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I developed an iOS app which detects your sleeping position and starts buzzing if you’re on your back. Similar to the tennis-ball-sewn-into-pyjama’s hack. Apple kept refusing to approve stating medical reasons. Still use it myself though, works great.

We have an app which delivers medical care, and Apple let us on but required proof of medical licenses, malpractice insurance, etc. Medical apps are allowed, but there's a higher bar for evidence.

Good. Back in 2015-2016, I worked on an app that improved user's vision. Genuine science, publications in peer-reviewed journals (even Nature). But the whole category was a vast ocean of bullshit apps, and our product just sank in it, unable to differentiate itself and prove to the users that it was the real thing.

Got any links to the research? My vision sucks.

The papers are mentioned here:

https://web.archive.org/web/20200714114922/http://www.glasse...

Unfortunately, no. Company was called InnovisionLabs, renamed GlassesOff, if I'm not mistaken. Website is down, and I wouldn't expect it to be up — company's runway ended about 2016. And the two apps we released (one looking like a game with some basketball player branding, and another one from scratch, with clean, medical design) are probably removed from app stores too.

What was the mechanism that improved vision? I have worked on medical devices and of course waiting on a clinical study is difficult for any business and many fail for one reason or another. But as an ecosystem for medical software Apple does quite a lot of damage compared to conventional platforms.

Commenting here as a bookmark to not forget.

If you click on the timestamp of the comment (e.g "N days ago"), you should be able to add it to your favourites, which is then accessible through your profile.

Ah, thank you! Alas, can’t remove my comment anymore.

TIL

Could you not just feature your qualifications front and center?

Can you post this app?

[dead]

> Medical apps are allowed, but there's a higher bar for evidence.

Except when you are Apple. /s

What do you mean? The article is about how they got FDA approval... Isn't that the way to go? As in, it's a much higher bar than having a medical license and insurance no?

Simply not true. I once spoke to an old coworker (who's now a senior executive at a Fortune 500 company, not Apple). And he said in these large companies, there is so much discussion around risk, because the larger the company, the more of a juicy target they are for lawyers and lawsuits.

So the thought that Apple wouldn't have their ducks in a row isn't true. Especially since any feature they release, will be used by millions of people pretty quickly.

Just to be clear, I'm not claiming Apple doesn't give themselves special treatment in the App Store. They absolutely do (as you'd expect). Just pushing back on the notion that they wouldn't have documentation and all their legal stuff taken care of.

Don’t assume large corporations have their shit together. They fuck up all the time.

[flagged]

Question: were the "medical reasons" specific or a generic "no because it's medical related" reason?

As in, did their refusal say "no because the way you're tracking if the user is on their back is not accurate enough?" or did they say "we don't allow people to write watch apps related to medical diagnoses / treatments / etc?"

Just say it's a game. Add some social widgets ("Get your non-back sleeping scores on the leaderboard!"). Maybe throw in a T&C forbidding using it for medical purposes.

Any chance that you'd be interested in open-sourcing that app?

A very long time ago, I got the impression that sleeping on your back is healthy, and successfully "trained" myself into the practice… now I'm trying desperately to untrain the habit 9_9

I have sleep apnea and specifically asked my doctor if there was a best or better sleeping position, and she said no. I find laying on my back causes the least interference with the mask, but I've yet to manage to actually sleep on my back yet, been trying for like 3 years now.

Ever try a weighted blanket?

I haven't. I'm pretty comfortable on my back, just can't seem to fall asleep.

If they open source it but the app isn't allowed on the app store, how will anyone install it?

If they're on Mac, they can import it into XCode and install it as a development app.

In my understanding it can be allowed as long as they do not market it as medical app?

We've been sideloading iOS apps for years without any issues. You can use Xcode, or sideloadly, or altstore, or like a hundred other ways.

It is healthy, unless you have sleep apnea or snore a lot.

Is this a sleep apnea thing because I've always been told you want to sleep on your back?

Told by whom? Gravity works against you when you sleep on your back: your jaw falls in on itself, your tongue relaxes down into the back of your throat, stomach acid can flow up into your esophagus with relative ease. AFAIK the left side is generally the "recommended" position. It addresses all of those issues.

In some cases sleeping on the stomach might be preferred, as that helps the lungs take in more oxygen, which is why patients on respirators are often kept on their stomachs in hospital.

That being said: if you don't have sleep apnea or reflux, any position that's comfortable is probably fine. No one stays in one position the whole night anyway.

>Told by whom?

I sort of feel my body telling me, my back hurts because I never sleep on my back (because of sleep apnea, or at least horrendous snoring) but when I lay on my back it feels much more comfortable, but can't sleep that way because I will wake up the house.

Your back hurting could be a number of factors, but the big two would be your mattress or your posture/overall while awake. Try doing planks and crunches each day to build up core strength, which makes it a bit easier to maintain good posture, though that still takes considerable corrective practice. I have two back injuries, so all sleeping positions suck in different ways for me, but doing daily core exercises helps take the load off my back while awake so it hurts less at night.

> my back hurts because I never sleep on my back

Try a body pillow. Having something to wrap your arms & legs around and keep your spine aligned counteracts at least some of the discomforts of sleeping on your side.

> just get a waifu bro

It doesn't need to have a picture on it. Orthopedic pillows exist, as do plain covers for dakimakuras, lol.

> AFAIK the left side is generally the "recommended" position

whats wrong with right side?

Sleeping on the left side allows the stomach to operate better while sleeping on the right favors the heart. I'd always heard this, but recently read a short article confirming it. Dunno if it's true, though.

Sleeping on the right side has been reported to help clear cerebrospinal fluid from the brain which might slow the buildup of plaques related to Alzheimer’s.

for people with acid reflux / GERD / heartburn at least, the "sleep on your left side" thing has to do with the layout of the esophagus. For whatever reason, sleeping on your left means that gravity helps work to prevent acid reflux, whereas the opposite is true for the right side. Not sure if there's any benefit other than that

Radiologist here. We actually put patients in LPO (left side down oblique on your back ) followed by RPO to elicit reflux to catch it on the xray camera.

The opposite is RAO (right side down on belly oblique), when we want to show the opposite esophageal emptying into the stomach.

But any one position is probably not good to maintain for a long time. That’s why patients on respirators get turned so they don’t develop pressure ulcers.

Personally I have found 15-20 minutes prone (on my belly) is helpful reducing fatigue after intense exercise.

> For whatever reason

The short answer is that your organs are mostly asymmetric and the esophagus connects to the stomach on the right so by laying on your right your stomach acid flows to the sphincter connecting your stomach and esophagus, making it easier to leak into the esophagus. This is especially a problem with GERD because you don't have pain receptors on that end of your esophagus but the stomach acid can still damage its tissue, which can lead to further complications including cancer.

A common cause of acid reflux is a herniated diaphragm (hiatal hernia) in which part of the stomach slips through the diaphragm into the upper chest. In this the esophageal sphincter will not be the highest point of your stomach, further adding to the problem when sleeping on your right side. Imagine a plastic water bottle deformed in such a way it stands slanted with the opening to the right, now imagine laying it on that side or the other. Laying it on the side with the opening makes it more likely to spill if the lid isn't forming a perfect seal.

The arrangement and orientation of organs means you're a bit more likely to have acid indigestion if you're on your right.

Your heart is on the left side of your chest so its probably reacted to that

> which is why patients on respirators are often kept on their stomachs in hospital.

Yeah, since COVID-19, and even then, only for patients who are severely hypoxic (ARDS or severe respiratory failure). That said, it is not universally applied to all ventilated patients, and in many countries it is not even practiced at all.

Yes, sleep apnea mostly gets worse if you sleep on your back so they suggest sleeping on your side.

Yes, although untreated sleep apnea is dangerous and you shouldn't rely on this if you suspect you have it. It may make it better but you may still be starving your tissues of oxygen.

I have sleep apnea that I treat with a BiPAP machine. The neurologist who manages it said that everybody has sleep apnea to some degree, and, as a matter of fact, with my BiPAP machine, I have fewer episodes than the average person.

Starting CPAP tonight. Wish me luck!

How did you sleep?

Good luck!

Conversely, for my case:

I was told that my sleep apnea didn't rise to the level of a medical condition needing intervention, but I should try to avoid sleeping on my back to help with the problems that do present.

I've always been jealous of people who can sleep on their back as it would allow them to sleep on thinner mattresses when camping!

Everyone's talking about the app but I'm impressed by the tennis ball idea.

Great minds think alike! Here's my attempt using an ESP-based smart watch that clips onto your clothes at night: https://github.com/a1studmuffin/lilygo-twatch-sleepdevice

Interesting and frustrating story! There's an Android app I've used that does that: https://play.google.com/store/apps/details?id=com.koalative....

How can a phone know which position you're sleeping in?

Obviously the user untapes the tennis ball on their back, and tapes on their iPhone instead.

I thought you were supposed to use an iPad Pro.

I wore it on a chest strap. awkward but not impossible

Aha!

Yeah, that would work!

How does it detect your sleeping position? Is it based on the watch position or is there another trick?

Can you reverse the function to buzz you when you're NOT on your back if you use a cpap? (It only works most effectively when on your back.) Also, what's wrong with being on your back?

I don't think I have sleep apnea, but I know that if I fall asleep on my back, I begin to snore, which actuates my wife's elbow, which causes me to turn onto my side.

Incidentally, I believe I had sleep apnea when I was a kid, and for years into adult life until my wife elbowed it out of me.

My parents never thought I needed a diagnosis, but when I was just a few years old I got pneumonia from a bad cough and was prone to chest infections all my life afterwards. It was after I had whooping cough that my dad came in to check on me, and he noticed that I "wasn't breathing" (which he told to mum in a typically 'Irish Farmer'). She thought he was telling her that I was, in fact, dead and to my bedroom in a panic. Turns out she had previously noticed that I "didn't breathe". Basically, I'd appear to stop breathing entirely for very long periods of time. I think that the air would be very slowly leaking out for about a minute, and I'd be making a low whine noise. Then I'd take in a huge breath... and the low whine would begin again. I wasn't overweight, I was actually as thin as a rake, and my mother nicknamed me "Boney M" (which might show my age).

It was when I met my wife, back in the late 90s, that it became a "problem". She'd tell me I was making a terrible noise in my sleep, and I said "oh yeah, I do that". Every time my weird breathing woke her up, she treated it as if I were snoring: elbow me and say "YOU'RE DOING IT AGAIN". And I'd kinda wake up and then focus on breathing properly as a fell back asleep. I also took up running around that time.

After a few years the weird breathing (which, I now think, was asleep apnea) stopped. I had better sleep and woke refreshed, whereas all through my childhood, walking up and getting out of bed was a gargantuan effort. I could sleep till noon and still be foggy.

Anyway, aside from losing weight and doing cardio, maybe a watch that activated an elbow would be an idea?

Incidentally, another thing I trained myself to do was sleep with my mouth closed. I used to wake up extremely dry and absolutely need a pint of water beside the bed. I read once about surviving in the desert: keep your mouth shut too conserve moisture. So I'd intentionally keep my n mouth closed and breathe only through my nose. That worked too - except when I have a head cold, but I take antihistamines before bed to avoid blocked sinuses.

This literally just happened and now I’m posting a weak comment on HN at 2:19am.

Get diagnosed!

If you’re based in Europe you could launch it on the AltStore.

I decided to clarify why sleeping on your back can sometimes be bad. I found out that it's undesirable for pregnant women to sleep on their back. It must be a very useful app for many

Makes sense. Apple could be held liable for any false or misleading health claims made about an app.

Sleeping on your back isn’t a medical treatment. It’s a snoring reduction. You can buy snore guards, nose strips, special pillows etc to prevent snoring and none of those require FDA approval because snoring isn’t a medical condition.

Is it marketed as "intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals"? That's one of three things that gets you categorized under the FDA regulation. There's even a term for it: "SaMD".

It seems less likely to me that this is Apple being ruthless or pigheaded and more than you really do have to be careful how you market your iPhone apps.

I take your point; the FDA doesn't recognize "snoring" as a medical condition (but OSA is!)

So long as you're very careful what you say in the ad and within the app, sure.

Yeah, but the question is really about how the app was presenting it. If it was making anything that sounded like a health claim...

Ironically if they stopped this gimmick they keep up to be able to charge 30% they could have the app and the developer would be the liable one. But the developer doesn't even have to make these claims, they can just put it up and say "this may detect if you're on your back".

Apple isn't liable for you looking up medical misinformation that kills you using your iPhone on the Safari browser. Why would it be for an app that is clearly made by someone else? The difference is only because of the vetting, and they only do vetting to charge their fee, otherwise they'd vet other things too.

It's incredible how companies bend backwards to bullet proof any liability whatsoever on anything, except if they can make money on it.

> they only do vetting to charge their fee, otherwise they'd vet other things too

They also vet apps to keep garbage and scams out of it.

Many of the things they prohibit are things that are overwhelmingly good for their users:

https://developer.apple.com/app-store/review/guidelines

Now we're into a semantics meaning over "garbage and scams", as I believe pretty much all social media apps are a form of "garbage and scams". They just happen to have enough features that people like so they accept it.

Which is why Apple's page that I linked is quite a lot longer than my comment. It is more carefully worded. It also isn't based on your particular preferences or tastes, but the tastes and preferences of their target market(s), which may vary well not include you.

There’s a reputational risk in selling software that gives unvalidated medical advice.

There's an even larger legal one!

No, it's illegal to participate in the advertising or promotion of products making false health claims in any way.

I am no lawyer, but I guess any such law has to take into account physical possibility. Like, e.g. youtube itself can’t possibly flag every copyrighted content streamed live/etc.

> But the developer doesn't even have to make these claims, they can just put it up and say "this may detect if you're on your back".

Can you get your app to detect if your user's weight suddenly doubles while they're lying down?

Pets giving you a hard time?

It's for when the AG unit breaks on space stations. :(

Boeing has really gone down hill since the 2800s

I have sleep apnea and I have an implant to stop my apnea / snoring.

1. if your watch tells you that you might have apnea go get a sleep study! 2. apnea and snoring do tend to happen together but not necessarily. you can have apnea without snoring(sometimes the other way but not as common) 3. apnea is like high blood pressure it's slowly killing you. 4. there are a lot of options now to help you. one might be losing weight. one might be sleeping on a side or stomach.. you won't know until you do a sleep study! get it done.

After I got my apnea fixed I feel like a new person. I did not even know how tired I was or what being "awake" was like anymore. My body adjusted to a new normal. Please look into treatment!

> you can have apnea without snoring (sometimes the other way but not as common)

Got a source for the "not as common" part?

From my personal anecdotal experience snoring without apnea is excessively common. Most of people whom I had a pleasure hearing snore would just go on in a steady rhythm and that's it.

How do you know they don’t have sleep apnea? You’re making the assumption that the snoring people are healthy, whereas the logical assumption would be that something is making them snore. Given that snoring is caused by an obstruction to their airway, it’s reasonable to assume that obstruction will impact their breathing.

Because they are breathing in a sustained steady rhythm.

Apnea, by definition, is not breathing, so if they are snoring and breathing, they aren't likely to have apnea, are they?

> You’re making the assumption that the snoring people are healthy

I am not making this assumption.

Tell me more about this implant. Is that the electric one that basically tenses up your tongue as you breathe in?

How long until you got it? Did you have to 'fail' CPAP & the mandibular device?

I did fail at CPAP.. it really is hard to do; but I have friends who swear by it.

mandibular devices.. rarely work.

I am using inspire. It's great. Turn it on when I go to sleep after 15 minutes it turns on and it moves my tongue depending on my breathing. It is basically a pacemaker but connected to tongue instead of the heart. And if you look at pictures of an inspire and a pacemaker they look exactly the same.

So the reason everyone isn't getting it.. is not really for the side effects. But cost. My bill was 150k.. luckily I only paid a few thousand. So in order for your insurance to approve it you have to meet certain criteria.

(talk to your doctor for an exact list) 1. Can't have a high BMI. Snoring and Apnea are closely related to weight. Your doctor should get you on semaglutides first. 2. You must have failed at using CPAP. It failed for me for multiple reasons. But like I said I have friends who love CPAP and get the same relief as me. 3. You have to get a type endoscopy to see if the procedure will work.

I'm sure there are some other things they check but those are the main ones..

Now once you get the surgery.. recovery isn't tons of fun. When they are programming it while you are in surgery they are moving your tongue in all sorts of ways.. It took about a month to get to the ability to eat a sandwich again; and I was still sore for some time after that. They also have to do some craziness to get the wiring from your chest to throat(where the nerve for the tongue is actually stimulated. So my chest was sore and my arm was unable to pick up anything heavy for a couple months..

Also it takes a few months for everything to heal and for them to first turn it on. Then 3 months of programming to be stronger and stronger without waking you up.

But one day it clicked and I was sleeping like a baby!

Looked up inspire just now and the procedure (and your description of it!) feels really extreme.

I realize these are intrusive questions, but can't help but ask - Are you overweight? Did sleeping on a side/stomach not help?

Not overweight (5'11 170). Side / stomach sleeping makes my apnea / snoring go down but it's still 'moderate'. My snoring is extremely loud. You can hear it in the entire house. It's definitely ended relationships.

Procedure is definitely extreme. Just like any operation. But my situation was extreme. I literally was killing myself each night slowly.

Thanks. Damn. I'm glad you managed to resolve this.

150k is just obscene

I wonder how much it costs in other countries. There was a whole host of people working on me. Multiple doctors (surgeons / anesthesiologist) .. Inspire tech. Multiple nurses.

Because you are dealing with breathing and the tongue it's critical to monitor the patient very closely.

Below is a link to a view of someone getting the device(not for the screamish) https://www.youtube.com/watch?app=desktop&v=HAmtAynxW7w

The user you're responding to is probably in the US, where medical billing has no real relation to the amount of money an individual is expected to pay. It's just numberwang.

we don't call it numberwang, we call it freedom. /s

It is probably "Inspire is an implantable device that treats obstructive sleep apnea by stimulating the tongue nerve to keep airways open during sleep. It's an option for people who have moderate or severe sleep apnea and can't use or don't benefit from a CPAP machine.

Here's how Inspire works: Components: The device consists of a generator, sensing lead, and stimulation lead, all implanted under the skin. It also includes a handheld remote that patients use to turn the device on and off, adjust stimulation strength, and pause it during the night. How it works: When the sensing lead detects breathing, the generator sends a signal to the stimulation lead, which then stimulates the hypoglossal nerve. This causes the tongue to move slightly forward, which helps keep the airways open. FDA approval: The FDA approved Inspire in 2014.

Some potential side effects of Inspire include: Damage to blood vessels near the implant, Excessive bleeding, and Nerve trauma or damage"

There's a reason it hasn't taken off in 10 years.

I like the concept but I'm curious how it works. It sounds like it's based on detecting the movements of the wearer? Does that work?

It's a shame Apple is having patent issues with their SpO2 sensor. The O2Ring was a huge help in me understanding my sleep apnea early on, in combination with a formal sleep study. Sleep apnea is a very common and harmful problem, any sort of way of helping detect it will improve a lot of lives.

Are the patent issues just refusing to pay now or are they more complicated than that?

Their most recent press announcement around Android Wear seemed to imply that they don't license the tech outside of selling their own biosensors.

https://investor.masimo.com/news/news-details/2024/Masimo-Pa...

And they seem to have too high of a market cap for the Inception solution. "I just bought the airline. It seemed neater."

It’s only turned off in the US right? Would they use the data in the rest of the world since SpO2 data is available there?

The SpO2 data isn't useful for detecting sleep apnea because the sampling frequency on a smartwatch is way too coarse to pick up on it.

oh that's too bad. The O2Ring samples every 2 or 4 seconds but a lot of cheaper devices take an average reading once a minute or so which definitely obscures sleep apnea. (normal adults take a breath every 3-5 seconds when sleeping. with obstructive sleep apnea that can be more like once a minute.)

I don't think the apple watch is as accurate as they claim, and it seems to need many nights of data to make a sleep apnea decision, so in that respect it is vastly inferior to polysomnography. But hey, if it helps more people seek a proper diagnosis, then I'm all for it. Sleep apnea sucks. It seriously ruins lives.

Also: SpO2 is less useful here than you might think. Most at-home sensors are pretty unreliable, and it's possible to have sleep disordered breathing without having significant desaturation.

Well if you already have an Apple Watch and don’t want to spend the night plus potential sleep study cost (can be above $1000 for a lot of people), then this may help someone. Especially if they don’t even know.

I have sleep apnea and used Lofta’s service for $187 and paid for the machine out of pocket. So there is definitely a need for this type of testing.

> I don't think the apple watch is as accurate as they claim

What is the claim that they’re making that you take issue with? You should probably let the FDA know.

For real; this stupid patent thing is just one greedy company trying to get royalties from another while an entire built solution that could tangibly help regular people hone down on medical issues is completely disabled. I’m not usually the type to trash talk capitalism but this is stupid. I hope the company chasing down Apple for this goes bankrupt. It’s not like they’ve offered something I want to go buy that does the same thing.

They're tracking movements. Apple has a doc on how it works here[0]

>Apple Watch tracks movement with triaxial accelerometer signals, which capture coarse motion of the body as well as fine movements including motion associated with breathing. Apple developed an algorithm that uses the accelerometer time series data to classify Breathing Disturbances that occur during sleep tracking, which are temporary interruptions in the breathing pattern.

> A total of 1499 participants were enrolled, with 1448 completing the study. The sensitivity was 66.3% (95% CI: 62.2% to 70.3%), and the specificity was 98.5% (95% CI: 98.0% to 99.0%), demonstrating that the feature meets the design objectives to confidently identify sleep apnea while minimizing false positives.

>It’s important to note that the specificity was 100% (95% CI: 99.7 to 100%) for the normal category, indicating that all participants with a “positive” algorithm result had at least mild sleep apnea. Also, sensitivity was higher in the severe category at 89.1% (95% CI: 83.7% to 93.2%), indicating that the large majority of severe cases were identified.

0:https://www.apple.com/health/pdf/sleep-apnea/Sleep_Apnea_Not...

The problem is that these at home tests aren’t good enough to eliminate the costly and time consuming and inconvenient step of a sleep study in the lab. At least near me, to get a CPAP you first do a take home study with a wrist based (watch like) recorder. Then they make you go into the lab for an overnight sleep study (or multiple of them) anyways, for a study that costs your insurance several thousand dollars per night (and you have some copay potentially) and it is of course a massive hassle and barrier to getting CPAP treatment. They claim it is so they know your air pressure numbers but it is all just regulatory capture, because CPAP machines can auto adjust your pressure and people like to tweak numbers manually to their comfort level anyways.

Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

> They claim it is so they know your air pressure numbers but it is all just regulatory capture

I disagree. In lab titration is not about regulatory capture. It's the best place to get a good ballpark start. The rest should be up to the patient, but informing the patient of that is where things go wrong, alas.

> CPAP machines can auto adjust your pressure and people like to tweak numbers manually to their comfort level anyways.

They cannot. See my rant about APAP in the comments here, or my previous APAP rants in my history. Current generation APAP is awful and it needs to die. PAP machines are awful at detecting events. This could probably be partially mitigate with better software. But there is a reason why a sleep study is very much the gold standard. 12+ channels of valuable information. Versus 1 channel on the PAP device.

Current generation APAP works great - not sure why you’re calling it awful. And I disagree that more channels are necessary - that’s a statistical implication that not true in general and shouldn’t be assumed blindly here. What needs to die is regulatory capture and bureaucratic barriers that take health care out of patients own hands, which is what the sleep study scam does, at least in the US, where you cannot get a CPAP/APAP device otherwise.

> Current generation APAP works great - not sure why you’re calling it awful

It doesn't. Your PAP machine doesn't even know whether you're awake or sleeping. It can only ever play catch-up to your breathing getting worse. Properly titrated CPAP (or BiLevel or ASV) is vastly superior both in terms of therapy and comfort.

> What needs to die is regulatory capture and bureaucratic barriers

That I agree with.

> which is what the sleep study scam does

It's not a scam. It provides incredibly useful data. Sleep problems are not just a boolean sleep apnea yes/no. All kinds of shit can go wrong during sleep. Maybe you have central sleep apneas, or complex apneas, maybe you need ASV rather than CPAP. Maybe you have restless leg syndrome (orthogonal to sleep disordered breathing). Maybe you just have positional apnea. Maybe you have REM disorders. Your apple watch won't tell you any of that.

Many people end up getting a sleep study because they're tired. That doesn't have to be apnea. Other people get sleep studies because they snore or because a bedpartner tells them they breathe weird in their sleep. That's more likely to be apnea.

> Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

I sure hope so, because my experiences with sleep apnea made it seemed very quack-ish. I keep on hearing ads on the radio by a company called ADVENT with a catchy jingle promising that surgery is the solution to snoring. At the time I had my study (2013) I did not have an in-home test and had a sleep test (which was an awful experience). I was prescribed a Phillips CPAP machine and was very good about adhering to it and keeping up with regular doctor visits. During the 3 years I had it, I lost a significant amount of weight and each time my doctor re-programmed my CPAP SD card so it was a lower and lower setting. I always had very little face time with the doctor, I wish I knew about Sleepyhead earlier as I could have done this myself. The practice I was referred to would always try to sell me stuff like new masks, tubes, etc. when everything I had was in good condition and frequently cleaned. I even used distilled water in the CPAP itself. Eventually I went on a long vacation and didn't bring my machine and been off it since. I'm glad I did, it turns out Phillips was negligent about foam breaking down in their CPAP machines and even the replacement devices have this issue as well. At this point I don't know who to trust, and with something with Apple's name on it would give to some more legitimacy.

> Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

Integrate with the existing providers (= making deals with all the existing players and provide the adequate SDKs) and bring more accurate and reliable measurements than dedicated, calibrated devices.

That sure could be possible, but has Apple ever done anything like that ?

They couldn't come to an agreement wit Massimo, I wouldn't be holding my breath on them sealing deals with the incumbents in the field.

The largest barrier by far is actually starting the process to get a diagnosis. It's often a family member that notices and raises the alarm.

Note that you can be diagnosed with sleep apnea based on the home study alone, you don't always have to go to a sleep clinic. If you are really sure you have sleep apnea (and you can be pretty certain with a home sleep study + symptoms) you can just go online and get a prescription for free by talking to a doctor at one of the companies that resell CPAP machines. At least in the US, other countries can be more bureaucratic.

I have tried for months to use my APAP machine, and failed. My wife has no problems using her. I’m not really sure what the next step even is. It’s frustrating because I can tell when I get a bad nights sleep I can’t think as well, but it feels like there’s nothing I can do about it. I can breathe through the CPAP exclusively for hours but then as soon as I try to go to sleep I feel like I’m being smothered and my heart starts racing. Does anyone have any advice?

Reddit is pretty great for cpap related help and hints.

I just did 3 nights with mine and conclusion: it's all about the type of mask + settings.

First 2 nights was terrible (and painful on the face) due to wrong masks and wrong settings. 3rd night was best I've slept in a longgggg time.

I can't tell you which masks or settings (it will be completely different per person), but reddit is pretty great at providing hints.

My case: disaster with nasal mask and full face mask size L and high pressure settings (lots of central apnea). Almost perfect with 4 to 10 pressure setting and face mask size M (which should be too small for me according to the manufacturer).

I use a Resmed Airsense 11, soon getting a heated tube so I can crank up the moisture setting without getting condensation and noises in the tube. Will try more different full face masks as well.

This is 100%. I've been using mine close to a decade not only mask size but seal type. My wife can only use the foam rubber type masks I use the regular ones. I also have a Resmed Airsense with the heated hose and it really helps.

It took me a few weeks to truly get comfortable but now I can't imagine life without it. Never thought there would be a time when I could get 6-7 hours sleep and I would be fully rested.

I’ve been using a CPAP for 15 years. A few items I had to adjust when getting that suffocating feeling a few times:

1. When getting a new CPAP I had to reduce the pressure from 15 to 14 or 13 to mitigate the suffocating feeling. I still get my normal 0.5 events per hour while I’m use. I also got a different type of mouth and nose mask which may have contributed to needing to adjust the pressure.

2. I was trying to mitigate the colder air being distracting by enabling the humidifier and tube heater. With the humidifier level too high at 5 I got a suffocating feeling, reduced it down to 2 or 3 and the air was warmer while not feeling suffocating. 3. I also turned off the dynamic pressure on breathe out as the timing felt off and would cause a hitch in breathing, so I have just plain constant pressure.

The name of the game is tweaking and experimenting.

Followup sucks in most part of the world, unfortunately, which leads to awful compliance.

Best thing to do is install Oscar [1], take screenshots of your data, and post it to Apnea Board [2]. The folks there will likely be able to offer some solid advice.

Without knowing anything about you or your data, all of this speculation, but: APAP sucks, it is always too slow to respond, it won't know to increase the pressure until after you needed more pressure. This is especially true for wide ranges which are often the default (like 5-20cm). If you need 15cm, it will take forever to get there, because you'll start at 5, start to drift off, get an apnea, the machine will increase the pressure, you'll wake up ever so slightly from the apnea, the machine will decrease the pressure because now you're breathing fine, and the cycle will continue.

[1] https://www.sleepfiles.com/OSCAR/ [2] https://www.apneaboard.com/forums/

Things that have helped me:

- nose mask rather than full face mask

- nasal spray if my nose feels congested

- upping the pressure. In theory a professional is supposed to set your pressure but I do tweak mine. If the setting is not visible it's probably in a hidden menu - Google for how to enable it for your machine.

- sleeping pills

I hope you find a solution. Sleep apnea is terrible.

I’ve seen someone go from AHI of 15 to a 1 during at at-home sleep study and asked what they did differently, they said their nose was stuffy so they took some cold medicine/allergy before bed.

I wish at-home sleep tests didn’t require a physician to prescribe and review results. It would allow people to experiment with sleeping positions, snore guards and other methods to get their AHI down.

Please don't recommend sleeping pills to people who have sleep apnea. They can make apneas worse.

> as soon as I try to go to sleep I feel like I’m being smothered and my heart starts racing

You may need your pressure adjusted. You are awake so whatever pressure the machine is using is fine. Then you start falling asleep and that's when your apnea kicks in.

If you are using the standard autoset 4-20 setting it may not be enough. Ideally this would be done by a medical professional and yada yada - insert standard disclaimer here. I would suggest increasing the lower pressure (say, to 7) to see if it helps you. I was using the default for years and, while it did help me, apparently it wasn't enough. After increasing, it's been night and day.

It _could_ be an issue with your mask but given what you described, probably not.

Sounds like you aren't getting enough pressure. Also sounds like there could be some mechanical reasons like gerd, allergies or inflammation that cause your apnea, especially if you start fine.

I agree. When we fall asleep we lose muscle tone, which makes apneas more likely -- that is why we have trouble breathing when we sleep, not when we are awake.

GP needs to find out how to set up the pressure in their CPAP device. YouTube has tons of videos on that subject.

I went through the same thing.

- #1 - switch to Nasal pillows.

- I had to learn to breathe through my nose

- I had to learn to sleep on my back with a pillow that cradled my head without raising it

- I had to make sure the level of distilled water in the humidifier was not too high.

- make sure the tubes are not higher than your nose (otherwise condensation water drips into your nose)

Did you try different types of masks? I found that I felt like that during the initial phases of the titration study (where they determine the right settings for you) but once they dialed in the pressure, that feeling went away and now I actually quite enjoy it, since it makes it easier to breathe through my nose. I use a nose pillow.

This is a common and difficult problem. Has your sleep doctor helped you with it? You might also find an online Sleep Apnea forum has ideas for you. I learned a lot from https://www.apneaboard.com/

I was prescribed a CPAP (well, APAP as you mention) and the first week was miserable. I think I got 3 hours of sleep total that week, and obviously felt like crap. I talked to my primary doctor and she's like "well then go back to the specialist". That's what I'm doing.

My plan is to get a prescription I can use to buy a bunch of different masks (I don't care about the cost), and get a few days of sleep aids. That should sort it out.

The few hours I did sleep with a CPAP were crazy. I forgot that I stopped having dreams. I had so many dreams while I could breathe at night.

What bothers me is that you need a prescription to get a mask for a CPAP - I kinda get the prescription needed for the CPAP - but the accessory mask - that just seems absurd to me.

Looks like there's plenty of masks available on Amazon. I suspect a major part of why the mask gets a prescription is to make insurance covering it simpler.

There's a funny workaround where mask parts don't require a subscription. The ones I've seen on Amazon are usually selling parts, perhaps a kit of parts, and not a complete mask.

Yeah, doctors can write a prescription for over the counter drugs for this reason.

I bought masks at sleeplay and another cpap store and they didn't ask for prescriptions. Sleeplay did ask for a prescription when I wanted to buy a travel CPAP.

You don't need a prescription for CPAP masks and you don't need a prescription for CPAP devices. You can freely buy both in most parts of the world. If you happen to live somewhere where you can't (and you can't get a prescription for some reason), then I suggest you find an online reseller anyway.

From a few minutes on Google, it appears like most developed countries require a prescription to purchase a CPAP device, including the US (varies per state), Canada, UK, Australia, Germany, France and Italy.

The most notable exceptions I find are Japan and Singapore, where it can be purchased without an Rx.

I think those places need a prescription in order for insurance to pay for the machine, not to buy the machine.

No, you need a prescription in the US. And that prescription is withheld by sleep specialist “doctors” until you do an expensive and unnecessary sleep study. These doctors serve no useful role other than telling you really obvious things, but you are forced into multiple appointments with them just for the prescriptions. Going through insurance then can require at least one more follow up appointment, but sometimes more depending on your plan. Some of them require multiple appointments where the doctor confirms your usage.

That is incorrect in at least Canada and Spain.

As for other developed countries, they typically have universal healthcare and the patient does not need to pay for CPAP devices. Regardless, insurance and prescriptions are orthogonal.

You can order them online, not sure if a prescription is required:

https://cpapoutlet.ca/

You need to email them or fax them a prescription. I live in Canada. I know this for a fact. I had to do it myself.

From the website you linked:

> All CPAP machines require a prescription for shipment. Details of submitting a prescription are provided below. If you have any questions or concerns, please call us toll-free at 1-855-542-2727.

Source: https://cpapoutlet.ca/pages/shipping-returns-policy

That’s not true at all, I purchased mine in the UK without a prescription.

The websites I found indicate that a prescription is required in the UK to purchase a CPAP machine. If you have any alternative links, please do share.

Here is an example of what I found:

> Do I need a prescription to buy a CPAP mask?

> You do need to provide written confirmation of CPAP suitability when ordering a machine, but this is not required for a CPAP mask.

Source: https://www.cpap.co.uk/help-and-advice/cpap-mask/

I buy my masks on Amazon. No prescription needed.

Also, the nasal pillow "masks" are vastly superior.

at least for me, it took like two weeks of adjustment to get used to a CPAP.

one big thing is that you really should only breathe through your nose if you're using nasal pillows.

Your pressure is too low and you are suffocating. While awake you are manually breathing deeper which is why you are okay.

Set the minimum pressure to something higher, like at least 10, possibly more. If it’s an auto machine then it will adapt to you anyway. At the minute it’s probably set to something like 4 which isn’t any air at all.

Have you tried playing around with the humidity? If I have it set too low, that definitely makes a big difference. There are also other treatments for sleep apnea that you could look into which might work better.

Heated humidification is a crux. You only "really" need it when you have a mouth leak ( or if it's awfully cold and dry in your bedroom, like an igloo?). It also vastly increases the amount of maintenance you have to do on your CPAP device. It makes your masks wear our quicker. It makes your hose more susceptible to growing mold etc.

The real trick is to fix your mouth leak. Getting on the right pressure helps with that. Fixing your sleeping position can help. Mouth tape can help. A cervical collar can help. Anything that will help you keep your mouth shut at night.

Humidification is necessary in any place where winter is cold. Cold air can't hold much absolute moisture, and as you warm it up to room temperature, the relative humidity of that air drops. In Canada you will often find the relative humidity of the room to be below 10% in winter, which is uncomfortable even in the absence of CPAP.

I don't use the heated hose, but the humidity is invaluable since my sinuses often end up clogged if I don't use it. However, I also live in a desert and regularly have ~20% humidity in my house.

That feeling of being "smothered" might simply be that you need a higher pressure setting. The pressure that feels comfortable while awake might not be sufficient when your body is asleep.

Have you looked into "elastic mandibular device"? You can get a mouth guard that keeps your jaw from falling away from alignment. It was enough for me to avoid a machine entirely.

EASE and/or MMA

https://sleepapneasurgery.com/about-dr-kasey-li/

My kid had sleep apnea. His problem was narrow nasal passages. He got EASE surgery from Dr. Kasey Lee when he was 14, and was completely cured. You get better results getting surgery while bones are still pliable. It was like a miracle, an outpatient procedure that changes your life.

After the surgery, he was finally able to get quality sleep, and his personality changed. Before the surgery he was super-intense, slightly ADHD, not doing great in school. All this went away after the surgery, he is just a regular bright kid now. We noticed changes in the first week, took about 2 years to find new normal. Before the surgery, we tried CPAP for a while, and it helped a bit.

My wife also had the same surgery. It helped, but did not completely cure her apnea.

Do you have a slow ramp up of pressure? I have to start on low pressure when I first put the mask on each evening.

Your sleep doc/clinic may be able to help.

The 'ramp' setting made me panic and felt like a couldn't breathe. We go from zero to full force now, and it works just fine. I use a nose adapter.

That's what I found too (minus the nose part).

It's low pressures that feel suffocating (because there isn't sufficient airflow). High pressure feels great... as a life long asthmatic it's the best I ever breathe.

As an alternative, the opposite may also be true. I could never sleep when I had the slow ramp of pressure.

That sounds like a huge problem! Which masks have you tried? There are many different mask options that you may respond differently to

> I can breathe through the CPAP exclusively for hours but then as soon as I try to go to sleep I feel like I’m being smothered and my heart starts racing

I felt the same way when I was prescribed a CPAP about 20 years ago. I'd be set to go, get panicky, take the mask off and not feel like trying again for longer periods of time until I gave up. Then about 2 years ago I decided to get a doctor again, talk about my sleep apnea, get a new set of sleep studies done, try to get a machine (it took forever!). I got prescribed a similar machine called an ASV.

For me, the thing that works is a breathing technique the technician at the sleep study told me, which was breath in manually, but then just relax to breathe out rather than forcefully breathing out. Currently I do that by breathing in manually, and then relaxing while counting to three as I let it out. I don't know if it's just a mental way to relax or what, but it works for me. Also, when I was taking the sleep study, I was determined to complete the test, so taking it off wasn't an option, even if I got anxious. So I did the breathing thing, and they were able to get enough data to proceed.

I go to sleep when I'm very tired; that might help. As far as I remember, I fall asleep very quickly. If I wake up in the morning, I can't really get back to sleep since I just notice the mask too much while not falling asleep; I guess I'm not tired enough any more at that point. 7 hours is good for me, but often I'll get 5-6 hours.

Edit: oh yeah, my number of sleep events (when you stop breathing) went from 120 to ~1 per hour. For comparison, >5 is mild, >15 is moderate, >30 is severe.

Honestly? Find a new doc. I went to one for sorta similar issues and their advice was basically "oh well that sucks" and then years later went to another who said "okay let's try this instead"

Now I'm on a bipap and tolerate it through the night.

Check with your dentist also, some apnea cases can be treated with a mouthpiece you wear while you are sleeping.

> The feature, announced at last week’s iPhone 16 event, will arrive as part of the imminent watchOS 11 release.

how exactly was Apple able to preannounce approval for this before the, yknow, approval?

like exactly no other agencies work this way, precommiting them to a decision they havent formally taken, even if informally it was already taken they would frown very strongly on leaking their stuff

The announcement said that the feature was pending FDA approval.

Most likely the decision was taken internally, but sometimes to make it official requires some procedural paperwork. Apple probably got the green light that the approval was approved on the way.

Having been next to the people working with the FDA at one point, they do tend to give a lot of feedback, especially when they don't like something. And there were a lot of hoops to jump though where the feedback was "you are on track" for a while before the actual official approval of that step came through.

Very likely all of the core approvals were done, and they were just waiting on things like approval of software testing methodology (yes, they have to approve your software testing system), or something of the like.

I’ve always dealt with snoring and a take home test was inconclusive (so my doctors weren’t super pushy about me doing an in person test). I still worry a little and my dentist used their 3d head XRay to show me my airway is so slightly constricted and I will certainly have it one day if not now.

All to say I am elated to have my watch helping me just monitor and understand the issue and help give me more actionable data if I need to pursue the doctors again.

I just wish we could solve this with something other than needs-AC-plug machine. I’d like to be able to travel without needing to think about that

This is a great "free" feature in a wearable. I wonder how many years are left before Ozempic-like drugs make sleep apnea a rarity.

Sleep apnea is not completely due to being overweight.

Hence their qualifier “rarity.”

But it’s not that rare in non-obese people, I think is the point. Obesity is certainly a risk factor.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181619/

When I arrived at the sleep clinic with a BMI of 22, the first thing they told me was: there are lots of people with sleep apnea who have a healthy weight, including children.

The notion that sleep apnea is generally caused by weight needs to die. People also conveniently forget that being woken up multiple times every hour causes weight gain, so often times being overweight is the consequence of sleep apnea rather than the cause.

Thanks, I'm usually the one who has to get on their soapbox to say this. I'm glad I'm not the only one anymore :-)

What's crazy is all the downvoting. Why are people so invested in this idea that BMI is the primary/sole cause of OSA? It's literally killing people and the science is pretty conclusive. It should be one of those screens you take at certain milestone ages like colonoscopies.

People are ignorant about conditions they don't have and they want to believe that it won't affect them.

I started noticing clear symptoms of OSA when my BMI was less than 20 and my VO2Max was around 51. That is to say, I was leaner and fitter than most.

I completely agree that they should screen folks routinely.

> I wonder how many years are left before Ozempic-like drugs make sleep apnea a rarity.

Obstructive sleep apnea is not caused by being obese or old, although those things don't help. In some people, losing enough weight may allow for sufficient airflow despite their airway restrictions.

I wouldn't count the Ozempic chickens before they roost. So far it looks like it's a costly lifelong injectable drug with a lot of reported uncomfortable side effects. That doesn't bode well for adherence at the population level.

Weekly injectable semaglutide is the first generation.

Tirzepatide is already more effective and better tolerated for most people, and there is also semaglutide as a daily oral pill available as Rybelsus. Further generations of obesity drugs are already in human trials, and are showing even greater effects relative to the side effects (e.g. retatrutide and combination therapy with cagrilintide).

Price is an issue, but with multiple pharma companies that have effective drugs, the prices have already come down quite a lot. My tirzepatide is running me less than £200/month now, and I'm saving at least that on groceries and eating out. Not even counting that it's effectively cured a few weight related medical conditions that were costing me more.

Actually, it's also a miracle drug that can reduce inflammation and reduce the medication load of millions of people.

From what I've seen anecdotally, Ozempic adherence is much higher than most other meds. And the side effects are minor compared to, say, being 200 lbs overweight.

>And the side effects are minor compared to, say, being 200 lbs overweight.

I was about the reply the same thing. Obesity is directly or indirectly a risk factor for almost every health problem imaginable.

Even for a situation that looks completely unrelated like getting shot in the knee by a gun, the risk of dying during the surgery will be significantly higher if you are obese.

People have a real hard time with harm reduction strategies and I don't really know why. Ego, sense of moral authority, bein just plain old mean?

I heard all the same crap when vaping became big 10 years ago.

Given that >80% of Americans have some form of metabolic dysfunction, it's not surprising that those drugs are having miraculous effects.

That depends. A lot of people experience significant GI issues. And it isn’t clear yet if those issues are reversible after stopping. It’s still best for people to naturally control their weight and diet. Is one better than the other - depends on how overweight and how severe the side effects. Right now I feel like there isn’t much focus and rigorous study of those side effects but over time I expect it will reduce the overall positives of the drug somewhat.

"A lot of people experience significant GI issues. And it isn’t clear yet if those issues are reversible after stopping."

I don't think there's any reasonable definition of "a lot" where this is true. A significant number of people experience GI issues. Most of them subside after a time. There is some evidence that a small number of people may experience more severe GI issues that don't go away after stopping.

"It’s still best for people to naturally control their weight and diet."

What is your evidence for this? Right now, it's looking like the "unnatural" GLP-1 agonists are racking up quite a score against "natural" methods like "willpower" and programmed diets. It's not a useful distinction, in any case. These medications cause reduced calorie consumption, and reduced calorie consumption causes weight loss naturally.

The only advantage I know of for the natural way is you can retain more muscle mass potentially[0], so your relative body composition is probably better than someone who lost 75 pounds with Ozempic (eg. Ozempic Face).

[0]https://www.theatlantic.com/health/archive/2024/02/ozempics-...

[0-1] Especially if you: Try to consume about 1 gram of protein per day per gram of lean mass, lift weights, limit cardio intensity and duration (30 mins on stationary bike 3x a week worked for me)

In the first study (https://www.nejm.org/doi/pdf/10.1056/nejmoa2032183), the semaglutide group lost less LBM than the control group.

> the proportion of lean body mass relative to total body mass increased with semaglutide.

In the second study (https://link.springer.com/article/10.1007/s13679-023-00534-z), in the STEP 1 trial, the semaglutide group lost less LBM (40%) than the placebo group (56%).

Yeah, the lean mass loss effect associated with GLP-1 agonists is just the effect of rapid weight loss without lifestyle and dietary changes other than calorie restriction. There's nothing about Ozempic etc. that keeps you from eating more protein, working out more, and so on (in fact, it makes it easier to do those things in most cases). People are noticing "Ozempic face" because the people who are losing weight through calorie restriction via GLP-1 agonists previously would have just failed at dieting and kept the weight on.

Diet and exercise are also costly, have uncomfortable side effects, and require lifelong adherence.

It's free if you buy a brand new model. Ha.

Also works with last years model!

Yeah, I bought the "Ultra" less than 24 months ago, it was released September 23, 2022, only for it to be obsolete within 12 months and now it's the model that can't even do new features. IT'S LESS THAN 2 YEARS OLD!

Maybe I should learn my lesson and stop buying Apple Watches, it's really a joke.

It going to be great fun as Apple and Google add more and more medical features and then when they ban your account you lose them all. Maybe this will be more of the door to break their control on mobile computing.

You don't lose your HealthKit data when your AppleID gets banned. The data is still on your phone.

You can also backup your phone outside of iCloud.

"You can just back up your data" isn't a solution for most people.

What specific problem are you talking about?

I agree – there is precedent in the medical industry: in the US, providers that take Medicare and Medicaid require retention of patient records for at least 5 years for both portability and audit purposes. If that principle's sound (at least for portability), it may be a good argument to extend that to healthcare applications that reach a certain threshold of substantial content.

I understand the argument that it's quite annoying that so much of the hardware you own relies on Apple permitting you to keep using it, but on the other hand what are you even doing to make them ban you? Their terms and conditions make it fairly clear that the only thing that would cause this is if you upload illegal content to their platform or attempt to chargeback purchases.

> Their terms and conditions make it fairly clear that the only thing that would cause this is if you upload illegal content

This is false:

https://news.ycombinator.com/item?id=32547912

https://news.ycombinator.com/item?id=33737577

https://news.ycombinator.com/item?id=35133917

https://news.ycombinator.com/item?id=22146082

https://news.ycombinator.com/item?id=22705122

https://news.ycombinator.com/item?id=4013799

None of these are Apple except the one where someone was unable to access a verification email, which is hardly Apple’s fault

Those are all Google, argsnd is talking about Apple. But I'm sure one can get randomly banned by Apple as well.

Indeed you can: https://news.ycombinator.com/item?id=26310817

or you get hacked and your account is used for spam

or you email an innocent picture of your naked baby in their first bath and the ML gets your banned

Such a shame that my 2 year old, ultra high end watch can't use this feature. Apparently Apple Ultra is too dated to have this functionality, what a joke.

It’s always disappointing when high-end tech doesn’t support features that seem like they should be standard.

Especially when you pay a premium for the "ultra" which turns out to be the not so ultra 9 months after release and now, doesn't support one of the most enticing features.

I get it, Apple is a business, I love their products, but I can see why people hate the company.

What does that approval mean for the rest of the world? Do they still need a new approval in Europe before adding the feature in the EU? And if so, is the feature geofenced? E.g., you lose it when traveling or how do they prevent Europeans and people living in markets that are pending approval from using it?

Main reason for sleep apnea - in my opinion - is deformed/degenerated fascia in the neck aka head forward posture. It's the disease of our modern (sedentary) age. SA is only one symptom. If you heard this the first time please feel free to ask. I'm always astounded at how common these CPAP devices are. Truly frightening.

That is definitely one cause of OSA as is micrognathia and other craniofacial abnormalities, but it remains that the most common cause is fat mass constricting the upper airway - even if that person has completely normal craniofacial development and proper posture.

Does this mean that you could be prescribed an Apple Watch if you were at risk of apnea? Or even use an HSA?

I have been really curious to this. In IRS Publication 502, it states: "Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness."

You could make the argument that the Apple Watch can be used to manage your sleep apnea condition. On the off chance you get audited by the IRS you might just be better off paying for it with non-HSA funds rather than dealing with that mess.

PSA: HSA expenses are based on the honor system, but obviously don't go to Best Buy and buy a PS5 on a HSA debit card. You are allowed to reimburse yourself for medical purchases. For example, if you have a large ticket medical expense you can use a credit card that provides a perk like air miles and then just transfer the funds from your HSA checking account to your regular checking account. Just remember to keep detailed records/receipts.

No, the watch is not a medical device intended to treat something. Just a general fitness device. Even the built-in EKG doesn't qualify it for HSA, and that is a lot closer to being medical than a notification pop-up saying you might want to ask your doctor to test you for sleep apnea.

I can see it now: it's December and my FSA still has a balance, must be time to buy 12 Apple Watches and sell them on eBay.

Out of curiosity, does your health plan have an HSA? After learning about these I decided that FSAs are a total rip off. Why would my money expire?

If you know you're going to have certain recurring expenses, they can be great. That money's untaxed so you're basically getting a 25% or whatever discount on whatever you buy with FSA money. But yes, the expiration bit is insane. That's how I ended up buying a pair of prescription Ray-Bans in late December several years ago.

> That money's untaxed so you're basically getting a 25% or whatever discount on whatever you buy with FSA money

This is the same with an HSA. The difference is that you can invest funds from an HSA and the growth is tax free.

That's not the difference. The difference is that you have to have an HDHP to use an HSA. My employer pays for me to have a very good low-deductible policy. I did the math and it would almost certainly cost me more out of pocket to have an HDHP than what I have now. If you are young, single, and healthy, the equation may look different. If you're older and have a spouse and kids, it's shockingly easy to hit the deductible and OOP max year after year.

I could imagine a case where I'd start an FSA. An HSA did not work out well for me a few years ago when I tried it, and would be even less likely to be a win for me now.

Can a more Apple-minded person help me understand if the Apple Watch SE counts as "Series 9"? I don't totally understand how "SE" relates to numerical versioning, but I am also not an Apple person.

Apologies in advance if this question is somehow obvious to others.

"SE" denotes a cheaper, less capable model that is not part of the main sequence of product generation numbering. There have been two generations of Watch SE and three generations of iPhone SE; they're not updated as frequently as the flagship product line. The Watch SE does not have the sensors for EKG or blood oxygen, which are probably necessary for the sleep apnea detection.

SE is a line orthogonal to their flagship models. Usually it means they took the enclosure from a previous watch and shoved some improved guts in it. Apple Watch SE is similar to Apple Watch Series 8 in terms of processing power but externally (screen, sensors) it’s like Apple Watch Series 4 or thereabouts.

Steve Jobs must be turning in his grave over this dogawful naming scheme.

Will this work outside of US or does it need to get approved by other orgs, like whatever is EUs FDA?

They announced they're targeting 150 countries, so there will likely be CE-mark approval coming (this is the EU equivalent of the FDA).

CE marks aren't an equivalent to an FDA approval process, they're self-certified with no real oversight.

> By affixing the CE marking to a product, a manufacturer declares that the product meets all the legal requirements for CE marking and can be sold throughout the EEA.

> Please note that a CE marking does not indicate that a product have been approved as safe by the EU or by another authority. It does not indicate the origin of a product either.

https://single-market-economy.ec.europa.eu/single-market/ce-...

I'm not an expert on European law, but the requirements listed here for a CE mark indicate that the EMA reviews the safety and performance of the device and audits the manufacturer's quality systems, similar to the FDA: https://www.ema.europa.eu/en/human-regulatory-overview/medic...

CE marks for other categories may well be self-certified.

I suppose I could have been a bit more precise in my terminology, and said the EMA (who gives the CE mark) is the equivalent of the FDA in Europe.

The equivalent is the EMA.

I’ve completely stopped using my Apple Watch, but this is a tempting proposition. It looks like a one-off at-home sleep study is cheaper, but that doesn’t help me if the problem materializes a year after I get it.

I did one of the take home studies. It seems like there’s so many ways to get inconclusive results - they depend on a microphone that might end up underneath you, the probes could fall off, the battery could die, the “UI” is weird. I think continual testing is a very decent solve for some of those shortcomings and pushing people to the actual clinic for the real test

In term of tracking sleep, is there any alternative with better battery life? I don’t mind other sport tracking functions.

I find Garmin's sleep tracking on my forerunner 255 quite good. I have no idea how it compares to an Apple Watch though.

Withings sells a sleep mat that connects to a wall socket. Disclosure: I work there.

There's Whoop, but it's pricey.

this is pretty funny considering taking a nap w apple watch will completely break the health app sleep tracking for that day

what a coincidence that they've added nap detection just in time then: https://www.macrumors.com/2024/06/17/watchos-11-supports-aut...

Reminder that sleep apnea is mostly caused by something hindering the normal airflow. It might require a jaw/orthognathic surgery or a nasal obstruction surgery, depending on the cause being a jaw or nasal dysmorphia + muscular rehabilitation

Is any VC guy here that is interested in medical devices? I would have something for you.

This is groundbreaking

For Apple. Samsung Galaxy has sleep apnea and blood pressure as well.

Apple leads the whole market in wrist wearable heart rate and sleep accuracy. So I wouldn't be surprised if its sleep apnea detection is also much better.

Here's a chart: https://youtu.be/Jr4p66vSmLY?si=Ry3g80lh3kiDD12D&t=1100

The product isn't even on people's hands, and FDA approval only means it's not actively harmful and has a fighting chance of being somewhat beneficial.

Is there anything objectively groundbreaking at this point ?

This could be great for detecting it early where most people don't get help soon enough.

Can't wait to get this in more devices.

>Can't wait to get this in more devices.

Samsung received FDA approval back in February:

https://aasm.org/samsung-galaxy-watch-sleep-apnea-feature-re...

It works on a different monitoring method and requires 2 sleep cycles over 4 hours each in a 10 day window to start detecting.

>The feature, a software-only mobile medical app, uses smartwatch built-in sensors to monitor the user’s sleep for significant breathing disruptions associated with OSA. Users may track their sleep twice for more than four hours within a 10-day period to utilize the feature.

Yeah I'm generally a tech skeptic, but getting FDA approval for a real, common problem is a fantastic use for this kind of device. I did an at-home sleep study a few months ago, and while it wasn't an unpleasant experience, it did involve a long wait for an appointment, two trips to & from a specialty clinic, and awkwardly strapping on this device to sleep with overnight. That's a lot of barriers. Being able to do get a useful result for a very impactful health condition, just with an affordable piece of hardware that many people already have is a game changer.

Great job to the team at Apple for getting this together & getting real approval for it.

This won’t tell you that you have sleep apnea, it will tell you you might. From there you’d probably need a real sleep study.

However how many people will this catch that had no idea they should get checked? Not unlike some of the people who found out they have afib after their watches suggested they get checked? I agree this is great.

It’d be interesting if we find out that a very different percentage of the population have sleep apnea than we thought simply because so many more get checked as a result of this.

[dead]

Now we know why it's called Apple Watch.

It watches you.

Yes, always has, always will. Unlike products of many other manufacturers, it keeps what it learns on your devices, and doesn't send it home to big brother.

That's precisely why I got one.

Time to buy stock in the leading apnea machine manufacturers.

GLP-1s significantly improve the symptoms of sleep apnea, with tirzepatide reducing incidence by 2/3. Probably just stick to Lilly and Novo for a broader exposure ;)

https://www.healthline.com/health-news/glp-1-drugs-like-zepb...

Is it GLP-1 or just weight loss due to it? Most sleep apnea is caused by weight issues after all.

> Most sleep apnea is caused by weight issues after all.

Citation needed here. My understanding is that being overweight just narrows part of your airways and will make any existing flow restrictions worse. But given that most sleep apnea patients don't get off treatment even when they lose weight (although the severity may decrease), I'm pretty skeptical of this claim.

This is not a comprehensive response to your question but 41% of patients with BMI over 28 have sleep apnea, and that number grows to 78% by the time you get referred for bariatric surgery.

There is in fact a mathematical relationship. [1]

> For every 7-pounds drop in weight, expect a 7% drop in [apnea severity index].

It's basically caused by tongue fat, pharyngeal/neck fat and visceral/fat in the upper belly. [2]

I strongly suspect it's just a question of how much weight you lose. If you get down to 15% body fat you really won't have apnea anymore. Not for everyone, there's probably some structural issues that can also cause it, but if it's adiposity-induced, which it is for a huge number of people...

For the rest with skeletal or nasal structure issues, surgery may be appropriate.

[1] https://jcsm.aasm.org/doi/10.5664/jcsm.10190

[2] https://www.pennmedicine.org/news/news-releases/2020/january...

This is fantastic. Breaking into medicine would be amazing. Apple’s products are generally great. M

Tim loves when you bounce on it.

Why not Apple Watch 8?

Surely it’s not a technical reason, more a business one.

Apple has their standards high (though I agree they sometimes can't meet it themselves).

They wouldn't want their brand to be associated with some half baked feature that either runs very slow, or draws too much power/heats up, or unreliable.

So even if another version is technically capable of that feature, if it runs slowly/inefficient, they'd not enable it to protect their brand value which makes sense: as a user if Apple announces a feature, I know it's more "done" compared to the competition like say Samsung/Android etc. and I trust that it's not half baked (which sometimes fails to meet the expectations, but still MUCH better than the competition)

The business reasons are just a plus _on top of_ these reasons.

If it was purely a business one, they would not have put it on the Apple Watch 9 which is no longer available. Putting it on the 9 doesn't do anything for sales.

There must have been some hardware difference.

The Series 9 has a better low-power background accelerometer than the Series 8, which is likely the reason.

But, both devices have breathing rate detection during sleep. So it's active in both devices over-night.

Right, but I assume the "breathing rate" system kicks on much less frequently and precisely than what is needed to be clinically accurate.

Or perhaps the system in the 9 is more accurate/detailed in preparation for this feature.

What makes you so sure it’s not technical?

There are no new sensors in 9 than in 8.

Different processor, battery life, etc sure..

Business reason is clear: they lost the oxygen sensor, so people hesitant to upgrade.

Different processor seems like a possible reason if they’re using new instructions.

Of course I’m not saying it doesn’t line up nicely with a business reason to incentivize upgrades.

Someone else claims the 9 has a better accelerometer… what’s your source that ‘there are no new sensors’?

> Different processor, battery life, etc sure..

So there’s no way a better processor would be needed to get acceptable all night battery life and that could be the reason?

Sounds like you may have nailed exactly why they did it.

The Apple Watch 9 and Ultra 2 have a neural engine (GPU), which may be helpful if the sleep apnea detection algorithm uses a neural network. Those models also come with a third-generation heart rate sensor, although that part may not be required if the algorithm truly only relies on accelerometer data.

atleast due to processing/battery reasons.

I would be interested in knowing whether these are effective at detecting sleep apnea in flight crews to aid aeromedical certification.

>> detecting sleep apnea in flight crews to aid aeromedical certification.

24/7 medical monitoring via a wristwatch? Monitoring that may cost you your career? I can think of nothing pilots would resist more.

Many pilots already use a smartwatch to track their sleep and provide evidence for fatigue callouts. Right now, pilots are grounded and face an arduous process to prove they're healthy. Most pilots eventually receive a special issuance after a fair amount of hassle. What if this could help keep them flying instead?

And for all the pilots that don't have sleep apnea? What will insurance companies tell the airline to do if this app each morning tells them which of their pilots didn't sleep well enough? Well enough according to their apple watches.

Treated sleep apnea is not a disqualifier.

So on paper it sounds great, in practice this feature seems almost useless to me. As someone living in the garmin watch ecosystem, every time a new apple watch comes out, I quickly hit the specs page to see if they have made any progress at all on reasonable battery life and am continually let down.

With 36 hours being the absolute best-case scenario for battery life, it would seem your options are to either have two watches, or be perfectly fine only wearing your watch every other day? Otherwise, when do you charge?

I’m on Garmin watches as well but this line of thinking is getting old. Partner has an Apple Watch and they charge it while in the shower/getting dressed and occasionally 10-15 minutes in the evening to make sure it gets through the night. Charger is in a convenient location and it’s dead easy to drop the watch on it. If you’re running ultras, then by all means stay on Garmin. But honestly for the day to day I’ve rarely seen it be an issue.

ETA: there’s plenty of valid reasons to prefer other watches (ANT+ compatibility being one of mine) but honestly the battery life thing is really not that bad for most users.

The battery life is what got me off. I don't have good charging habits, and nothing was worse than not being able to use your activity tracker for your workout because you forgot to charge it. I got a Garmin and I hardly ever have to think about it now.

Having to plan your day around when to charge your Apple Watch doesn't sound like a good experience to me.

Same ish pattern for me on my Pixel Watch (2 mabye?) unless I forget there's plenty of time to keep it topped up for a day and change of use with just a quick charge in the mornings. There's plenty of time I don't need a watch on to give it a quick top up.

> With 36 hours being the absolute best-case scenario for battery life, it would seem your options are to either have two watches, or be perfectly fine only wearing your watch every other day?

That only makes sense if you think it takes 12+ hours to charge. 20 minutes on the charger in the morning while I'm taking a shower and getting dressed and it's fine for the next 24 hours. Oh no, I can't wear it in the shower. I wasn't going to anyways.

You're going to miss out when Apple expands the hand-washing nag to hair washing.

"'Wash. Rinse. Repeat.' You didn't repeat."

- This was just a quick rinse

- I already repeated

At the risk of sounding like a shill, you can get by on the Apple Watch ecosystem’s battery life. The charge time is really quick, so throwing it on the charger while showering each day is sufficient.

Your point that a 36 hour battery life on a watch is pretty inconvenient stands. I have an Ultra 2 almost entirely because it can be described as an Apple Watch with a slightly more reasonable battery life. That’s a price I don’t expect most folks to pay.

The 36 hour battery life also isn't a best-case scenario. According to apple.com

"All-day battery life is based on the following use: 90 time checks, 90 notifications, 45 minutes of app use, and a 60-minute workout with music playback from Apple Watch via Bluetooth, over the course of 18 hours;"

This is the approach I take and it works well enough to let me wear it while sleeping. With a USB-C charger (faster) and not putting it back on until I'm all done getting ready, I rarely have to charge outside of showering.

How is 36 hours different from 3600 hours, in your scenario? Either way, you need either need two watches, or not wear it sometimes.

The answer is, of course, that sometimes you don't wear it, but charge it. Like a few minutes in the morning and/or a few minutes in the evening while you shower or eat or whatever. Done.

The difference is that you don't need to do it every day. On the one hand, it's pretty easy to "multitask", like charging while while brushing/flossing, shaving, etc. But it's certainly much easier to not have to think about charging it at all in the evening basically ever, which is the joy that Garmin users have.

I currently have an Epix Pro and I use it to track a 45-90min workout about 6 days a week. I also have it set to "most accurate" (GPS + Galileo + GNSS) positioning and to sample blood oxygen all day rather than just at night, so it's getting quite a battery workout for a non-ultra-endurance-athlete user. When I opened this thread I decided it was a good time to charge it, since I'm in a work call anyway, and it was only at 53% after about a week since the last charge. I'll have it plugged in for 20-3min and it'll probably be around 90% when I put it back on after the meeting, and I'll find some other convenient time next week... but not until next week.

See you say that but I know if I had 5-day battery I'll keep forgetting about it. Happens with my airpods all the time.

But Apple Watch is part of my routine, same as with the iPhone.

> in practice this feature seems almost useless to me

Maybe to you, assuming you don't have sleep apnea.

Far too many people have it and it goes undiagnosed. Until that person goes on to have a stroke, heart attack or sleeps at the wheel.

It's a silent killer and I suspect we have an epidemic.

You’re missing the point. It’s not useless as a feature in a vacuum. It seems useless on a device that needs to be charged every night to be used during the day. I’m extremely skeptical of the folks saying they only need to charge for 20 minutes to get by for 24 hours when the specs say other wise and friends that have Apple Watches say otherwise as well.

My Series 6 Apple Watch lasts from about 8am to midnight every day. If I wanted to sleep while wearing it I'd just take it off around 11pm and it'd be done charging almost every time by midnight, sometimes even sooner.

I used to religiously wear Pebble watches because they lasted forever between charges. But in all honesty I just don't find the one day battery life of AW to be that bad considering how quickly they charge. IMO they do have all-day battery.

Don't get me wrong, a better battery would be great. But the only time I ever run into issues with my apple watch dying is when I am traveling and my routine is messed up anyways.

Otherwise I am just in the habit of waking up, sticking it on the charger, getting ready for my day and putting it back on. Doesn't take long to get to a full charge.

I get access to all of the features and just loose it for 30 minutes to an hour.

You're not supposed to wear it while you shower (soap is generally bad for any waterproof seals...). Just slap it on the charger while you shower. Or slap it on the charger when you wake up, during your usual morning routine. It's a bit of a change of paradigm from the 'charge while you sleep' that we do with phones, but you get used to it.

So you’re telling me a 20 minute charge is going to get you through 24 hours with a workout every day? That just seems unlikely to me based on everything I’ve read.

If you’re working out every single day, probably not. But it should absolutely be plenty to get you through a day and then you can top it off for another 10-15 mins before bed. It’ll even give you an alert informing you it needs charging to make it through the night at the appropriate time before your configured “wind down” period so you can charge right before bed.

Lower states of charge will charge faster, so 2 smaller charging sessions would result in less total time spent charging, actually.

When I come home from my morning walk, I'm usually a bit hot and sweaty, and it feels good to sit down and take the watch off and throw it on the charger. 10-30 minutes is enough for it to charge; I wish it would ding when full.

If it lasted 36 hours that would be enough for me to sleep with it.

your phone should get a notification when its full!

It does - but by then I'm working and don't look at it, and forget until I stand up a few hours later.

How does this relate to sleep apnea detection?

I agree the battery life is shit compared to Garmin, but then you need to compare features and usability too. And as a long-time Garmin owner I am 100% certain that is not a fair comparison either.

>How does this relate to sleep apnea detection?

Because every friend I've talked to about the apple watch tells me charging isn't a big deal because they just throw it on the charger at night with their phone and use it in the morning. If I'm wearing it all night to track sleep apnea, when do I charge it? Per my original post. It looks like it takes an hour and a half to do a full charge, so it's not like you can just throw it on the charger for 15 minutes in the morning while getting ready for work.

There are already numerous people in this thread saying that they charge it while showering in the morning and that is enough.

Everyone sets their own routine. I charge it every morning when I start working. Takes about an hour.

It is manageable, but really sucks.

It is a bummer not to have Garmin like battery life, but it takes like 15 minutes to charge so you just sit it on the charger while Itake a shower or something or while im working and other than that I can wear it all the time. Battery life is mostly an issue if trying to do a long hike, need a garmin for that.

It takes like 20 minutes to charge the watch. Just don’t wear it for that time

The manual says 45 minutes to 80%, 90 minutes to 100%. If I'm only charging to 80% that's roughly 14 hours of battery life on a Series 9 or 10 (18 hours on full charge). So not even a full day? I just don't get how the math works if I'm trying to wear it all night every night and wear it for workouts during the day.

There is a material difference between the older Apple Watch (where the charging puck uses USB A) and the newer Apple Watch and/or the Ultra (where the charging puck uses USB C). Plugged into an appropriate source, the USB C puck gets much faster charging and is usually sufficient for a day's wear after about 10 minutes (depending, of course, on what the day includes).

Charging to 80% is likely to be more than enough for most uses, and topping it up with another 15% just before bed is enough for overnight (probably).

I had the Series 4 previously and the Ultra 2 now; with the older watch, I would charge it for about an hour while watching TV in the evening. With the Ultra 2, I charge it for about 20 minutes here and there depending on what I’m doing and whether I remember. I’m currently at 39% which will be just fine for my hourlong exercise ride (with GPS), and then I can toss it on the charger while I shower and it’ll probably be at 70% which is good enough for another full day.

I charge it when I shower.

I charge when I’m in the shower each day and this works fine for me.