Commercial climates across sleep

Value is created when problems are solved. There are many sleep problems to be solved. There are also many problems that can be solved using sleep.

But this isn’t the whole story. All great businesses create value, but not all value creation creates great businesses. Great businesses require great markets, and great markets require advantageous commercial climates with favorable conditions prevailing from supplier to buyer. Vectors that coalesce to create an adverse or advantageous commercial climate include buyer awareness, unit economics, acquisition channels, distribution channels, competitor sets, complementary products, regulations, energy requirements, and technical infrastructure.

Sleep exhibits an array of categories at different stages of maturity with a wide spectrum of commercial climates. These range from proven categories with strong demand and many competitors all the way to sci-fi ideas still requiring major scientific advancements before commercial solutions can be built and sold. At Supermoon, we are tracking the evolution of commercial climates in real time across the full stack of sleep innovation.

This report groups 50 segments of the sleep market - product types, solution sets, and conceptual ideas - into five categories of market maturity. Although there are many segment to segment nuances, segments within each category generally share similar commercial climates, from buyer awareness levels to diversity of distribution channels to current states of scientific understanding.

Ultimately, sleep market innovation is still in its infancy. Proven segments are dominated by legacy incumbents with stale products. New entrants are beginning to capture net-new consumer spend by solving problems people are only beginning to realize they have. And at the frontier, basic science is uncovering both new problems and new solutions, creating new market segments still yet to emerge in the coming years.

Subscribe now

Tier 1: Proven

Commercial climates for these segments are generally quite favorable. Consumers have shown willingness to pay, distribution channels from DTC to DME are well-established, and at least one company in each segment has achieved positive unit economics.

In this tier, value capture is more difficult than value creation. Many businesses compete for the same spend and segments face commoditization and price-competition.

Many of these segments are dominated by legacy incumbents with stale products. Beds & Bedding, CPAP, and OTC Aids are three of the largest segments in the entire sleep market and are controlled by household names like Mattress Firm / Tempur-Sealy (Somnigroup), Resmed, and Proctor & Gamble.

But high segment maturity offers day one upside to startups that can successfully navigate the increased competition. Opportunities include reformulation, novel delivery formats, unique branding, and multi-segment bundling.

Still, storm clouds are on the horizon for many of these segments. New entrants targeting new customer types with new solutions in less-mature sleep market categories are likely to capture market share from businesses in this category as their own commercial climate improves.

Tier 2: Growth

Segments in this category benefit from highly favorable economic, cultural, and technological trends. Many segments are growing quickly with at least one company in each demonstrating strong product-market fit.

Some segments still require high-touch buyer education - novel supplement ingredients, circadian productivity, and light therapy in particular. Yet commercial climates in this category are defined more by distribution, differentiation, go-to-market strategies, and defensible product wedges.

Crucially, segments in this category often benefit from lack of a segment leader. These segments are often fragmented with no dominant leader with outsized market share.

Opportunities include workflow integrations, clinical-consumer crossover plays, and ROI driven enterprise sales motions.

Tier 3: Emergent

Segments in this category straddle the threshold between science and commerce. Many of the products in this category are scientifically validated but narratively unfamiliar. Although buyers may be aware they have a problem worth solving, they either do not know that new solutions exist or do not believe these new solutions will actually solve their problem. Retailers, providers, and other distribution channels need to see end-user demand before buying in.

Identifying early-adopter cohorts is critical for companies in these segments. Perhaps it’s elite athletes and military special forces. Perhaps it’s struggling sleep provider groups seeking new revenue opportunities and new ways to cut costs.

Notably, many of the products in this category can be classified as “insights” - diagnostics, trackers, sensors, etc. These segments are key to unlocking future growth across the broader sleep market. Understanding sleep precedes solving sleep. Historically, breakthroughs in lab EEG & PSG testing empowered the CPAP market and today consumer wearables & HSTs are empowering novel interventions. Breakthroughs in anatomical profiling, circadian rhythm diagnostics, and consumer EEG can help potential buyers identify problems they face and incentivize demand for new solutions.

Value creation is the opportunity. Other opportunities include leveraging sleep data for adjacent specialities (cardiology, pulmonology), FDA approval for clinical validation, and design collaborations with popular consumer brands to reduce unfamiliarity.

Tier 4: Frontier

Commercial climates for segments in this category are generally undetermined. There may be massive latent demand or none at all. Qualitatively, many of these segments sound like big opportunities, if only.

Many of these segments suffer from not just passive buyer ignorance but active buyer skepticism. Value propositions sound too good to be true. Products often come with a host of caveats, indicated patient populations are outrageously narrow, and companies often fail to replicate laboratory performance when faced with real world conditions. There are outliers of course, but most products in this category just aren’t good enough yet.

The highest-conviction Tier 4 opportunity may be in novel therapeutics for sleep: GABAa agonists, orexin modulators, adenosine modulators, and other compounds designed to improve sleep architecture without the sedation and dependency profile of current options. Idorsia’s Quviviq and other new therapeutics show that the bench to bedside pipeline in sleep remains strong. Still, the segment is categorized as tier 4 due to significant pharmacological work that remains to be done, long clinical trial timelines, and perhaps most importantly, a historically conservative prescriber base of sleep docs and lack of a popular Hims/Ro-type DTC drug company in sleep, severely limiting end-patient awareness and distribution channels.

Productization of scientific research is the main opportunity in this category. Other opportunities include DTC drugs for sleep, initial go-to-market in more mature, non-sleep specialties (ex. oncology), combination therapies, and launching first with entertainment/fun features to sidestep buyer cynicism on clinical/scientific value props.

Tier 5: Sci-Fi

These are a set of scientific frontiers that, if crossed, would likely create markets — some of them larger than anything that currently exists.

The commercial climate for these segments is cold by every conventional measure: no buyers, no distribution channels, almost no regulatory frameworks, and no timelines. But basic science is progressing faster than most people realize and potential downstream commercial consequences are difficult to overstate.

Laboratories across the world are working on each of these ideas. Artificial hibernation / synthetic torpor is perhaps the most “advanced”; beyond the two company examples, we’ve met with a handful of stealth biotech and medtech companies inching closer to preclinical prototypes. Sleep compression - preserving the full restorative and memory-consolidation functions of sleep in 3–4 hours - and sleep replacement - “sleep without sleeping” - would unlock trillions of hours of consciousness with unimaginable consequences on life, labor, and the human experience.

Diversified market maturity

At Supermoon, we invest in companies across all five tiers of the market maturity spectrum and seek to build a portfolio with a diverse set of commercial climates. Ultimately, our task is to improve portfolio company legibility to customers and capital alike, transforming contrarian ideas into consensus. This suggests focus on tier 3 - emerging opportunities, where most products are scientifically validated but “narratively unfamiliar”. A decade from now, if you plot all of our initial investments across these five tiers I suspect you would see a normal distribution centered around tier 3.

Next deep dive will be on tech adoption in sleep.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Supermoon is the only venture fund purpose-built to back the full stack of sleep innovation. We invest across every industry that touches sleep: consumer, enterprise, medtech, diagnostics, biotech, therapeutics, hardware, software, and content — giving our LPs the diversification of a generalist fund with the edge of a focused sector specialist.

Risk Architecture

Excessive exposure to a single sector, geography, or asset increases risk. Diversification reduces risk.

Megafunds investing across sectors, geographies, and growth stages are inherently less risky than sector, geo, or stage-focused specialist funds. These specialist funds are riskier because their portfolio companies face the same risk factors: regulations, reimbursement decisions, market sentiments, procurement cycles, etc. A single storm can lay waste to an entire portfolio of businesses building in the same city. An entire portfolio banking with the same bank can create a single point of failure.

Our thematic focus on sleep is structurally different. While our portfolio companies share a theme — the science, technology, and sentiment of sleep — they do not share risk profiles.

Consider the breakdown of risks across our 20+ portfolio companies:

Medical device interventions (Aesyra, Restera) face FDA clearance timelines, clinical validation requirements, and physician adoption curves.

Medical device diagnostics (Bairitone Health) face risk factors similar to medtech interventions (FDA clearance, reimbursement coding and coverage decisions) but are also more exposed to clinical workflow adoption and standard-of-care risks.

Pharmaceutical and therapeutics companies (Mosanna Therapeutics) face clinical trial risk, IP risk, and eventual payer negotiations.

Prescription digital therapeutics (Big Health) sit at the intersection of clinical validation and enterprise health system sales and face their own distinct reimbursement and formulary access dynamics.

Consumer hardware companies (FreshBed, Amira, Loftie, Kimba) face manufacturing risk, retail distribution risk, and consumer discretionary spending sensitivity — an entirely different set of drivers from any of the clinical risks above.

Consumer brands and CPG (Future State, Ritual Brands) face stiffer competition, retail shelf dynamics, and marketing efficiency risks.

AI, software, and data platforms (EnsoData, Arcascope, Sahha, Arctop, Sleep AI) face B2B enterprise sales cycles, technical differentiation, and developer adoption risks.

Content and entertainment companies (Endel, Mind Candy, Athvance) face IP, distribution, and audience monetization risks.

Deep tech and incubation companies (Dust Systems) carry early-stage technical and commercial risks characteristic of frontier research.

A CMS reimbursement ruling that disrupts our diagnostics companies has no effect on Endel’s streaming revenue. A consumer discretionary spending contraction that weakens Loftie’s sales does not affect Big Health’s enterprise health system contracts. A formulation issue with Mosanna’s nasal spray does not affect Sahha’s B2B API business.

All of these businesses are “sleep” companies yet they are widely diversified across distinct, largely uncorrelated risk vectors.

Revenue Model Diversity

How our companies generate revenue is as varied as how they manage risk. Distinct revenue architectures mean that macro shocks — interest rate cycles, consumer sentiment shifts, healthcare policy changes — hit different parts of the portfolio through entirely different transmission mechanisms:

These distinct revenue models diversify exposure to economic cycles.

Geographic Diversity

A less-discussed dimension of portfolio correlation is geography. Many specialist VCs inherit geographic concentration as a byproduct of specialist networks due to clustering of innovation around universities, incumbents, and startup communities. This creates single point-of-failure exposure. Natural disasters or regional conflict can disrupt an entire portfolio.

Fortunately for us, centers of sleep science excellence and innovation are distributed globally and our portfolio mirrors this broad distribution. Our portfolio companies span five different states and eight different countries, meaning that no single storm, war, or regional banking failure touches more than a small fraction of our portfolio.

Buyer Universe

Exit opportunity concentration also increases portfolio risk. A limited acquirer universe reduces optionality and number of potential bidders.

The broad range of categories and sectors featured across our portfolio maps to a diverse range of potential acquirers including Pharma/Biotech companies, Healthcare companies, Consumer/CPG companies, Media companies, Big Tech companies, Big Sleep companies, and PE firms.

No single acquirer category dominates.

Conclusion

No single scenario simultaneously impairs the full portfolio. In a downturn, our consumer businesses impacted by reduced discretionary spend would contract, our medtech & healthcare businesses would be less impacted, and cheaper digital therapeutics may perhaps accelerate. In an expansion, consumer brands and hardware may outperform while clinical-stage companies would continue to progress on their own timelines.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Gamified, mobile-optimized, and UX forward services continue to dominate product management strategies across the healthcare industry. From legacy health systems to startup virtual care platforms, the focus remains on “consumerizing” clinical products and services.

This movement is widely discussed. Less discussed, however, is the inverse movement rapidly gaining traction: medicalization of the consumer. Today, we are witnessing a cultural and commercial shift in which consumer brands adopt the language, authority, and aesthetics of medicine to sell everything from skincare to snacks.

Scary sandwich bags

Before brands began borrowing lab coats and clinical charts, the seeds of the medicalized consumer movement originated in the everyday objects around us. Risk was everywhere, quietly embedded in the mundane: sandwich bags leaching PFAS, black plastic kitchen utensils loaded with flame retardants, baby pacifiers harboring endocrine disruptors, food packaging infused with phthalates, and countless other invisible chemical exposures. These objects, once assumed inert, revealed the hidden ways that the environment could shape our biology, compromise health, and circumscribe autonomy.

In response, consumers began to see everyday products not just as conveniences but as powerful tools of disablement and enablement. As the landscapes of life - the kitchen, the bedroom, the playground - became as risky as the lifestyles themselves - smoking, sitting, drinking - new problems to solve emerged. This paved the way for a contemporary culture that treats consumption itself as a vector for medical intervention.

The evidence aesthetic

What once differentiated a luxury lotion from a pharmacy cream was branding; now it’s scientific validation.

Copy draws heavily from medical jargon. “Clinically proven,” “peer-reviewed,” “evidence-based,” and “doctor-developed” are no longer confined to pharmaceutical therapeutics but permeate consumer categories like beauty, food, and fitness.

This shift is also visual. Consumer brands are absorbing the aesthetics of the clinic: lab imagery, biotech graphics, and neon palettes that evoke the world of research, mathematics, and chemistry.

The aesthetic of wellness is being replaced by the aesthetic of evidence.

This statement has not been evaluated by the FDA

The result is a gray zone, a para-clinical culture. Consumer brands increasingly operate as if they were part of the healthcare system, but without its oversight or obligations.

We see this in nutrition brands citing “small independent studies” with the same gravitas as randomized controlled trials, or in beauty companies using phrases like “DNA repair” and “microbiome balance” to reframe cosmetic products as molecular therapies.

“This product is not intended to diagnose, treat, cure, or prevent any disease” lives rent free.

Flavors of science

Fear and suspicion fuel the medicalization of consumer. Concern that everyday artifacts are making us sick. Lingering guilt that we should use consumption as a means of medical intervention. Distrust in brands to sell us products that actually do what they promise to do.

Left fearful and suspicious, consumers increasingly migrate toward the domain of science-esq authority. Like religious relics, citations and white coats confer faith in a system of order amidst fear and suspicion.

As we continue pathologizing personalities and utilizing consumption as a means of medical intervention, health and wellness will increasingly form the basis of identity. This means further opportunities for consumer brands to utilize the language and aesthetics of medicine.

The paradox is that the vast majority of consumers aren’t actually reading the scientific literature. Clinical studies are table stakes but true brand differentiation occurs through influencer enrollment, celebrity endorsement, and retail curation. In a world where taste is the alpha, discerning which flavor of scientific marketing to utilize is the difference between good and exceptional. Do you like systematic reviews or are you more of a meta-analysis type of guy? Give me an N-of-1 any day.

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Dreams of revolutionaries hoping to bring forth new modes of political sovereignty often end up corrupted into nightmarish new forms of tyranny.

Supporters of the French revolution believed that overthrowing the monarchy would usher in a new era of prosperity. These revolutionaries dreamed of a new sovereign republic that would defend and advance the ideals of liberty, equality, and fraternity. This dream quickly descended into a nightmare as power-hungry politicians filled the power vacuum with political violence, public executions, mass imprisonment, and dereliction of national defense. France’s reign of terror ended only with a military coup that centralized power first into the hands of three consuls and then ultimately into a single, dictatorial emperor: Napoleon.

Removal of the established structures that once preserved a system of sovereignty creates the ideal environment for new forms of domination to emerge.1 Devolution from idealistic revolution to tyrannical resolution is a common theme across history: 1917 Russia, 1979 Iran, 2003 Iraq, 2010 Egypt, and 2015 Myanmar are well-known examples but there are countless others.

Just as political sovereignty untethered from traditional structure can give rise to chaos, disillusionment, and new forms of oppression, so too can biological sovereignty. In the struggle to secure biological sovereignty for our species, our communities, and ourselves, we risk building new prisons that are less conspicuous but just as oppressive.

As a species, the technologies we build to free ourselves from environmental pressures often introduces new forms of biological tyranny. Similarly, the struggle to secure greater biological sovereignty from legacy institutions as communities and individuals also introduces new forms of oppression.

New technologies and ideologies help us claim biological sovereignty but simultaneously spark new sources of risks and constraints. These introduced impositions are often less imposing than the ones they replaced; many would argue that suffering from chronic disease is still better than dying from acute starvation. But better does not equate to good. Every answer still produces new questions.

We organize political systems and build technologies, they produce externalities, we correct them, and these efforts produce new challenges in the process.

Subscribe now

Understanding sovereignty cycles

Cycles of sovereignty expansion and contraction are accelerating. Paradigm shifts occur more frequently as knowledge builds exponentially, systems become more interconnected, information loops tighten, and time between major innovations shrinks.

As these cycles accelerate, new value creation opportunities emerge more quickly and more frequently. Rapid technological deployment destabilizes traditional structures, introducing new demands, generating unintended consequences, and leaving needs unmet. Viral spread of ideology via memes and the greased tracks of internet media reshapes cultural landscapes far quicker than ever before, sparking new trends and advancing the velocity of new, serviceable consumer desires.

While paradigm shift acceleration amplifies new value creation opportunities, it simultaneously increases the difficulty of remaining valuable over consecutive shifts. Remaining embedded in the commercial infrastructure of an industry becomes increasingly harder as switching costs decrease, iteration speeds increase, and priorities shift. Cultural permanence is significantly harder to achieve as attention spans wane. The spotlight moves to the latest and greatest and environmental change introduces new behaviors. Futuristic innovation becomes more difficult when the future becomes more difficult to envision.

In this era of acceleration, it becomes increasingly important to identify where in the cycle a category sits. As seed investors, we seek to identify early signs of emergent externalities created by expanded promises of sovereignty. In other words, what frictions or failures are emerging for early adopters of a technology or early believers in a nascent ideology? These unintended consequences are likely to become the next established regime around which the next cycle revolves. We spend much of our time searching for health and wellness market categories that are entering the destabilization stage and identifying high-potential entrepreneurs from the early adopter cohort confronting emergent externalities.

Cycles of bio sovereignty are not just applicable to venture investors. For incumbents, understanding why the status quo is being challenged by new promises of expanded sovereignty may be the difference between enduring success and lost market share. For startups, understanding how backlash to emergent technology or ideology threatens continued growth may prevent customer churn and brand disillusionment. Regardless of occupational role or industry position, these questions should help guide allocation of resources for greatest ROI.

Case studies

Let’s use cigarettes and hormone replacement therapy (HRT) for menopause as two case studies to exemplify the cycle.

This arc plays out again and again throughout the history of medicine and spans procedures like bloodletting and lobotomies to pharmaceuticals like FenPhen and thalidomide.

The cycle is easiest to visualize when a safety failure underlies the destabilization stage as is the case for cigarettes, HRT for menopause, and the other examples above. But it plays out across safe medical innovations as well; new debates, inequities, or dependencies can surface not from safety risks but from economics, access, ethics, or cultural resistance.

Insulin and organ transplants are good examples of this.

In both cases, patients trade pharmaceutical dependency for the promise of survival. A fair trade, I’d argue.

But from a venture perspective, the fairness of the trade itself is not important. What is important is acknowledging that every time we claim biological sovereignty we simultaneously spark new risks and constraints. Sometimes these are new health risks (as with cigarettes), other times they are new dependencies (as with insulin), and still other times they are new global concerns (as with cars and air pollution).

There will always be new value creation opportunities. Make sure you know where to find them.

Stay tuned to see where the health and wellness tools of today - GLP-1s, wearables, probiotic supplements, etc. - fall along the bio sovereignty cycle and learn how early adopters are already highlighting where future arcs will occur.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

The crown is off the king’s head

For 72 years, King Louis XIV ruled France with absolute authority. Divined by the grace of God, the Sun King embodied unquestionable power over land, law, and life itself in a unified regime of state and bloodline. Sovereignty emanated from a single man.

73 years after his death, the doctrine of absolute monarchical sovereignty collapsed in a violent revolution that rejected the idea that power could be housed in a single, sanctified body. The beheading of the last king of the Bourbon dynasty was a dismemberment of the sovereign head from its political body. It was a rejection of inherited control, a call for collective autonomy, and a demand to restructure authority.

Today, the thrones of modernity are empty once more and wars are raging to occupy them.

Contemporary life is marked by renewed struggle over sovereignty. In eastern Europe, an ancient prophecy of Moscow as the third Rome empowers Russian ambition and fuels war across Ukraine. In the south China sea, disputes over territorial control fuse with lingering nationalist resentment to heighten tension between China and Taiwan. In the Middle East and southern Asia, religious fanaticism and historical partitions clash in contests over land and legacy. Each of these conflicts is a struggle for sovereignty: who rules, over what territory, and with what authority?

The scale and spectacle of these interstate conflicts is both captivating and terrifying. Tank columns in the Donbas, naval carrier groups patrolling the Luzon strait track, and ground to air missiles illuminating the skies over Tel Aviv track to classical understandings of conflict and sovereignty. There is a visibility and scale that allows us to easily recognize their presence.

Contemporary struggles for sovereignty are not just confined to interstate conflicts. Across the world, the legitimacy of national governments is increasingly contested by intrastate actors and organizations that seek to reshape traditional power structures, jurisdictions, and rules of law. These too are highly visible, in large part due to the juxtaposition of their conspicuous characteristics against the backdrop of norms and places we once thought immutable. I will never forget watching a viking run berserk in the halls of the Capitol building as Secret Service agents aimed handguns at men peering through the broken glass windows of the Rotunda. Could such an overt opposition to existing sovereignty be any more obvious?

The theater of these inter and intra state conflicts captures our attention and fills our screens. But these conflicts are simply battlegrounds within a far larger and far more diffuse struggle: the burgeoning fight for biological sovereignty. This is not merely a war over territory or ideology, but over the protocols of life itself - how societies are organized, how individuals are governed, how experts are authorized, how customers are sold to, how knowledge is produced, and how authority is granted. Sovereignty is no longer confined to dominion over subjects and land; today it includes dominion over bodies, behaviors, and biological data.

This war for biological sovereignty is unfolding across domains. It stretches from the legislative chambers where health data regulations are debated, to the algorithms of platforms that quietly reshape behavior, to the viral memes that recode our understanding of selfhood and autonomy. Everywhere, power is being renegotiated, legitimacy redefined, and authority redistributed.

Most of these battlegrounds lack the grandeur of conventional warfare between nations or the spectacle of anti-government riots. Instead, they are subtle, procedural, mathematical, and largely invisible, less blood and barricades and more dashboards and defaults. They are battles waged at the contested borderlands between legacy standards and emerging protocols, between federal regulators and disruptive startups, between accelerationists and doomers, between soldiers armed with databases, twitter threads, scientific studies, and GPUs. The crown is off the king’s head and many hands now reach for it.

Subscribe now

Borderlands of biological sovereignty

Sovereignty is supreme authority to govern without external interference. Biological sovereignty is thus the power to exercise control over time, body, and mind free from coercion or systemic dependence.

As a species, we secure biological sovereignty through the tools and systems we develop to insulate ourselves from the hazards of our planet. As communities, we claim biological sovereignty through national borders and local cooperatives. As individuals, we accrete biological sovereignty through self-experimentation, self-regulation, and self-sufficiency.

In the same way a state cedes sovereignty to a federation, biological sovereignty is often consolidated at higher levels of organization. Local governments and consumers grant control over food safety, sanitation, and standards to federal departments like the USDA, trading autonomy for standardized, scalable food security. Individuals relinquish control over care access and provider choice to insurance companies, trading responsibility for reduced personal risk.1

But as new technologies and ideologies emerge, these borders of sovereignty become contested; new tools enable communities and individuals to exercise control once only afforded to institutions with greater resources or economies of scale. Demarcation lines are redrawn as values are reconsidered and once-established understandings of health, liberty, and authority are reimagined.

Sometimes, rapid technological and ideological development coalesce into a particularly disruptive era that radically shifts the locus of control over biological sovereignty.2 At Supermoon, we believe we have entered the opening chapter of one such era.

Prelude to a new era

Constructive interference between waves of technological development and emerging ideologies is unleashing renewed struggles for biological sovereignty. Wracked by epidemiological change and a global pandemic, legacy structures offer little defense against the surging tide.

COVID

Struggles for biological sovereignty are often waged in the opaque battlegrounds of procedure, legislation, and statistics. The pandemic exposed these skirmishes and “brought the war home” to individuals who previously gave little to no thought about their health freedom. Mask mandates, lockdowns, and vaccine directives ignited debates over bodily autonomy versus collective safety. Misinformation flooded social media, eroding trust in both institutions and personal decision-making. Contact tracing, biometric sensing in public areas, and other forms of digital health surveillance introduced new friction between individual and state. Many people attempted to reclaim sovereignty through self-experimentation and off-label drug use. Poor and rural communities struggled to deploy adequate health resources, revealing the limits of their local sovereignty and ability to provide care. Supply chain fragility revealed dependencies on other countries to supply critical products and components, while reliance on international institutions like the WHO for critical epidemiological data and information exposed limits to national self-determination. Breakthrough treatments in the form of mRNA vaccines demonstrated the unique ability of our species to secure protection from external risks but simultaneously fueled biotech skepticism and distrust of powerful pharmaceutical companies.

Epidemiological Change

Widespread belief that the current health system in America is flawed lends support to disruptors seeking to reclaim biological sovereignty.

America is beset with chronic health conditions that weigh heavily on healthspan, reducing the number of years spent in good health; 6 in 10 Americans are chronically ill. Average life expectancy at birth fell year after year toward the end of the 2010s, reaching a low of 76.1 in 2021. While it has rebounded slightly since then, life expectancy growth is forecast to stagnate over the coming years. While healthspan falls and lifespan stalls, spend on healthcare continues to rise. Health spending in the U.S. increased by 7.5% in 2023 to $4.9 trillion, outpacing GDP growth.

A major cause of these epidemiological changes is lifestyle choice. Americans spend the vast majority of time indoors, sedentary, in climate-controlled environments, socializing online. The bed is no longer just a refuge for sleep; it is desk, barstool, pew, gallery, and bleacher fused into one.3

Ideology

Emergent and resurgent beliefs increasingly challenge once-dominant ideologies of neoliberalism and globalism. Nationalist, protectionist, and populist narratives seek to reclaim political and economic sovereignty from supranational organizations. Relativism and political activism shape identity politics, cancel alternative views, and remove books, symbols, and monuments promoting the counter-narrative. Liberals blast Trump and his band of populists as ignorant lay folk unable or unwilling to accept the truth, while conservatives turn up their noses at the rotten bias inherent to science and expertise. Nostalgic revivalism offers familiarity in quaint tradition and old customs. Technoutopianism, accelerationism, and other pro-tech philosophies weave across party lines, furthering top-down abundance agendas and bottom-up libertarian ideals.

This plurality of ideologies suggests the collapse of cohesive grand narratives4 - capitalism, communism, liberal democracy, etc. - into a fragmentation of competing micro-ideologies each optimized for certain communities or platforms. As the hegemony of traditional authority is increasingly challenged by alternative beliefs, communities and individuals increasingly seek to reclaim biological sovereignty from centralized institutions. Control is wrested away from the institutions that aligned themselves with the grand narratives of yesterday. Today, the institutions that are most under siege are non-corporate entities - supranational organizations, NGOs, political parties, universities, etc. but perhaps tomorrow is it technology incumbents that find themselves losing control to insurrectionists seeking greater autonomy.

Technology

The human mind once reigned supreme as the pinnacle of intelligence. Today, this once sacred doctrine is collapsing as superhuman artificial intelligence is born.

AI is increasingly able to perform tasks once reserved to humans - from writing code to designing drug formulations - faster, cheaper, and at scale. This can empower small groups and individuals to reduce reliance on others and consolidate control. Companies are using AI to reduce headcount, internalize functions, and minimize financing requirements in order to retain equity and long-term control. AI lowers the barriers to entry to supplying digital products and services, enabling non-technical and unskilled workers to build without relying on 3rd party labor.

AI also increasingly fills the role of expert, providing judgement and data-driven perspectives in realms once monopolized by board-certified, classically-trained experts. Just as claims to authority based on bloodline or piety began to weaken during the industrial revolution as trust in standardized scientific knowledge accelerated, AI is disrupting the locus of trust once more by giving people an alternative provider of truth.

Sensor and diagnostic technology is another major category of technological development facilitating new regimes of biological sovereignty. Across the medical field, miniaturization of diagnostic technologies is enabling diagnoses to occur outside of clinics and laboratories. Simplified user experiences enable usage by untrained individuals. Once large, complicated, and confined to clinical sites, diagnostic technologies are now small, simplified, and accessible everywhere, allowing individuals to reclaim sovereignty.

For a vibrant human future

Today’s burgeoning struggle for biological sovereignty is a crucible of change. This crucible will forge new regimes that govern the relationship between our species and the world around us, structure new systems of meaning, and advance the right of the individual to self-govern their time, health, and well-being.

New tools, rituals, narratives, and protocols will equip these regimes with fully-stocked arsenals to defend and extend borders of biological sovereignty. The companies building and distributing these arsenals will create exorbitant value and establish themselves as generational businesses in the process.

There is a moment in time emerging where the historical traditions and legacy institutions that have long-governed our world are becoming accessible, malleable, and refineable. It is as if the watch casing is being removed, exposing the gears whirring beneath. In this moment we can imagine futures that look vastly different than the world of today and alter the underlying structures that regulate how we experience time, value, and our relationships with one another.

We do not know how long this moment will last or what the world will look like when the watch is sealed once more. Nonetheless, we intend to exploit this historical moment in partnership with the scientists, technologists, and creatives dreaming ambitious dreams for a future that looks far richer, healthier, and more glorious than the present.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Yesterday

Our culture and economy are in the liminal space between yesterday and tomorrow. As consumer VC firm Hannah Grey described it in their latest Cultural Vibrations report, “we live in a moment where the economy and cultural fabric are straddling legacy systems while staring down a learning curve of unfolding possibilities.”

For some, yesterday is a memory of kids playing ball in empty lots and drinking pop for 10 cents a bottle. For others, it’s watching Forrest Gump on a VHS tape rented from Blockbuster as a dial up modem screeches in the background. Yesterday is as much Little House on the Prairie as it is Harry Potter, as much Led Zeppelin as it is Eminem.

Dusk came yesterday in two phases. As platforms like Google, Facebook, Amazon, Netflix, and Spotify bypassed traditional distribution constraints and simplified access to suppliers (webpages, content, vendors, movies, music), they offered better user experiences (choice, access, price, time-savings) and successfully aggregated consumer demand, shifting the locus of value creation from distribution of unique supply to aggregation of mass consumer demand. This evolution stripped suppliers of regional monopolies and industry-exclusive relationships, forcing them to compete on a now global playing field, against significantly more participants, in markets with significantly lower barriers to entry.

While this massive transformation upended centuries of traditional economics and alone would have reshaped cultural trends, tastes, and preferences for decades to come, the integration of software and data tools into this new economic structure accelerated the onset of the cultural witching hour in which we find ourselves. As platforms layered on analytical tools to monitor and improve user engagement and conversion metrics, they optimized marketplace dynamics for ultimate efficiency, promoting suppliers with proven, scalable products that appealed to the greatest number of consumers. Not only were suppliers now forced to trade in the new marketplaces developed by internet aggregators, they also needed to now supply products that aligned with the demand structures defined by the marketplaces themselves. This meant shorter songs, pastel color palettes, International AirBnB style, repeatable game mechanics, blanded logos, “1500 Bode clones from brands that wouldn’t be doing embroidery before, but now they’re doing fake vintage-tablecloth shirts for a 10th of the price”, movie sequel upon movie sequel, socially-engineered dating app profiles, political influence bots, and sensationalist news content. Across every domain, suppliers adapted to the structural scaffolding of algorithmically calibrated marketplaces by homogenizing products, reusing existing IP, copying popular aesthetics, creating for mass appeal, and making “data-driven” decisions to inform production choices.

Somehow, dreams of a better user experience corrupted into nightmares of cultural stagnancy, enshittification, and a dark age of average. Unprecedented access to an endless supply of seemingly everything - from news to music to movies to clothes - offered a tantalizing value proposition that truly did make our lives better or at least easier. But somewhere along the way, digital marketplaces turned vapid and stagnant.

Artificial intelligence now seems poised to reshape the supplier marketplaces that led us here in the first place. Digital marketplace aggregators forced suppliers to compete globally against significantly more participants in markets with significantly lower barriers to entry. AI will exponentially accelerate this transformation, removing almost all barriers to entry to supplying digital goods and services, from AI generated music and movies to software applications to ecommerce sites. It will superpower the algorithms that mediate marketplace relationships, removing almost all friction and unifying supply and demand in precise harmony. Demand can increasingly evolve into addiction, with suppliers able to formulate their products for maximum dependency. Perhaps the concept of marketplace will become extinct, with perfect, vertically integrated AI capable of predicting, making, and satisfying our demands before we even know what we desire.

Where do we go from here? It is nighttime and we are unsure of what the new day will bring. The vibes are shifting.

Subscribe now

Cultural Night Terrors

Lurking in the dark night is a deep yearning for a tomorrow that looks more like days past. The changing nature of culture and economy drives us backwards into tradition and history, inviting us to seek familiarity in the stability of a world we once inhabited. Or more likely, imagine our ancestors once did. Nostalgic revivalism and the resurrection of old customs gather speed just as the future races towards us.

But it is not just the future that pushes us into the past. The frictionless structures of digital marketplaces and global capitalism have consumed all - there are no dark spaces anymore. If there is no new territory to explore, no more frontier, than all that is left is to turn back. So we regurgitate the old world, strip it of its pretense, and declare greed is good since the roaring 20s are back (boom boom!).

Perhaps the rhythms of history are destined to cycle around and around in a cultural ouroboros, recursively producing anew the same narratives, tastes, and aesthetics of our ancestors 100 or 1000 years ago. Perhaps this feeling of a time between past and future is destined to be felt by every generation born in the delicate period when what has come becomes what comes next.

But what if there was a different path? Not just a long switchback on a single road but a second road altogether? Perhaps then the icicles of our frozen culture may instead become the arrowheads of a flourishing renaissance.

Dreaming Lucid

If we are to escape the echo chamber of history and forge a new path forward we must be able to consciously confront the psyche of modern society and see ourselves for what we are. We must see how time and time again we choose the path of least resistance. We must understand how the systemic outcome of a population demanding the path of least resistance within a cultural and economic framework hyperoptimized to satisfy demand is cultural poverty and corporeal gluttony. And we must learn how to terraform the terrain so that the path of least resistance leads to flourishing and vibrant communities.

Resistance is friction, and it exists in a range of shapes and forms: delays, constraints, information asymmetries, regulations, borders, and languages. Friction is the sea between an island and the mainland and the season between planting and harvesting. To the market, these are inefficiencies that hinder the movement of products, people, ideas, and energy from point A to point B and decrease potential profit. To the individual, these are difficulties, deficits, and limitations that hinder our ability to possess that which we desire. So much human ingenuity and technical progress has been directed at conquering friction - fire, the wheel, the printing press - that the story of mankind can almost be summarized as a war against friction. Digital marketplaces streamlined by algorithms accelerated humanity’s victory over friction by shortening time delays, removing borders, correcting asymmetries, democratizing information, and improving accessibility.

But we must remember that this is what we asked for. We wanted Amazon Prime and global content catalogs on-demand with no commercial breaks. We wanted bagels delivered on hungover mornings and the grocery shopping done for us. We wanted to reduce resistance to the friction of skin swiping across aluminosilicate glass.

Thus dreams of a different tomorrow cannot be naive. Degrowth visions of a post-platform, post-capitalist world fail to offer the standard of living so many across the world are accustomed to. Frictionless life, with its year round avocados, same day delivery, and dopamine on-demand, is an offer too enticing to pass up. Barring some catastrophic event, the era of mass self-sufficiency, little-to-no international travel, and decentralized energy is bound to the past.

Yet friction, in the form of distance, scarcity, time, and cost, shapes our values. Removing obstacles that hinder our ability to possess that which we desire ultimately reshapes the value that we once prescribed those same desires. Scarcity, for instance, precludes unhindered access and forces competition for finite resources. As digital marketplaces and artificial intelligence continue to increase the supply of content and information while simultaneously reducing barriers to entry, the value of any given digital resource is reduced. Moreover, information availability transcends digital bounds and affects the scarcity of in person experiences. Perhaps nowhere is this more evident than in travel, where publicized knowledge of “hidden gem” locations transforms those locations into the most popular destinations, reducing their appeal by increasing supply of visitors.

The course of a river is latent in a terrain before the first rain ever falls. We too will seek the path of least resistance.

Instead of attempting to turn the river around, we can shape its flow and direction. Instead of changing human behavior, we can shape where our paths wish to go.

Tomorrow

We sanded the rough edges and greased the tracks too zealously. All around the forces of globalization, capitalism, and algorithmic engineering work to flatten the ranges that once obstructed the exchanges between individuals. The topography is being leveled, the rivers bridged, and the roads paved. Designed in Cupertino, developed in Shenzhen, sold in Istanbul - using parts sourced in the Congo, people raised in Delhi, and designs scoured from Estonia. The tandem of digital marketplaces and data tools removed the obstacles to supply-demand efficiency and in doing so reduced the friction that fosters creativity, stimulates originality, enables self awareness, and generates richness of life.

By flattening the ranges of society, we at once dismantled the ivory tower that insulated traditional culture from mass popularization and filled the bohemian underground that insulated alternative individualism from traditional culture. As a result, we are left with a philistine society consuming dopamine culture and dragging every fringe style and activity into the mainstream.

But the novelty of unrestricted access to supply is wearing off and anhedonia is beginning to set in. The dopamine rush from our digital dope doesn’t feel like it used to. We can only scroll so much Tiktok, buy so many clothes, and react to so many sensationalist news articles. At some point a numbness develops. At some point, another sunny summer day doesn’t feel as warm as it once did and we must experience a cold winter to remember the joy we once felt.

There is a pressure forming to rebuild the towers and excavate the underground from both above and below. You can sense it in group chats and parties and Substack comment threads. We are remembering the uses of social diversity, not in the DEI sense, but in the sense that we remember we are dependent on others to define for ourselves what we stand for, and that if there are no others we are nothing at all. We are remembering that the breakup of Pangea is what supercharged evolution, that diversity and richness are predicated on division. In this process we must not forget that since we understand ourselves in relation to others, we are responsible for them, and they are responsible for us. Chauvinism and fascism reduce diversity as much as a supercontinent does. But to insulate culture and individualism from the pressures of mass society we must create intimate, gate-kept spaces and communities.

If friction shapes value, then meaning itself depends on boundaries. The flattening of culture is both a loss of creativity and a collapse of differentiation. When everything is accessible, nothing feels sacred. When every style is public, every place discoverable, every thought instantly shareable, the distinctions that once formed identity, belonging, and aesthetic richness erode. But by damming the valleys, building cultural high grounds, and allowing meaning to pool through intentional separation, we can use our natural tendency toward paths of least resistance into building a world that looks better than both the present and the past.

It looks like an archipelago.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Introduction

Legend has it that the field of modern medical diagnostics began in a wine cellar in Austria. In 1761, Leopold Auenbrugger, a physician working at the Spanish Military Hospital of Vienna, was exploring the possibility of performing an in vivo autopsy, searching for a way to discover the location of internal disease during the life of the patient as opposed to postmortem examination. Auenbrugger was the son of an innkeeper and during a trip to his family’s inn he observed his father tapping on wine casks to determine the amount of wine present. Utilizing the same technique on his patients back at the hospital, Auenbrugger discovered that he could correlate thoracic diseases with the sounds produced by a patient’s thorax when tapped. Auenbrugger had discovered percussion as a diagnostic technique and more importantly, had identified a method to diagnose the location of a disease in a living patient. Today, percussion - along with inspection, palpation, and auscultation - is one of the four actions that form the basis of a physical examination.

Physical examinations offer insights into a patient’s health that can be used to diagnose disease and inform treatment decisions. They give clinicians the opportunity to look for a problem (inspection), listen for a problem (auscultation and percussion), and feel for a problem (palpation). Before the advent of modern diagnostic technologies, clinicians would also taste and smell for problems, sampling patient’s urine to taste for diabetes and smelling sores for signs of infection. These actions enable doctors to perceive if a problem exists, where a problem exists, and to what extent a problem exists. Without these examinations, provisioning healthcare would be guesswork.

In the 250 years since Auenbrugger, the medical technology industry has invented a range of diagnostic technologies to supercharge physicians’ own faculties, from stethoscopes for intensifying sounds to MRIs for seeing under the skin. Modern diagnostic technologies, like blood panels and genetic tests, offer entirely new abilities altogether, enabling clinicians to gather diagnostic insights that are imperceptible to human senses.

At Supermoon, we believe the field of sleep medicine has benefitted more from the advancements in medical diagnostic than any other field. A highly complex physiological process, sleep involves unique changes to brain activity, eye movements, heart rate, muscle activity, and body temperature. These processes occur under the cover of darkness when a patient is unconscious, at home, and often alone. Traditional physical examinations are thus of little value in perceiving the symptoms associated with unhealthy sleep and are an insufficient means of diagnosing sleep disorders.

Fortunately, a range of technologies invented over the last 75 years have opened a window into the once-obscured realm of sleep and now provide crucial insights into the pathophysiology of sleep disorders. From the electroencephalogram (EEG) to the electrocardiogram (ECG) and the photoplethysmogram (PPG) to sonar sensors, contemporary medical sensing technologies are enabling sleep doctors to perceive if a sleep disorder exists, where a sleep disorder exists, and to what extent a sleep disorder exists.

As these technologies transcend the lab and move from bench to bedside, patients themselves are able to visualize and measure the quantity and quality of their sleep through wearable devices, “nearable” devices, and consumer EEG technologies. These devices enable individuals to track their personal sleep data longitudinally, affording the possibility of perceiving changes over time, recognizing undesirable trends, and incentivizing action toward better health.

What were once barriers to the diagnosis of sleep disorders are now benefits. The sleeping patient, unconscious and stationary for hours in a consistent, low stimulus environment, presents a uniquely valuable window of opportunity for physiological data collection. Sleep is the best time across the 24 hour cycle to capture large quantities of high fidelity physiological data; environmental noise is reduced, wired power generation can be utilized, and subjects are less likely to interfere with the recording device. Perhaps most importantly, an incredibly large amount of data can be captured. A standard sleep study captures data from four to six EEG channels, two EOG channels (eye movement), and one EMG channel (muscle activity), plus a range of simultaneously recorded cardiac and respiratory signals like pulse rate and blood oxygenation. Each of these sensors captures upward of 200 datapoints per second, collectively generating thousands of physiological datapoints per second and millions of datapoints throughout the course of the night. The quantity and comprehensive nature of this data is uniquely suited for machine learning algorithms capable of perceiving diagnostic insights imperceptible to human senses. Thus, sleep’s singular characteristics may ultimately position the field to benefit the most from advancements in diagnostic technology, from physiological sensors to AI software.

Bounding the Market

At Supermoon, we segment the sleep market spectrum into three broad categories: interventions - ways and means to treat, improve, and enhance sleep; insights - ways and means to track, monitor, and diagnose sleep; and infrastructure - ways and means to streamline, optimize, and enable sleep market businesses.

This grouping structure is not mutually exclusive, but it is, for the most part, collectively exhaustive. Many companies in the market offer products across segments, but we can generally always bucket a startup into at least one of these segments.

This profile focuses on the insights category of the sleep market spectrum. It is not meant to be comprehensive (there are hundreds of startups in the sleep insights market), but it should instead help provide an overview of the incumbents and startups building solutions to track, monitor, and diagnose sleep. You can find my previous profile on the sleep interventions market here.

Categories of Insights

At Supermoon, we segment the sleep insights market into four categories: trackers, diagnostics, tests, and supplies. At a high-level:

• Trackers help us monitor physiological, behavioral, and environmental variables over time.

• Diagnostics help sleep providers classify and measure health conditions along industry-established guidelines.

• Tests help us identify biomarkers of disease and provide a lens into our genes, hormones, and neurological health.

• Supplies furnish sleep providers with the hardware to collect information on our nocturnal health.

The vast majority of companies in the trackers category and the tests category sell B2C (with the exception of some companies in the fatigue, actigraphs, and intraoral segments), while the vast majority of companies in the diagnostics category and the supplies category sell B2B.

Market Evolutions

Everyone wants a piece of the home sleep test market: Covid flipped the switch for home sleep testing. Before the pandemic, about 70% of sleep tests were in-lab polysomnograms and only 30% of sleep tests were performed at-home. Today, the ratio is inverted: 70% of sleep tests are done at home and only 30% are performed in the lab. Recognizing the shifting landscape, incumbents ResMed and Zoll both acquired HST device manufacturers in 2021 (Ectosense by ResMed, Itamar Medical by Zoll). Startups like Onera, Acurable, and Wesper are all innovating around product design but offer sleep providers different “types” of HSTs, with some tests more comprehensive than others.

Harnessing the power of smartphones: In 2018, SleepScore Labs launched the first non-contact sleep tracking app, which transformed a user’s smartphone microphone into a sonar-based sensing technology. Instead of having to purchase a new hardware device, consumers could simply download an app onto their smartphone and begin tracking their sleep that night. Following SleepScore’s lead, startups like Apneal, Diametos, and SnoreLab are developing apps to track sleep, screen for sleep apnea, and diagnose snoring. Last year Pfizer acquired ResApp Health, which identifies respiratory disorders like sleep apnea by analyzing users’ coughs.

Connecting the dots between sleep and disease: The Digital Medicine Society publishes an open-source library of industry-sponsored studies of new medical products that utilize digitally-collected endpoints. Almost 30% of all records in the database are related to sleep. From using wake after sleep onset (WASO) to test the efficacy of a biologic for glucose intolerance to using sleep onset latency to test the efficacy of a drug for adrenal insufficiency, pharmaceutical companies and device manufacturers are recognizing both the value of physiological monitors to their R&D and the value of sleep related metrics as clinical endpoints.

Wearables as jewelry: Wearables are a form of social signaling, indicating to others that the wearer attends to their personal health and wellness and placing them among the ranks of other wearers of wearables like professional athletes and business executives. These devices become a part of an individual’s style and take real estate from rings, bracelets, and luxury watches. Incumbents like Apple and Oura have promoted this concept through partnerships with luxury icons Hermès and Gucci, while Whoop has pushed the customization potential of their wearable with a wide variety of straps.

Cautionary Tales

Differentiation in the B2B sleep test market is increasingly difficult: As incumbents and startups alike tap into the shift to home sleep testing and offer sleep providers cheaper, smaller, and sleeker hardware devices, capturing market share becomes increasingly difficult. Incumbents with economies of scale, global distribution, and large sales departments have significant competitive advantages. Startups in this category will need to differentiate their hardware devices with software offerings that improve provider efficiency and reduce provider costs. New entrants may also find success targeting customer cohorts that have been historically overlooked or underpenetrated by incumbents, such as dental practices and cardiologists.

Insights without interventions aren’t sticky: Much has been said about the overload of information provided by consumer tracking devices. In fact, some users actually end up developing insomnia by obsessively concerning themselves with the data gathered by such devices, a condition known as “orthosomnia”. Yet for the majority of consumers, devices that simply provide sleep insights without offering interventions quickly lose their appeal. Successful startups in this category will pair their insights with interventions, either through development of in-house interventions (sleep coaching, soundscapes, product recommendations, etc.) or by partnering with other businesses across the sleep care continuum. Founders should thoughtfully consider opportunities to quickly prove value to customers, as many users are likely to churn before value from longitudinal data insights can be recognized.

On the Horizon

To diagnose is to detect a deviation from the norm. For Auenbrugger, to diagnose was to hear a diseased thorax produce a different sound than a healthy thorax. But for the sleep industry today, the very nature of sleep diagnostics is in flux.

Who gets to diagnose? As dentists, GPs, and other specialists increasingly recognize the relationship between sleep and their own respective medical fields, they increasingly seek opportunities to involve themselves in the nocturnal lives of their patients. Should they be authorized to diagnose sleep disorders? As patients increasingly gather data and insights into their own sleep, they are increasingly empowered with the technology to detect deviations from the norm. Should they be empowered to seek out low-risk interventions like CPAPs without a prescription? As machine learning algorithms increasingly demonstrate the ability to score sleep studies faster, cheaper, and more consistently than registered polysomnographic technicians, they increasingly assume greater and greater responsibilities across the sleep care continuum. Should they be sanctioned to make definitive diagnoses without human sign off?

How is a deviation detected? As polysomnograms increasingly lose their once-held monopoly on sleep disorder diagnostics to a range of home sleep test types, the lines between medical device and consumer gadget become increasingly blurred. Should consumer wearable devices be legitimized as clinical diagnostic technologies?

When can a deviation be asserted? As the opportunity to longitudinally track sleep over many nights, months, and years becomes increasingly technologically and commercially viable, the traditional one or two night sleep study looks increasingly archaic. Should a single night of sleep determine a patient’s eligibility for a potentially life saving intervention?

What constitutes the norm? As sleep scientists increasingly learn more about the mysteries of sleep and the etiologies of sleep disorders, their research increasingly suggests a wide spectrum of individual sleep needs, patterns, styles, and benchmarks. Should the sleep community reconsider standardized definitions like “healthy” sleep quantity (7-9 hours) and “moderate” sleep apnea (15 to 30 events per hour)?

Opportunities to create value in the sleep insights market will appear while others disappear as these questions get answered over the coming years.

Stay tuned for my next sleep market profile covering the infrastructure category: companies developing solutions to streamline, optimize, and enable sleep market businesses.

Access the full list of companies featured in this profile here.

Did I miss a company? Submit companies you think should be added to the profile here.

Supermoon invests in the modern living market. If you’re building for the human future across sleep, health, wellness, and leisure or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Subscribe now

Introduction

In the mid 1940s, health officials in the UK noticed a startling trend: more people were dying of heart attacks. Dr. Jerry Morris, an epidemiologist working in London, set out to understand why. Working off a hunch that the problem was related to occupation, Dr. Morris analyzed data from 31,000 employees of the London Transport Executive - men of similar social class - and discovered that bus drivers had twice the risk of dying from a heart attack compared to bus conductors. The only difference? Conductors were unavoidably active, forced to ascend and descend hundreds of steps on the double-decker buses each day, while the drivers were unavoidably sedentary, forced to remain behind the wheel shuttling passengers. Morris had revealed what is today common knowledge: exercise extends lifespan.

Published in 1953, Morris’s study, “Coronary Heart-Disease and Physical Activity of Work”, was a watershed moment in the history of healthcare. But moreover, it helped set the scientific foundation upon which an entirely new industry could be born: fitness.

Promoted by popular influencers like Jack LaLanne and fueled by Cold War patriotism, the fitness industry witnessed explosive growth over the second half of the 20th century. Nike was founded in ‘64, Gold’s Gym in ‘65, and Schwinn lauched their first indoor exercise bike in ‘68. Today, companies like On, Equinox, and Peloton continue to innovate in fitness market categories created in the decade following Morris’s seminal study.

At Supermoon, we believe a similar chronicle is evolving in another health and wellness industry: sleep. The field of sleep science was born in 1953 - the same year Morris published his London busmen study - with the discovery of REM sleep by Dr. Nathaniel Kleitman and Eugene Aserinsky, along with parallel work by Dr. William Dement recording brain activity during sleep with the electroencephalogram (EEG). Yet it wasn’t until the early ‘70s that scientists began correlating sleep and health outcomes. Case reports of “serious complications and sudden death” in patients with Pickwickian syndrome (obesity hypoventilation syndrome associated with obstructive sleep apnea) and speculation regarding the link between sleep apnea and sudden infant death syndrome (SIDS) encouraged investigation into the pathophysiology of sleep apnea, culminating in Dr. Christian Guilleminault et al.’s publication of “The Sleep Apnea Syndromes”, which defined sleep disordered breathing and characterized its role in disease manifestation. Nevertheless, the “Morris moment” for the nascent field of sleep science was still to come.

In 1989, as the term karoshi was becoming common parlance in Japan to describe the alarming number of white-collar workers “dying from overwork”, Dr. Allan Rechtschaffen and his colleagues at the University of Chicago published a groundbreaking study on the effects of sleep deprivation in rats, research that for the first time established the critical importance of sleep to good health. Rats subjected to sleep deprivation developed skin lesions, became hypermetabolic, acted erratically, and ultimately died within 2 to 3 weeks. Rechtschaffen et al.’s study, “Sleep Deprivation in the Rat”, was a pivotal moment for the sleep science field, and much like Morris’s busmen study did for fitness, helped provide the scientific basis for the sleep industry to emerge.

Paralleling the contemporaneous innovation that occurred at the start of the fitness industry, a number of today’s sleep market incumbents all entered the market around the same time, coinciding with scientific discoveries in the ‘80s and ‘90s like Dr. Rechtschaffen’s. Mattress Firm was founded in 1986, Sleep Number (fka Select Comfort) in ‘87, ResMed in ‘89, SleepMed (fka DigiTrace Care Services) in ‘91, Tempur-Pedic in ‘92, Sound Oasis in ‘93, Sleep Country in ‘94, and SleepData in ‘95. While Mattress Firm and Sleep Country brought national mattress retail to the US and Canada respectively, a category once largely dominated by local mom and pop shops, the other new entrants pioneered new market categories entirely, including CPAPs, ambulatory EEG, memory foam mattresses, and hardware-enabled bed systems, categories that capture large swaths of the sleep market today.

Although the market continued to grow moderately throughout the first two decades of the 21st century, the explosive growth we’re witnessing today has only just begun. Toward the end of the last decade, sleep entered the public conversation. Books like Why We Sleep and The Sleep Revolution drew attention to the science and importance of sleep, while aggressive marketing campaigns by DTC “bed-in-a-box” companies like Casper heightened consumer awareness of the market. The proliferation of consumer wearable devices like WHOOP, Oura, and the Apple Watch is enabling consumers to “visualize” their sleep for the first time, providing a mirror to evaluate change over time and incentivize sleep improvement through product purchases, clinical treatment, and healthy lifestyle behaviors. Endorsements of healthy sleep and sleep products by professional athletes, teams, and leagues are helping validate the category in the eyes of the consumer, while similar endorsements by high-performing CEOs are helping validate sleep health for the professional class. These trends accelerated during the pandemic; as health concerns, isolation, and mental health took their toll, consumers turned to interventions to alleviate their anxiety and allocated personal savings toward improving their bedroom environments. The sleep renaissance is well underway.

Bounding the Market

The sleep economy encompasses a vast range of product categories, technologies, form factors, and business models, from consumer brands and enterprise applications to clinical services and medical devices. A highly interdisciplinary field, sleep science sits at the intersection of chronobiology, neurology, pulmonology, psychology, and dentistry, and draws from a wide variety of technical domains including neurotechnology, biotechnology, pharmacology, and computer science.

At Supermoon, we segment the sleep market spectrum into three broad categories: interventions - ways and means to treat, improve, and enhance sleep; insights - ways and means to track, monitor, and diagnose sleep; and infrastructure - ways and means to streamline, optimize, and enable sleep market businesses.

This grouping structure is not mutually exclusive, but it is, for the most part, collectively exhaustive. Many companies in the market offer products across segments, but we can generally always bucket a startup into at least one of these segments.

This profile focuses on the interventions category of the sleep market spectrum. It is not meant to be comprehensive (there are hundreds of startups in the sleep interventions category), but it should instead help provide an overview of the incumbents and startups building solutions to treat, improve, and enhance sleep.

Categories of Interventions

Interventions for sleep are as diverse as the sleep market itself. Further segmentation is required.

At Supermoon, we segment the interventions space into five categories: environmental interventions, behavioral interventions, OTC consumable interventions, interventions by disorder, and other interventions. At a high-level:

• Environmental interventions help us create a healthy sleeping environment by enhancing our comfort and conditioning the climate for optimal sleep.

• Behavioral interventions help us live sleep-healthy lives by coaching us on best practices, structuring our schedules, and providing activities, meditations, and games that help ease our anxiety.

• OTC consumable interventions help us fall asleep faster by providing quick-fix pills, foods, beverages, and supplements.

• Disorder-specific interventions help us sleep better by treating our afflictions and conditions.

• Other interventions help us improve our sleep by utilizing emerging technologies to manipulate our minds.

The vast majority of environmental, behavioral, consumable, and other interventions are unregulated by the FDA, while the vast majority of disorder-specific interventions are regulated, “clinical” companies. Counterexamples include companies in the OTC consumables category that are FDA “regulated” under the Dietary Supplement and Health Education Act (or federally illegal…) and some of the companies in the snoring, tinnitus, bruxism, and jet lag subcategories of the disorder-specific interventions segment.

Market Evolutions

Sleepy categories wake up: Companies like Thuma, with their easily assembled platform bed frame, and Loftie, with their thoughtfully-designed alarm clock, are bringing new life to once-tired categories. Canopy hopes to see the same success in the humidifier segment that Molekule saw in the air purifier space, while Mute and Smart Nora are bringing fresh innovation to the snoring category, a category once-dominated by BreatheRight.

Dynamic interventions: Companies across the interventions space are developing closed-loop interventions that adjust on-the-fly to the user. Dynamic interventions for sleep are not novel: automatic positive airway pressure devices (APAPs) that treat sleep apnea by automatically adjusting airway pressure to the optimal level have been on the market for decades, while organizations like NASA have long-used adaptive environments to improve the sleep of their astronauts. Today, category leaders like Endel and Eight Sleep are using AI to dynamically optimize the acoustic and thermal environments in the bedroom for better sleep, while behavioral intervention companies like Full Sleep are tapping into sleep tracker data to inform their sleep coaching protocols. Companies like Aesyra and Neosensory are developing closed-loop interventions for bruxism and tinnitus, while a range of startups are following Muse’s lead in developing biofeedback hardware devices and VR software applications for meditation.

More than just CPAP: Positive airway pressure (PAP) is the gold standard treatment for patients with moderate to severe obstructive sleep apnea (OSA). Unfortunately, many patients are non-compliant with their PAP treatment, with non-compliancy rates hovering between 30-50% after 12 months. Recognizing the need for new forms of therapy that patients prefer, numerous startups are building sleep apnea treatments with novel form factors and mechanisms of action. Following the lead of Inspire Medical, a cohort of companies like Invicta Medical, Respiosa, AvivoMed, and others are developing medical devices that stimulate the upper airway to reduce apnea events throughout the night. Other companies like Signifier Medical Technologies, which is commercializing a daytime therapy for OSA, and Sommetrics, which is developing a negative pressure device, are charting new paths with unique treatment approaches.

Price points trend upward: In 2010, <$1000 mattresses captured 54% of the global mattress market. Today, the sub $1,000 segment accounts for just 40% of the market. Market share has been captured by the $2,000+ segment, which grew from just 19% in 2010 to over 30% today. Companies like Bryte and Sleep Number have introduced beds north of $6,000, while companies like Avocado and Doorne target the luxury category with products over $20,000.

Behavioral care goes digital: Cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for insomnia recommended by the American Academy of Sleep Medicine. Historically provided face-to-face and in-person by behavioral therapists, a range of companies have digitized CBT-I to provide asynchronous, app-based therapy. Some of these companies, like Pear Therapeutics (R.I.P.) and Big Health, have pursued a clinical path, classifying their products as digital therapeutics, navigating regulatory environments, and seeking reimbursement from public and private payers, while the vast majority are opting to go-to-market faster through DTC and B2B approaches. Some companies, like Crescent Health (recently acquired by BetterUp) and Dawn Health, provide a virtual interface for CBT-I and use human therapists, while others like Docbotic remove the human-in-the-loop entirely and rely on chatbots and automated protocols. A similar schism is developing in the parental coaching category, with some companies like Batelle and Lullaai offering human interventions and others like Napper and Pampers offering purely digital interventions.

Drugs in demand: Incumbents and startups alike are pioneering new pharmacological interventions for sleep. Many of these companies are targeting the orexin receptor; Merck (Belsomra, 2014), Eisai (Dayvigo, 2020), and Idorsia (Quviviq, 2022) have all recently developed orexin receptor antagonists for the treatment of insomnia, with others from Minerva Neurosciences/J&J and Taisho currently in clinical trials. Takeda recently won breakthrough therapy designation for an orexin receptor agonist to treat narcolepsy. Cannabinoid-based treatments are also a promising field, with Zelira researching a drug for insomnia and both Incannex and SciSparc developing cannabinoid-based drugs for sleep apnea. Promising late-stage startups like Apnimed, which recently reported positive results from its phase 2 trial, are eyeing the public market, while pre-clinical companies like Mosanna Therapeutics, developing a nasal spray for sleep apnea, are raising venture rounds to study innovative compounds and unique formulations.

Cautionary Tales

Novel interventions require significant product education: Categories of interventions like transcranial electrical stimulation, virtual reality biofeedback, and nutraceutical supplements demand high-touch product education. Successful businesses in these categories will thoughtfully navigate potential consumer concerns around electromagnetic radiation, comfort, adverse effects, and side-effect profiles. Supplement companies introducing new ingredients will need to explain their scientific bases and justify their inclusions in their products.

Finding the marketing sweet spot as a clinical company is challenging: The war isn’t won after you’ve received regulatory approval, nor is it won after you’ve received payer coverage. While these are important milestones in a healthcare startup’s journey, companies must ultimately win the war with providers, and marketing to providers is both challenging and complex. Some companies take a patient-focused, “ask your doctor if _ is right for you” approach; Inspire Medical, for example, has driven patient awareness through national television campaigns to the point where patients now literally ask their sleep providers if Inspire is a treatment option for them. Other companies focus on marketing to providers directly, but they need to be wary of “intended use creep” and often face uphill battles convincing providers to prescribe novel therapies. Regardless, healthcare companies in the sleep interventions market need to think critically about their marketing strategies to avoid cash constraints post regulatory and reimbursement milestones.

On the Horizon

Although the interventions market has seen a few high-profile flyers shut down this year (Pear Therapeutics, SleepMe), the category continues to offer enticing entrepreneurship opportunities. Everyone sleeps, yet most people don’t sleep well. With sleep monitoring and diagnostics becoming increasingly accessible through consumer wearable devices, home sleep tests, and virtual care pathways, consumers and patients alike increasingly demand interventions to improve their sleep and treat their sleep disorders. Many sectors are still dominated by legacy incumbents with products that have been on the market for decades, sectors that can be disrupted by nimble startups that better serve the unique demands of specific customer cohorts with novel form factors, mediums, methods, and business models. Combination treatments for example, such as an oral appliance used concomitantly with a drug, may be able to better target the pathophysiology of a sleep disorder like OSA than one intervention acting independently.

Stay tuned for my next sleep market profile covering the insights category: companies developing solutions to track, monitor, and diagnose sleep.

Access the full list of companies featured in this profile here.

Did I miss a company? Submit companies you think should be added to the profile here.

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

Bucking the Trend

Over the past century, chronic diseases have increasingly replaced acute disorders as leading causes of death in developed countries. So-called “diseases of affluence”[1] like heart disease, diabetes, and hypertension kill more Americans each year than acute conditions like pneumonia, tuberculosis, and infectious diarrhea. Today, six out of ten Americans suffer from at least one chronic disease, and almost 75% of the $3.5+ trillion spent domestically on healthcare each year goes to chronic care.

Since the mid 20th century, when scientists first began to understand the relationships between lifestyle behaviors of the present and health outcomes of the future, preventing chronic disease has been a major focus of public health. Unlike acute conditions, which are often preventable with vaccines and treatable with modern medicines, chronic diseases cannot be prevented with vaccination and may not be amenable to treatment with medications. Moreover, while acute conditions may arrive one morning and disappear the next, chronic conditions fester and worsen as unhealthy choices and harmful habits take their toll over time.  

Motivated by chronic disease management shortcomings in our existing health care system, consumer technology companies have developed a number of wearable and other non-invasive devices designed to incentivize healthy behavior and track progress with quantitative metrics. The growing burden of chronic disease was the prevailing public health concern and motivation when Fitbit (2010), WHOOP (2012), Apple Watch (2015), and Oura (2016) were released. Each of these companies saw an opportunity to deploy consumer technology to prevent chronic disease by leveraging the notion of the “quantified self,” thereby allowing individuals to track aspects of their physiology and understand the effects of daily choices on their long-term health and well-being.

But this year, the unwelcome arrival of the novel coronavirus has profoundly reshaped the U.S. healthcare landscape and the context within which consumer technology companies operate. COVID-19 is already a top-3 leading cause of death in the United States, and could foreseeably become the leading cause of death for 2020 both domestically and worldwide. For the first time in 100 years, an infectious disease might once again be the leading cause of death in the United States.

This represents a substantial departure from the dominant trend in public health of developed nations over the last century. Although the shift from acute to chronic disease mortality risk has been sporadically interrupted by infectious disease outbreaks like HIV/AIDS, Ebola, SARS, and H1N1, these confined episodes pale in comparison to the extraordinary events of today. The COVID-19 pandemic – unprecedented in nature and magnitude – has reminded our chronically ill country of the threat posed by acute viral infections. As a result, predicting incident coronavirus is presently more important than preventing chronic disease.

Consequently, although originally conceived as tools for chronic disease prevention, healthcare focused consumer technology companies have been afforded the opportunity to deploy their technologies for acute disease prediction, and in doing so, improve their products, validate their accuracy, and take greater responsibility for public health. Indeed, the COVID-19 pandemic has broadened opportunities for consumer medical technology companies seeking to capture and reorganize the healthcare industry along a preventive care paradigm powered by remote monitoring, predictive analytics, and telemedicine. And sleep, traditionally under-appreciated and historically uncharted, is key to reconstructing a healthcare system defined by prevention not treatment.

Setting the Stage

For all the grief and suffering “unprecedented,” lethal events like COVID-19 impose, such disruption offers the opportunity to rethink, redesign, and reconstruct established structures, systems, and status quos. These interruptions captivate, provoke, and ultimately spur action (often deregulatory, sometimes hasty) by government organizations seeking all possible solutions.

In early March, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, waiving restrictions on Medicare reimbursement of telemedicine services. Reimbursement claims per week surged, 100x the volume of a month prior. Later that month, as the virus was picking up steam in New York and elsewhere across the country, the FDA issued a new policy allowing “manufacturers of certain FDA-cleared non-invasive, vital sign-measuring devices to expand their use so that health care providers can use them to monitor patients remotely.” In doing so, the FDA hoped to extend the reach of the healthcare system – predicted to strain with an influx of COVID-19 patients – out of the clinic and into the home, thus keeping healthy people out of and away from hospitals which would likely need to be reserved for patients infected with coronavirus. Furthermore, earlier this June, the FDA expanded their guidance to include, among other digital tools, “Clinical Decision Support Software for Monitoring related to COVID-19 and Co-existing Conditions,” specifically noting algorithms that compare vital signs obtained via consumer monitoring devices with clinical guidelines in order to recommend diagnostic tests, investigations, or care. These policy decisions have given wearable and non-invasive remote-monitoring device manufacturers the green light to develop predictive tools for acute disease prevention. This “all hands on deck” approach by the FDA has finally embraced the potential of consumer medical technology to improve individual and population health.  

To wit, a few weeks ago the NBA sent an exhaustive 113-page memo to the league outlining health and safety protocols for restarting the season, including strict guidelines dictating life inside the Disney World “bubble” where players and coaches will play, live, and sleep for the remainder of the season. The protocols, implemented to limit the spread of COVID-19, range from silly – stop fiddling with mouthguards – to serious – confinement to “Isolation Housing” for anyone who tests positive for the virus. While many of these measures are widely accepted by medical professionals and epidemiologists as best-practice methods to prevent the spread of coronavirus, one of the new protocols garnered significant attention on Twitter and in the press: player use of Oura ring sleep trackers to predict the onset of COVID-19.

Players traveling to Orlando will be asked to wear Oura rings, rings fabricated from titanium and equipped with physiological sensors to track sleep. The interior surface of the ring includes an infrared photoplethysmography (PPG) sensor that tracks respiration and heart rate, a negative temperature coefficient thermistor that tracks body temperature, and a 3D accelerometer that tracks movement. These sensors gather biometric inputs which can then be plugged into algorithms – “Clinical Support Software” as defined by the FDA – to determine an “illness probability score,” alerting both the player and their team when medical examination is advised. A number of studies testing and improving these predictive models and others are underway at institutions including Scripps, UCSF, UCSD, and WVU Rockefeller Neuroscience Institute.

The deployment of Oura rings to fight the spread of the pandemic in the NBA attracted a range of responses from sports, media, and medical technology professionals. Many questioned the accuracy of the ring’s biometric sensors, doubting the ability of the device to accurately measure the user’s heart rate, temperature, and sleep patterns. And even if the Oura ring can accurately gather players’ biometric data, can machine learning algorithms actually predict the onset of coronavirus? To a public weary of false promises from healthcare technology marketing executives, detecting viral infection in the midst of a global pandemic using software and wearable data seems like yet another PR play. These critics argue that many of the studies published on the ability of various models to predict infection have been funded by the device manufacturers themselves and that the FDA has yet to approve any wearable device or software application as a COVID-19 diagnostic.

Players have also weighed in on the rings, concerned for their personal privacy. Lakers forward Kyle Kuzma tweeted, “Look like a tracking device” while Nets point guard Spencer Dinwiddie asked, “Does Adam silver [sic] wear one with us while we’re all in there?” The NBA, however, has clarified that player usage is completely voluntary, rings will not be used in game, and teams will only have access to player data in the case that a player registers an elevated “illness probability score.”

Accuracy and privacy concerns regarding the NBA’s deployment of the ring are warranted, if not unique to the present. These concerns parallel ongoing debates in the sleep science community regarding the ability of sleep trackers like the Oura ring to accurately measure sleep and securely manage personal data. For years, sleep medicine and the Academies governing sleep science have scrutinized and challenged the accuracy of consumer sleep technologies. Polysomnography (PSG), the “gold standard” method of tracking sleep, monitors a range of body functions, including brain activity via EEG, eye movements via EOG, muscle activity via EMG, heart activity via ECG, pulse oximetry, respiratory effort, limb movements, and air flow. To many in the sleep science community, no consumer device or software platform could possibly rival the accuracy of clinical PSG.

While these concerns are not new, the use of Oura rings by basketball’s premier league has elevated the significance of such devices and their potential impact on the future of healthcare. Just a few days ago another professional sports league, the PGA Tour, followed suit with the NBA in announcing the deployment of consumer monitoring devices – in this case WHOOP straps – to PGA Tour players, caddies, and essential workers as part of ongoing efforts to prevent coronavirus on the Tour. Golfer Nick Watney recently tested positive for COVID despite showing no symptoms after he noticed unusual respiratory data from his WHOOP and proactively sought clinical testing.

Thus, regardless of the objective accuracy of these devices, they have now been endorsed by professional sports and will increasingly feature on the fingers and wrists of global celebrities like Giannis Antetokounmpo, LeBron James, and Rory McIlroy. This spotlight both normalizes their usage and validates their medical benefits in the eyes of the public. Furthermore, usage by professional athletes “raises the stakes” by greatly expanding the visibility of whatever outcome occurs. Success stories such as the Nick Watney case can go viral and provide significant, positive media coverage, but hardware or software failures will be illuminated for the world to see and cannot simply be buried in an academic journal.

The historical moment in which we find ourselves presents an opportunity for consumer medical technology companies to demonstrate the value of their products by saving lives in the short term, and in doing so, secure a larger role in the provisioning of public healthcare in the long term. And, as we’ve come to learn, the most valuable technologies are those whose primary focus is sleep, not wake.

Opening the Gates

Uniquely “modern” aspects of our society – globalized economies, population density, science skeptics, content reinforcement algorithms, decaying communities – have provided the ideal conditions for a novel coronavirus to take root. Acting like autobahns for COVID-19 transmission, the fault lines of our fractured nation have facilitated politicization of public health and promoted viral spread. And unfortunately, our underlying chronic medical conditions have offered easy targets to a lethal virus.

As we increasingly learn, those with pre-existing medical conditions have an increased risk of severe illness and death from COVID-19. One large study using data from New York’s outbreak found that patients with chronic conditions like kidney disease, COPD, obesity, Type 2 diabetes, and heart disease were 12 times more likely to die from COVID-19 than those without pre-existing conditions. It seems those whose health are most at risk in the long term are also most at risk in the short term.

In today’s America, that means that the virus has unduly affected socially disadvantaged communities, racially marginalized populations, and vulnerable, “essential” workers. These demographic cohorts have borne the brunt of the pandemic burden, suffering significantly higher rates of infection, hospitalization, and mortality.

By now, this uniquely American pandemic narrative is well established (at least outside of alt-right circles): contemporary problems have accelerated the spread of a virus that is most lethal to those with chronic diseases and who are most likely to be socially disadvantaged. Yet until recently, this narrative has overlooked and underappreciated the critical juncture at which these features of the pandemic converge: sleep.

Unhealthy sleep is a uniquely modern characteristic of our society. The introduction of the incandescent lightbulb in 1879 reshaped the temporal fabric of our society, enabling activity to take place at all hours regardless of the presence of natural light. As the nature of work has shifted from manufacturing to “neurofacturing,”[2] sleep has come under further pressure and for many has been marginalized. New technologies enable 24/7 productivity to an extent beyond just electric lighting. Today, insufficient sleep is a public health epidemic: 75% of Americans suffer from recurring sleep issues, 50% of Americans suffer from sleep issues each week, and 33% of Americans sleep less than 6 hours each night.

These sleep issues correlate with, contribute to, and cause a range of chronic health conditions that increase the risk of severe illness and death from COVID-19. Sleep disorders are common in individuals with chronic kidney disease, and findings suggest that short and poor-quality sleep are risk factors for chronic kidney disease progression. Sleep deprivation has been shown to be a causal factor of obesity, and 86% of obese patients with Type-2 diabetes also suffer from Obstructive Sleep Apnea. Unhealthy sleep has been linked to increased blood pressure, hypertension, heart disease, and mental illness. The nascent field of sleep science increasingly finds that sleep plays a critical role in maintaining corporeal and mental wellness and preventing chronic disease.

Unfortunately, the burden of unhealthy sleep is not distributed equally across society; socially disadvantaged populations are the most likely to be sleep impaired. Educational status and income are both inversely correlated with short sleep – those with higher incomes and more advanced degrees are more likely to get ample sleep. Racial minorities – African-Americans in particular – are more likely to be sleep deprived: white women get an average of 6.7 hours of sleep while black men only get an average of 5.1 hours. Neighborhood deprivation, characterized by high crime rates, noisy environments, and suboptimal sleep environments contributes mightily to these “sleep disparities.” Unhealthy sleep facilitates negative feedback loops that hinder social advancement for disadvantaged populations.

The social variables at play in the epidemiology of the current pandemic are obviously multifaceted and complex. But nevertheless, COVID-19 has been most damaging to socially disadvantaged populations with pre-existing medical conditions – the exact same communities that are also most likely to be sleep deprived. Sleep, or more accurately lack of it, along with its varying social determinants, needs to be considered as a major factor in the social epidemiology of the pandemic.

The confluence of contemporary challenges, healthcare trends, and social disparities, along with the current epidemic of unhealthy sleep, encapsulates flaws in our current healthcare system and epitomizes structural failures enabling the viral outbreak. It also vividly demonstrates why healthy sleep is the perfect platform on which to develop the consumer medical technology vision of personalized, predictive, and preventive healthcare.

Accounting for a third of each of our lives and affecting all aspects of our day, including our health, wellness, happiness, productivity, and safety, sleep serves as a means of access into homes, schools, businesses, and healthcare systems, and furthermore, provides fertile territory for emerging technologies to be developed and applied to other fields. Sleep is required literally each night, unlike fitness and nutrition which can be postponed for quite some time without acute reactions. Consistent, ample, quality sleep is perhaps the single most important determinant to our short- and long-term health across our lifespan. And now, because of a global pandemic, we are becoming increasingly aware of it.

The enrollment of consumer sleep tracking devices by the NBA and PGA as tools for acute disease prediction has brought sleep to the fore. Oura’s motto is “Better lives through better sleep.” WHOOP’s is “The world’s most powerful recovery and training tool.” The top two paid results for sleep tracking on Google are WHOOP and Oura, respectively. Let’s be very clear – these devices are first and foremost designed to track sleep.

These companies, and the rest of the consumer sleep technology space, now just need to execute on their promise. Forced into action by the ongoing pandemic, regulatory organizations have unlocked the gates for disruptive innovation. Desperate for any potentially season-saving tool, professional sports leagues have magnified the spotlight and intensified public scrutiny. And with both lives and fortunes on the line, the stakes have never been higher.

Subscribe now

Supermoon is a research-driven VC that invests in scientists, technologists, and creatives building the future of sleep and sleep-adjacent categories. We invest globally in pre-seed to Series A stage businesses across enterprise, consumer, and biotech. If you’re building in sleep or are interested in partnering with one of our portfolio companies, I’d love to chat. You can reach me on LinkedIn and Twitter, or email me directly at gj@supermooncapital.com.

___

[1] A misnomer, since these diseases disproportionately effect socially and economically disadvantage populations. However, the term speaks to international differences, not intranational disparities.

[2] Value creation though knowledge work rather than physical labor.