Dr. Nagarajan Ramakrishnan on Critical Care, Sleep Medicine & Building India’s First Comprehensive Sleep Institute

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In an exclusive conversation with Corporate World, Dr. Nagarajan Ramakrishnan — Founder of the Nithra Institute of Sleep Sciences and among India’s earliest board-certified sleep specialists — reflects on his unconventional journey into medicine, the evolution of sleep medicine  in India, and why sleep should be treated as a public health priority

Sleep disorders are fast becoming one of India’s most underdiagnosed health challenges, quietly fuelling hypertension, diabetes, mental health issues, and chronic fatigue across age groups. At the forefront of tackling this crisis is Dr. Nagarajan Ramakrishnan — Founder of the Nithra Institute of Sleep Sciences, one of the country’s earliest and most specialised centres for sleep health. In this conversation with Corporate World, Dr. Ramakrishnan reflects on his unconventional journey from critical care to sleep medicine, the growing burden of sleep-related illnesses, and why India must urgently treat sleep as a public health priority.

Q. What inspired you to pursue medicine, and how did you find your passion in critical care and sleep medicine?

I often say I became a doctor by accident, though today I wouldn’t change a thing. In the 1980s, I topped the country in Biology and secured admission to BITS Pilani for engineering. But due to financial constraints, my parents encouraged me to pursue medicine locally. At the time, I was disappointed, yet my father sensed I had the temperament and people skills suited to healthcare. Looking back, he was absolutely right.During my early training in the UK, I initially aimed to pursue cardiology, but realised that what truly fulfilled me was caring for critically ill patients rather than performing procedures. This led me to theUniversity of Pittsburgh, one of the world’s pioneering centres for critical care.While practising intensive care, I began to see how unrecognised sleep disorders caused major health crises — heart attacks, strokes, depression, and cognitive decline. Families of ICU patients also suffered from disturbed sleep. This powerful connection between sleep and critical illness is what drew me to sleep medicine, long before it gained recognition in India.

Q. You hold multiple board certifications across diverse specialties. What motivated you to develop such a wide range of expertise?

My career evolved in response to what I saw in real-world clinical settings. I began with internal medicine and then specialized in critical care because it allowed me to help patients at their most vulnerable moments. While treating ICU patients, I noticed a striking pattern: many had undiagnosed sleep disorders, especially sleep apnea, which contributed to chronic illnesses like hypertension, diabetes, heart disease and stroke. This led me to formally train in sleep medicine.

I later realised that obesity and sleep disorders were tightly intertwined — poor sleep could promote weight gain through hormonal changes, and obesity worsened sleep apnea. This synergy drew me into obesity medicine.

Finally, to understand healthcare beyond the clinical realm, I pursued a Masters Degree in Medical Management (MMM) in entrepreneurship at the prestigious University of Southern California Marshall School of Business. I wanted to bring global standards of sleep and critical care to India in a way that suits our population. Each qualification added a crucial layer to the holistic care I envisioned.

Q. What inspired you to establish the Nithra Institute of Sleep Sciences, and what vision guided the initiative?

When we launched Nithra in 2004, many questioned whether anyone would ever visit a “sleep specialist.” Sleep medicine was virtually unheard of in India. Even my family wondered if returning from the US to start something so niche made sense. But I had seen first-hand how profoundly sleep disorders affected health and productivity. For many patients, simply diagnosing and treating sleep apnea or chronic insomnia could change — even save — their lives.

My vision for Nithra was clear: create a dedicated, evidence-based centre for sleep health, supported by trained specialists, sleep labs, psychology expertise, dietary guidance, and long-term follow-up. We started with one patient a week. Today, the challenge is the opposite — people complain about inability to get an early appointment at times!  .

What keeps me motivated is knowing we are still seeing only the tip of the iceberg. India needs far more trained sleep specialists, but the awareness journey has firmly begun.

Q. Nithra offers expert consultation, testing, diagnosis, and customised treatment. What does a typical patient journey look like?

The journey begins with awareness — helping people understand that sleep issues include not just insomnia, but also excessive daytime sleepiness, sleepwalking, sleep talking, and sleep apnea. Modern work cultures, especially varying work times to provide services for other countries have created a chronically jet-lagged young population that needs structured guidance. We offer Corporate Sleep Health awareness programs and wish many more organizations engage us as it focuses on wellness, performance and productivity.

Once a patients visit us, we conduct a comprehensive screening involving physicians, psychologists, and dietitians. Based on their needs, we design a personalised plan — from sleep hygiene counselling and cognitive behavioural therapy to supervised medication when necessary. We strongly discourage self-medication, which is widespread in India.If sleep apnea or other physiological disorders are suspected, we perform a detailed overnight sleep study in our home-like sleep labs. These studies measure sleep stages, oxygen levels, snoring patterns, body movements, heart-rate variability, and more.

Post-assessment, we provide a clear treatment plan and close follow-up. Teleconsultations have been especially valuable for national and international patients. Continuous support is the core of the patient experience at Nithra.

Q. Beyond clinical care, Nithra has played a key role in raising public awareness about sleep health. What strategies have worked best?

Awareness is at the heart of our mission. Social media has been an invaluable tool for breaking myths and sharing practical tips on sleep hygiene, early symptoms, and the dangers of untreated sleep disorders.We regularly create videos, collaborate with media platforms, participate in discussions on Radio and Television, and engage with digital audiences to make sleep science accessible. Nithra also runs a Sleep Support Group — similar in spirit to Alcoholics Anonymous — where patients who have overcome chronic sleep issues share their experiences. This peer support helps others feel hopeful, understood, and motivated.

Beyond this, we contribute to print media, maintain a strong online presence, and publish educational books. I have authoured four books in Tamil – One on ‘What happens inside an ICU’ , Two on Sleep and another one to clarify myths on Organ donation. I hope some day, these could be translated in other languages. One of my Tamil books even reached the California Public Library, and a reader travelled all the way from the US to consult us. This reaffirmed how far awareness can travel when communicated meaningfully.

Q. Finally, what message would you like to share with readers who are struggling to get a good night’s sleep?

Sleep is not a luxury – It is a biological necessity. A good night’s sleep is essential to have a good day and healthy life. Lifestyle modifications focusing on sleep, nutrition and exercise can prevent the highly prevalent chronic health problems.

Many people think, “I don’t have diabetes,  blood pressure or a heart problem; it’s just a sleep issue.” But untreated sleep problems can cause these very conditions. Prioritising sleep can protect your heart, metabolism, mental health, and overall well-being. I sincerely hope that World Health Organization enlists Sleep Disorders with these  ‘Non-Communicable Disease (NCD)’ which are increasing and have been the focus in recent years.If you’re struggling with sleep, don’t normalise it or ignore it. Qualified sleep specialists are available, and timely intervention can transform your quality of life. Remember: sleep is a priority, not an indulgence.