Evaluation report of Somnox sleep robot. - By Ashish Mohite

1. Evaluation report of Somnox
sleep robot
-By Ashish S Mohite (1009436)
Integration of Somnox with Electronic Health Records for management
of insomnia cases in Australia .

2. Contents
• Introduction
• Background
• Main features
• Intended benefits
• Evaluation
• Conclusion
• Recommendation

3. Search strategy
• Somnox Sleep robot company website
• Somnox Scientific research
• Google and Google scholar
• Pubmed

5. What is Somnox Sleep Robot ?
• A sleep assisting device integrated with the mobile application ‘Somnox’.
How does it work ?
The Somnox sleep robot works on the principles of rhythmic breathing, where the
individual using the robot synchronizes his/her breathing pattern with the
breathing pattern of the robot and this creates a slow breathing state that aids in
sleeping. (1)
The product is based on the research conducted by Evan Ingersoll et al and Evelyn
Thoman et al ( from the University of Connecticut) on an infant sleeping with a
bear toy that has been engineered with a specific breathing pattern, and the
improvement in the sleep quality is documented in the research. (2)

6. Study of breathing patterns
Breathing frequency of two partners
when they sleep separately.
Breathing frequency of two partners
when they sleep together.

7. Supporting literature
Breathing pattern of Somnox
The article by Ravinder et al on the research question “Self-Regulation of Breathing as an
Adjunctive Treatment of Insomnia” supports the principles on which the product is
implemented. The study is published in Frontiers in Psychiatry in the year 2019. (3)
The Somnox sleep robot is also integrated with soft music and sounds with a flexible
selection as per the users choice.
Fan et al’s study on the research question “Can music improve sleep quality in adults with
primary insomnia?” by conducting a meta analysis, gives us a clear evidence based
conclusion that music is advantageous for patients with primary insomnia. A study
published in the International journal of nursing studies 2018. (4)

8. Why explore Somnox ?
"Sleep problems are a growing problem in Australia, and in fact, the
research that we've seen indicates that something like four out of 10
Australians are not getting adequate sleep on a regular basis" (6)
-Liberal MP Trent Zimmerman.
(Chairman of the national parliamentary Standing
Committee on Health, Aged Care and Sport)
Based on the most recent Sleep health survey conducted in Australia-
• 33 – 45% of Australian adults are suffering from inadequate sleep, and its
consequences are affecting their overall health (mental and physical).(5)
• 20% of the Australian adults are specifically affected with insomnia.(5)

9. Key terms and classification
Insomnia is defined as a self-perceived dissatisfaction with sleep, that indirectly
affects the day to day functioning of the individual. (8)
Medically insomnia is classified into two categories – (8)
1) Acute insomnia : Disruption in sleep for a few days, example pre-exam
sleeplessness.
2) Chronic insomnia : Disruption in sleep for at least 3 nights per week for a
minimum of 3 months.

10. Background
The guidelines as per the Australian Journal of general practice recommends
the clinical cases of insomnia to be managed by a pharmacological therapy in
adjunct with behavioural therapy. (5)
The present evidence based treatment modalities require multidisciplinary
sleep clinics and a joint collaboration between somonologists, sleep physicians
and psychologists. (5)

11. Before Somnox ?
Based on Australian Journal of General Practice sleeping disorders like insomnia
were treated by the following medications :- (5)
1) Benzodiazepines : they include nitrazepam, flunitrazepam, temazepam and
oxazepam. (5)
2) Non-benzodiazepines : zolpidem and zopiclone, they were collectively known as
the ‘Z-drugs’. (5)
3) Dual orexin receptor antagonists : suvorexant (suvorexant was the first new
class of medication made available in Australia specifically for insomnia) (5)

12. Before Somnox ?
Behavioural therapy for insomnia in adjunct with the pharmaceutical treatment
modality :-
Cognitive therapy : Cognitive behavioural therapy (CBT-I) is the treatment modality
that includes the identification of the patients deleterious thoughts and approach
towards sleep and intervene them by strategies that treat the issue psychologically.
(5)
Psychoeducation : Educating the patient about their sleep behaviour pattern and
ingraining them with methods to contradict their misconceptions about sleep. (5)
.

13. Introducing Somnox in this treatment modality and
integrating it with EHR
• Somnox can be used as the first line of management for eliminating the
incipient acute cases from the severe cases.
• It is easy to use and does not require complex technological knowledge.
• Does not have any side effects as those seen with the Benzodiazepines
medication.
• Does not require face to face counselling or clinical visits.
• The sleeping and breathing pattern is documented in the app for months
which can be made available to the somonologist for diagnosing the state
of the patient, if the condition persists for longer term.

14. Intended benefits of Integrating Somnox with the
Electronic Health Record.
Polysomnography is the procedure that studies sleep by monitoring the patient
overnight and documenting his/her biophysical changes. It is used to diagnose and
rule out the different sleeping disorders. This procedure is tedious and complex and
requires the patient to undergo a minimum of 22 wired attachments. The
procedure is conducted and validated by an accredited technologist or
somonologist. (9)
If the sleeping pattern and the breathing rate pattern that is monitored by the
Somnox app is integrated with the Electronic health record of the patient, then the
Somonologist gains a broader perspective of the patients sleeping patterns for the
last 6 months, on the basis of which an accurate diagnosis and a needs assessment
can be made if the patient needs to be subjected for the polysomnographic
procedure or not.

15. Evaluation (Pros)
• Technology factors –
1. The application is platform agonistic and runs on all mobile platforms like
iOS or Android.
2. The device is user friendly and allows the user to set the breathing pattern
n soft sounds providing flexible customisation.
3. Breathing pattern can be documented and used for analysing data.
• Social factors –
1. Does not require face to face counselling like CBT-I
2. No associated side-effects as those seen with the insomnia medications.

16. Evaluation (Cons)
• Lack of academic literature review on the product.
• The product currently costs 899 AUD and needs to undergo frugal
engineering in order to be more cost-effective.
• Currently not integrated with any Electronic health record systems.

17. Conclusion
• It is an exciting new product, which might have a positive impact on
the present treatment modality.
• It prevents the need to opt for a pharmaceutical intervention.
• 90% of the users in the scientific study of the product clamed to have
a better sleep.

18. Recommendations
• The supportive research is based on a qualitative questionnaire with a small
sample size for the estimation of efficacy of the product but there is no
adequate justification for the process of sample selection and the ethical
code of conduct, which can raise the concern of bias. An evidence based
cohort research is required with a large sample size in order to accurately
predict the efficacy of the product.
• The product need to be integrated with the standardised Electronic health
record systems for proper documentation of the breathing pattern and
quality of sleep data by the sleep physician or somonologist.

19. References
1. Somnox. Somnox sleep robot scientific background [Internet ]. United states of America: Somnox 2018 [updated
2017 November 13; cited 2019 May 20]. Available from: https://somnox.nl/files/science/SomnoxScientificValidation_v3.pdf.
2. Ingersoll EW, Thoman EB. The breathing bear: effects on respiration in premature infants. Physiology & behavior.
1994;56(5):855-9.
3. Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front
Psychiatry. 2019;9:780-.
4. Feng F, Zhang Y, Hou J, Cai J, Jiang Q, Li X, et al. Can music improve sleep quality in adults with primary insomnia?
A systematic review and network meta-analysis. International journal of nursing studies. 2018;77:189-96.
5. Natalie A Grima BBD, Mansfield Insomnia management [Internet ]. Australia: Australian Journal of General
Practice; 2018 [updated 4, April 2019; cited 2019 20 May]. Available from:
https://www1.racgp.org.au/ajgp/2019/april/insomnia-management.
6. Lane S. The Government is worried you're not getting enough sleep [Internet ]. Australia ABC News; 2018
[updated 2018 Nov 9; cited 2019 May 19]. Available from: https://www.abc.net.au/news/2018-11-08/am-sleep-
investigation/10477370.
7. Robert Adams SA, Anne Taylor, Doug McEvoy, and Nick Antic. . Report to the Sleep Health Foundation 2016 Sleep
Health Survey of Australian Adults [Internet]. Australia Sleep Health Foundation; 2016 [updated 2016; cited 2019 May 20].
Available from: https://www.sleephealthfoundation.org.au/pdfs/surveys/SleepHealthFoundation-Survey.pdf.
8. foundation Ns. What is Insomnia? [Internet ]. National sleep foundation; 2018 [cited 2019 May 5]. Available from:
https://www.sleepfoundation.org/insomnia/what-insomnia.
9. Wikipedia. Polysomonograply [Internet]. 2019 [updated 2019 May 15; cited 2019 May 20 ]. Available from:
https://en.wikipedia.org/wiki/Polysomnography.