Comment by gijsnijholt1980

Comment by gijsnijholt1980 4 days ago

90 replies

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 4 days ago

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 4 days ago

    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 4 days ago

      Got any links to the research? My vision sucks.

      • golergka 4 days ago

        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 3 days ago

          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 4 days ago

        Commenting here as a bookmark to not forget.

    • pmarreck 4 days ago

      Could you not just feature your qualifications front and center?

  • hulitu 4 days ago

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

    Except when you are Apple. /s

    • theFco 4 days ago

      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 4 days ago

      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 3 days ago

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

jbombadil 4 days ago

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?"

  • [removed] 4 days ago
    [deleted]
mullingitover 4 days ago

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 4 days ago

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 4 days ago

    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.

  • bhelkey 4 days ago

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

    • post-it 4 days ago

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

    • freehorse 4 days ago

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

    • slowmotiony 3 days ago

      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 4 days ago

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

Spivak 4 days ago

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

  • elric 4 days ago

    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 4 days ago

      >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.

      • 0xEF 3 days ago

        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.

      • jacobgkau 4 days ago

        > 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.

    • swyx 4 days ago

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

      whats wrong with right side?

      • fahrnfahrnfahrn 4 days ago

        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 3 days ago

          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 4 days ago

        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

      • delecti 4 days ago

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

      • daedrdev 4 days ago

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

    • johnisgood 4 days ago

      > 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 4 days ago

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

    • outworlder 4 days ago

      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 4 days ago

        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.

      • jfengel 4 days ago

        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 4 days ago

    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 4 days ago

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

NelsonMinar 4 days ago

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 4 days ago

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

    • ASalazarMX 4 days ago

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

      • xattt 4 days ago

        I thought you were supposed to use an iPad Pro.

ayhanfuat 4 days ago

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

pmarreck 4 days ago

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 4 days ago

    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 3 days ago

      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 4 days ago

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

consf 3 days ago

I decided to clarify why sleeping on your back can sometimes be bad. I found out that it's undesirable for pregnant women to sleep on their back. It must be a very useful app for many

isodev 4 days ago

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

eli 4 days ago

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

  • adrr 4 days ago

    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 4 days ago

      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 4 days ago

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

    • kemayo 4 days ago

      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 4 days ago

    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 4 days ago

      > 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 4 days ago

        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 4 days ago

          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 4 days ago

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

    • eli 4 days ago

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

      • kaba0 4 days ago

        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 4 days ago

        > 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 4 days ago

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