discipline has evolved into what we now call sleep medicine. Before we can understand sleep disorders, however, we must first understand normal sleep. The field blends basic knowledge, intuition, common sense, and scientific inquiry to help us grasp one of the most essential aspects of human life.
Which sleep disorders do you encounter most often in your practice?
Broadly, there are two types of problems: primary sleep disorders and sleep problems caused by other medical conditions. Among primary sleep disorders, sleep apnoea is the most common. To put it simply, it can be compared to a traffic jam at night. During the day, your airway is like an open highway, allowing smooth breathing. At night, however, it narrows or gets blocked, much like roads closing in Mumbai, Bengaluru or Delhi. This disruption reduces oxygen levels, fragments sleep, and prevents restorative rest. As a result, the body misses out on the rejuvenation it needs. Sleep apnoea affects not only the quality of life but also long-term health. Over time, it can contribute to high blood pressure, heart disease, stroke, memory loss and diabetes, among other conditions. That is why the science of sleep apnoea has gained such importance. Another common issue we see is linked to lifestyle, especially among young people who sleep late and wake up late. This is called a circadian rhythm disorder. Simply put, humans are wired to be awake during the day and asleep at night.
We are now staying awake when the body wants to sleep. We push through fatigue, trying to stay up until two or three in the morning and then expect to feel fresh the next day. For most of us, that simply does not happen.
Another factor is exposure to excessive light from our devices. Technology and gadgets keep us alert when the body is signalling that it needs rest. One part of the body, the mind, becomes overactive, driven by stimulation from screens, games and social media interactions across multiple platforms. This constant engagement is counterproductive to what the body actually needs. Over time, it creates a kind of internal conflict.
These patterns are often referred to as delayed sleep phase disorders. At the other end of the spectrum, older adults tend to fall asleep early and wake up around three or four in the morning, unable to return to sleep.
As we began to recognise these varied problems, the science of sleep medicine became increasingly fascinating. Before we conclude, I must mention one of the most common conditions worldwide: insomnia. Everyone experiences short-term insomnia at some point-difficulty falling asleep or staying asleep. But chronic insomnia has now become a major modern health concern.
That, in brief, is a quick introduction to the vast and evolving field of sleep medicine.
What is the connection between obesity and sleep disorders? Many people discover potential sleep-related issues during routine or corporate health check-ups, where sleep studies are increasingly recommended. There is also growing awareness that individuals with cardiovascular conditions need to be cautious about sleep apnoea. Are obesity, cardiovascular health and sleep disorders interconnected?
Absolutely, it is all interlinked, almost like the blockchain of healthcare, where one thing leads to another. Over time, we have divided healthcare into specialities such as cardiology and pulmonology, but in reality, it all connects. A good clinician
recognises that while specialisation is valuable, someone still needs to see the whole picture.
The relationship between obesity and sleep apnoea is quite mechanical and easy to understand. When excess fat accumulates around the neck and airway, the passage narrows, increasing the likelihood of breathing problems at night. Obesity also reduces muscle tone over time, causing the muscles in the airway to become more relaxed or floppy. This makes obstruction more likely, much like traffic congestion on an urban highway.
Snoring is often an early sign, a harbinger of sleep apnoea, though not all snoring indicates the condition. In addition, anatomical factors play a role. People who naturally have narrower airways, including many individuals from India’s northeastern regions, can develop sleep apnoea even if they are not overweight.
The link between sleep apnoea and cardiovascular disease is equally strong. During sleep apnoea, the airway repeatedly opens and closes, causing fluctuations in blood pressure and heart rate. The heart, which ideally should rest at night, is forced to work harder. Over time, this leads to hypertension and increases the risk of heart disease.
If someone already has a cardiac condition, low oxygen levels during sleep can further strain the heart. The constant variation in heart rate and blood pressure means the heart never truly rests. Remember, the heart and lungs are the two organs that never stop working. If either one slows down too much, survival is at risk. In simple terms, sleep apnoea creates multiple potholes in the smooth functioning of the heart. That is why addressing it is so important. The key message is that even if patients undergo advanced cardiac procedures such as angiograms, angioplasties or bypass surgeries, they should not overlook sleep apnoea. A long-term plan must include identifying and treating it to prevent recurrence of heart problems.
India reportedly has fewer than 200 accredited sleep labs serving a population of 1.4 billion. What do you see as the most significant barriers to establishing more sleep-diagnostic facilities?
The worrisome part is that even after 25 years of discussion, sleep apnoea remains underdiagnosed, undertreated, under-recognised, under-investigated and underappreciated. The positive side is that awareness has improved, especially in urban areas. However, what is needed now is greater willingness among people to take the next step and get treated. Rural India is also part of the larger healthcare challenge. Like rural diabetes or kidney disease, sleep apnoea in these regions remains a concern. The good news is that diagnosing it has become easier with better technology, screening questionnaires and diagnostic tools. What we now need is a renewed awareness and a stronger message about sleep apnoea so that it does not continue to affect people’s quality of life or worsen comorbidities such as heart disease.
What are the most promising innovations in sleep medicine?
I am not aware of any head-to-head studies comparing these new devices like rings, which look sleek and appealing, with conventional sleep studies. We do know, however, that the tools they use are based on established sleep medicine principles. For example, the Ultra ring and similar watches rely on standard mechanisms used in clinical settings. What remains unclear is how accurately these devices compare with conventional sleep studies. I do not think the evidence is strong enough yet to say that such wearables can replace a proper sleep study. They can certainly provide useful insights, especially for educated urban users who may find them convenient. The data can alert users to possible issues, but any such indication should always be followed up with a proper clinical evaluation. As of 2025, a formal sleep study is still essential. It assesses multiple parameters such as breathing patterns, brain activity through EEG, and leg movements, among others. However, I believe this will evolve over the next three to five years. Just as sleep labs once gave way to home-based studies, these devices are likely to play a greater role in the future. For now, if you use a wearable and it flags a concern, do not ignore it. Consult a qualified doctor who can investigate further and confirm whether treatment is needed.
If a patient comes in with suspected sleep apnoea what tests do you prescribe?
When a patient is referred, or when we identify symptoms during routine consultations, the next step is taking a detailed sleep history. If someone is simply not getting enough sleep, it is impossible to diagnose sleep apnoea accurately. So we begin by understanding the person’s sleep schedule, followed by a physical evaluation of the airway, neck size and related factors. We then use standard questionnaires that help assess the likelihood of a sleep disorder. Based on these, we estimate the probability of sleep apnoea and evaluate related comorbidities such as daytime sleepiness, poor alertness, irritability, accidents, high blood pressure, diabetes or heart problems.Once this evaluation is complete, we decide whether the patient requires a home-based sleep study or a lab-based one, known as polysomnography, which is considered the gold standard. Unfortunately, in India, this step is sometimes rushed. Patients or technicians may request a sleep study without proper evaluation, which compromises accuracy. A proper process matters. Just as in any scientific assessment, you must take the time to understand, engage and evaluate before running the test. After the study, the data must be interpreted carefully, ideally by reviewing the raw readings, which does not always happen. Finally, we discuss treatment options based on the findings. Like most fields in medicine, sleep medicine relies on a structured, step-by-step approach to ensure effective outcomes.
What are the main treatment options available for sleep apnoea today?
When someone has sleep apnoea, the airway repeatedly closes during sleep. The simplest way to treat it is by keeping that passage open using air pressure. The most common method is continuous positive airway pressure, or CPAP, which works like gently blowing air through a syringe to keep the road clear. It involves wearing a mask connected by tubing to a machine.
Treatment depends on the severity of apnoea, which is classified as mild, moderate or severe. CPAP is one option, but there are others. Surgery is available, though not widely accepted, and it continues to evolve. Another option is an oral appliance that moves the jaw slightly forward to create more space in the airway.
More advanced treatments are emerging. Some devices help control tongue position, while newer technologies being developed in the West aim to strengthen airway muscles. Sleep medicine has now become an innovative field, no longer limited to simply diagnosing apnoea and prescribing a mask.
Unfortunately, in India, treatment often begins before proper and detailed evaluation, which reduces its effectiveness. Careful diagnosis and personalised therapy remain key to managing sleep apnoea successfully.
Since the pandemic, there has been a renewed focus on sleep. Do you think these conditions existed earlier as well, or did COVID-19 make people more aware of them? During the pandemic, everyone seemed to have an oximeter and was tracking their oxygen levels. Did that heighten attention to health help in any way?
I am not sure whether it is entirely due to COVID-19 or simply because people are becoming more aware. The pandemic certainly reminded everyone that health is important. Many young people who had never sought medical care before suddenly faced life-threatening illness, and almost everyone lost someone close. It created a general awakening about health.
As for sleep, the post-COVID phase is over. We are now back in a fast-paced, technology-driven world that operates 24/7. Constant connectivity and screen exposure are major contributors to poor sleep. Added to this are affluence, changing lifestyles, unhealthy eating habits and rising obesity. This is the reality of a new, urban India.
At the same time, we are also seeing increased obesity in lower-income groups. Government food support schemes, while essential, have inadvertently contributed to excessive calorie intake in some cases. Childhood obesity is now at an all-time high. As a result, the prevalence of sleep apnoea, which used to be around 4 to 5 percent, has likely risen to between 10 and 20 percent today.
Who exactly is a sleep physician? Is it usually a pulmonologist, or does it require additional training? And why do we still have so few qualified sleep physicians in India?
The ideal path is to complete a formal one-year training in sleep medicine. In the West, it is recognised as a subspecialty called sleep disorders medicine, which is one of my qualifications.
In India, several fellowship programmes have been introduced by different organisations, but their numbers remain limited. Another route is through practical training, where physicians gain experience by attending continuing medical education programmes or short-term courses lasting two to three months. They then go on to practise as sleep physicians.
At present, there is no central regulatory body in India that defines who can or cannot practise sleep medicine. Because the field overlaps with many specialities, it attracts professionals
from diverse backgrounds, including pulmonology, ENT, neurology, psychology and psychiatry. The discipline is therefore still broad and somewhat diffuse in its structure.
In the next five to 10 years, what developments in sleep medicine are likely to shape its growth in India?
Therapeutics always takes time to evolve. Developing a new treatment is a slow process in medicine because it involves trials, regulatory approvals and several layers of evaluation.
The most significant progress in the near future will be in diagnostics, such as wearable devices and sleep-tracking rings. Over the next three to five years, awareness about sleep health is likely to reach an all-time high, particularly among urban populations. We will also see greater recognition of the links between sleep disorders and conditions such as cardiovascular disease, stroke, diabetes and uncontrolled hypertension.
If we are fortunate, newer therapeutic options may emerge, but that will take longer. In the next five years, the key developments will be in diagnostics and awareness. Over the next decade, I expect more innovation in treatment options as well.
Having worked in the U.S., how would you compare India’s progress in sleep medicine? Are we on par with them, or do we still have a long way to go?
No, we are still far behind. In the U.S., there are doctors who practise sleep medicine exclusively, with proper remuneration and recognition for the speciality. In India, very few physicians do only sleep medicine. It usually functions as part of another speciality.
In the U.S., many of my colleagues have spent their entire careers in this field and are now retiring as dedicated sleep physicians. It is considered a stable outpatient practice with a good work-life balance, and the system there reimburses and supports it appropriately. All insurance plans in the U.S. cover sleep apnoea because they recognise its long-term impact on health. By treating sleep apnoea, you can reduce hospital admissions and prevent complications. If even one case of angioplasty, bypass surgery, heart failure or uncontrolled hypertension is avoided, it translates into significant savings for the healthcare system.
Do private hospitals give enough importance to sleep medicine?
Because the focus in hospitals is largely on inpatient care, surgeries and intensive care, sleep medicine does not always get the same attention. By definition, it is an outpatient speciality. It does not generate admissions or procedures in the way other departments do, so its business value within hospitals remains limited.
In my view, sleep medicine should primarily be practised outside hospital settings. Only patients with severe complications, such as respiratory failure, need hospital-based management. For most others, the process of assessment, diagnosis, counselling and follow-up belongs firmly in the outpatient space.
Got a story that Healthcare Executive should dig into? Shoot it over to arunima.rajan@hosmac.com—no PR fluff, just solid leads.