4 ms·

There is a growing body of research showing that increasing slow-wave activity during sleep can improve outcomes, including sleep quality[1], memory, and correl

There is a growing body of research showing that increasing slow-wave activity during sleep can improve outcomes, including sleep quality[1], memory, and correlations with amyloid response[2]. Sadly, our latest grant application did not receive funding, but we are supporting other clinical researchers with our technology. Our technology is based on more than a decade of research with 50+ published, peer reviewed studies. We focus on sleep directly rather than the disease, which means people do not have to wait years for regulatory approvals before they can feel day-to-day benefits. For those curious about learning more, our approach and links to additional research are on our website https://affectablesleep.com https://affectablesleep.com . Mild-to-moderate Alzheimer’s changes in sleep https://doi.org/10.1016/j.jagp.2024.07.002 https://doi.org/10.1016/j.jagp.2024.07.002 Slow-wave activity, memory, and amyloid response https://doi.org/10.1093/ageing/afad228 https://doi.org/10.1093/ageing/afad228

DaveZale 1y ago
yes, poor sleep quality leads to bad days, bad days lead to more bad sleep, it is a downward spiral and may impact many of us in our prime years, too. All the best on your research and funding. Quality sleep has been undervalued, especially among work cultures that value overachieving at the expense of personal health.
- pedalpete 1y ago
  Thanks. A researcher we work with has postulated that build-up of metabolic waste (amyloid and tau, among others) directly impairs the glymphatic system, leading to more build-up. A viscous cycle. I don't think she's the first to postulate this, but I believe she is researching this relationship now. Though work culture is an important one, we're somewhat more focused on the less self-imposed sleep challenges related to maternity and perimenopause/menopause.
  - DaveZale 1y ago
    that's a cute Freudian slip (or deliberate joke) - viscous cycle - sure, amyloid and tau are probably very viscous when you poke at them with the laboratory utensil of your choice. And accumulation of them is like a viscious cycle of plaque accumulation and even worse clearance. It seems exponetial
    - maybelsyrup 1y ago
      Came here to say this. Also lol: > And accumulation of them is like a viscious cycle I don’t know what this slip meant though ;-)
    - pedalpete 1y ago
      LOL :) Unintentional, but I like it!
- tootie 1y ago
  I have narcolepsy and it's hard to describe what an absolute fog I was in for years before diagnosis. The current best treatment is a powerful depressant taken at bed time and again middle of the night to induce deep sleep.
  - pedalpete 1y ago
    Is that gabapentin? Or is there something else that is the go to these days? There was a comment on reddit a few days ago from someone with narcolepsy who was looking for a sleep tracker. Sadly, our technology does not "induce" deep sleep. It is suspected that the reason the Alzheimer's study showed such an increase in deep sleep was due to decreased cortisol as a result of stimulation, but that is just a theory at this point. Studies do show a decrease in night-time cortisol (https://doi.org/10.1038/s41467-017-02170-3 https://doi.org/10.1038/s41467-017-02170-3) early in the night during stimulation.
    - tootie 1y ago
      Sodium oxybate. And yeah most commercial sleep trackers are not going to work for someone with such disordered sleep. There have been retail EEGs available but they never catch on.
Citizen8396 1y ago
What do you do with user data?
- pedalpete 1y ago
  We don’t sell or share EEG data with third parties. The data is encrypted on the device and in storage. Our system processes it to show the user how they respond to stimulation, but company staff do not have direct access to individual user data. Internally we only look at anonymized or aggregated data to improve the technology. Is that what you meant? I assumed you meant from a privacy perspective.
  - octaane 1y ago
    Are you planning on allowing this device to work with Android? I'm asking because I can see on your website that it requires an iphone currently.
    - pedalpete 1y ago
      Yeah, we definitely will have Android. Almost everyone on our team is on Android, but we wanted to iterate on the platform that most users are on and focus on getting that experience right. Sales will somewhat depend on when we bring on someone to pick up the Android front-end. We're a really small team, and with hardware, firmware, services, and apps, the engineering footprint becomes quite large. What often doesn't get factored in is manufacturing test rigs, plus we have software to support clinical research. I'm not complaining about it, but holding off on Android seemed to be the right move, as we can't remove any of the other functions. We've had quite a few requests for Android.
Workaccount2 1y ago
Was really interested in this until I saw it was another static hardware product with a subscription as if it were a service. If the toilet was invented today, plumbers would all be telling us how $1/shit is a steal.
- codebje 1y ago
  Here I sit, broken-hearted...
- deleted 1y ago
  [deleted]
- nick49488171 1y ago
  Great incentive to hack it open (like people did with eight sleep) or use prior art for an open source version.
  - privatelypublic 1y ago
    Theres foss EEG machines already. $300ish to buy a fully working "same device as The FDA version just sans-certification." Much less if you want to build it yourself.
- bravetraveler 1y ago
  Consumer Poop Index, used to be a dime
- yieldcrv 1y ago
  That’s… actually a good way to have premium services on a bidet
  - deleted 1y ago
    [deleted]
- sschueller 1y ago
  Then I could theoretically use a shit coin to pay for an actual shit...
danielscrubs 1y ago
Does it back up that it increases deep sleep? Just see word salads on the web page and: ”dont ask how it sounds, if it where a pill you wouldnt!” Just red flags everywhere.
- pedalpete 1y ago
  Fair point. To be clear, time in deep sleep does not increase. What increases is delta power, the primary measure researchers use for how restorative deep sleep is. This has been shown in the research, and our technology has been validated by an independent laboratory so that they could use it in their own clinical trial. On our site we simplify the language. That is partly because of the regulations do not allow us to make clinical claims prior to approval, and partly because explaining the neuroscience in detail would overwhelm most visitors. I link to the research so those interested can dive in deeper, and that is allowed.
  - deleted 1y ago
    [deleted]
ionwake 1y ago
really cool Im sorry to hear you didnt get funding. I dont know much but isnt the problem related to what causes the build up in teh first place? wasnt it scarring or something?
- pedalpete 1y ago
  Thanks. We're used to not getting funding. It's part of the journey as a start-up and in research. The build-up isn't scarring. It's misfolded proteins in the brain which stick in places they shouldn't and the glymphatic system which flushes cerebrospinal fluid through the brain removes the build-up of these protiens. If you have poor sleep or lack of sleep, these proteins don't get removed and that build-up interferes and disrupts the firing of neurons. Alzheimer's drugs are able to help remove the build-up, but unfortunately are not able to repair the damage. That's why they only slow progression of the disease, not treat it. If slow-wave enhancement lives up to the potential, it would likely also only be preventative. It would be surprising if it was able to treat AD. If you want to know more, a comment in this post has what I think may be the most thorough breakdown of AD. https://www.astralcodexten.com/p/in-defense-of-the-amyloid-hypothesis https://www.astralcodexten.com/p/in-defense-of-the-amyloid-h...
  - ionwake 1y ago
    Great stuff thank you!
arunabha 1y ago
Getting better sleep has been a bit of a personal quest for me. Having said that, much as I would love to get the device, having been bitten by a bunch of subscription locked devices by startups, I have (reluctantly) settled on a policy of not purchasing hardware that can't work independently of the company. Startups are hard at the best of times, hardware startups are harder. When the company making the hardware inevitably goes under, you are left with a useless piece of plastic that you paid a ton of money upfront for, and then paid a hefty sum every month on top.
- pedalpete 1y ago
  Thanks for this thoughtful response. The reason we use a subscription is to keep the upfront cost much lower. It's important to us that we make better sleep as accessible as possible. A one-time payment makes that more challenging at this stage. We also wanted to keep things simple at checkout. Too many options can be confusing, and at this early stage our priority is making it straightforward for people who want to try the technology. It's a delicate balance.
  - sebasvisser 1y ago
    Having to select 2 items for 1 sleep intervention is a weird way of keeping things simple.. To help you a bit: 1 is easier… So 1 hardware product working independently is what we want. If you must to appease the shareholders do a subscription…make it add some functionality that would be impossible without a subscription… But locking people in a subscription to “keep upfront cost lower” is devious at best. Add to the world..don’t (cash)grab.
  - esperent 1y ago
    It's understandable why you would need to do that. I'm not against subscriptions in cases like this. From my side as a customer, here's what I would need to see before supporting you: 1. A one off payment to own the current version of the device. This must include the ability to download all of my data that I generate from using the device. It can be in raw, unporcessed form. 2. A subscription is acceptable but would pay for cloud based data processing, generating reports etc. Processing and storing my data, in other words 3. A clear privacy policy stating that you will never sell my data in either raw or processed form. But I assume as a medical device that's already in place?
dotancohen 1y ago
Constructive criticism Your first FAQ answer begins extremely apprehensively. Is that even the number one most frequently asked question? I would suggest heavily revising that answer or getting rid of it completely. Many devices today support dark mode, such as my S24. The website does not display clearly in this mode.
- pedalpete 1y ago
  Thanks for the feedback. You’re right about the first FAQ, it doesn’t read well on mobile and I’ll rework it. On dark mode, we deliberately avoided it. Most sleep products lean into dark, sleepy visuals, which makes sense if the goal is to help people fall asleep or stay asleep. Our product doesn’t do that, so we are careful not to give the impression that it does, even though sleep is at the center of what we build. Our hope is that the brightness of our brand doesn’t mislead people, or lets us prevent them from misleading themselves. Does that make sense?
  - dotancohen 1y ago
    To me it does not make sense, but I'm not your PM. Just your target market.
  - sokka_h2otribe 1y ago
    You're describing why your default aesthetic is not dark. Dark mode however is just an accessibility concept, not really about aesthetics. For some people they work hard to make it aesthetically consistent. But honestly I think dark mode compatibility should not have to be a perfect replication
    - dotancohen 1y ago
      > But honestly I think dark mode compatibility should not have to be a perfect replication I agree with this.
impendia 1y ago
I have been on your mailing list for time, and at least semi-seriously thought about buying one. Like other readers, I saw the subscription business and got put off. Especially since it seems that every company eventually either "enshittifies" or goes on an "incredible journey".
- pedalpete 1y ago
  Well, start-ups are an incredible journey! :) We have no aim to "enshittify", I'm actually not sure what an incredible journey is? Can you elaborate on who has gone on such incredible journey's? I wonder if some of the enshitiffication is a result of investor demands (as another comment alluded to). We're doing our best to bootstrap Affectable. Bootstrapping a neurotech hardware start-up is not easy, and it's a bit of a miracle we've mostly managed so far. Thanks for your input, and your early support. I'd be keen to know if there were other details you'd like to hear about on our mailing list. We'll keep reviewing our pricing model based on feedback. We do appreciate you taking the time, and for your consideration.
  - impendia 1y ago
    I'm referring to this website: https://ourincrediblejourney.tumblr.com/ https://ourincrediblejourney.tumblr.com/ Blog posts from startups who get acquired by big companies, talking about what an incredible journey their startup has been, and thanking their customers and promising ongoing support for their products. And then breaking these promises soon after. And no one aims to enshittify, but my understanding is that pressure from investors eventually becomes louder than that from customers. (Although perhaps less so in your case, as you say you're bootstrapping.) If you have a subscription model, you're asking me to trust you over the long term. But, if I understand your product correctly, there's no technical reason why I need to have an ongoing relationship with you or even an internet connection to use your product. Those are apparently business decisions. And I'm afraid those are decisions which lead me to trust you less.
    - pedalpete 1y ago
      Oh, I hadn't heard of that tumblr. The reality is that without a subscription, the product would not be viable. We would either have to charge nearly double upfront, or risk not being around to support it in a few years. The subscription lets us keep the starting cost lower, which makes the tech inaccessible for many people. The subscription balances that out, and it also means we can keep supporting the system over time instead of leaving people stranded. In a sense, it is actually what makes the long-term viability and hopefully trust possible. That's how we view it.
nozzlegear 1y ago
I'm a bit late to this, but if you're still around, I'm curious if this research would necessarily mean that people with sleep apnea or other sleep disorders (untreated or treated) are more prone to Alzheimer's as they age? I'm also curious if there's been any research on your technology being used on people who have sleep disorders. I took a look at the research you linked, but the second paper noted that people with sleep disorders were excluded from the study, and the first paper didn't mention sleep disorders or apneas at all. I ask as someone who has sleep apnea and uses a CPAP machine.
- pedalpete 1y ago
  My understanding is there is a directional correlation between untreated sleep apnea and Alzheimer's. Do you feel your CPAP improves your mental clarity, or mood? The reason I ask is the cognitive benefits of CPAP are inconclusive. It works in some people, not in others. It solves the hypopnea, but that doesn't mean slow-wave activity increases as a result. There is no research I'm aware of that has been published showing how slow-wave enhancement impacts people with sleep apnea. We work out of The University of Sydney, where CPAP was invented and work with a few former ResMed employees, and know a bunch of people who still work at ResMed. When we approached them a few years ago, they didn't seem very interested, but the science has progressed significantly since then, and it's getting pretty difficult to ignore it. I'll reach out and see if they're keen on supporting a study. BTW, have you tried a mandibular splint (biteplate)? My brother was on CPAP for about 8 years, and then moved to a moved to the biteplate about a year ago. He's MUCH happier with it.

DaveZale 1y ago

yes, poor sleep quality leads to bad days, bad days lead to more bad sleep, it is a downward spiral and may impact many of us in our prime years, too. All the best on your research and funding. Quality sleep has been undervalued, especially among work cultures that value overachieving at the expense of personal health.

pedalpete 1y ago
Thanks. A researcher we work with has postulated that build-up of metabolic waste (amyloid and tau, among others) directly impairs the glymphatic system, leading to more build-up. A viscous cycle. I don't think she's the first to postulate this, but I believe she is researching this relationship now. Though work culture is an important one, we're somewhat more focused on the less self-imposed sleep challenges related to maternity and perimenopause/menopause.
- DaveZale 1y ago
  that's a cute Freudian slip (or deliberate joke) - viscous cycle - sure, amyloid and tau are probably very viscous when you poke at them with the laboratory utensil of your choice. And accumulation of them is like a viscious cycle of plaque accumulation and even worse clearance. It seems exponetial
  - maybelsyrup 1y ago
    Came here to say this. Also lol: > And accumulation of them is like a viscious cycle I don’t know what this slip meant though ;-)
  - pedalpete 1y ago
    LOL :) Unintentional, but I like it!
tootie 1y ago
I have narcolepsy and it's hard to describe what an absolute fog I was in for years before diagnosis. The current best treatment is a powerful depressant taken at bed time and again middle of the night to induce deep sleep.
- pedalpete 1y ago
  Is that gabapentin? Or is there something else that is the go to these days? There was a comment on reddit a few days ago from someone with narcolepsy who was looking for a sleep tracker. Sadly, our technology does not "induce" deep sleep. It is suspected that the reason the Alzheimer's study showed such an increase in deep sleep was due to decreased cortisol as a result of stimulation, but that is just a theory at this point. Studies do show a decrease in night-time cortisol (https://doi.org/10.1038/s41467-017-02170-3 https://doi.org/10.1038/s41467-017-02170-3) early in the night during stimulation.
  - tootie 1y ago
    Sodium oxybate. And yeah most commercial sleep trackers are not going to work for someone with such disordered sleep. There have been retail EEGs available but they never catch on.

Citizen8396 1y ago

What do you do with user data?

pedalpete 1y ago
We don’t sell or share EEG data with third parties. The data is encrypted on the device and in storage. Our system processes it to show the user how they respond to stimulation, but company staff do not have direct access to individual user data. Internally we only look at anonymized or aggregated data to improve the technology. Is that what you meant? I assumed you meant from a privacy perspective.
- octaane 1y ago
  Are you planning on allowing this device to work with Android? I'm asking because I can see on your website that it requires an iphone currently.
  - pedalpete 1y ago
    Yeah, we definitely will have Android. Almost everyone on our team is on Android, but we wanted to iterate on the platform that most users are on and focus on getting that experience right. Sales will somewhat depend on when we bring on someone to pick up the Android front-end. We're a really small team, and with hardware, firmware, services, and apps, the engineering footprint becomes quite large. What often doesn't get factored in is manufacturing test rigs, plus we have software to support clinical research. I'm not complaining about it, but holding off on Android seemed to be the right move, as we can't remove any of the other functions. We've had quite a few requests for Android.

Workaccount2 1y ago

Was really interested in this until I saw it was another static hardware product with a subscription as if it were a service. If the toilet was invented today, plumbers would all be telling us how $1/shit is a steal.

codebje 1y ago
Here I sit, broken-hearted...
deleted 1y ago
[deleted]
nick49488171 1y ago
Great incentive to hack it open (like people did with eight sleep) or use prior art for an open source version.
- privatelypublic 1y ago
  Theres foss EEG machines already. $300ish to buy a fully working "same device as The FDA version just sans-certification." Much less if you want to build it yourself.
bravetraveler 1y ago
Consumer Poop Index, used to be a dime
yieldcrv 1y ago
That’s… actually a good way to have premium services on a bidet
- deleted 1y ago
  [deleted]
sschueller 1y ago
Then I could theoretically use a shit coin to pay for an actual shit...

danielscrubs 1y ago

Does it back up that it increases deep sleep? Just see word salads on the web page and: ”dont ask how it sounds, if it where a pill you wouldnt!” Just red flags everywhere.

pedalpete 1y ago
Fair point. To be clear, time in deep sleep does not increase. What increases is delta power, the primary measure researchers use for how restorative deep sleep is. This has been shown in the research, and our technology has been validated by an independent laboratory so that they could use it in their own clinical trial. On our site we simplify the language. That is partly because of the regulations do not allow us to make clinical claims prior to approval, and partly because explaining the neuroscience in detail would overwhelm most visitors. I link to the research so those interested can dive in deeper, and that is allowed.
- deleted 1y ago
  [deleted]

ionwake 1y ago

really cool Im sorry to hear you didnt get funding. I dont know much but isnt the problem related to what causes the build up in teh first place? wasnt it scarring or something?

pedalpete 1y ago
Thanks. We're used to not getting funding. It's part of the journey as a start-up and in research. The build-up isn't scarring. It's misfolded proteins in the brain which stick in places they shouldn't and the glymphatic system which flushes cerebrospinal fluid through the brain removes the build-up of these protiens. If you have poor sleep or lack of sleep, these proteins don't get removed and that build-up interferes and disrupts the firing of neurons. Alzheimer's drugs are able to help remove the build-up, but unfortunately are not able to repair the damage. That's why they only slow progression of the disease, not treat it. If slow-wave enhancement lives up to the potential, it would likely also only be preventative. It would be surprising if it was able to treat AD. If you want to know more, a comment in this post has what I think may be the most thorough breakdown of AD. https://www.astralcodexten.com/p/in-defense-of-the-amyloid-hypothesis https://www.astralcodexten.com/p/in-defense-of-the-amyloid-h...
- ionwake 1y ago
  Great stuff thank you!

arunabha 1y ago

Getting better sleep has been a bit of a personal quest for me. Having said that, much as I would love to get the device, having been bitten by a bunch of subscription locked devices by startups, I have (reluctantly) settled on a policy of not purchasing hardware that can't work independently of the company. Startups are hard at the best of times, hardware startups are harder. When the company making the hardware inevitably goes under, you are left with a useless piece of plastic that you paid a ton of money upfront for, and then paid a hefty sum every month on top.

pedalpete 1y ago
Thanks for this thoughtful response. The reason we use a subscription is to keep the upfront cost much lower. It's important to us that we make better sleep as accessible as possible. A one-time payment makes that more challenging at this stage. We also wanted to keep things simple at checkout. Too many options can be confusing, and at this early stage our priority is making it straightforward for people who want to try the technology. It's a delicate balance.
- sebasvisser 1y ago
  Having to select 2 items for 1 sleep intervention is a weird way of keeping things simple.. To help you a bit: 1 is easier… So 1 hardware product working independently is what we want. If you must to appease the shareholders do a subscription…make it add some functionality that would be impossible without a subscription… But locking people in a subscription to “keep upfront cost lower” is devious at best. Add to the world..don’t (cash)grab.
- esperent 1y ago
  It's understandable why you would need to do that. I'm not against subscriptions in cases like this. From my side as a customer, here's what I would need to see before supporting you: 1. A one off payment to own the current version of the device. This must include the ability to download all of my data that I generate from using the device. It can be in raw, unporcessed form. 2. A subscription is acceptable but would pay for cloud based data processing, generating reports etc. Processing and storing my data, in other words 3. A clear privacy policy stating that you will never sell my data in either raw or processed form. But I assume as a medical device that's already in place?

dotancohen 1y ago

Constructive criticism Your first FAQ answer begins extremely apprehensively. Is that even the number one most frequently asked question? I would suggest heavily revising that answer or getting rid of it completely. Many devices today support dark mode, such as my S24. The website does not display clearly in this mode.

pedalpete 1y ago
Thanks for the feedback. You’re right about the first FAQ, it doesn’t read well on mobile and I’ll rework it. On dark mode, we deliberately avoided it. Most sleep products lean into dark, sleepy visuals, which makes sense if the goal is to help people fall asleep or stay asleep. Our product doesn’t do that, so we are careful not to give the impression that it does, even though sleep is at the center of what we build. Our hope is that the brightness of our brand doesn’t mislead people, or lets us prevent them from misleading themselves. Does that make sense?
- dotancohen 1y ago
  To me it does not make sense, but I'm not your PM. Just your target market.
- sokka_h2otribe 1y ago
  You're describing why your default aesthetic is not dark. Dark mode however is just an accessibility concept, not really about aesthetics. For some people they work hard to make it aesthetically consistent. But honestly I think dark mode compatibility should not have to be a perfect replication
  - dotancohen 1y ago
    > But honestly I think dark mode compatibility should not have to be a perfect replication I agree with this.

impendia 1y ago

I have been on your mailing list for time, and at least semi-seriously thought about buying one. Like other readers, I saw the subscription business and got put off. Especially since it seems that every company eventually either "enshittifies" or goes on an "incredible journey".

pedalpete 1y ago
Well, start-ups are an incredible journey! :) We have no aim to "enshittify", I'm actually not sure what an incredible journey is? Can you elaborate on who has gone on such incredible journey's? I wonder if some of the enshitiffication is a result of investor demands (as another comment alluded to). We're doing our best to bootstrap Affectable. Bootstrapping a neurotech hardware start-up is not easy, and it's a bit of a miracle we've mostly managed so far. Thanks for your input, and your early support. I'd be keen to know if there were other details you'd like to hear about on our mailing list. We'll keep reviewing our pricing model based on feedback. We do appreciate you taking the time, and for your consideration.
- impendia 1y ago
  I'm referring to this website: https://ourincrediblejourney.tumblr.com/ https://ourincrediblejourney.tumblr.com/ Blog posts from startups who get acquired by big companies, talking about what an incredible journey their startup has been, and thanking their customers and promising ongoing support for their products. And then breaking these promises soon after. And no one aims to enshittify, but my understanding is that pressure from investors eventually becomes louder than that from customers. (Although perhaps less so in your case, as you say you're bootstrapping.) If you have a subscription model, you're asking me to trust you over the long term. But, if I understand your product correctly, there's no technical reason why I need to have an ongoing relationship with you or even an internet connection to use your product. Those are apparently business decisions. And I'm afraid those are decisions which lead me to trust you less.
  - pedalpete 1y ago
    Oh, I hadn't heard of that tumblr. The reality is that without a subscription, the product would not be viable. We would either have to charge nearly double upfront, or risk not being around to support it in a few years. The subscription lets us keep the starting cost lower, which makes the tech inaccessible for many people. The subscription balances that out, and it also means we can keep supporting the system over time instead of leaving people stranded. In a sense, it is actually what makes the long-term viability and hopefully trust possible. That's how we view it.

nozzlegear 1y ago

I'm a bit late to this, but if you're still around, I'm curious if this research would necessarily mean that people with sleep apnea or other sleep disorders (untreated or treated) are more prone to Alzheimer's as they age? I'm also curious if there's been any research on your technology being used on people who have sleep disorders. I took a look at the research you linked, but the second paper noted that people with sleep disorders were excluded from the study, and the first paper didn't mention sleep disorders or apneas at all. I ask as someone who has sleep apnea and uses a CPAP machine.

pedalpete 1y ago
My understanding is there is a directional correlation between untreated sleep apnea and Alzheimer's. Do you feel your CPAP improves your mental clarity, or mood? The reason I ask is the cognitive benefits of CPAP are inconclusive. It works in some people, not in others. It solves the hypopnea, but that doesn't mean slow-wave activity increases as a result. There is no research I'm aware of that has been published showing how slow-wave enhancement impacts people with sleep apnea. We work out of The University of Sydney, where CPAP was invented and work with a few former ResMed employees, and know a bunch of people who still work at ResMed. When we approached them a few years ago, they didn't seem very interested, but the science has progressed significantly since then, and it's getting pretty difficult to ignore it. I'll reach out and see if they're keen on supporting a study. BTW, have you tried a mandibular splint (biteplate)? My brother was on CPAP for about 8 years, and then moved to a moved to the biteplate about a year ago. He's MUCH happier with it.