Launch HN: Helio Sleep (YC S21) – One-stop portal for sleep apnea (heliosleep.com)
An estimated 30M Americans suffer from sleep apnea. Getting diagnosis, treatment devices, and ongoing support can be difficult, and is getting harder, because fewer physicians are practicing sleep medicine. There is a serious "conversion funnel" problem. 50% of patients give up before making it to a sleep specialist; of those that get to a sleep specialist, 50% don't get a sleep study; and of those that do get care, more than a third fail to continue within 6 months. As a result, 24M Americans are currently untreated, leaving them tired and also at risk for serious health problems such as diabetes, heart disease, and high blood pressure.
Clearly, a lot more support is needed. That's our intention with Helio Sleep. We coordinate the care journey by connecting patients directly with sleep specialists, following up to make sure they have access to treatment, and coaching them to help them stay with it.
We encountered this problem repeatedly with family and friends who were having difficulties getting diagnosed and treated for sleep problems. Because of our backgrounds in digital health, we knew we could assemble a process to do something about it. We had previously worked at digital health companies including Medallion, Truepill, Counsyl, and Q Bio, building tools for patient education, telemedicine networks, pharmacy fulfillment, and automated reporting. We knew a lot about the difficulties of delivering and supporting prescription medical devices for at-home care.
One of the biggest challenges for such a solution is the complexity of the healthcare system. There are regulatory barriers to operating a provider network and a licensed durable medical equipment supplier. We also need to coordinate with payers and manufacturers. We’re building tools to coordinate all of these steps and provide a seamless experience.
Sleep apnea lies at the intersection of medical and dental treatment in the US, so due to US billing structures, patients typically aren't presented with all treatment options. There is a need for a sleep apnea 'portal' where everything relevant is addressed, and nothing major falls through the cracks.
At Helio Sleep, patients can self-refer or be referred through their medical or dental provider. They are evaluated for sleep apnea through a protocol-driven provider consult and a home sleep test. They then select from a range of evidence-driven therapies to treat their sleep apnea, and also their snoring if that’s needed. To help patients adhere to their treatments, we follow up with them, closely monitoring efficacy and adjusting care as required.
We went live at the end of February, offering consultations with licensed providers, home sleep tests interpreted by board-certified sleep physicians, and treatment devices including oral appliances and sleep positioners from industry-leading manufacturers, and we look forward to adding other treatment options including CPAP. We make money in an old-fashioned way by charging for diagnostic and treatment devices and for provider consults. We currently accept cash payment, and we’ll be adding insurance coverage. Getting medical care in the US is expensive, and we’re committed to finding ways to extend access to as many people as possible.
We’re excited to share what we’re working on and look forward to your thoughts! If you have or suspect you have sleep apnea, we’d be really interested to hear about any experiences that you’ve had in getting care. If you’re curious about your risk, one of the most widely used sleep apneas screeners is the STOP-BANG questionnaire. You can find a version of it here: I WFH, I haven't worn a collared shirt in over a decade. Who knows their necksize? FWIW I think it's reasonable to collect emails. But at least be honest as to whether the email field required (or not) on the form. 1 https://imgur.com/a/DcZSFHd
2 https://imgur.com/a/FLc5YzE I hope you get your site in order, it sounds like a promising market. $200 for a mouthpiece that you can get online for $20.
What so special that makes that piece of plastic worth more 10X more? $180 for a pillow you that can be had online for $30. Would you mind sharing where I can get the testing apparatus for cheaper? At first they were real pissy about me buying things from third parties but eventually just gave me the part list and stopped mentioning how I never bought stuff from them. The CPAP worked OK, but I couldn't stand wearing the thing. I opted for surgery (UPPP, probably the most painful thing I've experienced), which has "cured" me (ironically I'm back on the multi month wait to verify my sleep apnea is gone via another sleep study). Do you recommend surgical or weight loss options to your customers? Could be a conflict of interest if you're set on recurring supply refill revenue... I think this is his unit - https://lofta.com/products/resmed-airsense-10 >With auto titration technology, the AirSense™ 10 AutoSet™ monitors you- breath by breath and adjusts your therapy delivery to maximize outcomes https://gameready.com/gr-pro-cold-therapy-unit/ I think it must be some quirk of insurance that they will only pay for something IFF it requires a prescription If something requires a prescription, it's usually because the company wants a liability chain to go through a doctor and their malpractice insurance, rather than bankrupt the company. However - I am reasonably confident that given a prescription and some documentation - and a decent instruction manual/video, most people could get through it. (I certainly had no issues with downloading some software/utilities, yanking the SD card and examining my data during the first few months) But - ultimately it is probably more about risk mitigation and liability for the doctor/sleep technicians and clinics who prescribe these things. Which is ridiculous. By "configuration/calibration" they mean setting a value in the software settings. Something that takes 2 seconds and could easily be done by the user (in fact most CPAPs have the ability to have the user set it, but it's disabled by the manufacturer because of stupid regulations). > ultimately it is probably more about risk mitigation and liability for the doctor/sleep technicians and clinics who prescribe these things. If people could just go buy them in drugstores by their own choice then doctors and clinics wouldn't be on the hook for having prescribed them. Plus there would be more competition and the devices would be cheaper and more widely available. My grandmother died from complications with her CPAP machine (long story and user error) so I don't know that making them available off the shelf is a great idea. At least behind a prescription, more care can be put into the testing of the devices rather than churning them out by the lowest bidder for pickup at your local Walmart. I've tried to think of other devices/treatments that are available OTC and I'm coming up short. Drugs are heavily regulated and quality tested. I think the big factor is that using the device requires unconsciousness which ups the risk if something goes wrong. All speculation on my part. I would love to manage it myself of course, but treating OSA is not 100% as simple as using a CPAP. And if you are indeed stopping your breathing while you are sleeping, do you personally want to be responsible for setting the machine properly? Mine was about 20 years ago. Avoid UPPP for snoring. My snoring was so bad that I would often wake up with my uvula dangling on my tongue, before the surgery. There is a risk of having a tonsil hemorrhage with adult tonsillectomies (which I got with my UPPP, I think most do?). There is a vein/artery that runs right behind your tonsils and causes them to bleed really bad. Your surgeon will cauterize it, but a week or two after surgery your scabs start coming off, and if they come off too quickly you'll start bleeding. This bleeding won't stop on its own, you need to get to the hospital ASAP. This didn't happen to me thankfully but it was weighing on me pretty heavily from an anxiety standpoint. I would absolutely do it again. My sleep apnea is gone, I have incredible sleep quality and am no longer a zombie. I was a good candidate for the surgery though--I had a really big uvula and medium sized tonsils, so it didn't take much to block my airway while I slept. It might look a bit flimsy with the dental rubber bands, but that's actually the best feature. Most other oral appliances have a hook or solid point where both halves of the top/bottom mouth pieces are locked in place. What happens is that after 6-12 months of usage, the stress points will eventually break and you are left with a useless device. This has happened to me with 3 previous "solid locked" devices. The zyppah device requires you to change out the dental rubber bands every few weeks, but the flex it gives and longevity is worth it. If you have moderate-severe apnea, just go to a dentist who also specialize in sleep apnea and get it taken care of. You would be amazed at the difference it makes. When I got tested for it I did the full sleep study in a hospital with all kinds of wires and things attached to me. How does a "NightOwl Home Sleep Apnea Test" compare to the test I had? Is the NightOwl good enough? Or is it there to tell you that you might/might-not need to do more intense sleep study? I'm curious about the oral appliance. I've seen people post about it on /r/SleepApnea. Curious if anyone here has had success with it. Once you use an APAP, you actually are able to discern between apnea types with some degree of confidence if you dump the diagnostic data and use a tool like OSCAR to analyze it. Obstructive apneas are caused by an anatomical problem - your upper airway is blocked by relaxed tissues. Central apneas are caused by a neurological problem - your brain doesn’t communicate the signal to inhale to your diaphragm. As for treatment - yes. BiPAP, ASV and nerve stimulation are all more effective for central apnea than CPAP or APAP. I have a CPAP and hate it, I need to switch to a dental appliance but these are $$$ ... CPAPs are also annoyingly $$$ and I think all of the telemetry and crap is just nonsense. 99% of them auto-adjust their pressures. Then go buy anything you can. If you're a mouthbreather at night, get a full face mask and a humidifier. That said, the over the counter devices that can do this reliably generally cost half as much (or more) as an at home sleep test. But I am using the app SnoreLab which records me at night and scores what percent of the night I'm snoring and how loud (and lets me listen to it back). The lowest tech way is to just record audio of yourself sleeping. If you snore, you've got it. If you stop breathing / choke / do a "snort snort snort"--you've really got it. I urge you to set aside a few nights and get this figured out! It could be the most important decision you make for your health in your entire life. "Snoring is often associated with Obstructive Sleep Apnea... Not everyone who snores has OSA". Snoring is really, really bad. A cute little "snooze" could be okay, but anything more than that should be considered a potential life-shortener and potential-limiter. And yes, I am saying that almost everyone is in danger of apnea. I think this is one of the many ignored epidemics of our time, similar and related to obesity. Also, if you do end up getting a CPAP, those things have a fascinating amount of time-series data stored on their SD cards. If I recall mine logs about 20 independent datapoints, which is a surprising number for something that's just blowing air into your nose. :D But for example, it can detect when you're snoring and it logs a boolean for that all night long. (will submit to the queue too, I think this is cool). Not everyone who snores has sleep apnea, but it is a HUGE symptom. Basically if you snore and have even ONE of the other symptoms, you should see a doctor. https://www.mayoclinic.org/diseases-conditions/snoring/sympt... However, apnea is very very common and very hereditary. If all the men in your family snore and wake up multiple times per night to pee and are tired all the time, as they are in my family, it's easy to think of those things as just a part of aging. Sleep apnea is a serious condition. I believe that if you would have it you would wake up suffocating, unless you would die in your sleep. My mother had sleep apnea as a consequence of severe surgery followed by a few weeks in intensive care. Fortunately, in her case that was a temporary condition. After a few terrible weeks during which I was almost unable to sleep because I feared that I will not wake up in time during her next apnea crisis to help her, the apnea crises disappeared suddenly, from one night to the other, exactly when I was about to buy a CPAP apparatus. https://www.mdcalc.com/stop-bang-score-obstructive-sleep-apn... The blood oxygen level dropping so low so frequently is what finally motivated me to take it seriously. Your heart goes into overdrive when that happens, and it's not good for you long term to be going at 90bpm all night. It increases your blood pressure too. I actually feel fine if I don't use the CPAP, but having concrete data showing it's probably taking its toll is very useful. His apnea got cured with EASE surgery. It dramatically changed his personality. Sleep apnea is often misdiagnosed as ADHD in kids. Is it though? To be clear I'm all for letting patients get access to their own data and think it should be required, but I totally understand why companies would limit their liability by locking consumers out of their own data. Patients are notoriously bad at interpreting their own data and test results. That last thing you want are patients changing their own treatment because the misinterpret their own data and then blame the device. Just by connecting Apple Health to my health care system, I can see every lab result, most of which I’m not qualified to interpret. My brother had a CT scan, and upon request, got a DVD with the scan data and a viewer for that data. If my healthcare provider prevented me from seeing this info, I’d find another provider. Getting back to the core question: is it surprising? I don’t think it’d be surprising in the consumer or enterprise spaces where lock-in is a feature. But I don’t think that automatically extends to healthcare, where such restrictions are extremely problematic, and threaten my ability to get care from my provider of choice. (And to clarify, I don’t think this is good or acceptable for consumer/enterprise products either, but the implications there are different, where I might just choose another vendor - a choice I might not have for medical devices). "We believe you have the right to see your results as soon as they’re available. However, this means you may see results before your provider does. In some cases, results can be serious or hard to understand. If this concerns you, you may want to wait a few days to hear from your provider or, after waiting, message your provider." I have no problem with that and thing it is a great thing. For me it's hold two buttons down to reveal the settings. Navigate to the setting, change the setting. Done. Fisher-Paykel. I think they lock this behind this setting because they don't want amateurs blowing out their lungs. I move around a lot so I've been to a bunch of doctors for apnea, and I assure you that I am better qualified than most of them to review my data and adjust my machine. What I want now is a better CPAP at lower cost, and access to the data it gathers, and the ability to share that with my health care professionals of choice. A full mouth/nose mask (ala "fighter-pilot-mode") was useless, incredibly constricting and confining - I ended-up always removing it after a couple hours of fitful sleep. Moving to a "nasal pillow" mask made all the difference - I slept the entire night through the first night - and ever since. While some people need a "chin strap" to keep their mouth closed, I found that I did that automatically. Daytime though I try to breathe through my nose when possible and also breathe as deeply as possible - it really is a waste that most people only use a small part of their lungs So, you just have to stick with it and study the exercises and tape your mouth shut if necessary at night. Things will get better, it just takes practice. Thanks! FWIW sleep apnea isn't that much more prevalent in older people. The risk of developing it approximately doubles between 30 and 60, but that could be partially explained by people being more willing to seek help with their sleep as they get older. A lot of younger people with sleep problems just ignore them and remain dangerously tired all the time... I observe that my mother has the similar condition like myself when sleeping, and persuaded her to get diagnosed. She has OSA as well, but less severe. Maybe the indicator of abnormal sleep condition as observed by self or someone close by would convince people to seek help. I know our local Vetrans hospital has a small sleep study room for diagnosis and will supply CPAP to those in need. How are you different then something like Lofta? I tried signing up to use Lofta recently, but dropped off once they wanted me to sign some documents and I felt like it was no longer a simple test, but I was in a relationship with this provider, so I dropped off. Do you know if this due to regulations? (Edit: I recall now, I didn't want to chat to a doctor). I'd love if this was as easy as sleep tracking with an Apple watch and SleepWatch app (got me to reduce my drinking considerably). It was a life-saver - as I have a high-level of sleep apnea (90+ incidents per hour) - a regular CPAP does not cut it, I was prescribed a BIPAP. It has changed my life - I am incredibly lucky that I got treatment. https://lofta.com/products/sleep-apnea-test Disclaimer: I've not used them. No experience with them. I've just seen their name mentioned as an affordable sleep test. EDIT: Just realized the company of this submission has similarly priced sleep apnea test. I should have probably clicked through before commenting. Or, you know, has insurance as required by law - which covers said sleep study. And, I'm very sorry to say that surgery is NOT a guarantee of a solution. Had another friend with very bad apnea, who got the surgery which removes everything that can be removed, and after that he had... apnea. Bad enough to need a CPAP machine. Sigh. [0] https://en.wikipedia.org/wiki/Positive_airway_pressure#Bi-le... At first I thought your name was "Hello Sleep" which brought back faint memories of https://en.wikipedia.org/wiki/Hello_(company) & https://www.kickstarter.com/projects/hello/sense-know-more-s... I am curious on the problem statement though. Is it really difficult to get a diagnosis? I've read a number of sleep books and it was suggestive that you can generally get diagnosed fairly easily with proper equipment and options by general practitioners and specialists worldwide. I'm a bit concerned personally with the diagnosis industry moving straight to consumer. I think it's cool and all, but is diagnosis through tech potentially bad for changing human behavior? The reason I bring this up is because similar companies exist for ADHD and other human conditions that I'm curious if this really solves people's problems, or just introduces a problem that they then pay for because they aren't making the right change in their life. In other words, if we make it easier to diagnose, will people more likely believe something is wrong with them and be subscribed to a lifetime of products instead of making the foundational change to improve these problems? Are you in the business of putting yourself out of business like a good doctor in other words? For example books like "Breath" by James Nestor suggest that we're having trouble sleeping because we're breathing wrong in the first place. What about permanent solutions like surgeries? There are a range of treatment options out there including weight loss, CPAP, oral appliances, and surgery, and selecting the right option can depend on a number of factors including a patient's lifestyle and the severity of their sleep apnea. We're looking to coordinate access for this full spectrum. There's another book about breath that you might be interested in, which includes a chapter on breathing for healing [1]. [0] Life in the Fasting Lane (public library) https://www.worldcat.org/title/life-in-the-fasting-lane-how-... [1] Breath Taking (public library) https://www.worldcat.org/title/breath-taking-the-power-fragi... I suspect I have a very mild case ( my mother has a more severe one but is also extremely overweight ). I do not really snore and often wakeup feeling quite refreshed. But I know partners have also told me that I occasionally in certain positions sound like I have labored breathing and will wakeup gasping for air. My problem is that I also enjoy backpacking and mountaineering quite a bit and a CPAP is never going to work with that. I know there are a lot of bullshit mini passive devices out there that do not really actually help - is there anything truly portable and lightweight I can bring with me? Def recommend try to get a study if you can find/afford it. I have a mild case, but getting used to CPAP was still life changing. That said, I find sleeping on my side is enough to avoid most symptoms for a few nights, and if I’m camping I stick to that (there are tricks for preventing back sleeping if it’s an issue). Fortunately it was free thanks to UK's NHS, because I cannot use due to discomfort and teeth movement, causing disrupted sleep. What's your experience been like, and are you doing anything to combat users giving up on treatments due to discomfort? Curious also why you aren't offering CPAP machines. I've had 4 sleep studies in the past - professional ones where they wire up your entire body for monitoring. They all produced wildly varying results. So I'm quite skeptical of at-home sleep studies. Maybe you can employ some sort of ML to record snoring and make a determination as to OSA? Suggestions for your site: you need a little bit more supporting text, especially with the products. On a separate topic - one of the coolest things I've seen which I think really does "solve" snoring - and persistently is https://www.inspiresleep.com/ - but my feeling is people will avoid invasive surgeries to embed nerve-stimulating devices in their bodies. If we could design such a product without surgery - that would be a game changer.187 comments
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