EverSleep Wearable Sleep Tracker: Product Review and Interview with CEO

Interview

Michael Batista, Medgadget: What gaps in sleep monitoring technology did SomnoHealth identify that lead to an interest in developing your own product?

Chris Crowley: Perfect question Mike!  EverSleep fills a huge gap between the $99 motion-based fitness trackers that have a sleep mode and a night in the sleep lab which may cost $2000 plus physician’s fees. Many sports watches claim to have a “sleep” measurement mode, but they are only measuring motion, and they cannot differentiate between different types of sleep problems. These solutions typically deliver a sleep efficiency number like “79” in the morning, which means nothing. EverSleep delivers the same data that you’d receive from a sleep lab and plain-English interpretation and coaching specific to your sleep problems that previous night.

 

Medgadget: Why did you decide to use crowdfunding through Indiegogo as a way to raise funding and interest in the product? Was there a particular reason to use Indiegogo over other crowdfunding platforms like Kickstarter?

Crowley: Crowdfunding was a great experience for us – it gave us the resources to build and ship 750 EverSleep units to backers in 37 countries! I’m sure Kickstarter is good, but we chose Indiegogo because their team “held our hand” and was so helpful to us along the way. We had a campaign manager who worked daily with our marketing team and always had good suggestions. Also, Indiegogo is teamed with Arrow Electronics, who gave us a no-strings-attached $50,000 grant! Kickstarter may be larger and more well-known, but we might have gotten lost in the “crowd,” pun intended!

 

Medgadget: At what stage was the product when you launched the Indiegogo campaign? Did EverSleep evolve as a result of input received during the course of the campaign?

Crowley: We were quite far along when we launched the campaign. We had our injection molds completed, our 4th version of the circuit board designed and tested, most of the firmware completed, and a big portion of the app working.  This really helped drive credibility for our campaign and helped us quadruple our initial funding goal. We made changes based on input from backers, lots of in-house prototype testing, and serious beta testing with about 30 outside users.

 

Medgadget: The EverSleep product captures a number of different data points: oxygen, pulse, blood pressure, and sleep quality. Can you comment on the importance of tracking these metrics and how the product uses this information to help users improve the quality of their sleep?

Crowley: We touched on this in an earlier question, but you can only get a valid analysis of your sleep if you are measuring continuous blood oxygen saturation and pulse rate. We measure this 30 times per second! The other “fitness bracelet” and “sport watches” only measure motion, and an occasional pulse rate, usually once every 10 minutes.

For instance, there are 5 main recognized types of insomnia. Two of the five are directly related to sleep apnea, and the “fix” for these two is dramatically different than the other three types that are not related. However, you cannot tell these apart without the oxygen measurement. EverSleep measures, analyzes, correlates, and then generates plain-English interpretation and coaching tips for that user’s specific sleep problems.  The app suggests to the user what happened during the night, why it happens, and how to fix it.

We should note that EverSleep is a consumer health device and does not have FDA 510(k) clearance. Thus EverSleep does not claim to diagnose, treat, or cure any disease. Users are encouraged to speak with their doctor before starting any health improvement plan, including sleep.

 

Medgadget: What are the different types of insomnias and how does the EverSleep product identify and differentiate between them?

Crowley: The technical terms are SOL (sleep-onset latency), WASO (wake time after sleep onset), and EAI, but the WASO and EAI can be caused by airway issues or other internal and external issues. Only EverSleep can determine which of those types you may be suffering from and provide DIY tips that might improve your sleep.  Of course, EverSleep puts specific numbers to your insomnia types, so you can chart your progress as you try different lifestyle changes or other remedies.

 

Medgadget: There are a number of technologies available today that take different approaches to tracking sleep. For example, at Medgadget we’ve recently covered sleep monitoring technology that sits by the bedside or tracks sleep using only a mobile app. Can you summarize what makes EverSleep unique?

Crowley: Again, it is our direct oxygen, pulse rate, and motion monitoring. If those other technologies worked well, they would be used in a sleep lab!  We are literally bringing the advanced sleep lab technologies directly to the consumer. But don’t be fooled, all of the technology and graphs in the world won’t help you mom sleep better – she just wants to sleep better.  So EverSleep’s interpretation and coaching tips are the real jewel of the product.

 

Medgadget: Now that the product is available for purchase, what has been the response from consumers using EverSleep? What’s next for EverSleep technology and SomnoHealth? 

Crowley: We have over 1400 EverSleep units shipped to 37 countries. About half of those are our crowdfunding backers. We’ve received emails and phone calls and many reviews saying that EverSleep has changed their lives.  People are sleeping better than they have in 20 years, or perhaps the measurements from EverSleep encouraged them to see their doctor about their sleep. Often wives hear their husbands stop breathing at night, but the husbands won’t do anything about it – until they see the results from EverSleep!

 

Product Review

What’s In The Box?

The Eversleep product comes with:

• Eversleep wrist-worn sleep monitor with pulse oximeter
• USB to micro-USB charging cable
• Small roll of athletic tape
• Quick start guide
• Information card

The blue wristband running through the white sleep monitor has a rubbery, but soft feel that is comfortable when worn. The pulse oximeter component is not an attachment but is firmly fixed to the sleep monitor, requiring them to be transported and stored together. Besides what comes in the box, to begin using the Eversleep product, I also needed to download the free matching mobile app. I downloaded the iOS version of the app to an iPhone 8, though an Android version is also available for download. All the physical items can be easily returned to the original box for storage or transport.

Setup

Software

Unlike most mobile apps, the Eversleep app does not require a user to create a profile with personal information or set login credentials, the former is optional, the latter is nonexistent. Upon login, the app presents a series of “Getting Started” screens after which the user lands on the home screen to begin using Eversleep. The home screens have navigation to begin recording a new session, view previous results, view trends, and create the optional profile. For users who do opt to create a profile, the information requested is personal but not directly identifying (i.e. first name, last name, date of birth). Instead, the information that a user can provide specifically relates to information that helps the Eversleep app provide relevant, targeted feedback such as whether the user has been previously diagnosed with insomnia or sleep apnea or if the user takes certain types of medications.

 

I appreciated the fact that I did not have to provide significant identifying personal information about myself in order to begin using the Eversleep software. The time between download and the first recording was mere minutes. This did lead me to wonder how Eversleep manages user data. Digging a little deeper, I found in the Settings menu an option to “Send anonymous data to help us improve,” as well as a Device ID. Asking Eversleep for comment about the lack of user profile, ability to share data anonymously, and overall data management, CEO Chris Crowley shared the following.

“We chose [this approach] out of an extreme concern for user privacy and security. There is no way that we can ever connect a specific user to their data on the server. If we received a subpoena for somebody’s data, we still could not supply it, because we have no way to ‘match’ them to a specific file. We use Amazon Web Services for our server data, and we expect that they have the utmost security – however, if they are breached the EverSleep data is still anonymized. This has one slight drawback, which is that users cannot ‘log in’ to a website and see their data – all of the review has to be done on their phone or tablet. However, we think it is worth it for the peace of mind and the ease of setup.

Also -This lets EverSleep be multi-user! Since all of the data is stored on the phone, and not on the EverSleep unit, you can loan EverSleep to your friend or spouse or neighbor. All they need to do is download the app. The EverSleep wrist unit is not “attached” to any specific mobile device.

The ‘Device ID’ is actually a completely random number that we assign to your phone – it is part of our anonymity system. Note that this is not your phone’s UUID or IMEI or Mac Address or Serial Number. We never track the ID of your EverSleep, because it is multi-user.”

Hardware

Before each recording session, the Eversleep hardware needs to be affixed to the arm and paired with the Eversleep app. Putting on the Eversleep sleep monitor involves securing the wristband and attaching the pulse oximeter to the ring finger on the same hand. The athletic tape provided is used to keep the pulse oximeter in place throughout the night. The tape was necessary, as the finger clip did loosen over time even when using the athletic tape each night.

The software-to-hardware pairing was both a high and a low of my experience. On a positive note, the mobile app is conveniently capable of identifying the hardware without needing to be paired through the phone’s Bluetooth settings. However, the mobile app cannot pair with the hardware unless the hardware is on and there is no one or off switch on the Eversleep device. To turn the device on, it has to be connected to a power source with the charging cable. This begins charging the device, as expected, but also turns the device on and allows it to interact with the mobile app after it is unplugged from the charging cable. After a night or two of using the Eversleep product, I started keeping a portable power source with the charging cable near my bed. When I went to bed, I plugged the Eversleep device into the charging cable for 30 seconds initiating charging (flashing red light), unplugged the Eversleep device, which kept the device on (green light), then tapped “Record” on the mobile app to begin a session.

Usage

Upon tapping the “Record” button on the home screen, the Eversleep app lists a series of questions about the previous day, such as alcohol intake and exercise, followed by a visual reminder of how to wear the Eversleep hardware correctly. Most sleep systems I have demoed involve a “question and answer” step right before bed. The content of the questions and information requested by Eversleep was consistent with my previous experiences and was quick to complete. As with most sleep systems, answering the same questions every night did start to feel redundant and I can imagine some users skipping this step over time or only responding when there is a notable or atypical event to document, such as ingesting a significant amount of caffeine before sleeping. There is also a diary option to add notes about the previous day.

Unlike other sleep monitoring devices I have tried, the Eversleep product is the most noticeable to the user when falling asleep. I found the sensation of the pulse oximeter finger clip to be the hardest for me to acclimate to when trying to fall asleep and staying asleep. Even after falling asleep, I was not always able to keep the device on throughout the night. Some nights I woke up in the middle of the night to find the wrist or finger attachments in need of repositioning. Other nights I woke up the following morning to find I had completely removed one or both components of the device during the night. These events were experienced both when sleeping alone and with a partner. While useability was not the best part of my experience with the Eversleep product, as with most wearable devices, familiarity comes with repeated use and my demoing only took place over the course of a couple weeks.

I did appreciate that once the app begins recording, the screen does not need to stay on and any phone-based alarms can be set without impacting EverSleep’s ability to begin monitoring. After a sleep session is complete, the user ends the session and immediately receives a quantitative report tied to qualitative feedback about the sleep session. All this information is documented for review in the “Results” section of the mobile app.

Reports

Each report contains three sections: Overview, Details, and Coaching. The Overview screen presents both a visual summary of how much time during the sleep session was spent in quality sleep, fragmented sleep, or wakefulness, and a quantitative summary of sleep duration as well as the number of pulse, oxygen, and motion-related events. Any diary entries added by the user are captured here as well. The Details screen breaks down sleep quality, oxygen level, pulse rate, motion, and snoring events into more details timecourses covering the duration of the sleep session. The visuals on both the Overview and Details screens are useful though some graphs were missing clear units and the definition of an event for each measure was unclear. To my understanding, events appear to be defined as significant deviations from baseline for each measure though the baseline and deviation required to trigger an event are not defined. Somewhat more useful were the drop down menus for some graphs where data for a given measure is organized into bins, such as the duration when blood oxygen levels were between 70-80%, 80-90%, and 90-100%.

In order to clarify the distinction between the key measures of quality sleep, fragmented sleep, and wakefulness, I again went back to CEO Chris Crowley who provided the following response.

“We actually measure quality sleep – this is the deep, restorative sleep that you need to feel rested in the morning. Wakefulness (better termed as ‘arousal’ or ‘restlessness’) is measured by the Cole-Kripke algorithm which is well studied for over 20 years to match wrist motion to EEG while asleep. Note that you may not remember being awake for these short times. Fragmented sleep is sleep that’s interrupted by sleep apneas, autonomic pulse rate excursions, or involuntary motions. Many people have these interferences throughout the night and they ‘penalize’ the user because they interrupt the ‘architecture’ of the sleep.  The key to restorative sleep is reducing these interruptions. Fragmented sleep is also a well-studied phenomena, not something that we’ve “invented” for the EverSleep product. So in summary, your Quality sleep is just your overall sleep time, minus your wake time, minus your fragmentation penalty. EverSleep is the only consumer sleep tracker that can make these measurements because we are the only tracker to use continuous blood oxygen measurement, along with pulse rate, motion, and snoring.  These technologies are currently only found in a hospital sleep lab and in EverSleep.”

The final section of the report is Coaching where the feedback provided to the user immediately following the sleep session is documented. Feedback provided appears to be associated with both pre-sleep question responses and actual data from the sleep session. I found the presentation of feedback in the form of short, digestible chunks to be effective and the ability to open a drop-down menu for more ideas or suggestions based on the feedback to be valuable. That said, some feedback points were slightly contradictory or repetitive, even from the same sleep session, as shown in the Reports screenshot.

Before I recorded a single sleep session’s worth of data, I found three existing reports in my version of the mobile app. When asked about the inclusion of this data, Eversleep shared that, “These three nights are simply sample data, so that people can download the app and try it out prior to purchasing EverSleep. There are three nights so that you can see some trended data and an individual night’s data with graphs, statistics, and coaching for each night. The first time you use EverSleep, these three nights are ‘hidden’ by the software.” I found this to be a nice feature for new users to get a feel for how the analysis component of the EverSleep system works.

In addition to the “Results” button, the EverSleep home screen also has a “Trends” button that, when tapped, shows more graphs of sleep quality, blood oxygen level, pulse rate, motion, and snoring events over the five most recent, complete sleep sessions. I see the value in identifying changes over time though I would like to receive feedback based on these long-term trends. For example, I know personally that my sleep habits vary between weekdays and weekends so being able to identify those differences to attempt and normalize my sleep behavior would be beneficial.

 

Summary

Overall, I found the EverSleep product to be another effective tool at documenting sleep measures and the first that I have tried to measure blood oxygen levels. By requiring the user to wear the device throughout the night, EverSleep contends with the tossing and turning of a sleeping individual, or more likely, an individual struggling to get a good nights sleep, which hampers usability. Feedback was presented in a concise, easily digestible manner though the algorithm generating feedback could use improvement to avoid repetition and confusion. I’d also like to see further personalization in the feedback provided, perhaps once a critical mass of sleep sessions are recorded by the user.

Pros:

• Easy software setup with no identifying personal information gathering
• Automated pairing without additional Bluetooth setup
• Unique capture of blood oxygen level data
• Concisely presented, useful feedback with more information available
• Compatible with both iOS and Android

Cons:

• Added workflow to make sure device is on before pairing
• Useability challenges wearing the device consistently throughout the night
• Unclear data definitions such as baseline and event triggers for each measure
• Missing some user interface elements (i.e. graph axis labels)
• Redundant and contradictory feedback