Sleep Monitoring at Home: Interview with Ziv Peremen, CEO of X-trodes

X-trodes, a medtech startup based in Israel, created Smart Skin, a wireless monitoring and analytics technology that is suitable for at-home sleep monitoring

At present, diagnosing sleep disorders is an arduous and expensive business, requiring patients to attend a specialized sleep clinic and wear bulky and uncomfortable equipment, all while attempting to sleep in a strange environment.

Part of the problem is that many technologies used for sleep monitoring require patients to be tethered to stationary equipment with wires. This means that patients must sleep on their back and limit their movements, which can disturb sleep and affect the results of the sleep monitoring.

To address this, X-trodes developed this wireless, gel-free technology that can be used at home. The Smart Skin can detect a wide array of sleep disorders, including sleep apnea, narcolepsy, bruxism, restless leg syndrome, and insomnia. The wearable electrodes can also obtain an array of data, including EEG, EOG, EMG, and ECG/EKG tracings.

Medgadget had the opportunity to speak with Ziv Peremen, CEO and Co-founder at X-trodes, about the company’s technology.

Conn Hastings, Medgadget: Please give us a basic overview of sleep disorders and their consequences.

Ziv Peremen, X-trodes: Sleep is an essential stage for our brains and bodies, providing a crucial maintenance period that supports our cognition, physical recovery and immune system. There are multiple parameters that can adversely affect sleep. These can be roughly divided into three primary categories:

1. Sleep hygiene – this covers a wide spectrum of contributing factors that might affect our sleep, such as noise, light, temperature, family members or roommates, and other external disruptors that have an impact on sleep duration and quality.

2. Sleep disorders – there are currently more than 40 different sleep disorders that interrupt with our sleep. Some are well known, such as sleep apnea that is related to the breathing process. Others are more rare or challenging to measure and diagnose, for example insomnia, narcolepsy and other disorders related to our muscle activity or brain function.

3. Sleep-related disorders – these are known comorbidities linked to poor sleep and can range from conditions such as depression and anxiety to Parkinson’s disease, heart-related disorders and even cancer. While in many cases we still do not understand the exact connection, there is a clear correlation showing that patients suffering from these disorders also have many sleeping issues.

Each one of these causes can have a major impact on the duration, efficiency and quality of one’s sleep. While we are mostly aware of the short-term impact of poor sleep and how it affects our mood, cognitive abilities, vitality and energy, many are not aware of the long-term ramifications that poor sleep can have on our health, immune system and overall wellbeing.

Medgadget: How are sleep disorders traditionally diagnosed and monitored? How is this suboptimal?

Ziv Peremen: Sleep monitoring traditionally takes place in dedicated sleep clinics. However, the process is often highly disruptive to patients’ lives and clinics are generally not conducive for encouraging proper sleep, which can affect the diagnosis. Patients are not able to sleep in their own beds, instead finding themselves in unfamiliar environments, and have to be connected to an array of monitoring devices taking different measurements. They are connected to these machines via wired electrodes that, along with the ambient noise emanating from devices, further impacts the quality of their sleep.

The average sleep diagnosis journey takes approximately four months and entails high costs of around $1,500 per session ($4,000 for children). The result is that a significant number of patients do not manage to complete the entire assessment process.

Recent years have seen the introduction of at-home sleep monitoring devices. However, these often still tend to be overly large and cumbersome and require the patient to be hooked up to a multitude of wires and so are not conducive to facilitating a proper night’s sleep. Meanwhile, initial attempts to miniaturize the technology for wearable solutions to measure brainwaves have resulted in a compromise on the quality of the signals, resulting in less accurate monitoring and diagnosis.

Medgadget: What inspired X-trodes to focus on this disease space?

Ziv Peremen: We strongly believe that sleep can provide a hidden window for a deeper understanding of our health. The current practice of measuring sleep based on a single timeframe within the confines of a clinic is a limiting factor for truly understanding our sleep. This usually provides only a partial insight into our sleep profile, the sleep disturbances and their causes.

By making sleep monitoring accessible at home, in our natural sleeping environment and over multiple consecutive nights, we can optimize the potential of understanding our health. We can leverage a test that is primarily intended for diagnosis of sleep disorders to learn much more about sleep-related disorders. We can then monitor the progression of the sleep and sleep-related disorders and, through continuous monitoring, guide treatments and select the best treatments and doses. We hope that, in the near future, we will be able to harness vast amounts of sleep data to facilitate preventive strategies, learning about new disorders early enough to improve treatment and postpone the onset of complications.

The potential for this is huge. However, until now, it has been curtailed by a significant technology gap. The highly sensitive monitoring of our brainwaves and muscles that is so integral to understanding our sleep was simply not available for home use. Once we saw that our sensors were capable of bridging this gap, we realized there is a great opportunity for using our platform to facilitate a paradigm shift in how we approach sleep monitoring and diagnosis.

Medgadget: Please give us an overview of the wearable technologies that X-trodes has developed to detect sleep disorders and how they work.

Ziv Peremen: At X-trodes, we have developed Smart Skin, the first customizable wireless wearable technology for advanced electrophysiological monitoring and analytics. For the first time, we are bringing medical-grade electrophysiological monitoring capabilities to the comfort of users’ homes and familiar environments via a user-friendly wearable solution.

The solution comprises wearable multi-modality electro-pads. These can monitor a wide range of physiological signals from anywhere on the body to acquire EEG (brain activity), EOG (eye movement), EMG (muscle activity), and ECG/EKG (cardiac monitoring) data. The electrodes connect to a wireless data acquisition unit, which seamlessly transfers the data to a secure cloud storage, enabling remote real-time monitoring of patients in their natural environments.

The wireless, dry-printed electrode patches are easily self-administered by patients and, unlike traditional electrodes, do not require any gel or medical adhesive. They are flexible and comfortably conform to the natural contours of the body, enabling the monitoring of patients’ natural sleeping habits in their usual surroundings.

Our solution can shorten the diagnosis process from four months to just two weeks, at a tenth of the cost of traditional in-clinic sleep assessments. The ability to monitor sleeping patterns for several consecutive nights helps to ensure that even periodic symptoms are not overlooked.

Medgadget: Which sleep disorders can your technologies detect?

Ziv Peremen: Our technology is able to monitor for a wide range of sleep disorders, including narcolepsy, bruxism, sleep apnea, RBD, insomnia and restless leg syndrome. By comparison, most at-home solutions currently on the market focus solely on apnea.

Medgadget: Was it difficult to develop wireless solutions? Please speak to the importance of wireless tech in this space.

Ziv Peremen: The wires that are so integral to providing the current gold standard of polysomnography (PSG) are also the limiting factor when it comes to the ease of use of the system. On top of the general complexity when dealing with a system containing in excess of 30 wires, the wires also force the user to sleep on their back, which for many is not a natural sleeping position. One can only imagine the stress of being forced to sleep in the same exact position without changing position at all for the entire night. This is one of the main reasons that in-clinic sleep studies are unable to measure our real and natural sleep.

The main challenge we had to overcome in order to create a wireless solution was how to manage the transfer of such large amounts of data over Bluetooth technology. To solve this, we had to develop entirely new transfer protocols and compressing methods that could handle large quantities of data without compromising on quality or security.

Once we began experimenting with a wireless solution, we were amazed to see the benefits for users simply by being able to sleep in their regular positions. All the sleep patterns were changed by allowing them to enjoy a proper night’s sleep while still being monitored. This has opened a new dimension of comfort for users. They can sleep in any position, wake up and move around their homes without having to lug around a cumbersome device, and there is no risk of them accidentally pulling out a wire and invalidating the entire test.

Medgadget: How might someone use the wearables at home to assist in detecting a sleep disorder?

Ziv Peremen: The entire platform is optimized to provide a simple and seamless user experience. The patient receives the system at home and follows a brief explanatory video through the dedicated smartphone app to set up the system.

The setup process takes just a few minutes, and the user does not need to wear the system or “break it in” just before use. It can be worn any time during the evening without disrupting one’s usual nighttime activities.

The patient conducts a short calibration process and then simply goes to sleep, in their own room and their own bed, with all the regular sleep conditions they are used to.

In the morning, the patient needs only to press a synchronization button on the app and the data collected overnight is uploaded directly to the cloud, which the physician can then access for sleep scoring and clinical evaluation.