The problem with Ireland's obsession with sleep trackers

Fantasising about the perfect night's sleep is not unusual for busy professionals and sleep-deprived parents. Getting a full eight hours is #weekendgoals after all. Comedian Mindy Kaling famously said "there is no sunrise so beautiful that it is worth waking me up to see it".

But what about when this fantasy, fuelled by wearables and other sleep tracking tech, turns into obsession? There is, in fact, a clinical term for this: orthosomnia. Researchers coined the word after observing patients complaining of sleep disorders, convinced that data-gathered by their wearable device was a more accurate indicator of their quality of sleep than how the patient themselves felt upon waking.

One case study cited by these researchers tells us of a 40-year-old man who was referred for treatment for insomnia. The man reported light and fragmented sleep and an inability to achieve a full night’s sleep, which he said was leading to poor concentration and irritability. In place of a sleep diary he presented the graph on his sleep-tracking app showing “undeniable” evidence of this broken sleep and an average of seven hours and 45 minutes of sleep per night. If only he could make it to the full eight everything would be alright.

Further questioning revealed he worked right up until he went to bed, and frequently woke during the night to check his phone. It was suggested that his stressful job combined with anxiety was causing his poor mood and inability to concentrate. But he remained convinced that the data from his sleep app was the key to solving his sleep problems. And so he continued to keep a sleep schedule of 5:30pm to 6am in a quest to win a higher score on his sleep app.

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"Each patient was seeking treatment due to perceived insufficient sleep or periods of restlessness or light sleep," said Dr Kelly Glazer Baron and her colleagues in their Journal of Clinical Sleep Medicine research findings.

“Despite multiple validation studies that have demonstrated consumer-wearable sleep-tracking devices are unable to accurately discriminate stages of sleep and have poor accuracy in detecting wake after sleep onset, we found patients’ perceptions difficult to alter,” they added.

And this is the crux of it: when quantified self-ers want to live and die by the data, what if that data isn’t as reliable as they think?

Sleep diaries

A 2018 study compared the accuracy of four wearable sleep trackers: the Jawbone UP3, Fitbit Charge HR, Garmin Vivosmart, and Sensewear Mini. Twenty-four-hour monitoring of 79 subjects over a three-day period found that these trackers, when compared to the subjects' sleep diaries, did a good job of detecting when someone fell asleep.

Crucially, however, the trackers “cannot be considered valid regarding wake times during a night of sleep”.

In other words your sleep app may be telling you about broken sleep that didn’t actually happen. This is something that needs to be taken into account when, as the study authors say, “users are trusting these devices to provide them with information about their daily sleep patterns, potentially in the hopes to make positive lifestyle changes”.

Before even considering a sleep tracker, better sleep could be achieved by making lifestyle changes around when and how your smartphone is used. Because researchers say the more interactive the device, the more likely it is to cause problems with both falling asleep and with the quality of our slumber. But this is only if you are using smartphones or tablets within an hour before bedtime. Perish the thought.

The problem with us Irish is that we are glued to our phones: a Deloitte survey from 2017 found that a third of us are checking our phone within five minutes of going to sleep, while 40 per cent check their phone within five minutes of waking. And if that's not bad enough almost half of us sneak a look if we wake up in the middle of the night.

There are several reasons why this is thought to be bad for our sleep. Research suggests light emitting devices can delay one’s circadian rhythm and supress the sleep hormone melatonin, which reduces alertness upon waking. There is even a tentative link between night-time exposure to blue light (what smartphone screens emit) and diabetes, heart disease and obesity. Additionally, the stimulating nature of using interactive devices (as opposed to a TV or radio playing in the background) may make it tougher to drift off.

Sleep hygiene

It’s a vicious circle when a wearable tracker’s data is typically accessed via a smartphone app, but one solution is to implement good “sleep hygiene”. This is essentially a set of techniques or habits to encourage better sleep.

The American Heart Foundation has developed a specific list for smartphone addicts: move it, dim it, set it, lock it, block it. In other words keep the phone away from your bedside, turn on the blue light filter, set an alarm to remind you to stop using your phone, lock down social media apps that may tempt you, and put your phone on "do not disturb" or airplane mode.

And educating ourselves about the limitations of sleep trackers is also useful.

"People who don't have experience interpreting data may not detect when unusual patterns are just a fluke in the system," says Erin Gwozdz, a user experience designer with data visualisation company GroupVisual.io.

In her Medium post on problems and possibilities for the self-tracking industry she warns that this lack of understanding can also lead to these potentially useful devices being ditched too soon. “People who aren’t comfortable with technology will be more likely to ‘give up’ quicker, creating more waste and missed opportunities.”

This rings true because although the wearables market is doing well and, according to PwC, is expected to reach $150 billion by 2027, studies show that around a third of owners ditch their device within six months.

Lynn Coorevits and Tanguy Coenen carry out research into hurdles to adoption of certain innovations, and they have concluded there are several reasons including that fact that the device doesn't meet expectations, isn't robust/accurate enough, or they forget to wear/charge it.

Consistency

“One of the challenges in wearable technology is the consistency and accuracy of data,” they say.

“To be of more value the device and application will have to capture more accurate and diverse data that can be integrated in a broader ecosystem. Data inaccuracy and access to limited data is mainly a byproduct of mismanagement of expectations of the device’s capabilities and its expected usage.”

So, what should we expect? What are these devices measuring while we sleep?

The most common are wearables worn on the wrist. Whether it's a FitBit, Garmin, Samsung, or Apple Watch, these all-round activity bands primarily track movement (and sometimes heart rate) to gauge: 1) sleep duration, 2) sleep quality i.e. amount of tossing and turning, waking up during the night, and 3) sleep phases (light, deep or REM).

One of the more tailored devices on the market is the Withings Sleep, a smart mat designed to sit under a mattress and monitor multiple inputs to give the user an overall sleep score. In addition to detecting movement and translating this into the various sleep phases, the mat has heart rate and snore detection (although your partner may already have pointed this out).

Of more interest is a feature for those who suspect they have sleep apnea: the mat detects nocturnal breathing disturbances. The app advises that if the mat is reporting a high level of sleep disturbances and the user is waking up with sleep apnea symptoms including morning headaches and daytime sleepiness, they should consult a doctor. As Withings points out, sleep apnea is an often silent condition that roughly 80 percent of sufferers do not know they have.

More features

If you are willing to throw down €100 it’s a sleep tracker with more features than others and you don’t have to remember to wear it, just keep it plugged in. I bought this recently and I like the fact it doesn’t have to be charged or worn on the wrist but I take my sleep score with a pinch of salt; it has sometimes recorded sleep when I know I was awake and vice versa.

A colleague of mine bought the Oura Ring (endorsed by Twitter's Jack Dorsey) and although it is one of the more accurate trackers on the market, he said he was losing sleep over worrying about losing sleep. Sleep data-induced anxiety was ironically leading to a worse night's kip.

What’s the point of these devices if they’re not always accurate and we’re tying ourselves up in knots over our “sleep score”?

Well, in addition to the technology becoming more accurate with each iteration, there are many uses. It could mean the end of waking up groggily to the sound of an alarm blaring because you were roused from deep sleep: sleep trackers can time the alarm to go off within a certain window of time when it detects that you are sleeping less deeply so in theory you’ll be less dazed and confused even if it is an early rise.

The Withings Sleep mat uses the IFTTT service to connect to both Philips Hue and Nest Thermostat so it can dim or switch off the lights when it detects you have fallen asleep or turn on the heating when you wake up.

If you are a bone fide member of the quantified self movement and like to log other things including your steps, exercise, and diet, then the combined data can yield interesting insights. For example, you might find that you sleep better after a day spent mostly outside, your sleep is deeper on days in which you fit some mindfulness practice, or a steak dinner leads to hours of tossing and turning.

Deep sleep

Sleep data is also interesting across a population level. It can tell us about differences in sleeping patterns across gender, age and location. With the caveat that this data isn’t 100 per cent reliable, FitBit carried out the biggest ever sleep study in 2017, combing through data from millions of its users.

The average FitBit user falls asleep at 11:36pm and wakes up at 7:17am. They don’t get the full eight hours but rather six hours and 38 minutes.

Although deep sleep for 25 per cent of the night is said to be optimal, the average person achieves only 15 per cent. If anything, technology is allowing us to see that these prescribed norms for good sleep are not actually that “normal”. So if you want to buy a sleep tracker go ahead – but don’t lose any sleep over it.