Wednesday, May 10, 2023

Home sleep monitoring with Apple Watch and Google (Nest) Home Video in adult with limited ability to describe a nocturnal health issue

I'm changing the details here for privacy reasons, but sharing some technical setup advice.

A special needs adult with limited ability to give reliable history has a medical issue under complex active evaluation. Since the issue often manifests during sleep it has been difficult to observe. This person's parents/guardians are both physicians.

Valuable results have been obtained with a combination of an Apple Watch (already owned), Apple Health App, Heart Reports for iPhoneGoogle Nest Cam (already owned), Google Home app, and a Nest Aware subscription ($12/month for 7 days of continuous monitoring -- camera comes with a 30 day free trial.)

When you set up the camera you need to turn on the continuous video AND (if desired) the continuous audio. The Nest cam's green "active video" notification light may disturb sleep; it cannot be turned off (feature removed 2022) but you can turn down the intensity and cover it with tape.

The patient wears the Apple Watch during sleep. The following day one can review the Apple Watch report using either the native Health App or, as many will prefer, the 3rd party "Heart" Reports App. That last product outputs a wide variety of reports as PDF that can be shared with a healthcare provider; it's $4 one-time and supports family sharing.

With the Apple Watch report and the Nest Aware automated it's possible to scroll through an evening's sleep fairly quickly with special attention to Apple Watch awakening events and Nest Aware event detection.

After a few days of study the Nest Aware subscription can be disabled. The Health app and Video can be shared with providers if needed.

This cannot replace a formal sleep lab observation study but those are rarely done now and are very expensive. This method had a total cost of $16 (less actually since the free trial was active). The technique may be particularly useful for persons whose ability to give history is limited. It may also be useful when sleep labs are not affordable or available.

UPDATE 5/15/2023. We concluded our clinical evaluation and discontinued the trial subscription. Although the video record was very valuable, and although the hardware performed very well, I was unimpressed with Google Home software. In particular:

  1. The iPhone History view really only works in portrait mode, in landscape mode the bottom part of the image doesn't render well. Navigating the history is tedious and the playback can get stuck. Sometimes I had to quit and restart.
  2. The web view is much more limited than the older Nest software and has NO support for history review at all.

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