Voices in Health and Wellness

From CPAP Confusion to Confident Nights: Carissa Hankins on Reinventing Sleep Care

• Dr Andrew Greenland • Season 1 • Episode 44

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What if CPAP success isn’t about willpower, but design? We sit down with nurse practitioner and founder Carissa Hankins to explore a coaching-first model that finally makes therapy tolerable, personal and effective for people living with obstructive sleep apnoea. From the first “why does this mask leak?” to the moment the data actually matches how you feel, Carissa shows how small, human-centred changes create big, sustainable wins.

We start with crystal-clear foundations—what apnoea and hypopnoea are, how CPAP works as an air splint, and why one in three midlife adults may be affected. Then we pull back the curtain on the real barriers: poor mask fit, suffocating airflow sensations, rushed setups, and a numbers-first mindset that ignores lived experience. Carissa’s virtual approach blends education, data interpretation and practical troubleshooting, turning download graphs into a story you can act on. You’ll hear how platforms like SleepHQ, smarter ramp and pressure strategies, and patient-led tweaks can turn “I can’t do this” into calm, steady nights.

Looking ahead, we explore new paths for people who won’t or can’t tolerate masks. GLP‑1 therapies that drive weight loss have already shown meaningful AHI reductions, and a potential combination drug (often referred to as AD109) aims to stabilise airway tone. Carissa explains how these options might complement CPAP, and why ongoing monitoring and re-titration will matter as bodies change. Along the way, she’s candid about building Hello Sleep Health without insurance friction, the challenges of being a team of one, and her plan to add on‑demand courses and group education so more people get help, faster.

If you’ve felt unheard, overwhelmed by “squiggles,” or ready to give up, this conversation offers a different path: clear language, tailored guidance and practical steps that respect both your data and your day-to-day life. Listen, learn, and if it resonates, share it with someone who needs a better night. Subscribe, leave a review, and tell us what CPAP roadblock you want us to tackle next.

👤 Guest Biography

Carissa Hankins is a board-certified nurse practitioner and the founder of Hello Sleep Health, a virtual coaching service dedicated to helping CPAP users overcome treatment barriers and finally get the sleep they deserve. With over a decade in sleep medicine and pulmonary care, Carissa now offers highly personalized post-diagnosis support that bridges the gap between clinical prescription and real-world success. Her work combines deep clinical knowledge with warm, human-centered coaching—making her a true innovator in modern sleep care.

    About Dr Andrew Greenland

    Dr Andrew Greenland is a UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Drawing on dual training in conventional and root-cause medicine, he helps individuals optimise their health, performance, and longevity — with a particular interest in cognitive resilience and healthy ageing.

    Voices in Health and Wellness explores meaningful conversations at the intersection of medicine, lifestyle, and human potential — featuring clinicians, scientists, and thinkers shaping the future of healthcare.

    🔗 Connect with Dr Greenland:
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    Dr_Andrew_Greenland:

    Welcome back to another episode of Voices and Health Awareness, the podcast where we explore the business models founded innovation taking care delivery for small health providers and wellness entrepreneurs. Today's guest is someone who truly embodies that spirit of reinvention. I'm joined by Carissa Hankins, founder of Hello Sleep Health. Carissa is a broad certified nurse practitioner who made a bold pivot from traditional sleep medicine to a fully virtual coaching forward model that helps patients thrive with CPAP therapy. Her approach is personal, scalable, and designed around one of the most persistent problems in sleep health, patient adherence. So, Carissa, welcome to the show and thank you very much for joining us this afternoon.

    Carissa Hankins:

    Thank you for having me.

    Dr_Andrew_Greenland:

    So maybe we could start at the top. Could you maybe just walk us through your journey into sleep coaching?

    Carissa Hankins:

    Well, before we get to sleep coaching, it's how did I get to sleep in the first place? And I think sleep actually found me. I wasn't looking for it, it found me. When I was right out of nurse practitioner school, there were not a lot of job opportunities. And so I was imported from just outside of Philadelphia to northern Maine, where I worked in an outpatient walk-in clinic. And then from there, I joined the sleep medicine practice that I stayed with for nine years. Then I switched over to pulmonology for three years, and then I'd had enough of it, which is actually where the current iteration kind of started. So I said, you know what? I'm done with clinical practice, at least in this conventional model, the one where I miss dinner, the one where I can't be there for my family, the one where I spend all my weekends just recovering. And I said, you know what, I can be my own circus master. And one of the biggest problems for the people I'd been serving all along was they get a diagnosis of sleep apnea. They don't quite necessarily understand it. But even if they do understand it, when they get on whatever their therapy is, which is typically CPAP therapy that's mask-based, there's a lack of support there and there's a lack of understanding there. And even healthcare providers are not given enough in the general sense to be able to manage folks. So if you go to your regular primary general practitioner and you say, I'm having this problem with my CPAP therapy and my mask, they're gonna go, eh, or they're gonna go, your AHI looks fine. Well, that's not helpful. And um, so that's kind of where I decided to focus my energy because much of what I did in sleep medicine was just troubleshooting CPAP and going, you know, this symptom over here, this hooks in with the sleep apnea that you have that is not being treated. And then they go, Oh, well, that symptom is making me crazy. So let's do something about it.

    Dr_Andrew_Greenland:

    Okay. So just in case we haven't got an entirely technical audience, can you just give us a very, very quick um explanation of what sleep apnea is and what CPAP is, just for to cover off those terms since we're going to be using them today.

    Carissa Hankins:

    Absolutely. Sleep apnea is nothing more than a repetitive lack of airflow that lasts at least 10 seconds. There's a miniature, miniature version of it, which isn't really miniature, those are called hypopneas, and that's where we have a reduction in airflow of at least 30%, and either an arousal from sleep, so it can be very disruptive to sleep, or a drop in oxygen saturation from three to four percent from baseline. And it the definition is fluid because it depends on how we're assessing for this. A normal person is gonna have less than five breathing events per hour of sleep. Normal. That's the that's the the threshold. You can still be symptomatic around that threshold, but typically we're saying above five will be considered a problem. And CPAP therapy uses air to hold the throat open. The most common version of sleep apnea is where the throat muscles are relaxing so much that air can't get in. So it's not like I'm holding my breath, it's that I've already breathed out and I can't pull that air in. And that's a very different feeling from like I'm gonna dive off a diving board into a swimming pool and hold my breath to do that. Totally different feeling because in that scenario, you already have air in your lungs, but in this scenario, you've already breathed out and nothing can come in. So CPAP uses a mask and a machine that blows air, and it's an air splint to hold the throat open, so then air can move normally like it's supposed to. And if you can breathe right when you're sleeping, you're gonna sleep better and feel better and do better, even if you don't really notice that you're not um that you have a problem. Because some people they they feel like they sleep fine, and some people do, they just are not breathing right when they're sleeping.

    Dr_Andrew_Greenland:

    Got it. Can you give us some sense of the scale of the problem? Obviously, you're probably a US perspective, but just give us some sense of how big a problem this is.

    Carissa Hankins:

    I think we can safely say that sleep apnea is in the top three for sleep disorders. And if you count insomnia as a symptom of sleep apnea instead of its own thing, which yes, it can be its own thing, but more often it is a symptom of something else, then I think sleep apnea would be probably the number one sleep disorder that we're dealing with on a regular basis. In the adult age group, 45 to 65 years of age or so, the current estimates are something like one in three adults in the US have it. So, you know, if there was one other person in this conversation with us, we'd be able to look at the three of us and go, well, somebody here has it, right? So it is a very big problem.

    Dr_Andrew_Greenland:

    Thank you. And you talked a little bit about your journey into sleep and your sort of reasons for why you wanted to leave regular clinical practice. Can you tell us a little bit about the evolution of Hello Sleep Health?

    Carissa Hankins:

    That is a very interesting story. So when I first left clinic practice and said, I'm going to be my own, my own circus master, I had my business was called the Sleep NP, and I still have the Sleep NP. But what I learned over that first year or so from being out of clinical practice and just working on my own is that the Sleep NP is a great name for people who are located within the healthcare community. But outside of the healthcare community, nobody knows what MP stands for. I had some very, very smart, intelligent people go, what does NP stand for? Nobody's searching for Sleep NP outside of healthcare circles. And so we had the conversation, me and my business mentors, of you know, if you're gonna be serving CPAP users directly, then they need to have a better sense of what it is you do based on your name. And so we did a lot of brand work and came up with hello sleep health. And I it exemplifies kind of my personality. Like I don't like to be boring and I don't like to be cold, and so it just feels very warm and welcoming. And that's kind of what I was going for with the name.

    Dr_Andrew_Greenland:

    Great. And can you um when did you realize that there was a space or even a necessity for a different approach to supporting CPAP users?

    Carissa Hankins:

    I think I don't know that it was so much a realization that there was space, so much as I realized that I didn't have to be a board-certified sleep physician to do this work. For a long time I had this block in my head that was like, well, if you're gonna do this work, then you have to have a sleep lab. And if you're gonna have a sleep lab, then you need to be able to read studies. And if you're gonna need to be able to read studies, then you have to do all the classes in the school. And I don't have 12 extra years in my life to do all of that. So a piece of my learning was actually just focusing on, you know what, I don't have to own the entire patient journey or the entire client journey. I can focus on post-diagnosis. So somebody else can order a sleep test, or if it's my patient, I can order a sleep test or refer to the appropriate place for those diagnostics, but I don't have to own that piece. And I think for me, that was a huge weight that was lifted off my shoulders. Like, I'm not in charge of that, and I don't have to be in charge of that. Now I looked for, I think I spent a good couple of months when I was first getting going with Hello Sleep Health to figure out am I going to offer diagnostics myself in-house or am I going to order them out? And what are the what are the options there? And basically what I found in my situation was um there are a handful of vendors that I can choose from based on the situation where I can just send the patient to or the client to and say, here you go, these entities will take good care of you, and we can expect to get a decent result out of it. And then I don't have to have the overhead of the equipment or the consumable supplies because technically most tests, there's stuff that you use just for one person and then you get rid of it. And I don't have to pay for software to read the testing and hold on to the testing, and I will have to pay a sleep physician to do the interpretation. So I think that was the biggest thing for me is just being able to niche down and choose where do I want to live and not having to own everything. Because for a while I was like, I have to own all of this. No, I don't. I can just do the part that I'm really good at, which is talking to people, looking at downloads, seeing how masks fit, and taking the story and using that to help troubleshoot so that people can feel better, even if you know the end result is that CPAP is not for them. Um, because sometimes it's just not.

    Dr_Andrew_Greenland:

    And um, how is your what does your role look like day to day? I mean, I especially I don't know if there is such a thing as a typical day in the work that you do, but can you give us a kind of an outline as to how your day and how your week pans out with your work that you do?

    Carissa Hankins:

    So it really depends on what all I have going on. If I have coaching clients that I'm meeting with, I'm gonna spend some time going through whatever they've sent me to look at so that I can be prepared for their session. Maybe they've had some blood work done and they have questions about it. Uh typically the folks who come to see me, they're like, I was told that I would feel better with this CPAP thing, and I don't. And I feel like we're missing something. And so we'll say, you know what, uh send send whatever blood work you want me to look at, or we'll look at the uh the original or the previous sleep testing or the CPAP download data that they have available. And so, because I like to do my homework instead of walking in just kind of like, oh, here, what are you what are you here for? So that's a good chunk of uh the time that I would spend just preparing for clients. I'm also currently doing a sleep medicine mentorship for healthcare providers. So today, actually before I got on this call, I was going through our lecture content to make sure that our slide deck is ready for our next session, where we're gonna sit down, me and another nurse practitioner, we're gonna sit down and kind of go through some of the things that she didn't get in school, but she needs in her everyday practice. And and then there is just the stuff around the home, right? The laundry and the dishes and keeping up with the children and making sure that I'm spending time just kind of giving myself the time and the space because I'm no good to anyone if I am totally frazzled and burnt out. So yeah.

    Dr_Andrew_Greenland:

    Amazing. And um, I mean, there's obviously no shortage of work. Is there anybody else doing what you do at this level? I mean, are you going to be completely um saturated with um demand if you're not careful?

    Carissa Hankins:

    So I'm not the only person doing this work. I'm the only nurse practitioner that I'm aware of doing this work. The other folks that I'm aware of are in the respiratory therapy realm. So they're really just focusing on CPAP therapy and that download data stuff and some of the diagnostic stuff, but they don't necessarily, they're not necessarily stepping back to look at what are the other things that could be driving this. Because that was a really important lesson that I learned, not specifically in sleep medicine, but as I shifted away from it into the pulmonary clinic to go, wait a minute. While I see everything is sleep apnea and everyone has sleep apnea, that's not the only thing that's out there. And being able to go, well, what about this and what about that? I think that's one thing that that sets my expertise apart. And I don't know, I feel like the highest compliment I get is from my clients who say, you know, you're the only person who listened. And even if I can't fix you, because I'm not a fixer necessarily, just that piece of being able to listen, I think, is really, really valuable. And to go, I get it. You're not crazy. This is legit. It's a mystery, but it's still a legitimate thing.

    Dr_Andrew_Greenland:

    So thank you. And what are some of the biggest um changes that you're seeing in the world of sleep health right now, whether that be clinical or patient expectations or payer behavior from the insurance side?

    Carissa Hankins:

    Well, speaking of insurance, my coaching services, I don't mess with insurance. Uh, it allows me to offer services outside of the state where I'm licensed in. So for our coaching stuff, it's not medical advice. It's a topic that is health related, but I'm not diagnosing anything. I'm not treating anything, I'm not prescribing anything. And that gives me a lot more flexibility to be able to educate and coach and help folks kind of worldwide. From a what's on the horizon and exciting sort of standpoint, I think there are we at least here in the US, we're expecting approval from the FDA on a combination medication for obstructive sleep apnea. It would be the first one of its kind, and it's a combination of what is it, adamoxetine, and I think it's our oxybutanin. So adamoxetine or SRTER was a medicine for ADHD, and oxybutanin is one for overactive bladder. I talked to a urology PA and she's like, I don't like that medicine. Uh, and then we talked about dosing, and she's like, Well, that dose is probably okay. Uh, but what the research found is that it's supposed to decrease and decrease the AHI, so that's the sleep apnea number, and stabilize the base of the tongue. So then we have less sleep apnea. So that combined with the approval for GLP1 therapy for sleep apnea, that's opening the door for a lot of people to get help for their sleep disorder breathing, especially those folks who are like, I can't do a mask. Um, still, a lot of folks would benefit from a mask, but it does also open the door for more people to get treatment and to feel better.

    Dr_Andrew_Greenland:

    I was gonna ask with the drugs coming in, is it likely that they will replace the need for mask for some people? Or is it just going to be um an adjunct?

    Carissa Hankins:

    Do you think I expect it's probably the data we have from the terzepatide trial that got the approval for sleep apnea showed that with or without CPAP therapy, the weight loss that came with that particular medication in that particular group of people helped significantly with the AHI. Whether you were on CPAP or not, CPAP helped more. That group had a better um final endpoints at the end of the 52 weeks than the folks without the CPAP. But the folks without the CPAP, they weren't gonna do CPAP anyway. Um, and I think that group of people is probably the most highly underserved because a lot of them are under the impression that, well, you know, if it's CPAP or nothing, I'm gonna pick nothing. And so these other medication options that are becoming available and we hope are becoming available, I think that is definitely an opportunity for people who otherwise wouldn't have treatment. I think it's also going to disrupt the the world of CPAP because as weight comes down and as we have more stability of our throat muscles, then we're gonna need different settings on our CPAP therapy. So we have less weight, we need less air. We have more stability of our throat muscles, we're probably gonna need less air. Do we have the data on this right now? No, that's just my clinical two cents. But it uh it's an exciting time. And the the medicine right now, it's called AD109. I don't know what its actual name is gonna be when it comes out, but if you wanted to look it up and do some research further, that would be what you would search for, AD109.

    Dr_Andrew_Greenland:

    Thank you. In terms of how patients are seeking you out then, so are they actually seeking out health coaching or sorry, sleep coaching rather than prescriptive care, or is this something that you kind of have to educate them on in the conversations that you have up front?

    Carissa Hankins:

    Well, most of my coaching clients actually come to me from a platform called SleepHQ. SleepHQ is a third-party download platform, it's cloud-based. And when you sign up for a free account, you have a certain amount of time to try out the full platform. So that includes the download data, but it also includes the private community, which you can then sign on to as a subscription model. And I'm one of the I was the first sleep health consultant within that platform. So most people find me through the platform. Inside the private community, I will periodically look through and go, oh, I can help with this particular question. And I try to focus on questions that I'm pretty sure nobody else is gonna have that sort of perspective on. So yes, most of most of the people come from that community. So a lot of times they're very they're very interested in getting things to go right or better, or they're like, you know, things are not going right. I need some help with this, or I need help understanding what is all of these squiggles and lines and all of this stuff coming off of my machine. What does that stuff mean? And so uh the Sleep HQ community is a really good place for folks who are just starting off. And uh sometimes people go, Oh, hey, uh, you want to talk to Carissa? And they'll tag me in the post, and then that's kind of how we get to work together.

    Dr_Andrew_Greenland:

    I understand. So your site does a great job of highlighting you know common frustrations like poor mask fit feeling alone in the process or even giving up on CPAP altogether. But where do most people get stuck? And how does your model kind of help them through?

    Carissa Hankins:

    I think most people get stuck because when they get their machine, whether it's something that they decide to purchase on their own or their doctor prescribes it, they get their machine, they get thrown all this information if they get any, and then they just are expected to make it work. Uh a lot of areas, there's a lot of areas, but probably the two biggest areas for folks that are challenges if they're going to be successful CPAP therapy. Number one is mask fit, because if it doesn't fit right, how is it ever going to work? And then number two is the air. If it feels like you're suffocating or smothering or getting blown away, that's not sustainable. And I don't care what the download data says or how good the numbers look, if you can't tolerate it, that's not gonna be a good thing, and you're not gonna be able to stick with it and get the benefit from it.

    Dr_Andrew_Greenland:

    Understood. Um, what's really clicking for you in your business right now? Obviously, this is something you've developed over time. What do you think is the best elements of the model that really work for people?

    Carissa Hankins:

    That it would be a very challenging question. Um, I don't know that I actually have a good answer to that one. What would be I think the personalized in-depth consultation that I offer is not typical for what most people end up getting in their healthcare journey, and being able to go through somebody's sleep testing with them so they actually understand like this is the picture of your night, and that goes with this story over here for what you've been experiencing to watch the light bulb go on, um, or kind of going through that sleep uh download data to go, oh yeah, you know, it looks like your mouth is opening, or it looks like your pressure is way too high, and that's why you're seeing this factor and that that item over here.

    Dr_Andrew_Greenland:

    And is it that data that sort of gives the biggest results or are hard moments for your clients when they can see it in black and white?

    Carissa Hankins:

    I think the data is huge for for our patients, and I've seen some practices, and I will not name names, but I've seen some practices where a person didn't really want to get a sleep test to begin with, so they kind of just begrudgingly go, and then they don't even get decent follow-up on it. It's a phone call from support staff saying you have sleep apnea, start on CPAP, like there's no conversation, there's no here's your options, and here's why this thing over here is the best. And so giving people that space to be able to participate in their care, to feel like they actually know a couple of things. I think that is huge for people.

    Dr_Andrew_Greenland:

    And on the flip side, what's um continues to be frustrating or slower than you'd hoped in the model that you have?

    Carissa Hankins:

    Well, I am the only person that works for me. And I don't like marketing. It's not my favorite thing. And I think we all have issues, and that's kind of my issue is is marketing. Don't like it. I would be busier, I think, if I marketed more. So that's that's part of the current challenge that I'm facing is to be more consistent and intentional in marketing.

    Dr_Andrew_Greenland:

    When you I think you mentioned one of your main sources of um clients comes through the cloud-based um platform that you mentioned. So where where do all your other patients come from?

    Carissa Hankins:

    Um most of the other ones, which is actually has not been very many, it's only been a handful. The others have come from just Google searches online or referrals from their healthcare team.

    Dr_Andrew_Greenland:

    If we um obviously you're running a business, um if we zoomed into your metrics for a second, what are you most focused on when you're looking at how how things are going for you? Or is there anything that you're really trying to kind of improve on or change? Whether it's around I don't know, retention or conversion or patient activation or whatever it might be.

    Carissa Hankins:

    Right. Um I don't know. I don't know. It's I think it's the kind of thing where you don't know what you don't know. I think if I think I would like to see a higher, more consistent volume of clients coming through, but at the same time, I also want to build out um on-demand options for folks, especially people who are like, I don't need to meet with you one-on-one. I just need to kind of get some answers and feel like I know what I'm doing. And I do have my CPAP downloads course, which is really good if you want to know what your machine is trying to tell you. Um, but I think I can do better and do more as far as having those on-demand resources available for folks.

    Dr_Andrew_Greenland:

    Okay. I mean, is this something that would ever work in a group model, do you think?

    Carissa Hankins:

    I expect it would, at least for some of the educational components. And what I've already done in my course will be easily converted or adapted to a more of a group model. Um, I think one of the challenges is that the individuals who come to me for coaching, they're all a little bit different. Like, so there's nothing super cookie-cutter about them because the reasons that they seek me out are different. Some people are like, there's this thing that's showing up on my data and it's kind of freaking me out, and I need to figure out what to do with it. And I've tried all these things and it's not going away. And then we have the folks who are like, I can't sleep, and they said CPAP would help with it. And then the folks who are like, CPAP is making me feel worse. So I have people all across the spectrum, and I think that's the challenge, is even though everybody has converged mostly within this one community, their their scenarios are all very different. So trying to plan something that's more general outside of like this is what you can expect from your CPAP machine, that that's a challenge. Um, that you know, we continue to adapt and continue to to try and work with.

    Dr_Andrew_Greenland:

    If you had a magic wand and could fix one business, one thing in your business overnight, what would that be?

    Carissa Hankins:

    Hmm, oh, there's so many things. I don't know. Technology is always a challenge, right? So even if we have a system that works, you know, it's very easy to work, there's always a challenge with technology. But I think the bigger one, if I could just wave a magic wand, would be to have higher volume through through our coaching practice.

    Dr_Andrew_Greenland:

    Thank you. Um, and if similarly, if you had um a massive influx of clients next week, I don't know, maybe 10 times the normal number you would get in a month coming in a week, what will be the first part of your system or delivery that would break? And don't say you.

    Carissa Hankins:

    Um, well, right now, part of my strategy is if someone submits the lead contact form or the prospect form on my website, which is just, you know, here's here's my information, give me a call, or um I'd like to book a just a meet and greet with you just to make sure that we're on the right page and that you're the right person to work with me. Um, I think scheduling would probably be the biggest issue because right now people will put their name in my hat and then I will reach out to them right away. And if I'm back to back to back with preparing for to see clients and actually seeing clients and supporting clients, then I think that prompt turnaround time is gonna get a bit longer. And the wait time to get in is probably gonna get longer. So, I mean, right now it's typically there's typically room in the schedule to get people in within a week, which is not terrible.

    Dr_Andrew_Greenland:

    Cool. And where do you see sleep health? Um, hello sleep health, I should say, being in six to twelve months' time. What's the direction of travel for you?

    Carissa Hankins:

    Direction of travel. I think having uh multiple entryways to services as far as service lines. So we have our lead magnet, which is just our CPAP tip sheets, which is the things that everybody needs to know that took us forever to figure out as people in the field. And you know, this is all stuff that came from CPAP users but took way too long. Um uh more in the way of courses and then probably some group group activities and offerings.

    Dr_Andrew_Greenland:

    I mean, you do see do you see that being single-handed or taking more people on? I know you talked about you having somebody that you were training up at the moment, but is this going to be just you or do you want a team?

    Carissa Hankins:

    Well, I already had a team, and it turns out as a business owner, that you don't know what you don't know. And so originally I had a team, but I didn't know what I didn't know. And so now I don't have a team. And my strategy is when that it will be clear when I do need to hire on more help to make sure that we can still provide a quality service and good turnaround time.

    Dr_Andrew_Greenland:

    Amazing. Carissa, thank you so much for your time this afternoon. It's been really interesting hearing about this important work you do. I mean, I work in functional medicine and I'm very, very acutely aware of sleep apnea, massively undiagnosed in this country, probably similar kind of statistics in the US. Um, and I do a lot of work with cognitive decline. So I'm seeing the effects of um undiagnosed sleep apnea in affecting people's cognition in their latter years. So this is incredibly important work that you do. And thank you very much for sharing your story, what you do, how you're helping patients. It's really amazing. Thank you so much.

    Carissa Hankins:

    Thanks for having me.