Mobile Tools and Sleep
A podcast excerpt from an interview with Chief Medical Officer of Somnology, INC., Dr. Melissa Lim
In this interview, Art Dogtiev of ComboApp is talking with Melissa Lim, MD, CMO and Founder of Somnology, Inc.
Melissa is a board-certified sleep specialist, entrepreneur and medical technology executive who created the first version of MobileSleepDoc Pro mobile app in 2012. Her idea for the app sparked after treating hundreds of her own patients and realizing there were still thousands of people out there suffering from poor sleep who do not have access to the proper care and knowledge to treat their problems. She attended Ohio State University College of Medicine and completed her fellowship training at Johns Hopkins and the University of California, San Francisco. She founded MobileSleepDoc, LLC, which is now owned by Somnology, Inc. Dr. Lim is the Chief Medical Officer of Somnology, Inc. and runs a busy private practice in Redwood City, CA, in the heart of Silicon Valley.
Art: Hi Melissa, welcome to Marketing Tidbits with ComboApp!
Melissa: Hi Art, I’m happy to be here to talk with you today!
Art: Thank you for coming. Today, my guest is Dr. Melissa Lim. I want to start off with a question to people who are listening to this show! Did you all sleep well last night? Do you feel refreshed and ready to rock your day? I hope the answer is yes! No matter what you do for a living or what country you live in, the quality of sleep you get influences your life in a big way. Today we are going to talk about the app, MobileSleepDoc Pro. It is a unique app that can help you with your sleep disorder. We are going to talk about the history of the app, marketing challenges Melissa faced, and of course, talk about how the mobile app can help people with their sleep disorder.
My first question to Melissa, can you please tell our listeners about yourself and your professional background?
Melissa: Sure. I am a sleep specialist. I practice in Redwood City, which is close to San Francisco, California. I did my fellowship training at Johns Hopkins and the University of California, San Francisco (UCSF). I am board certified in sleep medicine and pulmonary disorders. I have been treating sleep patients for twenty years now and over the last few years I have noticed an incredible demand for clinic spots and consultations in regard to sleep problems. This was one of the earliest signs for me that something needed to be done about the way people receive help for their sleep problems.
Art: How did the idea to create a mobile app, to help those with sleeping issues come about? Please elaborate more about the history of the app.
Melissa: Of course. The first problem I noticed was the numbers and ratio. By this, I mean if you look at the number of people who have sleep problems in relation to the number of sleep specialists certified to treat them, it could be as high as twenty thousand to one. The enormity of the problem was there. Then, I noticed the rise in technology that has come around in the last few years. With mobile apps allowing us to reach people all over the world, I saw this as an opportunity to provide people with more information about the kind of sleep problems that they might be suffering from, and to give them some tips as to how to help themselves. That’s the beauty of mobile app technology.
Art: And how exactly does the app work? How does it help people with their sleep disorder(s)?
Melissa: We started developing the app back in 2012 and a second version is currently out. The app is interactive and designed for the user, meaning when the new user signs in they answer a few simple questions about their sleep patterns. The app will then give them some feedback as to what their answers are pointing towards in terms of the diagnosis. Now we understand an app is not meant to replace a doctor-patient relationship but it certainly can be used to give people some answers and point them to the closest sleep center or sleep specialist that can provide them with further assistance. Again, the app is interactive and we really tried to focus on two main sleep problems, which is also what we saw in the vast majority of our patients in the office. The two biggest problems people suffer from are Insomnia and obstructive sleep apnea. Insomnia is when a person experiences trouble falling asleep, staying asleep, or both. Obstructive sleep apnea is a breathing disorder and it is characterized by periodic reduction in airflow when one sleeps. People who suffer from this constant reduction of airflow can suffer other health problems such as poor sleep quality, cardio-vascular problems, memory loss, and accidents caused by daytime sleepiness. To sum it up, the app will ask questions and if you have signs of either Insomnia or obstructive sleep apnea, it will lead you in two different directions to get more information and to receive help. For Insomnia patients, the app actually takes users through two different behavioral treatment programs.
Art: I see. Very interesting. It’s great to know that I don’t personally suffer from either of those sleep disorders!
Melissa: Honestly, you are very lucky!
Art: I agree and I hope it’s not going to change anytime soon. Moving forward, I know that for professionals who work on their product before it is released on the mobile market, it is a challenge to tackle the marketing problems because they are focused on its features and the concept behind the app from their professional perspective. What they don’t understand is that marketing the product is not necessarily something they are really great at. What marketing challenges did you see for your product? What was a really puzzling thing for you when you were releasing it on the market?
Melissa: You bring up a really good point here! I think when you make something that you are really excited about, it’s a great feeling, but just because you build a field of dreams doesn’t mean people will come to play on it. App marketing is really a big challenge. You are trying to get your app to stand out in a market that already has hundreds of thousands of other apps to potentially compete with. It’s difficult to try to get your features noticed and unique so that’s really one of the main challenges. Another difficult task is trying to maintain relevance to your users because I think people in general have short attention spans and an app needs to remain relevant for the user to stay engaged. These are two big challenges that app designers talk about all the time.
Art: Yes, I can see what you mean about the challenges to keep your users engaged. Because the market has so many apps being released on a daily basis and the difference between them may not be that clear or distinctive enough, an application may not stand out and be picked by the audience. Let’s go back to your app and talk about creating hardware for an application. It takes two to tango, having a piece of hardware and the application. Can you talk about it a little bit because I’ve seen many cases when app owners release an application that would work on a smartphone and basically that’s enough for them–to have a smartphone as a piece hardware and their app as a software platform. Why do you think this is not enough when you are working on the hardware side?
Melissa: The app definitely has value as a freestanding, independent product but we really wanted to pair it with our own self-designed wearable device that would allow users to have a lot more information. The first round of wearable integration was with the Fitbit. Our current version of MobileSleepDoc syncs with the user’s Fitbit account on the Fitbit server. It provides the user with their sleep logs when they are wearing the Fitbit, making MobileSleepDoc more convenient with less manual logging of information. I want to touch on the topic of sleep logs for a couple of minutes. Keeping a sleep log is like taking a snapshot of your nighttime behavior and can be of importance when looking at your sleep patterns. You can also use a sleep log to monitor your progress if you go through a behavioral treatment program for problems like Insomnia. To help users with this, we’ve incorporated a sleep log that is central to MobileSleepDoc. Interestingly, a lot of wearables out there, even ones that say they are for sleep, show calculations of the user’s sleep efficiency, and therefore sleep reports, that are either inaccurate or insufficient. We took a different path and decided to make sleep our main focus.
So, after the first round of our integration with Fitbit, we decided that we needed to tackle more on sleep breathing issues. We currently have a developed product in its prototype phase called the Plex Sleep Scanner. This device is very modern, small and uses medical grade sensors to help monitor one’s breathing pattern at night, oxygen saturation, pulse, etc. We plan to take all of that gathered information to give users a simple and meaningful report about their breathing pattern at night. It is really the first wellness tracker that is meant for both Insomnia and possible obstructive sleep apnea. Now again, it is not a diagnostic tool. We are focusing it as a wellness tool to give people just a little bit of extra light on what is happening with their sleep problems. They can bring this information to their doctor for further testing and treatment.
Art: Thank you, now I understand the difference, because regular smartphones or even those that are sophisticated like an iPhone are not capable of gathering all that information [by themselves]. A great point you also made is being able to bring all the information you have gathered from the hardware and application to a professional sleep specialist. We are not just talking in general terms about what is wrong with you but you can provide real data which is useful to the doctor so they know where you already stand. Moving on to my next question, what do you see as a competitive advantage of mobile apps compared to other ways of helping people with their sleep disorder?
Melissa: The first thing that comes to mind is accessibility. With the small number of sleep specialists available in relation to the number of people who are suffering from sleep problems, chances are low that people actually go to see a doctor and receive proper help. It’s no secret that access to care is one of the biggest problems to tackle, but I think medical apps and some fitness apps will be able to help with that. Another thing with apps is the ability to provide personalized information. This is a very popular concept in medicine these days and with MobileSleepDoc, we hone in on what is your sleep profile looks like. It can provide feedback about you and what we suggest to make you feel better. Overall, I believe mobile apps are a great way to reach a wider audience than the current delivery of care provides.
Art: I see. A point that I would like to bring up is a time that we have in our lives to spend on things we need to take care of. Sometimes, we don’t take care of ourselves and our health as much as we should because we live such a complex and dynamic life. Mobile applications on smartphones can be your tool that can help you to balance this equation. Do you think that there are any downsides of using mobile applications?
Melissa: Sure, there are some of [potential] downsides with the use of mobile apps in your sleep disorder recovery. This is something that I learned from my patients, and I have talked with some [app] users about this. The point is, sleep is one of those things that we have to let happen. It is not something that we “achieve” and [simply] practice to become better at. In other words, sleep should not be thought as a skill per se. I think that people who are prone to Insomnia, in particular, tend to be a little self-critical and a little bit more prone to anxiety. Monitoring of one’s sleep behavior for some people can trigger a little Insomnia because the user feels like it is something else they have to do and something else they need to be good at. [Detailed sleep monitoring] is not allowing them to forget about their sleep enough to allow it to happen. This can cause a paradoxical reaction from “hyper-monitoring” of apps. Again, this may not a majority of people who have such a reaction. The majority of people actually gain a lot insight when they monitor their behaviors at night, but there are some people for whom the act of monitoring may heighten their arousal around sleep, and that heightened arousal would make it harder for them to fall asleep. I believe that that is one potential pitfall. Hopefully, it only applies to minority of users. Certainly in clinical practice I think that is true.
Another issue would be users who do not look at the sleep reports an app generates in the right context. Some sleep apps and fitness trackers may show patterns of movement at night and confuse this with wakefulness, or the reports say too much about a user’s sleep stages. Users should keep in mind that fitness trackers are not capable of giving them information about their stages of sleep, and that only an EEG brain tracing can do that.
Art: Wow! It is definitely not something your smartphone can do at home!
Melissa: Yes, but I do see some people looking at their sleep reports that they get from their smartphone trackers presumably reflecting what stages of sleep they’re in, and I always have to explain to them that this may not be accurate information and not to take it too far.
Art: Well I see the point that for some, they may think trying to fix their sleep problems is like going to a gym to trying to fix their weight but it’s not. You don’t just go to a gym and do certain exercises like it’s something you do naturally. I can understand why it might be the case for certain people to get not an advantage but instead, feel a disadvantage when using an app. It is just like with any type of technology. Unfortunately, it does not guarantee to work perfectly for everybody but it is not to say that we should not work on further improvement. Where do you think mobile apps and smartphones will stand in the next 5 years?
Melissa: I definitely think that more apps will be directed at chronic disease management. Let’s only focus on medical apps for the moment since it is a large area of need which has not been [adequately] addressed. I know there are certain ethical aspects to consider when dealing with any chronic disease, and [chronic disease management] is not a sexy topic to talk about. However, how will mobile apps help manage your asthma, diabetes or other illnesses that are common that many people suffer from? I would like to see the app community address actual chronic diseases better than they are doing right now. It is an area with potential enormous benefit. I believe in the future we will see a big expansion in that area.
Current fitness apps focus on those who are already health conscious, and it would be a challenge to expand our reach to get more people to care about their health, or more people who have some of these chronic diseases to seek better health maintenance Overall, I think there is a great opportunity for medical apps to take over the app arena.
Art: How can we get involved with these kinds of apps that help people manage their health, people who are not already into these kinds of apps? How can we shift them to think towards this direction? How can we make this switch from not thinking about your health, and how can apps make a difference to those using apps to become healthier?
Melissa: It is definitely going to be a big challenge. It would be a great start to get physicians to utilize these apps, use them as a resource and to recommend the best ones to their patients. I know that in my own practice, my patients are showing me their data and what new apps they are using on the frequent basis. To me, this is great–really fun and interesting to see that some of these apps are becoming extremely useful!
Art: I think about Apple’s latest technical advances when they released the Research Kit for medical professionals to gather the exact kind of information that you were just talking about. It is something that I am personally very excited about. When I first heard that the health kit was the predecessor of this latest kit, I thought it should be the direction Apple to go towards. You have so many devices in people’s hands and you should be able to take advantage of working on that scale in gathering the right information for medical professionals. We are not talking about ten, twelve or a hundred people, we are talking about hundreds of thousands of people and even millions. This should be very powerful and helpful in the near future.
Melissa: Exactly! I am also excited about that. I think standardization is going to present its own challenge, but the sheer number of people that will be able to enroll in these studies is amazing and will hopefully advance our knowledge.
Art: Right, ok! I think that does it for this week. Melissa, please tell our listeners where they can read more on what you do and what you are currently up to!
Melissa: Interestingly, you actually mentioned MobileSleepDoc as our company and that was the original version of it [when we developed our app MobileSleepDoc Pro], but since then we’ve developed our own wearable device. We have therefore created a new company overarching above MobileSleepDoc and the Plex Sleep Scanner, called Somnology, Inc. So listeners, stay tuned for our new website (www.somnologymd.com) which will be launching within the next month. In terms of my practice, my medical practice is Redwood Pulmonary Medical Associates and we have a website (www.redwoodpulmonary.net). MobileSleepDoc also has a website, www.mobilesleepdoc.com. You can learn more information at those two sites.
Art: Thanks a lot Melissa!
Melissa: Thank you so much Art. It was great to talking to you.