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"Improving Snoring With a Game" Is No Longer a Dream: A Keio-Born Startup Challenges the Paradigm of SAS Treatment【2025 ICT Startup League Member Interview: ALAN Inc.】
In recent years, many people have likely heard the term "Sleep Apnea Syndrome" (SAS). It is a disease in which apnea (a state where breathing stops for 10 seconds or more) occurs 5 or more times per hour during sleep, or is repeated 30 or more times over a 7-hour night.
It is widely warned that leaving SAS untreated is dangerous, as the resulting low blood oxygen levels can lead to conditions such as high blood pressure, heart disease, cerebrovascular disorders, and diabetes.
ALAN Inc. is a startup from Keio University School of Medicine that is developing a therapeutic app for patients with mild SAS. CEO Takahiro Kondo is a doctor who balances clinical practice and research, treating patients at a sleep disorder clinic while also serving as a Project Assistant Professor at the Department of Orthopaedic Surgery, Keio University School of Medicine. He founded ALAN while leading this busy life because, as a doctor, he was concerned about the current situation in Japan, where it is estimated there are about 9 million moderate to severe SAS patients and about 22 million mild patients.
"For moderate patients, there is a treatment called CPAP (Continuous Positive Airway Pressure), but for mild patients who don't need to go that far, the current situation is that we just give them advice on daily life after diagnosis. There isn't enough of a medical approach for mild patients." We asked Mr. Kondo how ALAN is tackling this challenge and for details about the business.
Takahiro Kondo, CEO of ALAN Inc.Using "Gamification" to Promote Behavioral Change: A System to Support Continued SAS Treatment
SAS is being covered more in the media. Could you tell us about its dangers?
Kondo: It wasn't originally recognized as a dangerous disease, but in 1998, a study reported that the 10-year survival rate for severe SAS patients was in the 40% range, which shocked the world. The reason is that leaving it untreated makes one more susceptible to myocardial infarction or stroke.
That triggered more research, and from around 2010, awareness and treatment became more active, which brings us to the present. The Japanese Society of Sleep Research is also focusing on sounding the alarm.
I see. In that case, please tell us the details of the SAS treatment app ALAN is developing.
Kondo: We are aiming to commercialize a therapeutic smartphone app that analyzes the apnea index measured by our originally developed home sleep assessment device, "nemurin," in the cloud and uses AI to guide users toward improvement in 4 weeks. Simply put, it's an app aimed at treating patients with relatively mild SAS. SAS occurs when the airway (the path for air from the nose or mouth to the lungs) narrows during sleep. There are two main causes for airway obstruction. One is obesity. The other is having a small jaw. Many Asians naturally have smaller jaws, so symptoms can appear even in people who are not obese. Also, as is common among menopausal women, there are cases where symptoms occur even in slim individuals due-" to the tongue muscles weakening and turning into fat.
It makes sense that there are many mild cases among Japanese people.
Kondo: In many cases, SAS is discovered when someone points out symptoms like loud snoring or a sudden stop in snoring. However, in the case of women, they may be embarrassed by this and unable to bring it up, even if they want to.
So, in that sense, there are likely more latent mild patients than we imagine.
Kondo: Yes. So, what measures should mild patients take? If obesity is the cause, they need to lose weight. It's known that a 10% reduction in body weight can lower the severity index by 26%. Also, regardless of body type, the most effective thing is to do exercises around the mouth to strengthen the tongue muscles. As I mentioned earlier, the airway narrows because the tongue muscles relax and fall back. Therefore, strengthening the tongue muscles will widen the airway.
A "tongue workout," then.
Kondo: In fact, it's known that continuing appropriate tongue exercises for about a month can halve the numerical value of airway narrowing. If you ask what the app's main feature is, I believe it lies in promoting this tongue training and dieting to lead mild patients to treatment.
Is the image like a health management app, similar to a diet app?
Kondo: It proposes a treatment plan optimized for each patient by an AI algorithm, but it might be close to an app that says, "Let's do this workout together." I also want to include things like diagnostic questionnaires. SAS is often noticed through symptoms like loud snoring, sudden stops in snoring, waking up many times during the night, frequent urination, strong daytime sleepiness, headaches upon waking, and a lack of feeling rested from sleep (not feeling like you've slept soundly). So, a questionnaire can also give you a good idea of whether you likely have SAS.
It's said that the number of single-person households, including middle-aged and elderly people, will increase in the future. If there's no one to point out symptoms during sleep, such a questionnaire would be helpful.
Kondo: We are conscious of creating a mechanism for people to notice SAS early. By using nemurin's medical-grade measurement and analysis algorithm, which will be reflected in the app, we hope to achieve early screening centered on sleep clinics and improve treatment continuation rates. This could lead to the cure of mild patients and an associated reduction in medical costs.
It has the potential to dramatically advance SAS treatment.
Kondo: However, I don't think everyone will use it immediately just because we say, "We made an app, please use it." So, we plan to add game elements to the training. It's easier to change behavior if there's an element that gives you a gentle push. This is so-called "gamification" (incorporating game elements into non-game fields to improve motivation). We also plan to include educational content that promotes understanding of the condition to lead to prevention. We want to make it a comprehensive app that includes various content related to SAS treatment.
App screen under developmentInspired by a "Higher Perspective": The League Academy Accelerated the Pace of Social Implementation
What motivated you to apply for the ICT Startup League?
Kondo: We had originally developed nemurin, but we felt that as both doctors and a company, we needed to intervene not just in sleep assessment but also in treatment. So, we started developing a mouthpiece to secure the airway for moderate patients. We were then considering the development of a therapeutic app for mild patients, for whom treatment approaches are lacking. Right at that time, I learned about the ICT Startup League and applied, thinking that an app, unlike the mouthpiece, would be eligible.
What aspects of the league did you have high hopes for?
Kondo: Development funding, of course, but even more so, I believe awareness and dissemination activities are crucial for an app. The ICT Startup League was attractive because it seemed they would provide hands-on and background support in those areas as well. As a hook to get people to know the app, I thought if we could put out a message like "Improve your snoring with a game!" people might get interested. We want our app to be the starting point for a platform that disseminates information about SAS.
That's true, even for someone with extensive experience in medical research and practice, that's outside your specialty.
Kondo: We have abundant knowledge about the world of medicine. However, to spread the app further, activities in a wider range of fields, including media, will be necessary. In that sense, the existence of the League Academy is also a big factor.
In what way?
Kondo: For example, the Value Up Sessions have been very stimulating. It was great to see up close how they think big, like "What connects to what?" and "What is value?" Their perspective is just one or two levels higher. For our business, I feel I've become able to see it not just as "healthcare," but as "healthcare within some larger framework."
It's common for people to be unaware of their own potential or the scale of their possibilities.
Kondo: We had been thinking about expanding our app by partnering with some large company or project. However, I thought that move was for next year or the year after. But now, after participating in the League Academy, I have a feeling we might be able to do it by the end of this fiscal year. Right now, our company's business is mainly development. As we move toward social implementation, we may need to bring in people skilled in business. I have high hopes for the ICT Startup League to provide possibilities for such encounters as well.
From Japan, a Leader in Sleep Issues, to the World: A Roadmap Drawn with an App and a Mouthpiece
Regarding the app under development, please tell us about your future plans.
Kondo: We are focusing on sales to corporations. Since we have the nemurin device, people can get their sleep evaluated without going to a clinic. By combining that with the app, we can promote the health of employees. The Ministry of Economy, Trade and Industry (METI) is currently promoting corporate health management, so we believe there is a need there.
It seems there would also be demand from government and municipal health promotion initiatives and health checkups.
Kondo: Yes. We can't reach all of them right now due to staffing issues, but it's something we see in our future. For example, events like sleep seminars held by doctors get a good response, so we'd like to popularize the app through those channels as well.
Getting the word out is the first priority.
Kondo: Japan is a country with overwhelmingly little sleep time to begin with. Sleep disorders themselves are often taken lightly, and it's sometimes called a "nation of insomnia." In a sense, this means we are an advanced country in terms of sleep problems. So, I would be happy if the spread of apps and other tools promotes awareness and raises sleep literacy.
If Japan is an advanced country for sleep problems, it seems the know-how ALAN gains could be exported overseas.
Kondo: Of course, we are considering overseas expansion. However, the mouthpiece will probably come before the app. The app reflects the local circumstances of each country in its treatment methods and characters, so it's difficult to export it as-is. In that respect, the mouthpiece is deep tech, so I think it will be easier to spread overseas.
Just like the League Academy discussion earlier, ALAN's business holds great potential.
Kondo: Sleep is a very large market. If we can establish a position there as "ALAN for sleep tech," the company should be able to grow significantly. However, our stance is that we are developing a treatment method rather than just doing business. It's meaningless if we don't deliver results to the patients who are genuinely in need, so I want to emphasize that.
Do you have any other ideas for new businesses?
Kondo: Just an idea, but since tongue training is training for the area around the mouth, I feel it could be linked to oral training for the elderly. But first, sleep. Getting results with the SAS treatment app is the priority.
Sleep assessment device "nemurin""Delivering to Those in Need Now": A Doctor's Mission to Implement Research in Society
What motivated you to become a doctor?
Kondo: I originally went to medical school wanting to be involved in medicine in the field of research rather than clinical practice. It started when I read a biographical manga about Hideyo Noguchi in elementary school and thought that treating diseases through medical research was cool. It's often said that a clinical doctor can treat about 100,000 patients in their lifetime, but with research, if you can discover a new treatment method, you can save tens of millions of people in the future. That's what I was aiming for, and it's why I'm still involved in research today.
That's very inspiring. Was starting a business also part of that flow?
Kondo: That's right. For example, a world-changing discovery of a new treatment method is something that only happens when an incredible genius, through incredible effort, also has incredible luck. As I also gained clinical experience, I saw the front lines and realized there isn't much in the "middle ground" between clinical practice and research that leads to world-changing discoveries.
Could you be more specific?
Kondo: In short, there is a lot of research and discovery that, while not a world-changing finding, is at a level that can improve or suppress some symptom. However, perhaps because it doesn't make money, those research results are not often implemented in society—that is, they have difficulty reaching the front lines. This kind of research result might disappear in the future, unlike a world-changing discovery, but many of them are effective for people who are in need *right now*, so shouldn't we deliver them immediately? Isn't that also a form of treatment? That feeling also influenced the founding of ALAN.
If meaningful research results don't reach patients because they "don't make money," then by starting a company and making it even a small business, you can lead it to treatment. I can feel the origin of your respective projects—the SAS treatment app, the mouthpiece, and nemurin.
Kondo: The realistic trigger for starting the business was the COVID-19 pandemic, though. I was scheduled to study abroad starting in 2020, but it was canceled due to the pandemic. While I was feeling frustrated, a colleague mentioned that we might be able to start a business with our research. That's when I started applying to business contests.
So it wasn't "business first" from the beginning.
Kondo: That's why my focus is not on the business but on social implementation. Emotionally, even though it's a business, it feels like I'm treating patients. That's precisely why the SAS treatment app is only meaningful once it's disseminated and popularized. I genuinely want to deliver the treatment. At its core, that's the same as my reason for wanting to become a doctor.
Editor's Note
The analysis algorithms and AI technology play a crucial role in the SAS treatment app. At first glance, they may not seem directly connected to medicine, but Mr. Kondo says he encountered them during his research in his younger days.
"We ended up using big data analysis when testing treatment methods. I didn't dislike math, so I was able to handle it. I'm 42, but in the medical field, there aren't that many people my age with knowledge of analysis systems, so I became sought after for various things."
Amidst this, while analyzing animal locomotion, he thought the technology and results could be applied elsewhere, which led him to analyze the gait of Parkinson's disease patients. As it turns out, sleep disorders were one of the symptoms of Parkinson's, and that became his encounter with sleep disorder research.
"As a result, I also started analyzing human sleep data." It was an episode that made me feel anew that you never know what will become a turning point in life.
■ICT Startup League
A support program launched in FY2023, originating from the Ministry of Internal Affairs and Communications' "Support Program for R&D in Startup-driven Advanced Technologies."
The ICT Startup League supports startups through four pillars.
①R&D Funding / Hands-on Support
Provides up to 20 million yen in R&D funding as a subsidy. Additionally, through hands-on support, the selection committee members who were involved in screening the league members stay with them post-selection to promote their growth. For companies that a committee member "absolutely wanted to select," a "fan-like" support system is built where the committee member themselves continuously provides advice on business plans and offers growth opportunities.
②Discovery & Development
We provide opportunities for learning and networking to promote the business growth of league members.
We also work to discover those aiming to start businesses in the future, aiming to expand the base.
③Competition & Co-creation
It serves as a place for positive competition, much like a sports league, with a system where startups learn together, engage in friendly competition, and win the funding they truly need (up to 20 million yen). We also provide a venue for co-creation, where league members can collaborate and expand their businesses through various opportunities, such as sessions by the selection committee members.
④Promotion
We will promote the initiatives of league members in collaboration with the media! By letting many people know about their businesses, we aim to expand opportunities for new matching and chances.
■Related Websites
ALAN Inc.
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ALAN Inc. (LEAGUE MEMBER)
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ICT Startup League
