Adaptive Neuromodulation Breathing Therapy vs. Natural Arousal and effects on Sleep Architecture
WhisperSom’s proprietary sensors and signal procesing software are purpose-designed to deliver adaptive acoustic neuromodulation therapy (A2NT) to terminate episodes of snoring and pauses in breathing before they become apneas and dangerous to health.
We cite evidence in our white papers documenting the efficacy of auditory stimulation using tones to produce arousals that terminate apneas without waking the patient up. However those research projects used sine waves (approximately 0.5-4KHz) to cause those arousals. The researchers increased the amplitude of the signals during the tests in order to cause the arousals, sometimes to deafening levels. They were apparently not aware that tones are notoriously poor methods for causing a controlled arousal (see the paper titled “Children and Smoke Alarms UL Committee”). The tones they used were uni-dimensional, which while advantageous in a research environment wherein one attempts to minimize variables, are unsuitable for being adapted to subtly applying the required stimulus to produce a non-cortical, central nervous system (CNS) arousal that causes an upper airway opening. Indeed research has shown that stimulus reactions are unique to the individual. The problem of deriving individual specific stimulus patterns that rely only on tones are compounded, according to research which shows that there is sleep-specific dampening peculiar to inspiratory effort-related stimuli for those with OSAS.
We use research done in the field of psycho-acoustics and have designed a different approach. The audio files we use are designed to cause a low level activation of the central nervous system without recruiting the ascending arousal system, and we use an adaptive algorithm so as to ”learn” and follow the stimulus requirements of an individual for any given night as their sleep state waxes and wanes between stages 1 – 3, and REM.
We must conclude that no research projects have been undertaken using our proprietary approach – adaptive auditory stimulation therapy.
This said, WhisperSom has discovered under restriction of NDA, an unpublished validation study of a prototype neuromodulation therapy device tested at Yale Gaylord Hospital. Please see: https://whispersom.com/wp-content/uploads/2023/03/Yale-Gaylord-Clinical-Validation-Report_Redacted.pdf
We believe that our key IP and patent applications pre-date and are substantially different than those of the device tested at Yale. While they use audio signals to terminate snoring and pauses in breathing before they become apneas as we do, our approaches diverge in the following key respects. Our device:
- does not use any face-mounted sensors, much less a “sticking plaster” on the upper lip that is also secured in place with a piece of elastic that runs around the back of the head (this “sticking plaster” is a piezo electric film sensor and will almost certainly need to be replaced on a regular basis).
- uses Bluetooth technology to eliminate wires necessary in the Dymedix device
- is smart phone-based which provides:
- the computing power required to drive our adaptive, heuristic, machine learning algorithms, enabling our device to deliver the lowest amplitude signal necessary at various stages of sleep to stimulate the user to take action: stop snoring, re-start breathing, and/or change sleeping position – assuring the best possible sleep architecture using auditory stimulation
- secure uploads and storage of basic patient data (i.e. sex, age, height, weight, etc.) to a central repository in addition to nightly sleep data for analytics, research, product improvements, compliance tracking, the delivery of rewards and special offers from retailers, etc.
- is intended for OTC broad consumer access and wide adoption vs. expensive sleep study + prescription
- is far less expensive at $1,200 MSRP plus $2.99 per month for data storage after the first year vs. $1,400 – $2,300 for CPAP or BiPAP with autoserv ventilation for obstructive and central apneas, plus approx. $60 per year in replacements masks and air hoses.
Additionally, the device tested at Yale is the size of an iPhone; they do not appear to have developed a satisfactory method of attaching such an unwieldy device to the user. It also lacks a 3-axis accelerometer and pulse oximeter. The data from those sensors allow us to use more sophisticated processing. For instance, WhisperSom™ will determine if the user has positional obstructive sleep apnea and will act forevermore to shift the user’s sleeping position to one that leads to fewer pauses in breathing.
We believe that the development and commercialization of adaptive auditory stimulation or neuromodulation therapy for sleep-disordered breathing is today, where CPAP therapy development was some thirty (30) years ago. For this reason we anticipate a dearth of informed opinions from international experts about the relevance and efficacy of the technology – except from those who conducted the research projects we cite.
The most common off-the-cuff response we have encountered is, “Oh, you’re waking the patient up to get them to re-start breathing. That will negatively impact sleep architecture and cause excessive day time sleepiness.”
In reality, those with un-treated snoring and OSA typically have arousals of varying lengths and intensities. These self-arousals, according to research, have far more adverse consequences than the short, non-cortical, CNS arousals produced in our approach such as:
- continuous exposure of cells, organelles and organs to epinephrine (aka Adrenaline®) night after night – preventing rest, building blood glucose levels and shortening life expectancy;
- large fluctuations of negative inspiratory intrathoracic pressure causing heart stress;
- ventilatory overshoots causing physical stress;
- large spikes in blood pressure causing heart stress;
- blood oxygen (SpO2) desaturation
- transient carbon dioxide (CO2) build up
All this is to confim that it is far more advantageous for a patient who cannot tolerate CPAP, nasal valves, a mandibular advancement device, surgery or an expensive implant, to receive adaptive neuromodulation therapy that produces non-cortical arousals to prevent pauses in breathing before they become apneas.
Within the context of the above observations together with our encouraging proof of concept results to date, we are confident that independent testing of our approach will show that our device is comfortable, easy to understand, encourages compliance, and:
- prevents apneas
- prevents hypoxemia (oxyheoglobin desaturation)
- prevents CO2 build-up
- prevents release of Epinephrine (aka Adreline in commercial form)
- prevents heart rate spikes and left-ventricular wall damage
- prevents excess glucose production
- will determine those users who could be helped by simply being stimulated to shift to a new sleeping position (positional OSA)
- provides users and clinicians with a graphic display of data each morning that tells them how well the device is working for them, or not – encouraging compliance or an indication to seek aditional medical advice and alternative treatment.