Wearable devices are becoming more and more popular, and people are using them in a range of ways that may or may not follow the instructions for use given by the manufacturers. Even more concerning, the companies that market these devices do not publish data about how they have been shown to work, or about the algorithms used to analyse if the wearer has had “good sleep” or not. External research has shown little, if any correspondence between the results from a wearable, wristwatch type device and those from the more accurate polysomnography tests, which measure brain waves through direct contact of electrodes with the skin. In contrast, the wristwatch device measures movement throughout the night. It may mistake lying awake and still for sleep, and it may not have any way to distinguish between “deep” and “light” sleep, and may even give a measure for REM sleep, which is normally only 11% to 12% of total sleep time.
However, clinicians are observing an alarming trend in which people come to them showing the device data as “proof” that they are not sleeping well. In many cases, they will actually disregard information from any other source, even a personal sleep diary, which may show feeling refreshed on waking, or low sleepiness throughout the day. Users are placing a level of credibility and reliance on the device which is not borne out, either by scientific data or by their own experience. People believe that there is some “ideal” sleep that they can chase using the device, and become anxious when their sleep doesn’t seem to fit the pattern. This concern is called “orthosomnia”, meaning there is a “true” or “right” way of sleeping that the device will monitor.
Katie Fischer, a behavioral sleep therapist quoted in the Guardian says: “[I have] seen clients distraught because their trackers have recorded only 11% deep sleep a night. I tell them that’s pretty normal. We sleep in cycles of roughly 90 minutes and we transition between light, deep and REM phases. For most people, deep sleep will only account for 13-23% of the night. Time awake is also a normal part of sleep. We can have between three and six rousings a night; often we’re not even aware of them. Most people have no idea what normal sleep looks like, so they panic when they see stats with lots of awakenings and not much deep sleep.”
Therapists have even seen patients complaining of insomnia refuse further treatment because the therapist tries to get them to look at the bigger picture beyond the sleep tracker. It will be important to find ways to acknowledge patients’ experience and trust in the device while helping them understand its limitations and the realities of “normal” sleep. Education about sleep and insomnia is not a priority of the companies marketing these devices, so people are not very well-versed in how the data from the device may be interpreted and used.
MoodSurfing recommends Cognitive Behavior Therapy for Insomnia (CBTI) above medication or other interventions. CBTI has a track record of producing measurable results across different populations and can be followed at low cost through online programs. The CBTI approach will incorporate data from a wearable device, but will not view that data as more authoritative or reliable than other available information and inputs.