Brian Lovin
/
Hacker News

Show HN: I'm a doctor and made a responsive breathing app for stress and anxiety

lungy.app

Hey HN! Some more info: I’m an NHS doctor and the founder of Pi-A (https://www.pi-a.io) which developed Lungy (https://www.lungy.app). Lungy is an app (iOS only for now) that responds to breathing in real-time and was designed to make breathing exercises more engaging and beneficial to do. It hopefully has many aspects of interest to the HN community – real-time fluid, cloth and soft body sims running on the phone’s GPU.

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 they 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!

The visuals are mostly built using Metal, with one or two using SpriteKit. There are 20 to choose from, including boids, cloth sims, fluid sims, a hacky DLA implementation, rigid body + soft body sims. 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).

There are obviously lots of breathing and meditation apps out there, I wanted Lungy to be different - it's about tuning into your surroundings and noticing the world around you, so all the visuals are nature-inspired or have some reference to the physical world. I didn’t like other apps required large downloads and/or a wifi connection, so Lungy’s download size is very small (<50MB), with no geometry, video or audio files.

Lungy is initially a wellness app, but I’d like to develop a medical device version for patients with breathing problems such as asthma, chronic obstructive pulmonary disease (COPD) & long COVID. Thanks for reading - would love to hear feedback!

Daily Digest email

Get the top HN stories in your inbox every day.

anonymouse008

Very interesting concept and neat visuals. Before I dive in, I'm a trained vocalist and breathing is core concept #1. My feedback may be geared towards our line of work, but I believe breathing mastery is analogous across domains. Here are my initial thoughts:

Using the microphone and camera makes sense. When the camera required calibration, my excitement grew. Then my anticipation gave way to disappointment when the bar had no sensitivity to silent breathing, nor 'shoulder breathing.' I'm now struggling to know what the camera is needed for - ideally you want to see if someone is shrugging their shoulders instead of filling their diaphragm, but the camera positioning isn't suited for that - nor did my experimentation reveal the app's sensitivity to that input.

Further, while one can 'cancel out' the audio stimulus from the audio input in software, I wonder if there's interference. I found it takes a significantly 'loud' breathing to get the bar to move along with me - and even still, the bar shifts before I'm ready to shift. In some sense, I guess that's the intended behavior change - however, not all loud breathing is good breathing and leaving us without feedback that we should change our breath tempo doesn't help us get better.

This overall is a wonderful idea - and would be perfectly fine (really better in my opinion) without the request for camera and microphone access.

lukko

Thanks, that's very useful feedback. At the moment, the camera isn't utilised to its full potential - it is used to guide positioning rather than measuring accessory muscles or shoulder movement. I think overall adding sensors to the experience does add something, and hopefully with more development the app could alert the user to things like hyperventilation and dysfunctional breathing patterns.

komatsu

You could use the front TrueDepth sensor that is behind FaceID unlocking. You will get quite detailed RGB + depth data. It could possibly capture even the subtle movements of upper chest.

see Steffen Urban, Thomas Lindemeier, David Dobbelstein, Matthias Haenel, "On the Issues of TrueDepth Sensor Data for Computer Vision Tasks Across Different iPad Generations" and Andreas Breitbarth, Timothy Schardt, Cosima Kind, Julia Brinkmann, Paul-Gerald Dittrich, Gunther Notni, "Measurement accuracy and dependence on external influences of the iPhone X TrueDepth sensor".

cloudking

Could you use the LiDAR data on newer iPhones to get more accurate assessment? https://developer.apple.com/documentation/avfoundation/addit...

lukko

Hmm it currently uses TrueDepth on devices that support it. I think LIDAR is only with back-facing cameras?

prox

I just bought it, the microphone doesn’t seem to do a lot (and I don’t gave access to camera) but I will try it out later.

It’s a well thought app. The core function is really good, I will enjoy trying out the different exercises! The design of the homescreen could be better, looks a bit cluttered.

Maybe some background information if it takes off in the future would be nice for people who don’t know the science behind each breath type.

Other than that, I wish you success!

ghostbrainalpha

It's not fair to judge the microphone when you didn't use the camera to position it correctly.

There is an exact distance and tilt the phone needs to get the best sound, and its not really possible to nail that without the help of the camera.

lukko

Have a quick look here if you think the mic input is not working correctly: https://www.lungy.app/how-to. If that doesn't help, please send a message to - hello [at] lungy dot app

I agree the home screen could be clearer and the layout could be improved on the exercises to include more info. Thank you for the feedback!

bikeformind

You might want to explore using haptic feedback via the devices vibrator motor to prompt the user to breathe in and out.

One short pulse for breathe in, and a longer pulse to breathe out.

This would allow the user to perform the exercises with their eyes closed and the phone on their lap.

I know the visual functionality is core to your design, but might be a good idea to provide some optionality for users who just want to do the exercises without looking at their phone.

selfportrait

+1 to this suggestion. It’s part of what makes the breathe app on the Apple Watch engaging, the stream of tapping on your wrist really helps. I’m sure the same can be achieved with the phone.

llagerlof

Also it will allow people with impaired vision use the app.

lukko

+1. I did add very subtle haptics (possibly too subtle) as the indicator changes, but I like the idea of making them stronger and recognisable for each breath phase

bikeformind

pick up a cheap Fitbit on Amazon, they have a pretty good haptic breathwork flow.

another interesting thought, maybe user could lay down on their back place iPhone on chest, and you can measure breathing with accelerometer? that could be even more accurate than camera + mic

jfengel

I can't test your app, since I don't have an iPhone, but I'm hoping you could answer a vaguely related question for me.

One of my COVID readings was Breath: The New Science of a Lost Art, by James Nestor. Its author says, "humans have lost the ability to breathe correctly". Like your app, it proposes a lot of breathing exercises. It explains their benefits in terms of increasing CO2 tolerance, and believes that we've all got too much O2 in our systems.

That smells like horse puckey to me, but I've been unable to find an informed review either way. I'm sure that slow, deep breathing as a focus for meditation is a very good thing, and I'm sure that your particular app is well founded. But I'm curious to know if you've read that particular book, and what your opinions are.

Thanks!

_yb2s

There is a feedback loop that characterizes the stress/anxiety response, where people breathe faster, which in turn increases the stress response, causing even faster breathing. People with chronic anxiety also develop decreased CO2 tolerance over time[1] from this rapid breathing, perpetuating the chronic rapid breath.

Breath exercises that increase CO2 tolerance like Buteyko breathing allow one to interrupt this process. It's not clear to me exactly what the increased CO2 is doing, if anything, but it's clear that this works to escape this chronic stress state, which is really unhealthy.

I think the Radiolab breath episode discusses this well: https://radiolab.org/episodes/breath

[1] https://pubmed.ncbi.nlm.nih.gov/11015814/

ElijahLynn

I recently came across this by accident and your explanation jives.

I noticed I would get fairly fatigued, and have to take a nap around 11am every morning, and eventually found that it was basically every 4-5 hours, even mid-day too. I would take a 10-20m power nap and usually wake up feeling really good, I would even hit REM in that time.

Then a few months ago, I noticed when I was having this feeling I was usually ruminating about something, and it was something like grappling or repressed anger, AND what this did was cause very shallow breathing and "breath holding" patterns. And I've been doing a lot of work around Gabor Mate, MD's work lately and processing trauma responses so I was able to identify this and feel the feelings in a more present way, and in doing so, start very intentional deep, slow breath and exhales.

Compared to my shallow breathing and holding, my breaths became like 3-4x longer. And... to my surprise, the fatigue would pass in about 5minutes or so and I would not need a nap, and get my brain back to an "alert" state, as opposed to that "foggy" state.

I have been doing this for months now, and it keeps working. And now, this was really blurry because sometimes I would be genuinely tired from sleep debt from pulling a late night, and it was a similar feeling. So when I get a solid nights sleep for multiple nights in a row, then the breathing works to keep me alert, and helps me get more in touch with my emotions and subconscious thoughts rise up and become concious. I can detect the shallow breathing/breath holding fairly well now, but not always, and it is still a work in progress to make these breaths the default. The breathing does help me move through life much better now, and I walk slower, and not so rushed, and am more at peace with doing things in the present.

This actually wouldn't really be possible though if it weren't for a discovery that I breathed through my mouth my whole life (40 years) recently too. I learned about the "nasal cycle" and in combination with a deviated septum I have, my nose would plug up every now and then with no rhyme or reason, I thought it was diet for a long time but eventually learned about the "nasal cycle" where the turbinates in our noses swap the swelling to change the airflow every 4-6 hours or so. And when it swapped to my non-blocked septum side, my airflow would stop and I would be forced to breathe through my mouth. What this meant is that I could never develop a habit of nasal breathing my entire life. I started using Afrin about 5 months ago, and then stopped because it says not to use it continuously and you get a rebound when you stop using it. But then I found a Ear Nose Throat doctor/surgeon and presented my hypothesis to him and he confirmed that the nasal cycle + deviated septum hypothesis was correct! And he suggested I use Afrin plus a nasal steroid (Sensimist) together and that will reduce the rebound effect and that enabled me to use Afrin long term to stop the natural swelling of the turbinates in my nose. And, so I've been using Afrin for 3 months now and can breath so good through my nose now, and it is so sweet, and so precious, I can't imagine going back to mouth breathing ever again. I do have increased sensitivity to cold with the Afrin and my nose drips like a faucet. Or maybe that was because I never breathed through my nose in the cold to begin with? Regardless, I need to bring tissues with me in cold weather wherever I go.

And that leads to the fact that now when I noticed the breathing pausing, I can take big deep breaths through my nose and it feels so good, and calming, I can break out of the trauma/anxiety cycle and self-regulate with breathing.

I think the breathing cycle issue is mostly a trauma response from a young age and then it turns into a learned habit. This is the result of a caretaker not being there for me/us to help us self-regulate at a young age. The Wisdom of Trauma film and In the Realm of the Hungry Ghosts book by Gabor Mate, MD. really was trans-formative in my understanding of all this and success here, combined with other things as I mentioned above.

Sleep debt is also super duper real, and from what I learned in The Promise of Sleep by William Dement, MD. is that if I miss 2 hours of sleep one night, it can take 4 nights to actually catch up on that, like 30 minutes extra a night. I can't pay it back in 1 night, and that I still need to take naps. If we don't have sleep we will be in a chronic stress state forever.

I also was recently diagnosed with sleep apnea, after going to the doctor for fatigue and mentioning how frequent and predictable my naps were, I thought I had narcolepsy. They had to do a sleep apnea test first for insurance reasons before narcolepsy testing could be approved. This was when I was still mouth breathing, and I was waking up like 10 times a night from chronic back pain, trying to find that perfect position, so never really slept more than an hour without waking. I was fatigued. So Sleep Apnea came back positive and one of the explanations for the waking up, (had to pee a lot too), was that when the airway closes the body releases adrenaline to wake up or do something with the airway, the adrenaline increases urine production, and so I was also waking up because of having to pee, not enough air, or back pain.

I finally got rid of all the back and neck pain (of 20 years) using Pain Reprocessing Therapy (Gordon) and Compassion-based trauma therapy (Compassionate Inquiry (Mate) + Internal Family Systems (Schwartz) and started sleeping through the night, without CPAP, and then I tried CPAP for a month and was still tired and fatigued during the day. So I stopped using CPAP and only later realized that I may have been getting enough oxygen at night but wasn't during the day.

This is all one giant hurried mess of a story, but I wasn't going to post anything and figured "perfect is the enemy of good" and that this could help some people connect some dots in their lives so I just blotted it all out here.

_yb2s

WOW this post resonates with me on so many levels. Thank you so much for writing it out!

-I have the exact same issue, I feel overwhelming fatigue that lifts with a 10 minute nap, and need to do it many times per day. I work from home, and can't really work in person because without a nap I just crash, despite getting a good nights sleep -My girlfriend pointed out that I normally breath unusually fast and shallow, about twice as fast as her -I've had some very traumatic experiences in the last few years that I still haven't dealt with fully. Around the time of these experiences I couldn't sleep well because I had to constantly get up to urinate, and also at the same time felt an "air hunger" where I felt no amount of breathing was enough

Could you recommend something specific to start working on with these things? I actually just started reading the Mate book "The Myth of Normal" but haven't gotten very far in it yet.

It seems like there are quite a few people here discovering these things, I wish we could form a discussion group or something.

thecoppinger

Thanks for writing this all out—I too have a deviated septum and can relate to a lot of what you wrote. Have you considered surgery for your nose?

TylerE

This resonates a lot for me. My nose has never worked right. Like, for instance when I get nosebleeds it always come out of the same nostril 100%.

Zababa

Thanks a lot for the detailed writup, I'm currently investigating similar stuff but didn't really know whereto look, this will help me a lot.

undefined

[deleted]

stevofolife

How do you feel now compared to before?

fud101

i want to ask chatGPT to summarise this for me and repost but i'm not sure if that's welcome here.

wjnc

As a permanent snorer and nose cold sufferer several tips in that book worked wonders for me. I already had a good set of lungs and low breathing rhythm thanks to swimming, but a few weeks of sleeping with my mouth taped shut and attention to my jaw posture solved quite some issues. (N=1 YMMV etc)

nick__m

+1 For tapping the mouth shut. I used to snore and wake up tired now that I use 3M-1530-2 tape I wake up refreshed. So N is now equal to 2 !

jackschultz

+2 for taping mouth shut.

I read the book a week ago, said, why not. Instant improvement. Before, I'd have to wake up to go to the bathroom every night for the past 10 years, and when I woke up I'd have this eye pain every day leading to these giant eye bags. On top of those, if I didn't get that last sleep cycle in, I'd have to take a nap to get rid of this weird headache which made the time in the morning before nap seem pointless. In the book he mentioned how face skin can improve, and less bathroom in the middle of the night because apparently the body releases something to tell the body to hold water because we're sleeping. Mouth breating at night didn't cause this to happen.

I did the mouth tape and instantly, first night and every night in the past week, eye pain is gone, I don't have get up to use the bathroom, and the amount of consistent energy is absurd compared to before.

Seriously, I want to shout it out to everyone to tape their mouths at night.

_xerces_

What kind of tape do you use? I've just started trying this and best I have found so far in my local grocery store is Nexcare Absolute Waterproof tape. It stays on all night, but I wondered if there was something a bit easier to remove.

wjnc

I just used a regular soft bandage tape (‘leukosilk’). In the beginning I sometimes ripped them off in the night, so I’d go with something soft.

matsemann

One great thing with increasing co2 resistance is I can hold my breath for ~5 minutes and thus freedive / snorkel deep and stay long under water. But other than that I'm not sure, also curious about if it has any more health related benefits.

For practicing breath holding, "co2 tables" is the exercise to go for, btw. I find it very relaxing in a sort of meditative "ignore the burning pain" sense, but not sure I'd recommend it vs the app in the OP hehe.

ectopod

My understanding from the book was that CO2 is an essential part of the mechanism that transfers oxygen to your muscles. If you breathe too much you have too little CO2, your muscles can't get enough oxygen and they don't work efficiently. I've no idea if this is true, but since I read the book I breathe less when exercising and it seems to help. Edited to add: I'd forgotten, when I first started breathing less during exercise it made a huge difference, like coming down from altitude. I recommend it.

dom96

As a fellow Londoner, thank you! I just gave it a try, it was very relaxing and responsive.

One thing I would suggest, and I know it's a bit of a balancing act, but it's what always irritates me about breathing exercise apps. When it comes to the "Breathe In" and "Breathe Out" instructions, I wish you would hold off on switching to telling me to "Breathe In" when I am still clearly breathing out (which you know based on the microphone). It always makes me feel rushed when I am not perfectly in sync with what the app wants me to do and I feel like the responsive way in which this app works could make this a bit better.

uxamanda

Neat app, I like meditating and this seems useful for feedback.

Ideas to consider

- I went through the tutorial and it taught me to breathe in through nose, out through mouth. When I was trying my first day, those tips weren’t there or available so it was hard to know if I was doing what you wanted

- the labels (breathe in, etc) fade to transparent before next one ends meaning there is a gap where it’s not clear what I should be doing. Would be nice to fade in incoming direction or push the old out

- not clear the relationship between bar and box. I think I’m the box, trying to match the pace of the bar, but that’s not totally clear. Would be nice to get some feedback of “too fast” or “slow down” when out of bounds

- I like the idea of the textured backgrounds but the one I got was high contrast and made me a little dizzy. Maybe more subtle colors? Also making sure the text is distinct. Also I wasn’t clear if I was effecting them. Shouldn’t they pause when I hold?

- when inside the exercise the button says “skip” but shouldn’t it be “end early”?

lukko

Really good points - thank you. Will look at making the indicator more intuitive.

kwooding

Exactly what I was looking for!

A quick suggestion, I’d love to see you add the “cyclic sighing” pattern from [1] as it’s recently gotten some amount of attention for it’s effectiveness, and is potentially less common than the others.

[1]: https://www.cell.com/cell-reports-medicine/fulltext/S2666-37...

lukko

This would be great to include! I have been getting a few requests since the article was published...

epicEHRsucks

First off, your website and app are aesthetically breathtaking. You have a real talent with design.

I have not used the breathing app, so ultimately there may be some context to which I am unware, however, my first thought when hearing the description of the App is why? Why do we as technologists insist on making things more complicated? Breathing is as old as life, and though I concede that there can be tremendous depth to the study of breathing, particular in relation to disciplines such as singing, meditation, anxiety, couldn't you more effectively teach someone a technique by simply informing them rather than making an app to accomplish that same goal?

I apologize if in any way this feels as if I am criticizing your creative work. I am a software engineer and medical student and I appreciate when the two fields collide. I also never want to put any creative work down because I understand the effort and risk one takes when doing anything of the sort.

refulgentis

Because its a scalable way of teaching adults breathing exercises.

I am much more likely to engage with beautiful app than remember "that guy pointed out breathing is simple i should do it more"

lukko

I think here the tech is justified - it adds a few added incentives to do the exercises (visuals responding, progress tracking, showing lung function if possible) and can guide people through in a much more scaleable way than in-person / or remote sessions. From literature, it seems breathing exercises do have real benefits, the problem is with compliance - completing them consistently and effectively enough. Lungy tries to make the process more enjoyable and fun (rather than following a worksheet or just breathing into a plastic box). But yep, I think in healthcare, the simplest possible approach with minimal, but not necessarily zero, tech is the way to go. Haha, nice username btw!

escape_goat

Nice but I believe that parody goes against the spirit of the comments section.

awfml

Designer here— This whole experience is really killer. Fantastic work, truly.

I was not sure what to expect when it requested microphone access, but the way you've done it is really clever.

The interactive tutorial is really cool as well. The visuals, also, are different and fun.

Never seen anything quite like this. Really great work. I'm going to share this with some friends.

lukko

Amazing, thanks so much for the feedback!

mikekij

Hey, the design of your homepage is awesome. Who did the animations / visuals?

lukko

thanks! I did - the animations are using AE and Lottie, the CG is Houdini + Redshift, and the rest of the visuals are captured from the app.

gerbilly

I wanted to chime in here and mention the concept of "Email Apnea"¹.

The idea is that we hold our breaths when anticipating an outcome.

The term was coined in relation to email, but I believe that programmers probably have it even worse, because we basically spend our entire day in a a loop where we, try something, anticipate the results try again, repeat...

I personally find myself doing it. I guess the best analogy for it is that we "wait with bated breath" to see the results of our last command or compilation. I think it's a problem inherent in all disembodied work.

We are supposed to move the body and the mind as a unit, instead, we are increasingly making ourselves into brains in a jar, and I think our breathing patterns reflect it.

1: https://www.msn.com/en-us/health/medical/email-apnea-is-a-re...

ElijahLynn

Looks cool. I would try it. I'm on Android. This could be a PWA for both web and Android targets. Not sure about iOS yet, do they still not support PWAs?

Zanovis

Or flutter to target all 3 :)

devadvance

Highly encourage exploring Flutter as well, at least for new platforms. Lottie animations would pair nicely, as would any future goal of expanding to web or desktop.

domber

Flutter is just awesome. Can't recommend it enough.

Never had an easier time porting UI to so many, different platforms.

Flutter alone saved a year of work.

ElijahLynn

Good point!

toastal

PWA would cover KaiOS as well.

amadeuspagel

Looks extremely cool, but I wish this was a web app. I can't use it because I don't have an iOS device and I also think it would be useful on desktop, to take a break, as an alternative to checking HN, twitter ...

lukko

Thanks! Yep, I would love for it to also be a web app one day, I think definitely would be possible now with WebGPU. Will hopefully be able to release an Android version this year..

tr33house

awesome. Looking forward to trying this on Android!

curun1r

I’ve done a lot of freediving training and your app is now my fourth breathing app on my phone, so I may be an outlier, but in trying a few exercises in your app, I found that it was going way too quickly and causing me to over-breathe (hyperventilate) and get light headed. I played with the settings a bit and, while it helped, it was still nowhere near the right timing for me.

It’s interesting and beautifully done, but unless there’s something I’m doing wrong I’m afraid it’s just not usable for me in its current form. Perhaps there could be an advanced setting tucked away that let me bump up the exhale and hold times to prevent over breathing?

Maybe not the most useful feedback, but I’m always happy to see more apps in this space and I’d love it if this became part of my routine. And, as a side note, some information about what Lungy Deluxe actually adds would be useful to know if I want to unlock it.

lukko

Thanks for the feedback and that's interesting - I wonder if your free-diving training has something to do with it - I guess you must be very attuned to feelings of hyperventilation before a long dive? If it feels like you're hyperventilating, you could try turning down the breath volume (to low) and increasing the sensitivity (to high). The standard box and rectangle breathing are relatively short breath phases and holds - the Deluxe version unlocks all the visuals, gives more progress data and does include some much longer breath phases. I would like to add custom timings too, so people can set their own exercise.

phaedrus441

Interesting feedback. What apps do you prefer?

curun1r

My favorite is an app called ApneaTrainer. It has two different breathing patterns, but I do the 1-4-2 pattern for 30 min, 3 times a week. It helps you set your level as you improve. I’ve mostly plateaued at level 16, but I still find it useful for maintaining my level and I love the post workout calmness that I get.

Daily Digest email

Get the top HN stories in your inbox every day.

Show HN: I'm a doctor and made a responsive breathing app for stress and anxiety - Hacker News