Stimulation methods and apparatus

Abstract

The present methods and apparatus can provide improved efficacy with improved tolerance. The methods and apparatus can be configured to alter the stimulus, which can decrease neural adaptation of the subject and provide an improved response. The acoustic stimulus can be delivered as a tone, which can make the stimulus more acceptable to the subject receiving the stimulus. The stimulus may comprise a varying stimulus in order to decrease neural adaptation to the stimulus. The stimulus can be varied by varying one or more of a duty cycle, a frequency, or a shape of the waveform. The waveform may comprise a plurality of individual pulses, in which the waveform varies among pulses of the plurality. Acoustic stimulation can be combined with electrical stimulation. The device may comprise a plurality of sensors to determine the response of the subject.

What is claimed is: 
     
         1 . A method of treating a subject, the method comprising:
 delivering a stimulation pattern comprising a combination of vibratory, acoustic, and electrical stimuli to skin of the subject in an area at or near one or more of an auricle or an ear canal of the subject, the area comprising underlying sensory nerve fibers and subcutaneous tissues; and   adjusting two or more of the vibratory, acoustic, or electrical stimulation while the stimulation pattern is provided to the skin of the subject.   
     
     
         2 . The method of  claim 1 , wherein the stimulation pattern is delivered as a plurality of vibratory pulses to the subject, the plurality of pulses comprising a frequency corresponding to a harmonic of a pitch. 
     
     
         3 . The method of  claim 2 , wherein the frequency is within a range from about 20 Hz to about 20,000 Hz. 
     
     
         4 . The method of  claim 2 , wherein delivering the stimulation pattern comprises stimulating the ear with a plurality of frequencies corresponding to frequencies of pitch. 
     
     
         5 . The method of  claim 1 , wherein the acoustic stimulus is provided at a frequency audible to the subject. 
     
     
         6 . The method of  claim 1 , wherein the stimulation pattern is delivered based on at least one real-time sensor measurement. 
     
     
         7 . The method of  claim 6 , wherein the at least one real-time sensor measurement is provided by one or more sensors comprising one or more of a heart rate, a heart rate variability, a measure of sleep quality, an ECG, an accelerometer measurement, a breath rate, an oxygenation percentage, or a temperature. 
     
     
         8 . The method of  claim 6 , wherein the one or more sensors are located behind an ear of the subject. 
     
     
         9 . The method of  claim 1 , wherein the stimulation pattern is adjusted based on the at least one real-time sensor measurement. 
     
     
         10 . The method of  claim 9 , wherein the two or more of the vibratory, acoustic, or electrical stimulus is adjusted based on real-time feedback from the subject from the at least one real-time sensor measurement. 
     
     
         11 . The method of  claim 1 , wherein the vibratory and acoustic stimuli are provided by an actuator positioned at or near the skin of the subject in an area at or near one or more of the auricle or the ear canal. 
     
     
         12 . The method of  claim 1 , wherein the electrical stimulus is provided by an electrode positioned at or near the skin of the subject in an area at or near one or more of the auricle or the ear canal. 
     
     
         13 . The method of  claim 1 , further comprising synchronizing delivery of the electrical stimulus with delivery of the vibratory stimulus and the acoustic stimulus. 
     
     
         14 . The method of  claim 1 , further comprising delivering a drug in combination with the vibratory, acoustic, and electrical stimuli. 
     
     
         15 . The method of  claim 1 , wherein the stimulation pattern is provided by an auricular stimulation device comprising one or more of an ear canal portion or a behind the ear portion. 
     
     
         16 . The method of  claim 1 , wherein delivering the stimulation pattern comprise delivering a first stimulation pattern to skin of the subject at or near one or more of an auricle or an ear canal of a first ear and delivering a second stimulation pattern to a second stimulation pattern to skin of the subject at or near one or more of an auricle or an ear canal of a second ear. 
     
     
         17 . The method of  claim 16 , wherein the first and second stimulation patterns are different. 
     
     
         18 . The method of  claim 16 , wherein the first and second stimulation patterns are the same. 
     
     
         19 . The method of  claim 16 , wherein the first and second stimulation patterns are synchronized with one another. 
     
     
         20 . The method of  claim 1 , wherein the stimulation pattern treats one or more of atrial fibrillation, bradycardia, tachycardia, pain, myocardial infarction, stroke, inflammation, heart failure, atherosclerosis, Alzheimer's disease, arthritis, Crohn's disease, or insomnia. 
     
     
         21 . The method of  claim 1 , wherein the adjusting of the two or more of the vibratory, acoustic, or electrical stimulation decreases a neural adaptation of the subject to the stimulation pattern. 
     
     
         22 . The method of  claim 1 , wherein the adjusting of the two or more of the vibratory, acoustic, or electrical stimulation is based on a response of the subject to the stimulation pattern. 
     
     
         23 . The method of  claim 1 , further comprising cancelling environmental noise with one or more of the vibratory stimulus or acoustic stimulus provided by the first actuator.