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Orthosomnia & Wearable Sleep Tech - The Apeiron Life Perspective

6 min read

What it is:

Wearable health and fitness trackers are currently used by about 30% of people in the United States. Towards the end of the 20th century, wrist and hip-worn devices began to be utilized by sleep researchers to record sleep-wake patterns in the context of sleep disorders while monitoring the effects of various interventions. These days, commercial wristwatches, rings, and “nearable” (meaning placed next to, but not on, the body, such as in a mattress, for example) multisensory devices are available for the general population to use.

These devices are generally connected to a cellphone app via Bluetooth, and the data are accessible at the touch of a button. For some people, this proves highly effective in helping them to prioritize sleep and develop better bedtime habits. But for others, the constant feedback, combined with the growing popularity of “sleep optimization” to achieve better health, can lead to orthosomnia or the obsession with perfecting sleep.



What the science says:

Sleep researcher Dr. Kelly Glazer Baron and colleagues coined the term "orthosomnia" in 2017 after noticing that patients seeking treatment for insomnia were voicing concerns about their wearable data upon visiting the clinic. Akin to the term "orthorexia," or the obsession with healthy eating, orthosomnia refers to an unhealthy preoccupation with achieving what a person perceives as "optimal" sleep, to the detriment of their wellbeing.


There are many reasons that health trackers can improve personal wellness goals. One of the more commonly reported is the reminder to get more steps in during the day. In the context of sleep, pre-bedtime reminders can help the wearer to unplug from work or other stimulating activities and promote a regular wind-down routine that improves relaxation and better sleep.


The problem is that some of the other parameters - that vary from one app to the next - can trigger unnecessary concern. Furthermore, the devices currently on the market are generally not nearly as accurate as an in-lab sleep study and, therefore, typically do not capture sleep as it truly is.

Apps that assign a score to sleep, such as a percentage out of 100, combined with terms like "good" and "fair," can be motivating, but they can also lead to a perception of feeling as though one is not doing well enough. Perfectionist-type personalities often struggle with this.


But we cannot force sleep. Nor is it a time to perform. In fact, the best way to think of sleep is as the ultimate act of letting go. Seeing a poor score for the previous night should not be an incentive to "try harder" at the next opportunity but rather an indication that one might need a little more downtime.

Most of the devices on the market today use movement and heart rate to approximate sleep versus wake, and the different stages of sleep itself, known as "sleep architecture." Commercial-grade device developers typically utilize a proprietary algorithm to estimate whether any given timeframe (sleep is usually broken down into 30-second or 1-minute epochs) is a period of sleep or wakefulness. They do this by considering what happened a few minutes before and after the timeframe. For example, suppose the wearer has been lying very still for several minutes. In that case, the next minute in question is more likely to be a sleep period, especially if the several minutes following it also lack movement. But the problem is that one can be lying awake very still in the middle of the night and the algorithm might predict this period as "sleep" when in fact the person is awake.


The algorithms tend to incorporate time of day into their models as well. This means that night or rotating shift workers who sleep or nap during the day are likely to have even less accurate data.

The added heart rate measure helps to build a clearer picture of sleep-wake patterns than movement alone, as resting heart rate slows at night, becoming lowest during deep or "slow wave" sleep. Even if movement is lacking, an elevated heart rate can signal wakefulness. Newer devices build on this further by monitoring skin temperature and conductance, which can also indicate autonomic nervous system arousal throughout the night.


A landmark study led by Dr. Evan Chinoy in 2021 compared seven popular sleep trackers with the gold standard, in-lab polysomnography (PSG). All devices (including models from Fitbit, Garmin, EarlySense, ResMed, and SleepScore were highly accurate at detecting sleep but much less accurate at detecting any wake within or at either end of a period of sleep.


When approximating the time spent in various sleep stages (i.e. light, deep, or rapid eye movement (REM) sleep,) these devices generally performed much worse than PSG. Sometimes scores were correct only about 50% of the time.

Dr. Chinoy's study highlights some noteworthy items when measuring sleep using wearable or nearable devices at home.

Firstly, take a cautious approach when viewing the snapshot of a full night of sleep that shows the total time spent in various sleep stages. This data is unlikely to be accurate.

Many people fear they are not getting enough deep or "slow wave" sleep, technically defined as non-REM stages 3 and 4. But it's important to note that the amount we get naturally varies from night to night (affected by things like exercise and illness) and generally decreases with age. Despite what we know about how vital this type of sleep is, there might not be anything inherently wrong with these patterns, and the other stages of sleep are also incredibly beneficial.


Another issue is that because these devices are generally bad at detecting periods of wake during the night, they might not accurately record insomnia. When diagnosing insomnia in the clinic, self-reported sleep quality recorded in sleep diaries and surveys is generally still the primary method used. At the end of the day, if a person struggles with excessive sleepiness during the day and spends too much time frustratedly laying awake at night, this needs addressing.

The feedback from devices can sometimes cause insomnia where it did not exist before. Given the general recommendation that adults need 7 to 9 hours of sleep each night, device wearers may worry if their app reports a sleep duration that is less than this and force themselves to spend more time in bed than is biologically necessary. Excessive time in bed, accompanied by frustration about not falling asleep, can lead to insomnia by creating a negative association with being in bed tossing and turning. While the recommended 7 to 9 hours applies to most people, there are exceptions. If you aren't tired, don't try and force yourself to spend more time in bed than is necessary.

Secondly, the growing popularity of sleep-tracking devices encourages additional cellphone usage around bedtime or in bed. Exposure to blue-light emitting devices (such as cellphones, tablets, and laptops) can suppress the sleep-inducing hormone melatonin, leading to wakefulness at night. This tends to be exacerbated when individuals don't spend enough time outside during the day, typical for many office workers or individuals who live at extreme latitudes during the winter months.


Cellphone use in bed can be stimulating, depending on the content, which may lead to sleep disturbances. What starts as a quick check of the sleep tracker app may end with an hour of responding to emails or using social media in a negative way that elicits a stress response immediately preceding sleep.



Our take:

How a person feels about their overall sleep quality and daytime performance is just as important, or arguably more important, as wearable or nearable data. Despite what the app indicates regarding the time you spent asleep the previous night or how much of that time was spent in the various sleep stages, the most important thing to pay attention to is how you feel. If you wake up feeling refreshed and can function well at work, during exercise, and in social activities, in the way you would like, then don't worry too much about the data. But importantly, if you find the constant feedback from devices is causing more anxiety than positive effects, speak to your Client Advocate, as this item may not be for you.


Will this benefit you?

Sleep trackers can help detect conditions like sleep apnea when someone doesn’t know they have it. As reported by these devices, frequent nighttime awakenings may indicate sleep-disordered breathing, which is associated with several adverse health outcomes. If this is combined with snoring, pauses in breaths during the night, morning headaches, high blood pressure, trouble concentrating during the day, and excessive daytime sleepiness, it’s worth speaking with a doctor about screening for sleep apnea.


Devices that record heart rate variability (HRV) can also be useful for athletes and those who enjoy frequent high-intensity exercise by providing feedback about overtraining. In general, high HRV is associated with a healthy balance of the sympathetic and parasympathetic branches of the nervous system. A sudden or sustained drop in HRV can indicate excessive mental or physical stress and call attention to the need for more downtime.



If you still want to try it, here’s what to look out for:

Like all technology, sleep trackers are tools that can help or hinder depending on the individual and various ever-changing factors. Their use should be a personal decision that promotes a greater sense of well-being, not an obligation that adds an added layer of pressure.


If you suspect the tracker might be doing more harm than good to your mental health, consider speaking with your Apeiron Client Advocate for alternative support.


References:

Evan Chinoy Sleep Tracker Comparison: https://pubmed.ncbi.nlm.nih.gov/33378539/

Past, Present and Future of Wearable Sleep Tech: https://pubmed.ncbi.nlm.nih.gov/34713186/

Performance of Consumer Sleep Trackers: https://pubmed.ncbi.nlm.nih.gov/32005346/

Sleep Stages Summary: https://www.sleepfoundation.org/stages-of-sleep


 

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