Apps to Track Exercise, Sleep Help Patients Participate in Clinical Trials

Smartphone data is used for crowdsourcing studies of diabetes, asthma, cardiovascular disease

http://www.wsj.com/video/apple-researchkit-links-users-to-researchers/324CA4EA-1B65-4318-A3C3-3A2E5EDE2B30.html


By RON WINSLOW / April 13, 2015 4:11 p.m. ET

Steven DeMello, like many people, uses a smartphone to keep a calendar, take notes, create artful photographs and listen to music.

Recently, he began using it for a new purpose: to participate in a clinical trial. Three times a day, the retired health-care executive, who is 60 years old and has Parkinson’s disease, performs four tests using an app on his iPhone that records his results and provides feedback to researchers—and to him—on how his Parkinson’s symptoms affect his daily life.

“If I know more about my condition, the better and smarter I will be in managing my own care,” he says.

The app, called mPower, is one of five disease-related apps for clinical trials released in March in connection with Apple Inc.’s introduction of ResearchKit, a platform where users can track personal health data and participate in health studies. Other apps include My Heart Counts for cardiovascular disease, Asthma Health, GlucoSuccess for diabetes, and Share the Journey, for a study of the after effects of treatment for breast cancer.

Together the apps—and patients like Mr. DeMello—offer a glimpse of how the ubiquitous smartphone has the potential to transform medical research. Taking advantage of smartphone features such as accelerometers, gyroscopes and GPS locators, the apps track real-time daily activity and supplement other information on a patient’s condition.

ENLARGE

Three times a day, Steven DeMello, a retired health-care executive who has Parkinson’s disease, uses an app on his iPhone to perform four tests that record results and provide feedback to researchers—and to him. PHOTO:STEVEN DEMELLO

Since the apps were launched March 9, some 60,000 patients have enrolled in five studies just by downloading the apps from the app store, answering a few questions about the disease and clicking through a consent form. None of the patients had to see a doctor to sign up.

Academic researchers doing similar trials might need several years to enroll only a few hundred patients. Pharmaceutical companies need scores of research sites and hundreds of millions of dollars to find 20,000 patients for a major drug trial.

“This is a whole new way of going forward with medical research that makes it quick, scalable and efficient,” says Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif., who is familiar with the apps but isn’t involved with developing them.

The apps all were developed by researchers at academic medical institutions leading the studies. Apps for more diseases are planned. The scientists aren’t testing new drugs, but rather hoping to learn more about the long-term effects of chronic disease on participants, including whether the use of a smartphone might help individual patients deal more effectively with their symptoms.

“The phone can be a powerful way to engage participants and make participating in a clinical study more of a two-way information exchange,” said Stanley Shaw, co-director of the Center for Assessment Technology and Continuous Health at Massachusetts General Hospital, Boston, where the diabetes app was developed.

ENLARGE

Apple's Parkinson’s disease app includes a finger-tapping test to determine the patient’s speed of movement. Other apps include My Heart Counts for cardiovascular disease, Asthma Health, GlucoSuccess for diabetes, and Share the Journey, for a study of the aftereffects of treatment for breast cancer. PHOTO: APPLE

For now, the apps work only on the iPhone 5, 5s, 6 and 6 Plus. Although tens of millions of Americans own an iPhone, the cost puts them out of reach of many lower-income earners. That raises questions about how relevant data from iPhone-based studies would be for the broader population.

Apple plans to make the ResearchKit available soon on an open-source basis. That would enable development of apps for Android-based phones, which are often cheaper than iPhones, and potentially extend use of the apps to a broader population.

Apple said it doesn’t collect or see any of the patient information researchers gather. Study participants have full control over when and whether their data, after it is uncoupled from their identity, can be shared with other researchers. Still, some worry a privacy risk remains. A significant privacy breach from app-based studies would be a “serious hit” to their use in clinical research, said Dr. Topol, of the Scripps institute.

Researchers are intrigued by the transformative potential of smartphone apps. Kathryn Schmitz, an epidemiologist at University of Pennsylvania and an investigator on the Share the Journey study, said it recently took her team three years, including the sending of 60,000 notices, to recruit just 351 patients for a separate conventional study about the impact of exercise on breast-cancer survivors.

In the first month of recruiting for Share the Journey—which she said has less stringent enrollment criteria—nearly 2,000 patients have signed up.

The apps also enable easy enrollment of patients no matter where they live in the U.S. (Apple plans international study launches.)

With Parkinson’s disease patients, mobility is a main concern. For patients who live, say, in New Jersey or on Long Island, “the idea of getting into the city to an academic center is way too overwhelming,” said Todd Sherer, head of the Michael J. Fox Foundation for Parkinson’s Research in New York, which is involved with several online research initiatives. “But if you can bring the technology to their house, they are very excited to participate.”

Smartphones also offer the capability to track people’s symptoms and activities continuously in their daily lives. In many conventional studies, patients might have just a few clinic visits a year for tests and symptom updates, and those snapshots may not provide a detailed picture.

“Patients say symptoms fluctuate over the course of a day, but we’ve never had a way of measuring that,” said Ray Dorsey, a University of Rochester researcher who heads the Parkinson’s app study. With a smartphone, patients and researchers can observe symptoms that may change hourly and see how the changes correlate with factors such as exercise, meal times and medication dose. The phone also objectively records measurements of activities—minutes of exercise, steps walked, hours of sleep—which in conventional studies are typically obtained from less-reliable patient recall.

Mr. DeMello, who lives in Oakland, Calif., says he has 20-minute visits with his neurologist about once a quarter. Yet, he lives with the disease 365 days a year.

Each day, he uses his iPhone to take a finger-tapping test to determine his speed of movement, a walking test to check his gait and balance, a voice test and a memory test. Results measure the effect of his disease.

So far, he says, he has learned his symptoms don’t move in lock step, contrary to what he used to think. “I have weeks when balance is an issue and weeks when it’s not,” he said. “Then I have weeks when I’m slower cognitively than others.”

The app, he said, “is a huge step in giving patients a chance to contribute data that is otherwise completely lost.” Now, he says, “what I mostly want to do is learn how things come together in my body and what do I have to do to make them better.”

Snoring could be an early warning sign for memory loss.

CBS NEWS     April 16, 2015, 12:43 PM

There's new evidence suggesting just how important sleep is for the brain.

A study, published Wednesday in the journal Neurology, finds that people who snore heavily and have breathing problems during sleep may develop memory loss and cognitive decline at a much younger age than average.

"This study might be keeping some people up at night," Dr. Carol Ash, director of sleep medicine at Meridian Health, told "CBS This Morning."

http://www.cbsnews.com/pictures/sleep-hacking-tips-7-ways-to-maximize-your-zzzzzs/

Snoring and sleep apnea -- a condition where breathing is repeatedly interrupted during sleep -- are common among older people, affecting about half of men and a quarter of women, according to the researchers from NYU Langone Medical Center.

They studied the medical histories of nearly 2,500 people ages 55 to 90. Participants were categorized as having either normal brain function, mild cognitive impairment (MCI), or early stages of Alzheimer's disease.

The study found that people with sleep apnea were diagnosed with mild cognitive impairment an average of nearly 10 years earlier than people without sleep apnea.

"That's significant," Ash said. Even though the study did not prove cause and effect, she said it adds to a growing body of evidence that links sleep to brain health.

• How to protect your aging brain
• New clue about what causes Alzheimer's disease

Fortunately, she said, there are things you can do to lower the risk. "When you have symptoms of snoring or symptoms that suggest you have sleep-disordered breathing, you really want to take it seriously. There's simple screening that can be done to identify somebody that has a problem. There's a home sleep test to make the diagnosis. Then there's treatment options."

For people with sleep apnea, a device called a CPAP mask, worn over the nose and mouth, can help keep the airways open at night. It may look uncomfortable, but Ash said, "When you have a patient who truly has this problem, it can change and save their life. You have to coax them through and get them comfortable, but once they're using it, they won't go back."

Losing a few pounds can also be effective, since excess weight often contributes to snoring and breathing problems. In other cases, dental work or surgery can make a difference.

The NYU researchers found that patients whose sleep issues were treated were able to ward off cognitive decline. "The age of onset of MCI for people whose breathing problems were treated was almost identical to that of people who did not have any breathing problems at all," study author Ricardo Osorio, MD, said in a press statement. "Given that so many older adults have sleep breathing problems, these results are exciting --we need to examine whether using CPAP could possibly help prevent or delay memory and thinking problems."

Ash stressed the importance of getting diagnosed and dealing with sleep problems, since in addition to memory decline, snoring and sleep apnea have also been linked to an increased risk of stroke, heart attack, and other life-threatening conditions.

"Sometimes you can't undo all of the damage, but I've seen significant improvements," she said. "It's worth looking into."

Could Chrona Be the Key to Deeper Sleep?

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Dental Clinicians’ Observations of Combination Therapy in PAP-Intolerant Patients

March 9, 2015

Based on the experiences of four highly experienced dental sleep practices, this pilot study sought to determine whether combination therapy, in which a PAP interface and mandibular advancement splint are physically connected, may provide a more acceptable therapeutic modality in obstructive sleep apnea patients who have abandoned conventional PAP therapy.

By Anne E. Sanders, MS, PhD, MS; Martin A. Denbar, DDS, DABDSM; John White, DDS, DABDSM; Ronald S. Prehn, ThM, DDS, DABDSM; Robert R. Rogers III, DMD, DABDSM; Thomas Pardue, BA; Max Schweizer, BS; and Greg K. Essick, DDS, PhD

TAP-PAPComboTherapy

In the PAP/MAS device, the PAP interface (nasal pillows) is connected to, and stabilized in position by, a rod extending from the oral appliance, a mandibular advancement splint. This obviates the need for headgear required when the PAP interface and oral appliance are not connected.

Patients with obstructive sleep apnea (OSA) attribute their poor tolerance of positive airway pressure (PAP) therapy to the presence and fit of headgear and chin straps, claustrophobia, unstable or inadequate fit of mask to facial contours, air leakage, mask-related skin ulceration and headache, aerophagia, and uncomfortably high pressure levels. As a result, only about 50% of patients continue to adhere with therapy after 1 year.

Anecdotally, sleep clinicians claim better tolerance when PAP therapy is used in conjunction with a mandibular advancement splint (MAS), but published evidence is scarce. The MAS stabilizes and advances the mandible, simulating jaw thrust and clearing the upper airway for unobstructed breathing. Improved tolerance of this combination therapy (CT) is attributed to fewer pressure-related complaints. El-Sohl et al showed in 10 patients that CT reduced both the effective continuous PAP and pressure-related complaints shortly after implementation. Consistent with lower effective pressures, Borel et al found that velopharyngeal resistance is lower with CT than with a nasal mask alone. 

In both studies, the MAS and PAP mask were not physically connected.

The PAP interface, however, can be physically connected to and supported by a MAS, eliminating the need for headgear. One early case report6 described a patient whose responses to PAP and to MAS therapy were poor, but who achieved near normal sleep respiration and a lower minimally effective PAP upon stabilization of the mandible in an upward and forward position, as corroborated elsewhere.  By analyzing existing data from four dental sleep practices, we sought to determine whether PAP delivered through an interface connected to a MAS can offer a more accepted therapeutic alternative for OSA patients who have failed conventional PAP therapy. 

Methods

The study employed a retrospective cohort design in which four dental sleep medicine experts in separate US practices retrieved existing data from records for all consecutive patients aged ≥18 years meeting inclusion criteria. The inclusion criteria were: physician diagnosis of OSA and referral to a dentist; having failed conventional PAP therapy; having attempted MAS-PAP within a specified time interval; and being on active recall for therapy evaluation. Clinicians were diplomates of the American Board of Dental Sleep Medicine with collective experience treating more than 14,000 patients with oral appliances for sleep-disordered breathing over a total of 79 years. The Biomedical IRB at the University of North Carolina at Chapel Hill approved the study.

De-identified diagnostic and CPAP titration information from patients’ sleep study reports and clinical records of CT were extracted and recorded on a standardized pretested electronic form.

Investigation was restricted to a single commercially available CT device—the TAP-PAP Chairside (manufactured by Airway Management Inc). In this device, a horizontal rod is secured to the upper component of a MAS, and a nasal pillow/hose assembly is attached using an acrylic material.

Tolerance was defined by clinician report that the patient was continuing to use PAP/MAS, based on periodic recall and ongoing evaluation by the dental sleep expert in the dental office. Acceptability was evaluated by patient report of complaints. Evidence of efficacy was determined in a subset of patients by comparison of follow-up polysomnogram or home sleep study against the diagnostic polysomnogram.

Data were imported into StataCorp LP Stata 13.1 Statistical Software for statistical analysis. Pearson chi-square tested the significance of differences between categorical variables. A paired t-test tested the null hypothesis that apnea-hypopnea index (AHI) values at OSA diagnosis did not differ from those obtained following PAP/MAS.

Results

Among 92 OSA patients aged 25 to 85 years (mean 55 years), the mean polysomnogram-determined diagnostic AHI value was 37.6 (standard deviation (sd): 25.9). Half (n=46) met the diagnostic threshold for severe OSA (AHI ≥30), a quarter (n=23) had moderate OSA (AHI 15–29.9), and the remainder (n=23) had mild OSA (AHI 5–14.9).  

Because the proportion of PAP/MAS tolerant patients did not differ between the practices (P = 0.612), results report pooled data. Overall, 65 patients (70.7%) tolerated PAP/MAS therapy, having used it for 14.0 months on average (sd: 11.1). Although tolerance was higher in patients with severe OSA (76.1%) than mild OSA (69.8%), this difference was not statistically significant (P = 0.421).

Patients expressed substantially fewer complaints to their dentists about PAP/MAS than conventional PAP (Table 1). The most common complaints about conventional PAP related to mask discomfort and leakage, and the perceived ineffectiveness of PAP. Again, mask discomfort and leakage were the most common complaints about PAP/MAS, but these were reported by only a small minority of patients. 

A follow-up polysomnogram or home sleep test was available for 34 of the 65 PAP/MAS tolerant patients while using PAP/MAS. Patients with severe OSA were more likely to have had the follow-up polysomnogram than those with mild OSA (P = 0.023). In these patients, AHI values decreased from an untreated mean of 48.0 (sd: 28.3) events/hour to a treated mean of 3.1 events/hour (sd: 3.8) (P < 0.001), indicating that, on average, PAP/MAS eliminated OSA.

Discussion

In this study of patients who had abandoned conventional PAP, 70.7% were reported using PAP/MAS for 14.0 months, on average, after initiation of treatment. PAP/MAS tolerant patients expressed to their sleep dentists substantially fewer complaints about the CT than conventional PAP. CT reduced the AHI to less than 5, on average, achieving values not dissimilar from those achieved with conventional PAP.

Several explanations may account for better tolerance of CT. Borel et al⁵ found that joint use of PAP with MAS was at least equally effective as nasal PAP alone by increasing airway patency beyond that achieved solely with PAP. Using a phrenic nerve magnetic stimulation paradigm, the investigators showed greater decrease in velopharyngeal resistance with CT. Since resistance values determined this way are related to pressures at which the pharynx collapses, the joint therapies act synergistically to improve velopharyngeal area patency, the area primarily implicated in upper airway collapse.

El-Sohl et al found that the CPAP intolerance was associated with high pressure-related complaints. In agreement with greater pharyngeal patency demonstrated by Borel et al, El-Sohl et al also demonstrated that CT lowered the optimal pressure 29% on average and was well tolerated.

PAP therapy adherence is influenced by the mask interface. Typically, when a nasal mask results in air leakage via the mouth, an oronasal mask is tried. However, the higher pressures required for oronasal masks are associated with greater air leakage, more arousals, more residual respiratory events, dry mouth, and worse adherence than nasal masks. In addition, their manner of attachment tends to push the mandible and tongue backward, increasing the airflow resistance.

A nasal interface used with MAD overcomes the aforementioned problems. The effective pressure is typically lower than with a nasal mask. Rather than pushing the mandible backward, it is stabilized in a neutral or forward position, lowering velopharyngeal resistance and improving upper airway patency. As the mouth is kept closed, air leakage and mouth breathing are minimized.

Because nasal pillows have less facial contact, problems of claustrophobia, air leaks around the eyes, and pressure sores are minimized.  In their randomized cross-over study, Massie and Hart compared nasal pillows to nasal masks using pressures ranging from 5 to 14 cm H₂0. They reported no differences in treatment efficacy, effective CPAP pressure, Epworth sleepiness score, or quality of life measures. The nasal pillows produced fewer adverse effects, less air leakage, less difficulty sleeping and maintaining sleep, and improved sleep quality.

The nasal pillows in our study were supported via a rod extending from the maxillary component of the MAS, obviating need for a chin strap and headgear to support the air interface. This confined facial contact to the external nares and lip vermilion over which the supporting rod extended. Moreover, the rigidity of the connection with the MAS secured the nasal pillows in a stable “locked” relationship with respect to the external nares to minimize air leaks and thus disruptive arousals from sleep. Air leakage is a major deterrent to the use of PAP, hence the substantial reduction in complaints of “air leakage” and “not being able to keep in place” with PAP/MAS may, in part, underlie its success.

PAP/MAS-tolerant patients had remarkably fewer complaints about the CT than conventional PAP. Our expectation that the addition of MAS would cause discomfort in masticatory muscles, TMJ, and teeth, was not met. CT may be successful with a lesser degree of jaw advancement than required for treatment with a MAS alone,¹ thereby minimizing dental side effects.

The use of CT as a first-line therapy, rather than a rescue, may decrease the number of patients who remain untreated from nonadherence to PAP therapy. Compared to conventional PAP, CT appears to offer improved comfort and interface stability, and a reduction in air leakage.

We recognize the many limitations of this pilot study. Data were limited to existing clinical records of community-based dental sleep practices. Because of this, the patients were not matched either within or across the four practices. There was no standardization of the PAP titrations, types of masks employed, or counseling that the patients received on use of conventional PAP or combination therapy. The amount of jaw advancement with PAP/MAS was not standardized within or between practices, which could have affected tolerance of the CT. There was no standardization of the follow-up PSG or home sleep study, and these data were not available for approximately half the CT-tolerant subjects. Data were not available for the nightly duration of PAP/MAS use. Nonetheless, the consistency of the experiences reported across the four unrelated, expert dental sleep practices supports the general conclusion that PAP/MAS can provide an effective treatment for OSA in many otherwise CPAP-intolerant patients and merits formal evaluation in a prospective controlled clinical trial.

Where and what is happening in your brain when you sleep?

Apr 08, Neuroscience

Sleep has profound importance in our lives, such that we spend a considerable proportion of our time engaging in it. Sleep enables the body, including the brain, to recover metabolically, but contemporary research has been moving to focus on the active rather than recuperative role that sleep has on our brain and behaviour.

Sleep is composed of several distinct stages. Two of these, slow-wave (or deep) and REM sleep, reflect very different patterns of brain activity, and have been related to different cognitive processes.

Slow-wave sleep is characterised by synchronised activity of neurons in the neo-cortex firing at a slow rate, between 0.5 and three times per second. The neo-cortex comprises the majority of the cerebral cortex in the brain which plays a role in memory, thought, language and consciousness. In contrast during REM sleep, when most of our dreaming happens, neuronal firing is rapid and synchronised at much higher frequencies, between 30 to 80 times per second.

Such patterns of brain activity during REM sleep are reminiscent of those observed during wakefulness, and for this reason REM sleep is often referred to as "paradoxical" sleep.

Cognitive functions

There is growing evidence that slow-wave sleep is related to the consolidation of memory and is involved in transferring information from the hippocampus, which encodes recent experiences, and forging long-term connections within the neo-cortex. REM sleep has been linked to processes involving abstraction and generalisation of experiences, resulting in creative discovery and improved problem solving.

Though there are substantial similarities between wakefulness and REM sleep, numerous studies have explored differences in the activity of brain regions between these states, with the cingulate cortex, hippocampus and amygdala more active during REM sleep than wakefulness. These regions are particularly interesting to cognitive neuroscientists because they are key areas involved in emotional regulation and emotional memory. 

However, which sub-regions are active within these broader cortical and limbic areas – the pathways in the brain that produce these patterns of activation – and the precise function of the activity in these regions during REM sleep is currently under-described. 

Cortical activity in rats 

A new study published in Science Advances studied the physiology and functionality of REM sleep in a group of rats and provides insight into the cortical activity and the sub-cortical pathways that result in this activity. The level of detail of this study provides a major step forward for our understanding of the effect that REM sleep has on our brain and cognitive behaviour. 

The authors studied groups of rats who were allowed to sleep, but prevented from entering REM sleep for three days. Six hours before assessment, half of the rats were allowed to sleep normally, and half continued to be deprived of REM sleep. The rats that were permitted to sleep normally then demonstrated raised levels of REM sleep within those six hours. This enabled a comparison of the effect of recent REM sleep between groups. An additional control group of rats were allowed to sleep normally throughout the study. 

Gene expression analysis involves tracking the presence of particular mRNA or proteins that can be identified as the consequences of certain genes operating. The rats who underwent substantial REM sleep before testing were found to demonstrate greater expression of several genes that are associated with syntaptic plasticity (how quickly their synapses can adapt to changes in a local environment) and which affects the efficiency of neural transmission in the hippocampus. 

In the neo-cortex, the gene expressions related to how well our synapses adapt also increased following REM sleep, but those related to neural transmission were reduced compared with the group that was prevented from REM sleep. So, the function of REM sleep appears to be due to changes in the way that neurons communicate. This is consistent with the view that REM sleep allows the brain's memory processing systems to re-balance, which enables effective responses to experiences the next day. 

Where in the brain? 

In a further study, the same group determined the precise location of where these changes actually occur in the brain. In the neo-cortex, there was a general increase in plasticity throughout several areas, including sensorimotor regions that bring together sensory and motor functions. In the hippocampus, it was generally confined to the dentate gyrus, which is thought to contribute to forming new episodic memories among other things. REM sleep was also associated with reduced neuro-transmission throughout many regions of the neo-cortex, indicating that REM sleep likely results in a general weakening of the connections between synapses, which may enable brain networks to better learn from multiple experiences rather than be affected only by single instances. 

The final studies the group conducted determined the source of the cortical changes in plasticity and neuro-transmission during REM sleep. By tracking signal transmission between different brain areas together with chemical lesioning (in which brain areas are temporarily inactivated), they identified two further areas called the claustrum and the supramammillary nucleus as having key roles during REM sleep. 

The claustrum: consolidating emotion and memory. Credit: Was a bee

These two areas have been identified as involved in integrating emotion and memory. The claustrum is a very thin layer of neurons that are found underneath the inner neo-cortex. It is known to link to and from very many regions of this part of the brain. As such, the claustrum has been implicated in integrating stimuli from several senses and is involved in linking areas involved in emotional processing and attention. 

The supramammillary nucleus, within the hippocampus, is also known to interconnect to multiple areas of the brain, several of which are associated with emotional processing. 

The implications of this work provide converging evidence that REM sleep modulates activation and synaptic processing in areas of the brain that contribute to the processing of emotion. This is also consistent with previously untested accounts that suggest REM sleep is important for encoding memories (but without their emotional content). While the role of dreaming during REM sleep is still yet to be linked to observed effects from neuro-chemicals in the brain, understanding what is happening in our brains when we dream could yet prove to be key to processing of emotion and memory.

Kids Sleep Doctor: App That Improves Your Kid’s Sleep Better Than A Doctor

By Nida I Zamir on April 6, 2015

So parents are about to sigh with relief as a free app to improve children’s sleep has been launched by doctors at the Evelina Children’s Hospital in London. The app, Kids Sleep Doctor, gives parents custom advice, based on the sleeping patterns of their children, like night terrors or teens staying up all night long.

Paul Gringras, a professor of children’s sleep medicine at the hospital, said that the doctors only skim through a patient, seeing “only the tip of the iceberg” due to the “massive” waiting lists. That is why the hospital decided to develop an app which could focus on the patients more closely and give advice along the way as different problems would pop up during the life cycle of the children aged 0 – 16.

The app initially requires details about the children, like bedtimes, where the child falls asleep, how much screen time they have, and consumption of caffeinated drinks.

After five days of collecting the data on the child’s sleep habits, like night-waking and bedtimes, the actual tailored service of advice begins.

“Hopefully they are sleeping in the normal range, but if they’re outside that then it advises parents,” Prof Gringras said.

“Take a five-year-old who suddenly is waking up every night screaming, doesn’t recognize parents and pushes them away. The app would say it is like a night terror and will happen in 10% of children in this age range and they will grow out of it, but they can also try a technique called scheduled waking half an hour after they have gone to bed.”

For teenagers who are unable to sleep until really late into the night, the app would advise parents that the child needs exercise in the afternoon as it promotes healthy sleep.

“These are not annoying daily tips, it’s tailored advice,” he added.

Considering how the doctors are actually letting their waiting lists shorten for an app, it points at the hospital’s ethical responsibility which is to reduce pressure on the overburdened service, and does not focus on making a few extra dollars.

“I think there’s a lot of people it could prevent needing to see a GP. Parents can do a brilliant job,” added Prof Gringras.

However, the 200,000 children diagnosed with serious sleep disorders such as narcolepsy or obstructive sleep apnoea would still require proper doctor consultation.

Moreover, the app has a dark and orange palette to minimize the amount of blue light emission, which is the wavelength of light that disrupts sleep.

Psychologist and child therapist Professor Tanya Byron commented:

“Many children are affected by sleep problems which can have a major effect on the whole family. Getting a good night’s sleep is so important for a child’s physical and mental development, behaviour and concentration – to name but a few. We know parents know their children better than anyone, and I’m confident that the ‘Kids Sleep Dr’ app will help parents to understand and better manage their child’s sleep problems.”

Kids Sleep Doctor is currently available free on iOS. Android and Windows versions are in the pipeline.

Can Orange Glasses Help You Sleep Better?

By KATE GALBRAITH
APRIL 6, 2015


Most evenings, before watching late-night comedy or reading emails on his phone, Matt Nicoletti puts on a pair of orange-colored glasses that he bought for $8 off the Internet.

“My girlfriend thinks I look ridiculous in them,” he said. But Mr. Nicoletti, a 30-year-old hospitality consultant in Denver, insists that the glasses, which can block certain wavelengths of light emitted by electronic screens, make it easier to sleep.

Studies have shown that such light, especially from the blue part of the spectrum, inhibits the body’s production of melatonin, a hormone that helps people fall asleep. Options are growing for blocking blue light, though experts caution that few have been adequately tested for effectiveness and the best solution remains avoiding brightly lit electronics at night.

A Swiss study of 13 teenage boys, published in August in The Journal of Adolescent Health, showed that when the boys donned orange-tinted glasses, also known as blue blockers and shown to prevent melatonin suppression, in the evening for a week, they felt “significantly more sleepy” than when they wore clear glasses. The boys looked at their screens, as teenagers tend to do, for at least a few hours on average before going to bed, and were monitored in the lab.

Older adults may be less affected by blue light, experts say, since the yellowing of the lens and other changes in the aging eye filter out increasing amounts of blue light. But blue light remains a problem for most people, and an earlier study of 20 adults ages 18 to 68 found that those who wore amber-tinted glasses for three hours before bed improved their sleep quality considerably relative to a control group that wore yellow-tinted lenses, which blocked only ultraviolet light.

Devices such as smartphones and tablets are often illuminated by light-emitting diodes, or LEDs, that tend to emit more blue light than incandescent products. Televisions with LED backlighting are another source of blue light, though because they are typically viewed from much farther away than small screens like phones, they may have less of an effect, said Debra Skene, a professor of neuroendocrinology at the University of Surrey in England.

LEDs are also increasingly popular as room lights, but “warm white” bulbs, with less blue, tend to be a better choice than “cool white” for nighttime use. The lighting company Philips also makes a bulb, called Hue, that can change the intensity of its component colors via an app, and GE last month announced a reduced-blue LED bulb, meant to be used before bedtime.

At night, Matt Nicoletti wears orange glasses to use technology. He says he thinks they make it easier to fall asleep.

BENJAMIN RASMUSSEN FOR THE NEW YORK TIMES

“Conceptually, anything that will decrease that blue light exposure at night will be helpful,” said Christopher Colwell, a neuroscientist at the University of California, Los Angeles. “I know some gamers who swear by those orange-tinted goggles.”

But orange glasses are not a panacea, Dr. Skene said. “It isn’t just get rid of the blue and everything’s fine,” she said. The intensity of light, in addition to color, can affect sleep, she said, and not all brands of orange-tinted glasses have undergone enough independent testing for their ability to aid sleep.

Screens that are not backlit, such as some e-book readers, are preferable to typical brightly lit screens, Dr. Skene said.

Mr. Nicoletti says that the orange glasses he wears, an industrial-safety brand called Uvex, do make some colors, notably blues and greens, harder to distinguish. He also uses applications designed to alter the blue light impact of his devices depending on the time of day: an app called f.lux for his computer and Twilight for his mobile phone.

Other ideas are proliferating. An Ohio company called LowBlueLights.com, for example, offers filters said to block blue light by covering the screens of electronic devices like the iPhone or iPad. Other company products include “low blue” LED lights and orange eyewear.

During the daytime, experts say, exposure to blue light is good. Best of all is sunlight, which contains many different wavelengths of light. “That’s what our brain knows,” said Kenneth P. Wright Jr., director of the sleep and chronobiology lab at the University of Colorado, Boulder.

A 2013 study he led, published in the journal Current Biology, showed just how different things can be without nighttime lights: After participants had camped in the mountains for a week, their bodies began to prepare for sleep about two hours earlier than normal.

Short of cutting out all evening electronics, experts say, it’s advisable to use a small screen rather than a large one; dim the screen and keep it as far away from the eyes as possible; and reduce the amount of time spent reading the device.

“If you can look at the iPhone for 10 minutes rather than three hours, that makes a lot of difference,” Dr. Skene said.