Next month, I will turn 72 years old. It is hard for me to imagine that it was almost 18 years ago when I left my position at Intel as Vice President of Corporate Business Development. I was just 54 at the time. My objective was not to retire but to rewire. For many years, I invested for my own account (hoping I could do as well for myself as I had done for Intel…I actually did better), sat on public and private company boards and some nonprofit boards. Slowly, I lost interest in business – but not technology. The tech bubble burst of 2001 had encouraged me to reduce my involvement. Fortunately, I had gotten out of the market before that happened.
I wanted to spend my time on personal creative pursuits, in particular, playing jazz piano and composing music. Life was good. My wife and I traveled all over the world for about four months a year. Then, four years ago, I was introduced to Sommetrics.
Avram: the Medical Scientist
To the extent anyone remembers me, it is for my work at Intel. Together, in 1988 Les Vadasz and I founded what became Intel Capital, the most successful corporate venture fund in the world. By the time I left in 1999, the portfolio was about $10 billion. My other significant accomplishment was taking the lead in the development of residential broadband. However, most people do not know that my career started in biotech and medical science.
Like many things in my life, it’s kind of a crazy story. I never went to University, but by the time I was 29, I was an Adjunct Associate Professor at Tel Aviv University School of Medicine. I started out in Neurophysiology, at the University of California San Francisco, where I developed the first equipment for EEG biofeedback working for Joe Kamiya. I later worked in cardiovascular and pulmonary medicine as a founding team member of the Thorax-Center, where I headed the computer departement, Erasmus University, Rotterdam. My expertise was in real-time physical signal processing. I spent about 14 years doing medical research and during the last five, created a medical computer business in Israel.
I had been designing computer hardware and writing software since 1966 and ended up managing people that did those things. In 1979, at the age of 34, I put the medical world behind me and joined Digital Equipment Corporation. At the time it was the second largest computer company in the world and I ran the hardware engineering group for small computers. I never thought I would be involved in biotech again.
My introduction to Sommetrics
I have a good friend that suffers from obstructive sleep apnea (OSA). He has to travel with a device called a CPAP, which many of you surely know. It is a very effective treatment for OSA, but for reasons I will discuss in a bit, it is not well tolerated. Less than half of the people prescribed this treatment still use it after a year. My friend, (let’s call him “A”), told me about a company in San Diego that had a breakthrough in the treatment of OSA: One that was as effective as CPAP, but much more tolerable. He asked me to check it out and introduced me to someone associated with the company. Of course, I agreed for the benefit of my friend.
I met with Richard Rose, MD, the founder of Sommetrics (5i Science at the time), and A’s contact, Walter Flicker. They demonstrated the company’s technology, and my life changed. I joke that my toes curled when I saw what they had. I could not imagine that such a simple, elegant, and effective therapy for the treatment of OSA had not been invented years earlier. I asked that they leave me an early prototype to sleep with for three nights. I found it very tolerable and while I had no way to actually measure the effectivity, I did feel that I was sleeping much better. Later, I was able to confirm that by doing home sleep studies.
Sommetrics on life support
Richard Rose and Jerry Aarestad founded the company in 2009. Richard had been a successful pulmonary doctor and was on the staff of Harvard before getting into venture capital work and becoming the CEO of a public company, Stem Cells, Inc. Jerry was an engineer who worked in aeronautics and then biomedicine. They were introduced by an IP lawyer. It was Jerry who came up with the original concept in an attempt to treat his own snoring. Their plan was to develop the technology, test it, patent it, and if they got good results, either sell the company or license the technology. They had no interest in developing an operating company but were soon able to get some angel investors.
Then they had an opportunity to present the technology to one of the leading companies in CPAP. They had a few meetings and were confident that they would be soon offered a deal followed by a big check. Instead, that company filed an almost 400-page challenge to the core patent. This is, unfortunately, a technique that some large companies use to destroy young companies that typically do not have the financial and legal resources to deal with the challenges. Because of this, Sommetrics was no longer able to raise money. I joke that the founders “went to the mattress.” Though it took about 18 months, Sommetrics was able to successfully defend its patents, resulting in a gold-plated patent; one that had been challenged and successfully defended. I met them just a month later.
Avram to the rescue
I could not help myself, really. I started funding the company myself—something that is very unusual for me. I raised money for the company and helped to build out the board and the management team, slowly getting more and more involved. I was appointed to Vice Chairman, but in many ways, I was functioning as a co-CEO. Richard and I worked very closely together. It turns out we have very complementary skills and great respect for each other. So for the last four years, I have been very involved in creating a company that I think will have a very important role in improving the health and wellbeing of millions of people. Not a bad thing!
What is Obstructive Sleep Apnea and why does it matter?
Obstructive Sleep Apnea impacts more than a quarter of the adult population worldwide. OSA results from the narrowing of the upper airway during sleep. The upper airway connects the mouth and nose to the lungs. When you’re awake, there are active muscles that hold the airway open so that air can pass into and out of the lungs. These muscles relax when you go to sleep, and in some people, they no longer do an adequate job of keeping the airway open. This can result in a variety of disorders including snoring and OSA.
If the airway collapses, it is not possible for air to enter the lungs. The blood’s oxygen level starts to drop and the CO2 levels start to increase. Eventually, the brain has to wake up. This is called an arousal (not the kind you might like), which creates a great deal of stress in the body. Some people have as many as 50 apneas an hour. The co-morbidity is significant, leading to diabetes, cognitive dysfunction, coronary disorders, and obesity. Poor sleep quality leads to overall sleepiness, and OSA is the second largest cause of automobile accidents and is a major cause of industrial accidents.
Only about 20% of adults living with OSA have been diagnosed. I believe this number will significantly increase as we begin to understand the vast impact this disease has on health and wellbeing. I also believe that having a treatment that is both effective and tolerable will cause more people to suspect that they have a problem and to seek treatment.
Snoring is the brother of OSA
There is a great overlap between snorers and those with OSA. In fact, snoring is one of the symptoms that indicates a sleep study should be done. Most people who have OSA snore, and as many as 40% of adults snore. Most of them have a bed partner whose sleep quality also suffers. There are many products that claim to treat snoring, but in reality, they are not very effective. CPAP is an effective treatment, but the tolerability issues prevent any widespread adoption.
CPAP stands for Continuous Positive Airway Pressure. CPAP is a form of ventilation: Patients breathe air that has been pressurized, which results in the expansion of the airway, like a balloon would expand if filled with air at a higher pressure. It works great: The positive air keeps the upper airway from closing and thereby prevents apneas, but it requires that the patient breathe through a mask that either covers the mouth and/or the nose. To fill the mouth, nose, airway, and lungs, a large volume of air has to be kept at the higher pressure, requiring an external pump. The air has to be humidified and the unit has to be kept clean to prevent bacteria from growing.
CPAP is the gold standard treatment for thoses that have been diagnosed with OSA. It is almost never prescibed for cronic snoring.
The brilliance of Sommetrics (the thing that made my toes curl) is that they accomplished the same result but in a different way. Rather than having the patient breathe pressurized air, the Sommetrics aer+™ technology, previously called cNEP (Continuous Negative External Pressure), creates a negative pressure around the throat in front of the area of the upper airway that has the tendency to get obstructed. As a result, the air the patient breathes is positive, and the airway expands in a fashion simular to CPAP. The important difference has to do with comfort.
The Sommetrics aer+ device is not attached in any way to the face, but rather is a non-invasive collar worn around the neck. Since the amount of air that has to be pumped out to reduce pressure is very small, the pump is embedded in the collar. The pump works above human hearing, so it is silent. Since it is not tethered to anything, the patient is free to get up to go to the toilet, for instance, without taking it off. I often have meetings in which I wear it to demonstrate this, including eating a meal with it on.
The company has already done extensive testing with patients, and the results demonstrate that it is as effective as CPAP in about 75% of patients. The average patient that uses CPAP only uses it less than four hours a night. We expect that aer+ patients will keep it on all night.
Sleeping on the Job
I have mild sleep apnea. The Apnea-Hypopnea Index (AHI) is used to measure OSA: People with AHIs over five have OSA. My AHI is about 11. I suffer from daytime sleepiness and do not drive at night because I have a tendency to fall asleep. It would be hard for most people that know me to imagine that I have a hard time staying awake. When I was first diagnosed with OSA, I said, “How is that possible? I wake up early and never take naps.” I was told that my energy level was so high that it overcame most of my OSA symptoms.
In the USA, about 80% of sleep tests which are called polysomnography, or PSGs, are done in sleep labs in an overnight sleep study. In the study, many parameters are monitored during the night, such has heart rate, respiratory rate, body position, blood oxygen levels (very important), and sleep stage. From all this, it is possible to detect any apneas and hypopneas (significant drops in blood oxygen due to the narrowing of the airway but without a full blockage). About 20% of sleep tests in the USA are done in-home.
Soon after joining the board of Sommetrics, I began to experiment using the collar. I decided I would start monitoring my sleep and comparing it with and without aer+. That started me on an amazing personal journey. So far, I have done about 65 home sleep tests which, if it is not a world record, I bet it is close.
First, I had to establish my baseline. I found that my sleep did not vary that much night after night: I definitely had mild OSA. I was also surprised to see that my resting heart rate, which is a very important indicator of heart health, was higher when I slept than when I was awake.
I then started using aer+. Happily, it significantly reduced my AHI to normal and eliminated my snoring. It also reduced my heart rate by 10-20%. I slept longer and got up later to go to the toilet (men my age seldom get through the night without having to do this). I felt better and was overall more energetic. In other words, it worked for me. I also found that I could tolerate wearing the collar all night and rarely felt it.
Make Sleep Count for More
I believer that there are three pillars to health and well being, Diet, Exercise and Sleep. Furthermore, they interact. While there has been a great deal of attention on diet and exercise, we are only beginging to understand the importance of sleep. Most of the attention on sleep to date, has to do with the amount of time spent sleeping, Sleep Quanity. But is not just simply the amount of time spent sleeping that defines healthy sleep. Restful and restorative sleep results in Sleep Quality. There is not agreed definition for Sleep Quality. I suspect the key parameters will be defined in the next five years as there will be a growing awareness of the importance of sleep quality and increased ability to measure it. While most wearable devices on the market that messure sleep are not very accurate, I suspect that will change significantly over the next five years. One of the things I think we are going to find out, is that for many people poor sleep quality is not a matter of having better lighting in the bedroom or a better mattress. Unobstructive breathing has the most impact on sleep quality.
What’s next for me and Sommetrics
Sommetrics will begin to offer its products commercially early next year in Canada, where it has pending regulatory approval. It will expand to Europe and, pending FDA approval, the USA. We have recently brought in a Chief Operations Officer, Peter Schineller, who will lead the commercial transition of the company. I plan to stay involved in the company’s strategic development while continuing to play a role in researching sleep quality.
Sommetrics intends to play an important role in educating consumers about the importance of sleep quality and ways that sleep can be improved. Sommetrics is also seeking to work with companies that monitor sleep quality, to increase the understanding of sleep.
Finally, what about you
If you think you might have Obstructive Sleep Apnea, take this survey . OSA is not a good thing to have and snoring will make your bed partner crazy. This is my motivation for working so hard with Sommetrics. At this point in my life, I can’t think of anything better I can do to help millions of people.