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Episode 78 - Sandy Smith - EnsoData's Mission to Improve Sleep Testing


Hey everyone, it’s Emma Cooksey here and I'm your host.

So we're if you're listening to the episode, the day that it comes out and we're expecting hurricane Ian here in Florida and I'm in Northeast Florida.

So by the time it gets to us as probably going to, you know, be a much less serious storm.


But we're still taking it seriously over here and we're doing lots of hurricane Pratt and making sure we have you.

Flashlights with batteries that work and all that kind of stuff, my kids just find out.

They have three days off of school this week, so they're delighted.


So I'm just hoping that we can hold onto power so that we have all of our Electronics on hands.

And, but seriously for people that are more affected by the storm, like, I'm sending you lots of love and I hope that you don't have damaged and, and you can stay safe.


So, Today's guest is from a company called Enzo data and I've met a number of people that work for them.

So we'll talk a little bit about what they do in a minute but I just wanted to say a really big thank you to see even from Enzo data.

He wrote a really nice article and for their blog.


So I'm going to go and link to that in the show notes and you guys can go and have a read of that article.

He wrote about me and the podcast and everything I really appreciate the help and getting the word out about the podcast.

So Enzo data is a health care technology company.


That's automating the scoring and Analysis process for both in lab and home, sleep apnea testing.

So today's guest is Sandy Smith who works for ends our data as the Director of National accountants.

So I was interested to have Sandy on the podcast to talk just about Enzo data and what they're doing.


But also I knew that Sandy had her own Own personal Journey with sleep, apnea, and especially the loss of her mother with what seems like undiagnosed sleep, apnea.

And it's a really tragic story.


But, I really appreciate Sandy taking the time and Having the courage to share that with people.

Because I know that whenever we do episodes where somebody has lost lost a loved one, I always get people and you know, sending me messages saying that No, this was the sign they needed to go and get tested for sleep apnea.


So I hope that if you're listening to this and you're you haven't had a sleep test and you don't know if you have sleep apnea, but you suspect, you do.

I hope that you will take that step and go and get your sleep test.

So, without further Ado, here is my conversation with Sandy Smith from Enzo data.


So Sandy welcome, thank you.

I actually got to meet you in Charlotte at the Sleep conference, which was so nice because normally I don't get to actually meet people before I talk to them.

So I'm really glad you're here.

So we'll get onto a little bit about why you're at the Sleep conference and Enzo D to the company that you work with.


But I wondered if perhaps you might want to tell us a little bit about where you are right now, maybe a little bit about where you grew up.

That kind of thing.

Sure sure.

So I was born and raised in where I live now which is Tempe, Arizona, I'm the youngest of six and I know say a little prayer but I got away with a lot because hence I was the youngest so yeah, I was born and raised in Arizona and moved to Seattle to go to college after my mom died.


Hints is my story and then came back about 13, 14 years later.

And now I'm back in Arizona where I Family.

You want to tell us a little bit about your family like obviously before your mom passed.

Like so there were six children.



Did your mom have any health problems or was this whole thing just out of the blue?

You know, looking back, right?

Looking back is always interesting.

She always snored.

I thought it was normal up until I started get into sleep apnea because that's what people do is they snore, right?


It's the norm.

And I was again, Young and the night before, I was the only one living at home.

The rest of my siblings have gone off to work or school, or what have you.

And the, my mom came up to me and said, you know, saint I I don't have any feeling in my left arm and I knew a little bit, I'm like, well Mom, let me take you to the doctor sick.


No, no I'll be fine.

I'm like, okay and it was spring break.

So I was out with my friends and the next morning I was very sorry.

What age were you then?



So you're right with your friends share.


So came back and of course your spring break and it was March 10th and I heard a thump and I ran into her room and she had fallen over.

So I started CPR Call 911 and they came in and I won't bore you with the details but I should have walked out of the room.


I saw things that I probably will never forget and they called it 1056.

So and there was the only other one in the highs of that point.

I was when I call 911 and started CPR.


I I didn't really know what I was doing.

I thought I did.

So for a long time after I thought, oh my gosh, it was my fault at that point.

I was told she died of a stroke, okay?

And that was, it kind of made sense when she was talking the day before, but having the, the numbness in her arm.


Yeah, but II didn't know, right, I know now.

Yeah, yeah, that's that's why I'm within so data.

And I'm passionate about sleep because 80% of the patient population are under diagnosed.


Yeah, why is that?

Why is that, could we prevent all the core morbidities?

The stroke the heart attack, the dementia, they all timers, not only the cost associated with it, the mental anguish, right?

You're not Not sleeping.

You're snoring for a reason.


It's not normal.


So when I became older and started become into medical, I started learning what that is, what sleep apnea is.


So did they, did they take a change?

What they thought she had died from after or, or you just kind of put it together later in your life and the second, you know, I could be way off, right?

I could be wrong because I can't go back in time and change her death certificate.


But what I do now know is all the signs of a stroke and the prevalence of snoring points in that direction.

And so, but thank you for sharing that because I think that these kind of stories even though it's really tragic and pretty traumatic to talk about.


I always feel like whenever I interview somebody who's lost a loved one, I always hear from people who say, I've never thought about actually getting tested for sleep apnea but I snore too, I have all those symptoms and so I really appreciate you being open enough to talk about it.


I will, you know, tell you, My age, I just turned fifty three, and I tell you that because I haven't shared my story in about 30 years.

I just, you know, just it was hard.


And I think, gosh, I'm 53.

I have two kids and I thought at the time, she's like old, I don't think I'm old.


So, my mind is his changed, but I say that because I'm 53 and I've never ever worked for a company that cares more about Outcomes in patients, in the delivery of healthcare.

Like, no other.


Unless I decide to, you know, do something else or I think I'm going to retire here.

It's a wonderful company and to your point fun.

But, you know in.

So Dad is a health care technology company.

We actually reduce the amount of time, it takes for Sleep professionals, to review, and to return a sleep test to the patient.


And you know, why is that important for me?

Is because we all know or maybe you don't 80% of sleep.

Apnea patients are not diagnosed.

Oh yeah and and it's it's scary.

We have sleep test scoring software where we do use artificial intelligence, right?


We read to analyze, the waveforms captured in sleep test, done both at home and in sleep labs.

And the great thing is currently we're in more than 500 sleep labs in the United States.

Do you help clinicians more easily, diagnose Sleep disorders for Just, you know, more quickly because I think that that's one of the things that I talk to people all the time about is, they'll say, well, I got in to do a sleep study, but it's not for, you know, months out just because there's, there's not really enough.


It depends where you are in the country and the world, right?

But they just don't seem to be, you know, enough of the testing facilities to go around.

So the quicker they can get through them.

I I think the better for patients.

Will you spot on it?

It seems so simple.



Many organizations have a scoring backlog covid didn't help, but that's still no excuse to some point.

So this delay in testing and the link Lee delays I should say in patients, receiving the results from their study is tremendous, right?


Because it really depending on what your age.

I is anything above a 5 15 or 30.

That's going to be too.

Raymond your disease State.


And the outcome do you need an oral Appliance?

Do you need a CPAP?


What is the high risk?

So we can easily treat you more effectively.

I've had some Hospital systems that I've been working with what they have a six-month backlog and so so nicer.

Explain to people who don't know anything about how sleep tests are scored.


Then the old way of or the normal regular way of doing it was Is to have a sleep Tech, actually, you know, manually go through the, the score, right?

Like they would actually sit with the screen and they mark down what the H I was.


And so, what you're doing is replacing all that time that it would take a person to do it with a software program.

You're exactly right.

And, you know, it's interesting because we still compare our artificial intelligence scoring against human scoring clinicians.


And, and we have about 80 Acura five percent accuracy.


So we're not going to replace these clinicians, but we're doing it in much quicker time, instead of 30 minutes, 45 minutes an hour to two hours to score one test because there's so many metrics right rapid eye movement, late.


Movement, how many, how many times you stop breathing and we can typically do it, whether in lab or home anywhere between 8 to 15 minutes.

So that's significant, you know, our marketing team, put together something brilliant, where it resonated with me, especially being a mom and working mom, what would you do with more time?


Let's find more patients that we can help.

How many more patients could we help?

Could we diagnose?

And if we do that, could we prevent all the other core morbidities stroke because it exacerbates right in the disease state.

So, that's, that's, that's my mission is, is to educate these.


These clinicians, the hospital's test, more patience and get early, early detection, because we are doing it and we're killing it with, with profound accuracy.


This episode is sponsored by Viva Therapeutics.

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That's Viva, / patients, So, the thing that I find quite interesting, I was talking to Nick one of your co-founders at but he explained to me all about how the scoring at the moment, if they're not using this kind of software can sometimes get an H.


I'm not quite correct because it's not taking into account.

How much of the night you're awake.

Like they're kind of saying, like, I don't know how to explain.

That better.

But like, you know, like if somebody's actually awake for 40 of the minutes of the hour and then they have a bunch of events after that in the 20 minutes, then your software is saying that they had that number of events in 20 minutes rather than an hour.


Well, use the diagnosis.


If how do you know your sleep actively?


How do you know that from a 5235?

That's yeah.

That's a game chick.

That's a life change.

Our we have, you know, total sleep time, which we have each of us, we have a very specific breathing and respiratory characteristics.


When we fall asleep, most people breathe more slowly when their sleep meaning breathing events.

You know, out with each successive stage asleep.

So research shows that when we breathe faster and more, you know, radically during the rapid eye movement sleep stage.


That's when we dream and the amazing thing about what we're doing in our Engineers, as we took thousands and thousands of studies with both EEG and airflow, respiratory signals and trained, our wake-sleep algorithm because that's what artificial intelligence has to point to recognize what the breathing pattern.


Turns look like in different stages of sleep versus awake.

So the wake-sleep algorithm is literally looking at each individual waveform and usually, well, we use the algorithm, you know, to make a cumulative, you on weight versus sleep prediction.


So and we like I said, we tested this algorithm on a separate patient database and we have about ninety percent agreement with the EEG based staging, which is pretty profound.

Yeah, yeah, because I think I think this is going to help to kind of get to the root of why.


Like, I talked to so many people, sleep, apnea, and I feel like people's experiences vary tremendously, like, people can have been told that they have, you know, this Shi have a certain number and their experience of having sleep apnea is completely different from somebody else who has the same h.


I and I think, Like, the more we know about what's happening when people are asleep and their arrivals and all these different things, the more we can kind of understand it and hopefully treat it better.

Well, when you're a child changes from say, a 25 to 35, based when you move from a moderate to severe diagnosis that's going to change your treatment pathway.



Absolutely you know and and to your point people think football players big neck fat overweight middle class like you know 50 year old Male.

No, that's not true.

My son actually had sleep apnea.


Very underdeveloped jaw.

You're gasping for air.

Yeah, Roman wasn't asked to beer, so he had treatment with an oral Appliance and is still in treatment.

His growth hormones.

How old was he when he first noticed that 14?

Oh, wow.


And what is he snoring and everything as well?



But again I thought it was normal.

Yeah, yeah.

And so what did you did?

You go straight to the oral Appliance, or did he have a sleep test or what happened with him?


We did a sleep test.

Of course, I wanted I wanted factual information.

I wanted to see his Airway.

I don't want him to get tested.

How many times he stopped breathing his H?

I was not as severe, but enough to wear He needed treatment took about two years of treatment.


Here's something else that I don't know if it's relevant, but it was relevant to me.

Since sleep apnea is a medical condition insurance will pay for a portion of oral appliances.

And, you know, that it's absolutely relevant.

We talk about this all the time.


You get diagnosed early.


What's the cost associated with that?

And what's the cost associated with?

It's so severe separate from, you know, you're going to die in your sleep.

Yeah, that's Literally scary.



This episode of sleep, apnea stories is sponsored by Better Health, how well we look after our mind, really affects how we experience, life therapy has been so helpful to me since I was diagnosed with sleep apnea, it helped me to work through the feelings.


I had about going undiagnosed for so long.

It also helped me to adjust to living with a chronic condition.

One of the best things about starting.

My podcast has been realizing Not alone and coping with mental health issues, along with sleep apnea.


Speaking to a professional therapist has helped me enormously to manage my anxiety and depression That's your help is online therapy and it's much more affordable than in-person sessions.

You can get matched with a therapist in under 48 hours.


Our listeners get 10% off their first month of better / Emma.

That's better



It's great that you spotted that in him.

I think it's so like I had my older daughter, I would kind of like just because of my experience with having a very narrow high arch palate and all I'm basically the poster child for sleep apnea, I was in my freezer as a child.


I develop moving forward, tongue Foster.

I have the high arch palette and just everything not going for me and I had terrible allergies and all these So, a lot of that is fed into my sleep apnea.

And so, with my oldest daughter, I was just like obsessed with how she breathing.


Like yeah, how's your tongue posture and all this kind of thing.

But it was actually my younger daughter who ended up and she had her tonsils removed, and that seemed to help us solve her sleep issues.

So she hasn't had any problems ever since.


But it does make you think.

When you have, you know, you have your Experience with your mom and my my personal experience and makes you really look out for those things.

You know, I really had a hard time.

I went to therapy probably about nine years because I had so much guilt that I didn't do enough, right?


And as I've matured and gotten older and a little bit wiser, it was lack of Education, it was lack of awareness.

Should she have gotten tested, should have got a doctor and a lot of primary care doctors.

A lot of cardiologists are starting to realize that there are the first line of defense.

Yes, so education, education.


Education is really, really key with with anything in general is my is my opinion.

Yeah, definitely.

And I think also like there's a lot of doctors who are not receiving enough training and sleep and Sleep Disorders.

So, you know, even doctors are missing this and people a lot.


So, I mean, I'm sure that you've been through it all and therapy but like you know it's not just, you know, average people that don't know this information.

Operation, a lot of doctors don't know, either.

If they don't specialize in that area, you know, in my email signature, it says, sleep deserves a seat at the table sleep.


In my opinion, often times in the clinical world where the redheaded stepchild.

Yeah, but then when it hits the fan and you go in for a stroke or heart attack, you know, you're not breathing, you have an enlarged heart, there's so many physical ailments that are contributing to that, that if we have Detection.


And my whole thing with within so data is because we're reducing the time and our accuracy, how many more patients could you get early treatment and save like that?

That's one thing that I never that.

I always find kind of odds in the whole sleep apnea realm when I go to conferences, or speak to different people because I feel like sometimes I mean there's some tremendous clinicians who are doing great work, and Collaborating and all of that, but I often find it funny because you'll have dentists and doctors locked in this like you know, which therapy is the best therapy discussion whereas I'm like which therapy is the best therapy for the individual person and there's so many people out there that still need to be diagnosed.


Let's focus on that.

I'm going to be believed one to your patients, to go, right?

Well I believe in collaboration, right?

So what if the car I would just worked with, as you put it out, the dentist and the dentist is when that first sees the airway in the cardiologist and then they work with the Sleep doctors, right?


And and can help more, it really is simplistic, but it's not to save more lives.

Because if you can imagine, you're not breathing, what it does, your brain and depression and you're tired, and I won't name names.

But someone I love tremendously was so tired.


Had a Pull over on the side of the road at 8:30, on the way to work to take a nap.

Yeah, that's that's how I felt for like 10 years.

Oh my gosh.

What does that do to your emotional state?


And then I don't go into REM, what does that do when your brain is starting to?


You know, clean?

Yeah, things like, that's pretty much partly why?

Sorry my podcast is.

So I got to speak to all these really interesting people but one of the researchers I talked to dr.

Allen pack and He's, he's talking all about, people like me who have gone undiagnosed for a long time and then are on CPAP.


So they're getting enough oxygen.

I know.

But what did that do to their brain for the however, long?

They went undiagnosed before because I have persistent like, pretty bad brain fog.

It doesn't really matter what I do.

And I just, I mean, I don't think we have enough research to this point to really know.


But just Just as a person living with it, I feel like something not great happened to my brain over those 10 years that I wasn't getting enough oxygen.

I wait for the day where we can have quantitative evidence, right?





If you don't sleep, if you don't sleep apnea, this and this and this is going to happen, we're not there yet we can speak rate on a qualitative level.

But but I'm hoping for that day, so we can say check, check, check do this, this and this but I think it is changing.



But I love what you're doing because it is about awareness and it is about, you know, education working on it.

Well, thank you so much.

I really appreciate you sharing your story and telling us a little bit of an so date.


It's been great.

You're welcome.

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