Sleep is crucial for our health and well-being. Unfortunately, 2-9% of adults have obstructive sleep apnea. It's a disorder that affects breathing at sleep and doesn't allow one to get the necessary rest at night. Untreated, it leads to cardiovascular diseases, diabetes, depression, or stroke. As a result, those patients are asked to always sleep with a continuous positive airway pressure device - CPAP. However, the therapy is effective, it is also cumbersome. Around 50% of users drop it despite all the health consequences. And adherence to the therapy is not the only challenge that patients are facing. Most of them are advised to change their lifestyle to decrease their body mass, but also many of them have cardiovascular diseases connected with sleep apnea.
With medical and technology limitations, CPAP will maintain the most used therapy for at least the next few years. So how can those devices better support patients? What if CPAP therapy not only helps patients get a good night's sleep but also helps them tackle the disorder and its health consequences? Also, what's the behavior and appearance of the medical device for the home environment?
Luno is a product system that helps patients manage obstructive sleep apnea by monitoring their health and providing accurate guidance and support. The system consists of a CPAP device, sensor, and interface. CPAP device helps patients get a good night's sleep and monitors their disorder. The sensor collects data about users' cardiovascular systems and sleep. Combined, it provides a full picture of users’ health and their needs. With TAMI (Technology Assisted Motivational Interviewing) - a scientifically proven tool, the interface uses the data to guide and support the patient as a smart assistant. With Luno patients are not left alone to face struggles of adherence, losing weight, lifestyle changes, and cardiac problems.
The project aimed to challenge the competencies of the CPAP device, the way it interacts with the user, and its medical appearance that doesn't match the home environment.
Obstructive Sleep Apnea (OAS)
Obstructive sleep apnea is a common sleep disorder. It occurs when the airway at the back of the throat becomes physically blocked. While deep phases of sleep muscles relax and close the airway. The disorder is connected with age, obesity, upper airway and craniofacial abnormalities, and larger neck size. The apneas (pauses in breathing) must last for at least 10 seconds and be associated with decreased blood oxygenation. For patients with severe OSA, it occurs more than 30 times per hour. Not only does it entirely prevents from taking a rest at night, but it also overburdens the body. Untreated, it leads to cardiovascular diseases, diabetes, depression, or stroke. Also, it increases the risks of automobile crashes and loss of employment, and relationships with partner and housemates.
The users of the project are people suffering from obstructive sleep apnea. It includes both women and men at any age, but with a significantly bigger group of adults. Based on the factors that increase OSA's chances, some of them might also have a problem with obesity, and nasal congestion. To better understand this group of people, 11 interviews were conducted with patients diagnosed with OSA.
Most people with mild to severe sleep apnea are being prescribed continuous positive airway pressure (CPAP) therapy. With the CPAP device, pressurized air is delivered into the nose to keep breathing passages open and decrease apnea episodes during the night. The main components of CPAP therapy are the CPAP machine, face mask, and connective hose. Although it maintains airflow to the lungs and helps get a good night's sleep, the experience of wearing a mask connected with a tube to the loud devices every night is challenging for many users. It takes around 50% of users to drop the treatment despite all the health consequences.
Obstructive sleep apnea & health - a holistic approach
Zooming out of obstructive sleep apnea disorder and looking at those patients more holistically reveals that other aspects of their health are strongly connected. Being overweight and having an unhealthy lifestyle can cause or enhance obstructive sleep apnea, at the same time, untreated OSA affects cardiovascular health. A change in one of them might affect not only the severity of others but also affects the patient's approach and motivation towards the treatment. Looking for the future of obstructive sleep apnea treatment, it is crucial to support patients in all those three elements.
All insights from the research were collected and transferred into the list of opportunities. Based on the decision to limit the scope of the therapy, the opportunities were arranged on the timeline. However, a new timeline of the therapy was created, which goes beyond the successful use of CPAP devices and high compliance. Three extra steps were added, which integrate the relation between sleep apnea and lifestyle changes: prevent OSA progression, decrease OSA, eliminate OSA. Together it presents a new approach to therapy. It not only focuses on supporting patients to live with their disorder but to prevent the progression of it and when it is possible to guide them on the journey to decrease sleep apnea. When apnea is decreased, it increases comfort by reducing required pressure or switching to different, less obstructive therapy (oral devices, position therapy). The ultimate goal of eliminating OSA can be achieved only by a small group of patients. Nonetheless, the device should support patients to regain full health.
With a holistic approach and stating that the therapy goal is patient health, CPAP devices for some patients don't have to be a lifelong therapy, and as a result, the device should guide patients in this transition.
Why? Lack of holistic approach in OSA therapy which will include: users' struggles with adherence, tackling OSA factors such as weight and lifestyle, and monitoring cardiovascular system diseases linked with OSA
What? A solution that combines OSA therapy and Motivation Interviewing techniques.
How? By monitoring users' health and providing accurate guidance and support
Technology - understanding health status
To be able to measure heart rate with the contactless sensor, the Ballistocardiography technology was selected. Ballistocardiography (BCG) is a technique for measuring a subject's heart rate (HR) based on small movements caused by blood flowing around the body. It can be used successfully by attaching a 3-axis gyroscope to the CPAP mask. The sensor has to be located in a position where its hard elements won't cause any discomfort. It also has to work with different accessories and be detachable. The monitoring device was defined as a connector between the hose and mask.
How to support patients?
Based on the interviews with the psychologist Motivation Interviewing technique was defined as the most promising for this application. It is defined as a "collaborative, goal-oriented type of communication with particular attention to the language or change" and "is designed to strengthen personal motivation for change". Motivation Interviewing is already being used and studied in the field of technology and is called TAMI. Technology-Assisted Motivational Interview (TAMI) is "used to define adaptations of MI delivered via technology and various types of media." It includes technological devices and creations such as computers, mobile phones, telephones, videos, and animations. The interaction might have a form: automated computer prompts, chat rooms, emails, videos, and animated characters. It allows for the implementation of personalized and tailored interventions without therapist-dedicated time. Studies reported high acceptability, and researchers generally indicated positive behavior change. Guidelines of Motivation Interviewing and examples of interactions were used to create the motivation interaction in the concept.
During the interview, patients were asked to evaluate the appearance of their devices and which characteristics they would like to change. The most often brought up points were decreasing the device's size, making it look less medical, and blending with the bedroom environment. There is still a stigma around sleep apnea, and users don't want the device to bring too much attention and communicate its medical purpose. They often put it in the closet or keep it under the bed to hide and avoid uncomfortable questions about health. To blend the CPAP device with the bedroom environment, the idea of duality was introduced. It created a concept of a CPAP that is a blend between a digital alarm (solid) and an art frame (interaction surfaced).
Luno is a product system that helps patients manage obstructive sleep apnea by monitoring their health and providing accurate guidance and support. It applies a holistic approach in therapy that includes: breathing support at night, struggles with adherence, tackling crucial factors such as weight and lifestyle, and monitoring cardiovascular system diseases linked with sleep apnea.
Most patients with obstructive sleep apnea also experience other health issues. Luno aims to provide a platform for health providers to extend the scope of CPAP therapy. Based on the patient's conditions and needs, the doctor might suggest combining CPAP therapy with one of the supporting programs which define the device interface:
The adherence Program focuses on the struggles with compliance. It keeps track of the frequency and duration of the CPAP use and guidance to prevent dropout.
The weight Reduction Program aims to present the link between obstructive sleep apnea and weight. It shows how the pressure changes are affected by lifestyle changes and gives recommendations on keeping up with them.
The cardiovascular Health Program uses sleep and heart rate data to keep track of cardiac diseases and their connection with CPAP therapy. This way, both patient and doctors have a full picture to make decisions about therapy success and needed medication.
The CPAP device is also a sleep apnea assistant.
The concept challenges the competencies of the CPAP device. Aside from providing the pressure to keep the airway open during sleep, it works as a smart assistant. Patients' health data is used to provide guidance and support. Luno supports patient motivation with the use of the TAMI method. It applies AI to chat and voice conversations with patients to act as a virtual therapist.
Luno sensor collects data about patient heart rate with gyroscope and sends it to the CPAP device by Bluetooth. It is powered by a standard CR2032 battery which can be replaced easily. The sensor has a form of a connector between a mask and hose. As a result, the main part is made of silicone to provide sealing of the air. The components are secured with the hard casing in the front, which can be slide away to access them.
Luno introduces a holistic approach towards sleep apnea, the idea of supporting patients in the process of decreasing sleep apnea so it is not a lifelong therapy and challenges the medical appearance of home healthcare devices.