[gijsnijholt1980]

I developed an iOS app which detects your sleeping position and starts buzzing if you’re on your back. Similar to the tennis-ball-sewn-into-pyjama’s hack. Apple kept refusing to approve stating medical reasons. Still use it myself though, works great.

[brandonb]

We have an app which delivers medical care, and Apple let us on but required proof of medical licenses, malpractice insurance, etc. Medical apps are allowed, but there's a higher bar for evidence.

[golergka]

Good. Back in 2015-2016, I worked on an app that improved user's vision. Genuine science, publications in peer-reviewed journals (even Nature). But the whole category was a vast ocean of bullshit apps, and our product just sank in it, unable to differentiate itself and prove to the users that it was the real thing.

[jfengel]

Got any links to the research? My vision sucks.

[buccal]

The papers are mentioned here:

https://web.archive.org/web/20200714114922/http://www.glasse...

[golergka]

Unfortunately, no. Company was called InnovisionLabs, renamed GlassesOff, if I'm not mistaken. Website is down, and I wouldn't expect it to be up — company's runway ended about 2016. And the two apps we released (one looking like a game with some basketball player branding, and another one from scratch, with clean, medical design) are probably removed from app stores too.

[raxxorraxor]

What was the mechanism that improved vision? I have worked on medical devices and of course waiting on a clinical study is difficult for any business and many fail for one reason or another. But as an ecosystem for medical software Apple does quite a lot of damage compared to conventional platforms.

[wiseowise]

Commenting here as a bookmark to not forget.

[_nivlac_]

If you click on the timestamp of the comment (e.g "N days ago"), you should be able to add it to your favourites, which is then accessible through your profile.

[wiseowise]

Ah, thank you! Alas, can’t remove my comment anymore.

[fivestones]

TIL

[pmarreck]

Could you not just feature your qualifications front and center?

[ransom1538]

Can you post this app?

[hulitu]

> Medical apps are allowed, but there's a higher bar for evidence.

Except when you are Apple. /s

[theFco]

What do you mean? The article is about how they got FDA approval... Isn't that the way to go? As in, it's a much higher bar than having a medical license and insurance no?

[atonse]

Simply not true. I once spoke to an old coworker (who's now a senior executive at a Fortune 500 company, not Apple). And he said in these large companies, there is so much discussion around risk, because the larger the company, the more of a juicy target they are for lawyers and lawsuits.

So the thought that Apple wouldn't have their ducks in a row isn't true. Especially since any feature they release, will be used by millions of people pretty quickly.

Just to be clear, I'm not claiming Apple doesn't give themselves special treatment in the App Store. They absolutely do (as you'd expect). Just pushing back on the notion that they wouldn't have documentation and all their legal stuff taken care of.

[Gud]

Don’t assume large corporations have their shit together. They fuck up all the time.

[jbombadil]

Question: were the "medical reasons" specific or a generic "no because it's medical related" reason?

As in, did their refusal say "no because the way you're tracking if the user is on their back is not accurate enough?" or did they say "we don't allow people to write watch apps related to medical diagnoses / treatments / etc?"

[mullingitover]

Just say it's a game. Add some social widgets ("Get your non-back sleeping scores on the leaderboard!"). Maybe throw in a T&C forbidding using it for medical purposes.

[Eric_WVGG]

Any chance that you'd be interested in open-sourcing that app?

A very long time ago, I got the impression that sleeping on your back is healthy, and successfully "trained" myself into the practice… now I'm trying desperately to untrain the habit 9_9

[gmiller123456]

I have sleep apnea and specifically asked my doctor if there was a best or better sleeping position, and she said no. I find laying on my back causes the least interference with the mask, but I've yet to manage to actually sleep on my back yet, been trying for like 3 years now.

[rogerrogerr]

Ever try a weighted blanket?

[gmiller123456]

I haven't. I'm pretty comfortable on my back, just can't seem to fall asleep.

[bhelkey]

If they open source it but the app isn't allowed on the app store, how will anyone install it?

[post-it]

If they're on Mac, they can import it into XCode and install it as a development app.

[freehorse]

In my understanding it can be allowed as long as they do not market it as medical app?

[slowmotiony]

We've been sideloading iOS apps for years without any issues. You can use Xcode, or sideloadly, or altstore, or like a hundred other ways.

[freehorse]

It is healthy, unless you have sleep apnea or snore a lot.

[Spivak]

Is this a sleep apnea thing because I've always been told you want to sleep on your back?

[elric]

Told by whom? Gravity works against you when you sleep on your back: your jaw falls in on itself, your tongue relaxes down into the back of your throat, stomach acid can flow up into your esophagus with relative ease. AFAIK the left side is generally the "recommended" position. It addresses all of those issues.

In some cases sleeping on the stomach might be preferred, as that helps the lungs take in more oxygen, which is why patients on respirators are often kept on their stomachs in hospital.

That being said: if you don't have sleep apnea or reflux, any position that's comfortable is probably fine. No one stays in one position the whole night anyway.

[bryanrasmussen]

>Told by whom?

I sort of feel my body telling me, my back hurts because I never sleep on my back (because of sleep apnea, or at least horrendous snoring) but when I lay on my back it feels much more comfortable, but can't sleep that way because I will wake up the house.

[jacobgkau]

> my back hurts because I never sleep on my back

Try a body pillow. Having something to wrap your arms & legs around and keep your spine aligned counteracts at least some of the discomforts of sleeping on your side.

[sva_]

> just get a waifu bro

[jacobgkau]

It doesn't need to have a picture on it. Orthopedic pillows exist, as do plain covers for dakimakuras, lol.

[0xEF]

Your back hurting could be a number of factors, but the big two would be your mattress or your posture/overall while awake. Try doing planks and crunches each day to build up core strength, which makes it a bit easier to maintain good posture, though that still takes considerable corrective practice. I have two back injuries, so all sleeping positions suck in different ways for me, but doing daily core exercises helps take the load off my back while awake so it hurts less at night.

[swyx]

> AFAIK the left side is generally the "recommended" position

whats wrong with right side?

[fahrnfahrnfahrn]

Sleeping on the left side allows the stomach to operate better while sleeping on the right favors the heart. I'd always heard this, but recently read a short article confirming it. Dunno if it's true, though.

[criddell]

Sleeping on the right side has been reported to help clear cerebrospinal fluid from the brain which might slow the buildup of plaques related to Alzheimer’s.

[throwaway920102]

for people with acid reflux / GERD / heartburn at least, the "sleep on your left side" thing has to do with the layout of the esophagus. For whatever reason, sleeping on your left means that gravity helps work to prevent acid reflux, whereas the opposite is true for the right side. Not sure if there's any benefit other than that

[hnbad]

> For whatever reason

The short answer is that your organs are mostly asymmetric and the esophagus connects to the stomach on the right so by laying on your right your stomach acid flows to the sphincter connecting your stomach and esophagus, making it easier to leak into the esophagus. This is especially a problem with GERD because you don't have pain receptors on that end of your esophagus but the stomach acid can still damage its tissue, which can lead to further complications including cancer.

A common cause of acid reflux is a herniated diaphragm (hiatal hernia) in which part of the stomach slips through the diaphragm into the upper chest. In this the esophageal sphincter will not be the highest point of your stomach, further adding to the problem when sleeping on your right side. Imagine a plastic water bottle deformed in such a way it stands slanted with the opening to the right, now imagine laying it on that side or the other. Laying it on the side with the opening makes it more likely to spill if the lid isn't forming a perfect seal.

[naveen99]

Radiologist here. We actually put patients in LPO (left side down oblique on your back ) followed by RPO to elicit reflux to catch it on the xray camera.

The opposite is RAO (right side down on belly oblique), when we want to show the opposite esophageal emptying into the stomach.

But any one position is probably not good to maintain for a long time. That’s why patients on respirators get turned so they don’t develop pressure ulcers.

Personally I have found 15-20 minutes prone (on my belly) is helpful reducing fatigue after intense exercise.

[delecti]

The arrangement and orientation of organs means you're a bit more likely to have acid indigestion if you're on your right.

[daedrdev]

Your heart is on the left side of your chest so its probably reacted to that

[johnisgood]

> which is why patients on respirators are often kept on their stomachs in hospital.

Yeah, since COVID-19, and even then, only for patients who are severely hypoxic (ARDS or severe respiratory failure). That said, it is not universally applied to all ventilated patients, and in many countries it is not even practiced at all.

[ayhanfuat]

Yes, sleep apnea mostly gets worse if you sleep on your back so they suggest sleeping on your side.

[outworlder]

Yes, although untreated sleep apnea is dangerous and you shouldn't rely on this if you suspect you have it. It may make it better but you may still be starving your tissues of oxygen.

[fahrnfahrnfahrn]

I have sleep apnea that I treat with a BiPAP machine. The neurologist who manages it said that everybody has sleep apnea to some degree, and, as a matter of fact, with my BiPAP machine, I have fewer episodes than the average person.

[op00to]

Starting CPAP tonight. Wish me luck!

[dotancohen]

How did you sleep?

[post-it]

Good luck!

[jfengel]

Conversely, for my case:

I was told that my sleep apnea didn't rise to the level of a medical condition needing intervention, but I should try to avoid sleeping on my back to help with the problems that do present.

[prawn]

I've always been jealous of people who can sleep on their back as it would allow them to sleep on thinner mattresses when camping!

[noman-land]

Everyone's talking about the app but I'm impressed by the tennis ball idea.

[NelsonMinar]

Interesting and frustrating story! There's an Android app I've used that does that: https://play.google.com/store/apps/details?id=com.koalative....

[BurningFrog]

How can a phone know which position you're sleeping in?

[ASalazarMX]

Obviously the user untapes the tennis ball on their back, and tapes on their iPhone instead.

[xattt]

I thought you were supposed to use an iPad Pro.

[NelsonMinar]

I wore it on a chest strap. awkward but not impossible

[BurningFrog]

Aha!

Yeah, that would work!

[a1studmuffin]

Great minds think alike! Here's my attempt using an ESP-based smart watch that clips onto your clothes at night: https://github.com/a1studmuffin/lilygo-twatch-sleepdevice

[ayhanfuat]

How does it detect your sleeping position? Is it based on the watch position or is there another trick?

[pmarreck]

Can you reverse the function to buzz you when you're NOT on your back if you use a cpap? (It only works most effectively when on your back.) Also, what's wrong with being on your back?

[analog31]

I don't think I have sleep apnea, but I know that if I fall asleep on my back, I begin to snore, which actuates my wife's elbow, which causes me to turn onto my side.

[raffraffraff]

Incidentally, I believe I had sleep apnea when I was a kid, and for years into adult life until my wife elbowed it out of me.

My parents never thought I needed a diagnosis, but when I was just a few years old I got pneumonia from a bad cough and was prone to chest infections all my life afterwards. It was after I had whooping cough that my dad came in to check on me, and he noticed that I "wasn't breathing" (which he told to mum in a typically 'Irish Farmer'). She thought he was telling her that I was, in fact, dead and to my bedroom in a panic. Turns out she had previously noticed that I "didn't breathe". Basically, I'd appear to stop breathing entirely for very long periods of time. I think that the air would be very slowly leaking out for about a minute, and I'd be making a low whine noise. Then I'd take in a huge breath... and the low whine would begin again. I wasn't overweight, I was actually as thin as a rake, and my mother nicknamed me "Boney M" (which might show my age).

It was when I met my wife, back in the late 90s, that it became a "problem". She'd tell me I was making a terrible noise in my sleep, and I said "oh yeah, I do that". Every time my weird breathing woke her up, she treated it as if I were snoring: elbow me and say "YOU'RE DOING IT AGAIN". And I'd kinda wake up and then focus on breathing properly as a fell back asleep. I also took up running around that time.

After a few years the weird breathing (which, I now think, was asleep apnea) stopped. I had better sleep and woke refreshed, whereas all through my childhood, walking up and getting out of bed was a gargantuan effort. I could sleep till noon and still be foggy.

Anyway, aside from losing weight and doing cardio, maybe a watch that activated an elbow would be an idea?

Incidentally, another thing I trained myself to do was sleep with my mouth closed. I used to wake up extremely dry and absolutely need a pint of water beside the bed. I read once about surviving in the desert: keep your mouth shut too conserve moisture. So I'd intentionally keep my n mouth closed and breathe only through my nose. That worked too - except when I have a head cold, but I take antihistamines before bed to avoid blocked sinuses.

[vibrio]

This literally just happened and now I’m posting a weak comment on HN at 2:19am.

[pmarreck]

Get diagnosed!

[isodev]

If you’re based in Europe you could launch it on the AltStore.

[eli]

Makes sense. Apple could be held liable for any false or misleading health claims made about an app.

[adrr]

Sleeping on your back isn’t a medical treatment. It’s a snoring reduction. You can buy snore guards, nose strips, special pillows etc to prevent snoring and none of those require FDA approval because snoring isn’t a medical condition.

[tptacek]

Is it marketed as "intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals"? That's one of three things that gets you categorized under the FDA regulation. There's even a term for it: "SaMD".

It seems less likely to me that this is Apple being ruthless or pigheaded and more than you really do have to be careful how you market your iPhone apps.

I take your point; the FDA doesn't recognize "snoring" as a medical condition (but OSA is!)

[eli]

So long as you're very careful what you say in the ad and within the app, sure.

[kemayo]

Yeah, but the question is really about how the app was presenting it. If it was making anything that sounded like a health claim...

[vasco]

Ironically if they stopped this gimmick they keep up to be able to charge 30% they could have the app and the developer would be the liable one. But the developer doesn't even have to make these claims, they can just put it up and say "this may detect if you're on your back".

Apple isn't liable for you looking up medical misinformation that kills you using your iPhone on the Safari browser. Why would it be for an app that is clearly made by someone else? The difference is only because of the vetting, and they only do vetting to charge their fee, otherwise they'd vet other things too.

It's incredible how companies bend backwards to bullet proof any liability whatsoever on anything, except if they can make money on it.

[kube-system]

> they only do vetting to charge their fee, otherwise they'd vet other things too

They also vet apps to keep garbage and scams out of it.

Many of the things they prohibit are things that are overwhelmingly good for their users:

https://developer.apple.com/app-store/review/guidelines

[dylan604]

Now we're into a semantics meaning over "garbage and scams", as I believe pretty much all social media apps are a form of "garbage and scams". They just happen to have enough features that people like so they accept it.

[kube-system]

Which is why Apple's page that I linked is quite a lot longer than my comment. It is more carefully worded. It also isn't based on your particular preferences or tastes, but the tastes and preferences of their target market(s), which may vary well not include you.

[kstrauser]

There’s a reputational risk in selling software that gives unvalidated medical advice.

[HeyLaughingBoy]

There's an even larger legal one!

[eli]

No, it's illegal to participate in the advertising or promotion of products making false health claims in any way.

[kaba0]

I am no lawyer, but I guess any such law has to take into account physical possibility. Like, e.g. youtube itself can’t possibly flag every copyrighted content streamed live/etc.

[vasco]

> But the developer doesn't even have to make these claims, they can just put it up and say "this may detect if you're on your back".

[AStonesThrow]

Can you get your app to detect if your user's weight suddenly doubles while they're lying down?

[saagarjha]

Pets giving you a hard time?

[wyldfire]

It's for when the AG unit breaks on space stations. :(

[sweetjuly]

Boeing has really gone down hill since the 2800s