People Are Losing Sleep Over Tracking Their Sleep

By Emily Reynolds | March 10, 2017 9:58 am | NYMag.com

The quantified-self movement is a multi-multi-billion-dollar industry; in 2015, the market was worth an estimated $123 billion, a figure expected by some analysts to grow to $612 billion by 2024. And yet the idea of keeping careful track of your steps (or your calories, or your carbs, or whatever) has taken some hits in the last year or so. Recent studies have found, for example, that the data some fitness trackers collect may be “highly inaccurate,” and collecting all that data doesn’t seem to help people lose much weight — perhaps because it makes exercise seem like an annoying chore.

And now, some researchers are starting to question the usefulness of sleep trackers. A new paper, published last month in the journal Sleep Medicine, links sleep-tracking apps and devices to more sleep problems, perhaps because of the way they tend to increase sleep-related anxiety.

Let’s not read too much into this report, authored by researchers at Rush University Medical Center, as it consists of only a handful of case studies. Still, the anecdotal evidence presented here may ring true for other users of sleep-tracking devices or apps. In one of those case reports, the study authors introduce a patient they dub “Mr. R,” who complained that he’d been waking up feeling irritable and absentminded. And according to his sleep tracker — a thoughtful recent gift from his girlfriend — this only happened when he hadn’t had eight hours of sleep. So he set himself a goal to sleep eight hours every night, as measured by his sleep tracker, of course. This, it turned out, was something of a catch-22 for poor Mr. R. Anxious about his need to achieve eight hours of sleep every night, he found his sleep getting worse and worse. And so too his obsession with his sleep tracker.

Mr. R’s experience echoes that of others, like the commenters on a Fitbit-themed message board. “I was very interested in getting the Flex to track my sleep,” one woman wrote in 2014. “[But] once I started seeing how much I was waking up and restless during the night, I had even more issues with sleeping.” And last year, science writer Ben Sullivan wrote a piece for Motherboard headlined, “Tracking My Sleep Kept Me Awake at Night,” in which he detailed his own sleep-tracking neuroses:

It became almost impossible for me to fall asleep peacefully because the Fitbit was making me so apprehensive. I would lie awake in bed worrying that the night before’s sleep wasn’t good enough (just one hour and 56 minutes of solid, undisturbed sleep, according to my app) and that tonight’s could be even worse. Sometimes, I would try to lie perfectly still in order to fool the Fitbit into thinking I was asleep.

It makes sense. As Kelly Baron, clinical psychologist at Rush University Medical Center and co-author of the study, explained, sleep trackers can cause people to “fixate on a number” — whether that’s calories, steps, or minutes of sleep. If you’ve ever had trouble falling asleep at night and have done the mental math to calculate how many hours of sleep you’d get if you fell asleep now — or, ugh, another hour has slipped by, but what if you conked out right now — then you know that fixating on a number is not the surest route to dreamland. The researchers even gave this fixation on healthy sleep a name: “orthosomnia,” which the researchers say they chose “because the perfectionist quest to achieve perfect sleep is similar to the unhealthy preoccupation with healthy eating, termed orthorexia.”

But, unlike other quantified-self offshoots, sleep is much harder to control. Walking 10,000 steps a day is pretty much in your hands. Getting eight hours of sleep, however, is not. And this fixation on getting the best possible sleep can also encourage problematic sleep behaviors, Baron says. “For example, it’s recommended to spend at least eight hours in bed,” she says. “But in trying to reach that perfect eight hours at night, people can get into bed too early, before they’re really sleepy, or lay in bed longer trying to force themselves back to sleep.”

Unsurprisingly, incessant checking of phones can also be a problem. Almost all sleep-hygiene plans recommend reduced screen time before bed, but worrying about sleep — and, therefore, checking tracking apps — can mean patients are “exposing themselves to light and mental stimulation,” which (surprise!) can also increase anxiety, Baron says.

So how useful are trackers, anyway? Baron is somewhat skeptical, though she’s “happy to see so many people are interested in improving their sleep.” Trackers can certainly help people observe their sleeping patterns, but she worries that some users fail to take promises of a truly quantified self “with a grain of salt,” she says. “They aren’t perfect at measuring sleep, and you can’t control your sleep every night.”

Simon Durrant, a cognitive neuroscientist who works in the Sleep and Cognition Lab at the University of Lincoln in the U.K., shares these concerns. “The level of precision promised by trackers, and hoped for by many users of trackers, is both unachievable in practice and not particularly beneficial in any case,” he told me. “As such, when people start to use that data as the basis for decision making, it’s a concern. It’s usually based on an erroneous belief that because the tracker is giving out numbers, it must be accurate and taken as gospel.”

Durrant says that the only circumstance in which he’d recommend a sleep tracker is if “someone reported a specific problem with the quantity of sleep obtained, and hard evidence was needed to better understand that.” For anyone else, he says, a sleep tracker will “at best” simply confirm that sleep levels are okay and at worst “mislead someone into potentially disrupting a sleep routine.” He also points to individual variability in sleep routines — consider, for example, the PER4 gene, which he described as “a genetic basis to some people being ‘larks’ and others ‘owls.’” Any attempt to conform to the average — as encouraged by sleep trackers — can be a “fundamental mistake.”

As for actually getting enough sleep, both Baron and Durrant have a few simple suggestions, none of which involve technology. Allowing enough time in bed — Baron suggests eight, though Durrant believes seven might be better — is a good start, as is keeping a consistent sleep schedule (yes, even on weekends). Durrant also offers what seems like a counterintuitive point: If you’re struggling to sleep, try “going to bed later.” (He’s referring to a cognitive-behavioral-therapy technique for insomnia, which Science of Us has covered before.) He also suggests investing in blackout blinds or heavy curtains and — sorry — avoiding looking at screens.

And if you can’t sleep? “Don’t lay in bed and stress about it,” Baron says. Instead — and this may sound strange — get up. If you really can’t sleep, get out of bed and do something else in another room, like reading, or listening to music. Do your chosen activity until you feel sleepy — and only then go back to bed. (Again, for more on that, check out this 2015 piece on CBT for insomnia.) It would be a shame to lose sleep over the fear of losing sleep.