Sleep Apnea + Wearables: Part I
In my previous thought experiments on “Can we use digital health to drive behavior change?” I’ve focused on wearables in the context of healthy people without underlying conditions. My BMI is in the ‘healthy’ range. I have no underlying conditions. Yes, I should probably definitely run more and drink less. Most of us should, the data tells us. Data tells me that these behaviors may increase my lifespan and number of quality years, but it is all so intangible. Sometimes I kick into “healthier Kimberly” mode for a day, a week or a month, but concretely linking this to long term health improvements, or even short term metric improvements (resting hr, sleep quality) is often not straightforward.
But what about situations where short term health is concretely dependent on behavior change?
[As usual, everything following is an n of 1 experience.]
In this series I’ll be looking at a case study of an acquaintance with sleep apnea.
Sleep apnea summary: This is a terrifying disorder in which breathing repeatedly starts and stops throughout the night. Short term signatures of this are snoring, daytime sleepiness, gasping for air, etc. Longer term, sleep apnea has been associated with increased risk of Type II Diabetes and heart problems. Risk factors are generally related to unhealthy lifestyle (e.g., smoking, drinking, BMI) and demographics (e.g. age, sex). Demographics are difficult to change, and in this case, they were already living a fairly healthy lifestyle.
In this particular case, a physician recommended two overnight tests a few years apart. These tests work by picking up equipment at the medical center to measure respiratory rate etc., wearing it overnight, and receiving a printout with results a bit later. The downsides of this is that this process is time intensive and only represents a snapshot in time. In this case, results for the two tests conflicted. One test indicated that the sleep apnea was positional (increased events when sleeping on back vs. sides) and severe, and the other indicated that it was not very positional nor severe. They were left with the advice “About moderate sleep apnea — maybe try not sleeping on your back.”
So what is a person to do with this information?
- You could try a number of interventions, including: not sleeping on your back (given the test results were contradictory, this may or may not decrease the number of low oxygen events (apnea-hypopnea index (AHI))), CPAP machine, oral appliance to keep throat open. But how would you really even know if it is working?
- You could buy, out of pocket, something like the Wellue O2 ring to measure SpO2, and vibrate to wake you when your oxygen drops too low. This may decrease the length of individual low oxygen events (as the waking disrupts the event), but in and of itself, doesn’t necessarily decrease the number of events over time.
- You could also get a sleep position app (e.g., http://www.proximalbox.com/), and get your data scientist friend to look deeper into the question “Is there anything I can do?”. ← I will point out, interestingly, I have not found a [good] solution on the market that already does this. With sleep apnea incidence around at ~20% of the population, that’s surprising.
To be continued in part 2 with data…
