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Show HN: I'm a doctor and built a responsive breathing app for anxiety and sleep (lungy.app)
51 points by lukko 5 months ago | hide | past | favorite | 31 comments
Hey HN!

I’m an NHS doctor and the founder of Pia (https://www.piahealth.co) which developed Lungy (https://www.lungy.app). Lungy is an iOS app that responds to breathing in real-time and was designed to make breathing exercises more engaging and beneficial to do. It’s been just over a year since Lungy launched (here’s the original ShowHN: https://news.ycombinator.com/item?id=34534615) and it's had a huge update and complete redesign. We rebuilt the whole app, and added a real-time 3D soft body solver which gives some really cool interactions like blobs / objects that inflate as you breathe. We also made a version for Vision Pro, called 'Lungy Spaces'.

My background is as a junior surgical trainee and I started building Lungy in 2020 during the first COVID lockdown in London. During COVID, there were huge numbers of patients coming off ventilators and patients are often given breathing exercises on a worksheet and disposable plastic devices called incentive spirometers to encourage deep breathing. This is intended to prevent chest infections and strengthen breathing muscles that have weakened. I noticed often the incentive spirometer would sit by the bedside, whilst the patient would be on their phone – this was the spark that lead to Lungy!

Since making the first version we’ve made exercises fully customisable (you can dial in exact timings for each breath phase), added new breathing indicators, learning modules, e.g. self-care for anxiety symptoms, and lots of new visuals. The free version gives you access to a new breathing exercise each day, whilst premium ($14.99 per year, $39.99 unlimited) unlocks the full library of exercises, exercise data and visuals..

The visuals are mostly built using Metal (a couple use SpriteKit) and there are lots to choose from - boids, cloth sims, fluid sims, a hacky DLA implementation, rigid body + soft body sims - each one reacts to breath and touch. The audio uses AudioKit with a polyphonic synth and a sequencer plays generated notes from a chosen scale (you can mess around with the sequencer and synth in Settings/Create Music). The nice thing about the visuals + audio being generative is that the download size is relatively small with no other downloads. We’re still working on improving the breath detection, using ML - currently, it uses microphone input, with optional camera input to guide positioning.

We’re also close to finishing the medical device version - http://lungy.health - designed as a pulmonary rehab platform for patients with asthma and COPD, it should hopefully be released in the UK early 2025.

Thanks for reading - would love to hear any feedback!

Lungy Version 2 here: https://apps.apple.com/app/apple-store/id1545223887




This looks great- I'd give it a shot.

Marketing note: I'm pretty sure it's regional, but in the very densely populated place I grew up, lungy was a synonym for loogie, which if you've never heard the term, is phlegm mixed with saliva forcibly spit at someone or something. Unfortunately, I just viscerally find that name pretty repulsive through some deep-seated associations that would be pretty stubborn to rewire and that would probably work against the app's intended function. I'm not sure how wide of a region that's true for, but like I said, it was a very densely populated part of the US.

This isn't a criticism, it's just that I'd want to know that if it was my app.


Thanks - that is good to know. I realised after launching that some people pronounce it Lunge-y (rhyming with grunge), which wasn't my intention.

Maybe at some point we'll rename...


Good luck! You've got a great mission and I'm sure you've already made a big difference in people's lives. Having worked in branding and identity, I think you'd probably have to rename really soon for it to be feasible, and depending on the size of your user-base it might be too late, but it might also not even be a problem to begin with.

Make sure you get recommendations from someone you trust for some experts to consult on the process. You could surely just consult with one for a short amount of time just to get a superficial sense for whether or not its reasonable, and if it's not, how to mitigate any concerns if it even is a problem at all. (Sometimes people not knowing how to pronounce the name right, for example, can actually create conversation about your product, and if the product is high quality, that's not a bad thing!) Marketing consultants always seem like a waste of money, but for consulting on something as important as a name change, you could have an exponential ROI. Like if you were concerned about it and they said "this affects a tiny fraction of the potential users-- it's not even worth doing a survey" then even the peace of mind is worthwhile.


In your experience do you also find that the average person making basic errors when breathing? Are they inefficient breathers? What are the long term consequences? I changed the way I breathe several decades ago after a few yoga lessons, and has come in useful almost every day. Being mindful of ones diaphragm was key, ie, if I am still doing it correctly.


I think you mentioned the main ones, awareness of breathing rate / depth and relaxing your abdominal muscles / diaphragm to breathe deeply. Interesting side note - the innervation for the diaphragm comes from the neck, so if you are aware of sensation of it, it's experienced in the shoulder region.

Breathing depth and rate is so closely linked to physiological stress. Breathing exercises are such a simple intervention to break this cycle but they do work surprisingly well.


What is this exactly? On one hand you're talking about anxiety and sleep, and in that aspect this looks like just a spin on guided meditation, unless you have studies that show that weak breathing muscles are an issue in this case. On the other hand you're talking about an incentive spirometer, which is a medical device. An app isn't a medical device, and I doubt you can give any guarantees it'll work. Besides that, if I needed treatment, I'd expect a licensed professional to give me exercises, and since the physical device is like 10$, I don't see how your 15$ subscription is competitive. Especially that breathing exercises can worsen some medical conditions.


Let's be clear - this is not a medical device and is not presented or marketed as such. Software / apps definitely can be medical devices (SaMD) and if it was used in someone with impaired lung function for whatever reason, or replicated the functionality of incentive spirometers then it would be regulated as such. The medical device version of the app will be a separate app, initially for asthma and COPD, and will have other features specific to these conditions. There is lots of functionality that can be added - compliance, medication tracking, physical activity, educational modules that you don't get with a 10$ spirometer. This health version will be a Class I medical device and we will publish the results of any trials with peer review.

Lungy is currently an app for people with healthy lungs - breathing exercises and mindfulness are effective at reducing anxiety and stress symptoms.


Any plans for porting to Android?


yep - I'm happy with the UI now. My main reservation is trying to get it to run smoothly across all Android hardware - there's obviously much more variation than iOS.


You don't need to focus on ALL Android hardware. Just look at one the best selling budget phones on the market and pick one from there. Something like the €200 Samsung A25. If it works good on that potato, it will work on everything.

Also there's a lot less variety in Android those days, both SW and HW. Most have 1080p displays these days apart from the flagships, so UI should be consistent.


Ok thanks, that's good to know. I guess porting the shader code wouldn't be too bad..


I'll be awaiting the android version too, best of luck and congratulations on the IOS launch.


ill be on the lookout for it once its on android


Same here.


Thanks a lot for sharing this the app is beautiful. I work in a same domain and the breath detection is always hit or miss, have you guys considered a technical newsletter or a blog in the future ?


Thanks so much. Yes a blog or newsletter is a good idea..

We have some results for improved ML breath detection which could be quantitative (real-world values for flow & volume). I want it to go through peer review ideally and then would try to publicise the results.


Your regulatory approach seems well researched. Nice job on that! Most people underestimate how much time and effort it takes to get a medical device certified. Launching as a non-medical device first, getting some feel for PMF and then expanding the claims is the smart way to go.


Yes! Thank you. I feel like some companies can slip into medical device territory to avoid all the hassle..

Honestly the regulatory process I have found to be incredibly opaque and difficult. It's tricky to find out what exactly qualifies as a medical device, and then the process for certification. A company called Open Regulatory helped us and the flow chart here is helpful (for UK):

https://www.gov.uk/government/publications/software-and-arti...


Why am I not surprised? ;) Open Regulatory is doing great work, the founder is a fantastic guy. A breath of fresh air in the opaque and boring regulatory world.


What do you think is the most effective breathing exercise to increase energy and focus? e.g. an exercise you might do before starting to write code.

I like 6 seconds in thru the nose, 2 seconds out thru the mouth (forcefully) for about 90 seconds, but would love to hear your thoughts!


Usually, a longer exhale is more relaxing - look up rectangle breathing. Also worth having a go at 'cyclic sighing'.


This is not answered in your FAQ: any plans for an Apple Watch app with a complication to show something and/or launch it? I presume how it would work with the watch would be different from how it works with the phone.


If anyone is looking for more in this space with a beautiful design, I’m a huge fan of unwind: https://apps.apple.com/us/app/unwind-guided-breathing/id1470...

Free version is really good. Not sure how it’ll compare to the premium version though.


It looks really cool. Do you think there’s any applications to central or obstructive sleep apnea?


Yes definitely. Potentially it could be diagnostic too - the periods of apnoea would probably have a unique audio and accelerometer signal.

OSA is typically diagnosed now with polysomnographs, which have a lot of wires and sensors and are quite uncomfortable to sleep with. I think there are a few startups in this space, making much more lightweight and comfortable hardware. It may be interesting to just use a phone though..


Anecdote: I did 5 sleep tests (over the course of 6 years or so) with different hospitals in different countries with very differing results. I (EE) have 0 trust in the hardware/software of some of these devices.

1st test (the most elaborate in-hospital polysomnography with the tons of wires and not being able to move around): AHI 17

Subsequent ones all of the "take-home/installed at homee" portable type:

2nd: AHI 6

3rd: magically completely cured AHI 0

4th: AHI 5

5th: AHI 7

Yeah right...


Have you found any root cause or are you still suffering from sleeping issues? I also repeated 3 times the exam with different results and I'm a bit discouraged about this situation at the moment


Hi, would you be looking for support to help build the Android app?


That's a very beautiful app


This is pretty great.


Oh this is great!




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