Category Archives: Sleep News (RSS)

How to optimize your sleep when you work night shifts0

Despite the constant warnings about the negative health impacts of shift work, the 20-30% of the workforce who work nights and irregular hours provide a vital function to our modern 24/7 society. 

So what are the best practices for shift workers to balance the demands of working shifts, disrupted sleep schedules and all the health, emotional implication this entails? 

We speak to Carolyn Schur who has been helping employers and workers develop practical, evidence-based strategies to cope with all the challenges of working shifts and nights.

This episode’s guest:

carolyn schur shiftwork and sleep podcast

 

Carolyn Schur is a sleep educator and coach who helps shiftworkers and those with insomnia sleep better. Carolyn works with organizations throughout Canada and the United States using her expertise to optimize employee performance and minimize absenteeism, risk and health costs. 

Her specialities include shiftwork, fatigue management, insomnia and sleep disorders, ‘night owl’ behavior, relationships, communication, conflict.

Resources:

Website: https://carolynschur.com/

Twitter @schurgoodesleep : https://twitter.com/schurgoodesleep

LinkedIn: https://www.linkedin.com/in/carolynschur/

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The great sleep tracker debate – Part 20

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What are the barriers for consumer sleep wearables being taken seriously as accurate, reliable sleep measurement tools by the research and clinical communities?

In the second part of this discussion we talk about the problems of proprietary algorithms, raw data access, and the challenges that need to be met by both science and commerce.

For Part 1 of the discussion see: https://sleepjunkies.com/the-great-sleep-tracker-debate-part-1

Skip to sections:
  • 2:52 The difficulty in creating validation standards for consumer sleep trackers
  • 4:17 Do consumer sleep trackers need to be regulated?
  • 5:45 Getting ‘under the hood’, proprietary algorithms, raw data access
  • 7:02 Understanding commercial incentives, intellectual property
  • 8:25 Stability of data, algorithm updates, lack of transparency 
  • 9:12 People are basing health decisions on consumer sleep trackers
  • 10:18 Consumer wearables have great potential but they are ‘black boxes’
  • 11:00 Data privacy, cloud-based platforms, security
  • 12:00 Data loss. How reliable are consumer wearables?
  • 15:23 The danger of using a sleep wearable if you have a sleep disorder
  • 19:10 Putting manufacturer’s claims into the spotlight
  • 24:08 Wearables that have already been validated, Fitbit, Jawbone, Oura Ring
  • 25:19 Choosing a demographic for the validation studies 
  • 26:28 Total sleep time (TST) estimations are pretty good in consumer wearables 
  • 27:21 Will consumer wearables ever be able to do accurate sleep staging?
  • 29:33 Sleepscore – are commercial, proprietary validation systems useful?
  • 31:54 What’s are some general tips for choosing a sleep tracker?
  • 35:43 Why there’s no such thing as the ‘best sleep tracker’
  • 36:38 Orthosomnia, when sleep tracking can cause anxiety
  • 40:47 A summary of all the issues discussed
This episode’s guest:

Jesse Cooke

Jesse Cook is a doctoral student within the Clinical Psychology program at the University of Wisconsin-Madison under the primary mentoring of David Plante, MD, PhD. Previously, he completed his undergraduate degree at the University of Arizona, whereby he assisted in projects directed by Dr Richard Bootzin.

Jesse’s research primarily focus on the assessment and treatment of persons with unexplained excessive daytime sleepiness. Additionally, he has published multiple papers evaluating the utility and ability of wearable consumer technologies as a sleep assessor, relative to PSG.

You can reach Jesse by email at jdcook4@wisc.edu

Resources:

Jesse Cook Researchgate: https://www.researchgate.net/profile/Jesse_Cook3

Jesse on Twitter: https://twitter.com/SleepAndSports

Review: Wearable Sleep Technology in Clinical and Research Settings: https://bit.ly/2K4e9MV

Fitbit/NIH research collaboration: https://bit.ly/2RUzsDa

Fitbit Alta HR validation study: https://bit.ly/2Ufbqor

Fitbit Flex validation study: https://bit.ly/2TVPLga

Jawbone UP3 validation study: https://bit.ly/2UeilhT

American Academy of Sleep Medicine: https://aasm.org/

Sleep tracking guide 2019

More Episodes:
Full Transcript

Jeff Mann02:12  I just want to talk about some of these dilemmas and just outline them. These are like the problems that need to be solved if we’re going to have a situation where consumers are able to buy a device to monitor their sleep and be confident what is telling them is actually what it’s doing. But also from the research side and medicine are able to rely on these devices as well and have some kind of structure and framework where they’re not guessing.

So some of the problems are, there’s no standards for validating, for designing studies. So briefly, you know, how do we start to tackle that situation?

Jesse Cook02:53  Yeah. That one’s challenging. You know, we’ve talked about this quite a bit as we’ve jumped around. One are the main problems that arises here that even as an isolated researcher doing prudent, effective research, I’m usually evaluating a device that’s been on the market for multiple years. So in the best sense, these things have been available without any sort of information backing them for multiple years.

Jesse Cook03:22  So staying on that horizon of technological evolution is seemingly impossible. And we’ve talked earlier about a relationship between manufacturer and researcher and the production of agnostic results in that regard. But as far as actually having systematic standardization, the review does outline a very thorough approach and how these devices need to be evaluated. And then it becomes, I think an impetus for maybe having like an approval label of some sort that says this device went through the appropriate testing under the parameters outlined by such and such. Similar to like a non GMO product or, you know, FDA approved in some aspects. But I think that would be useful in at least providing some comfort in the estimations that it’s producing.

Jeff Mann04:17  Who do you suggest comes up with that? Because big business and the world works in general, a lot of countries are anti-regulation and there’s a valid argument to say that regulation slows down innovation, all that kind of stuff. But if we do have something like non-GMO, you know, we need an external body to provide that rubber stamp. So would that be something like the AASM, the American Academy of Sleep Medicine, one of these bodies, or something on a high level above that, where would you think that would come from?

Jesse Cook04:53  Yeah, I think that’s a great starting point, at least jumping off point, at least getting having, first of all, the ASM adopt the standardization procedure because one does not exist. One is not outlined for actigraphy either. That’s a whole separate issue. But for them to adopt a validation approach and then having them have a stamp of approval or another governing body that’s on the same tier as that that’s related to sleep in that regard.

Jeff Mann05:23  Yeah. So we need some kind of framework some kind of infrastructure for regulation and validation. And as you said, Jessie, the review, it does flesh a sort of a step by step process to how we might start achieving that. And we’ll put all the links on the website. Maybe the biggest problem in terms of a technical nature is this idea of these consumer devices as black boxes. You know, a bit like the Google algorithm or the Facebook algorithm. Nobody knows how it works. And again, the review talks a lot about this in a few different aspects. You don’t have access to the raw data. So with an actigraph you can basically look at the raw data that’s coming off of the sensor and then there are algorithms which been validated scientifically. But with these consumer devices, you’re seeing what the consumer sees. Maybe you’ll get a spreadsheet if you’re lucky, but I think you told me at one point you were literally having to graphically pull data from a graph or a screenshot and somehow put that into your study. I mean that, that sounds like a nightmare.

Jesse Cook06:40  It was an extremely cumbersome process. Thankfully at the tail end of it I did adopt and train some, some very talented undergraduate research assistants to move that ball for me. But yeah, that’s a huge challenge right now and a barrier for implementation. And you know, we’ve, we’ve talked about this already, I understand as a researcher their desire to keep their proprietary information secret as it is a consumer market.

Jesse Cook07:12  It is in their best interest to produce a product that cannot be mirrored by other corporations and manufacturers. And as such, revealing what that product actually does would inhibit their growth as a company. But at the same time, if we have no idea what’s going on, how can we trust and how can we truly interpret the dynamics of the output. At the same time, I’ve actually had it happen to me where data that I acquired a year ago was in accessible through their online platforms. So now you start raising concerns about stability of data. If they make an algorithmic modification that they don’t alert people on and it changes the data. How does that fit into research and clinical domains? That’s a whole other point of complication, but it ties into this whole lack of understanding of what’s going on.

Jeff Mann08:14  It’s not helpful. Yeah. It’s in fact, it’s completely obstructive to the whole point of what you’re doing as a scientist and trying to present objective data. As you say, you may go back to a device and they’ve done a firmware update or whatever, and the results you’d get will be completely different. You would have no way of knowing.

Jesse Cook08:37  Yeah. And did my sleep changed that night? No. So what actually happened? Where in the algorithm schema did they modify it. Did it improve or not improve their congruent with PSG? These are important questions and at this time we just have an inability to assess that.

Jeff Mann08:56  Yup. And I mean, if it was a piece of technology, like a calendar or scheduling app or something that you use in your daily life, but it’s just, it’s just an app that’s fine. Update the algorithms, that’s fine. But if people are using something like this to monitor their sleep and trying to make life decisions based on it, this is people’s health.

Jesse Cook09:22  It’s their well-being. So, say Jeff, I’m tracking my sleep and I’m starting to notice that my device keeps telling me that I’m waking up 20 times during the night for a total of two and a half hours across the entire night. So I’m eventually prompted. I decide to go see my primary care physician and I present them to these data. And then as I go see my primary care physician, the data actually changes. And I’m now only waking up five to seven times a night for an hour.

Jeff Mann09:53  Because they’ve improved their algorithm.

Jesse Cook09:56  Yeah, or they’ve adjusted it in some fashion. So that makes the complexity of interpretation just astronomical and unresolvable.

Jeff Mann10:07  Yeah. So maybe the biggest sort of nut to crack this, this idea that in business you have competitors, you have to have a competitive edge. You don’t want to give away trade secrets. So all of these big companies in sleep tech have proprietary algorithms and they’re all black boxes. No really easy answer to that is there?

Jesse Cook10:32  No, absolutely. And you know, one of the main benefits of these devices is their ability to provide real time feedback. Somebody wears the device, it syncs to their phone or computer and they can see real time information, which is super cool. Whereas if I gave them an actigraph, they would have to bring it back to the laboratory, we would download it, we would process it and then we could give them some feedback. So much more cumbersome process in that regard. The problem that comes into play here is when we start utilizing these cloud based platforms, we start now bringing confidentiality issues as well. How secure are these databases? How protected are they? And then they can say over and over again that they meet certain standards and so on. But that’s certainly something that at least leaves an uneasy feeling if it’s truly going to be utilized for clinical purposes or other aspects as well?

Jeff Mann11:30  I haven’t really considered that this in conversation, but yeah, the whole idea, if there is going to be some kind of cross over between consumer sleep technology and medicine and research, who owns the data? How does the data get anonymized, where does the data reside. So that’s another big one.

Jesse Cook11:51  And that’s not just unique to sleep obviously. That’s on the forefront of all this health technology revolution that’s going on right now.

Jeff Mann12:00  Yeah, that’s massive, massive. Reliability as well. Another thing they talk about in the report, was it one of your studies where you lost…

Jesse Cook12:09  Yeah, significant portions of data. In just about every investigation I’ve ran, whether it be 10 to 20% of my participants data was inaccessible. Nothing changed in our process and our end as far as how we apply the device, how we synchronize the device, how we tried to extract the data. But for some reason or another, the device malfunctioned And that was similarly problematic for, I believe, Elisa Meltzer’s team experienced something similar in that regard and a Max’s team. The de Zambotti SRI International Group has also experienced data loss in that regard.

Jeff Mann12:50  That must be so frustrating.

Jesse Cook12:52  Yeah. When you’re on a strict budget provided by grant funding, that also is an issue as far as I don’t want to recruit more participants.

Jeff Mann13:02  Throw in the bin. Sorry, that’s a bit dismissive there.. Right, so we’ve got all these obstacles, but the fact is, at this point in time, and certainly five years and 10 years in the future, there’s no doubt that this sleep tech is going to be so much better and it’s going to be super, super useful to consumers. But also to researchers as well. So we need to find a way for industry and science to put their heads together and find some way of coming together,

Jesse Cook13:40  Absolutely. And I’ve been very careful in using any sort of manufacturer name explicitly for a myriad of reasons. But I will say that I’ve had direct contact with many of these manufacturers at past sleep conferences, over the digital technology that’s available. And most at least endorse similar sentiments that we’ve expressed today. They want congruency, they want alignment with the scientific and medical field. And they want transparency. But it just hasn’t unfolded yet. So, as you said, this is a field, this is an area that in 10 years it’s not going to look anything like it is right now. And that’s just the way our society from a technological standpoint is evolving. And you know, soon with Elon Musk we’re going to have a chip in the back of our brain anyways, that’ll probably track our sleep. So it’ll completely change in that dynamic. So I think at this time it’s a really challenged field, but I think I have the utmost confidence that in the coming years it will be resolved in a very appropriate manner.

Jeff Mann14:57  Yeah, I think so as well. We’re just a bit of a junction in the road at the moment. People have to decide which way to go. But bottom line is, it’s going to be good for business isn’t it? You get a rubber stamp of approval.

Jesse Cook15:13  Absolutely.

Jeff Mann15:13  So in that sense it’s in the interest of these companies to work this out with the scientific and the medical community. One other thing about these dilemmas that I was describing, sleep disorders as well. That’s a whole different kettle of fish as well, isn’t it? Because if people are buying these devices to find out if they do have a physical problem with their sleep rather than an anxiety related problem, then where does the responsibility lie with the manufacturer, you always see a disclaimer somewhere saying this isn’t a medically approved device…

Jesse Cook15:53  Well, the interesting thing is that it’s not always explicitly clear from these companies what their true purpose and utility is. For instance, one company had two different settings for their product. A normal and a sensitive mode. And on their actual help page it was explicitly laid out that it said people with – I’m paraphrasing now I guess in some aspects – people would sleep disorders should utilize the sensitive setting. And first of all what sleep disorder? Sleep disorders are vastly different across the board. And two, when I evaluated the sensitive setting, it underestimated total sleep time by two hours. And so it was kind of just this blind consideration or endorsement for their product that has vast negative implications for the individual. And so we in the research and medical community really just want them to characterize their product as a sleep estimation tool, a sleep tracker and not a measurement device.

Jesse Cook17:05  And it may seem trivial in the nomenclature, but just clarifying that to the consumer is really important that it’s not a surrogate for in-lab testing. And that if you have any concerns over your sleep that you should go to your primary care physician and maybe triage to a sleep professional in that regard. And most of the companies are getting on board with that, but it needs to be explicitly laid out in that fashion. There’s a variety of sleep disorders.

Jesse Cook17:31  For instance, I tend to study people who fall under this categorization of central disorders of hypersomnolence. Hypersomnolence being excessive daytime sleepiness. So individuals, persons with narcolepsy fall into that category. And within narcolepsy, you have those who have cataplexy and those who don’t have cataplexy, meaning that their muscles give out on them involuntarily and things of that nature. But you have your general insomnia and some people believe that there’s primary insomnia, which is more physiological and neurophysiological versus environmental insomnia, which is more based on how you manage your stress, how your sleep environment is set up. Are you appropriately handling sleep hygiene? You have just a myriad of different disorders, sleep apnea, various levels of sleep apnea. These devices currently provide a very, very, very limited lens of sleep apnea. You can look at your number of awakenings during the night and try and extrapolate that to, well I wake up 60 times during the night. There’s probably something going on there, but they’re not assessing breathing or oxygen saturation in any fashion.

Jeff Mann18:46  Yeah, I mean you said interesting space that one I’ve seen in the last year or so quite a few different wearables come into the market and measuring oxygen saturation and obviously going for that sleep apnea detection even though they’re not medical devices. But that’s a whole separate conversation. Not for today. I want to move on and I’m going to read out some manufacturer’s claims. I’m not going to mention the manufacturer and then what I’d like Jesse is for you to hear some of these claims and then mention some of the studies and again you don’t have to mention the actual devices themselves because we’re not trying to make any specific judgments and say this device is great, this device is bad. And just see how the claims match up to the peer reviewed science that you’ve done. So first I’m going to just read, these out really quickly.

Jeff Mann19:44  I’ve got one, two, three, I’ve got six things and I found all of these, these aren’t buried in blog posts or whatever. These are actually on the homepages of these websites. So one of them says “The most accurate sleep tracking next to clinical sleep measures. “One of them says it’s “the most accurate sleep and activity tracker.” One of them says “a degree of precision comparable to that of laboratory.” Another one says “access to information previously only accessible in a sleep lab.” Another one says “built for hospital grade accuracy.” Another one says “monitor up to two sleepers at once with pinpoint accuracy” Okay. Now in your experience, you’ve studied a lot of these devices. Do any of these claims sound vaguely like any of the results that have come out of your tests?

Jesse Cook20:41  In some aspects, yes, Jeff, to be honest. The word comparable, is a useful one when considering consumer sleep trackers and actigraphy when it comes to their estimations of total sleep time. So it’s really important to think about what the accuracy pertains to. Because accuracy could relate to its ability to detect the amount of sleep somebody getting versus the type of sleep that somebody’s getting. And as we kind of mentioned earlier, these devices seem really poor currently or limited in their ability to actually categorize sleep across the different stages. But for my research, these devices have improved to a point where their estimations of sleep duration, you know that 500 minutes or 420 minutes, whatever is output on the phone or the desktop that the individual sees, is comparable to that of clinical actigraphs from the data that I produced it and seen across other literature.

Jeff Mann21:53          Just to pause you there very briefly. They’ve thought about these descriptions here, but for me, when I see something like “a degree of position comparable to that of a laboratory” I’m thinking a sleep lab, somebody wired up to PSG. Or “the most accurate sleep tracking next to clinical sleep measures” I’m thinking what’s the most accurate? But they’re probably not hinting at that, they’re probably hinting at next to actigraphy. So to me I find these claims problematic,

Jesse Cook22:28          They’re very much hyperbolic, right? And that’s their intention is to attract the consumer. These devices still will overestimate total sleep time and will bias relative to PSG. But that doesn’t mean that they’re bad or useless as we’ve discussed. But again, you’re absolutely right that there’s a degree of fabrication in their very poetic description of their device trying to entice the consumer. And it’s amazing when you read through these and as you’ve showed each company says that they’re the most accurate product.

Jeff Mann23:08  Yeah, that’s quite interesting, isn’t it?

Jesse Cook23:09  How is that possible? But for my understanding, unless I’m completely amiss, the devices are different. So they can’t all be the most accurate.

Jeff Mann23:23  This is the argument for regulation and people like the FDA and having Kite Marks here and CE Marks in Europe. But again some people would argue that’s anti competitive..

Jesse Cook23:35  ..and potentially limiting, right? Has the boom that we’ve seen in technology due to the fact that it’s not being regulated at this time. Whereas if a governing body came out and said, we fully endorse this product for the sleep estimations, then do the other companies fall by the wayside and we don’t get any sort of competitive growth in that sense, which I think is what you were trying to hint at.

Jeff Mann23:56  Yeah, there’s no easy solution here because we can’t have a situation where everyone’s claiming they’ve got the best sleep tracker. But at the same time, we can’t have overburdensome regulation just slowing the innovation down. So, actually I am going to read out a few of these models because I’m going to put links to all these papers on the website as well. So some of these devices that you’ve measured, they’ve actually been through clinical validation. The Fitbit’s a couple of them, the Fitbit flex, the Fitbit, Alta HR, the Jawbone UP3, the Oura ring, another Fitbit, the Fitbit Charge 2, all of these have been studied in the lab properly. Can you just encapsulate the broad spectrum that they’ve fallen in with regards to accuracy and measuring up to the gold standard and actigraphy as well.

Jesse Cook24:45  Yeah, absolutely. So a couple of those devices you mentioned are the older models. And so for utilizing those you’re going to want to be skeptical of any of the outputs that they’re producing. But some of the newer models are getting really good at estimating sleep duration. So if you’re buying a device that has been recently produced and manufactured from one of these corporations, I think you can put a reasonable amount of confidence in the total sleep time estimations it’s producing. One thing that’s important to clarify though, Jeff, is that even in our kind of rigorous validation structure, we’re validating within a specific sample of individuals. So a lot of times that may be an adolescent group versus an adult group. That may be quote unquote healthy sleepers versus disordered population. And so it’s truly unclear whether findings from a study that I performed that’s in a disordered population would translate one to one to a healthy population. So although a device has been quote unquote evaluated, it was evaluated in a very specific circumstance.

Jeff Mann25:58  For instance you potentially might get different results between using for adults and using for kids.

Jesse Cook26:06        Absolutely. Kids are more likely to move around during the night. And we mentioned earlier that these devices have a lot of issues. Their estimations become much more inaccurate when there’s more movement. And so that’s a major challenge when considering the results that we produce in science.

Jeff Mann26:27  So you’re saying that the newer models, with regards to total sleep time, they’re getting pretty good.

Jesse Cook26:35  For total sleep time they’re getting pretty good. When it comes to the other components. Whether it be the REM sleep classification or your deep sleep classification, those outputs I would take with a grain of salt. Again, some of the research that I’ve produced has highlighted a range of 30% to 60% ability of these devices to correctly identify REM sleep. So if that’s something you’re really interested in, I would monitor it through these devices, but I wouldn’t think of it as like a liturgical output in that sense.

Jeff Mann:        27:21  Are we ever going to get there with these movement and heart rate based devices in your opinion with regards to sleep staging?

Jesse Cook27:30  That’s a great question and one that I think about a lot. If you looked at my a PubMed search history, you’d see Bluetooth, EEG, single sensor, typed in a lot into my search history. I think the technology’s there. I think the ability for somebody to manufacture an electrode that a consumer can put on their forehead in a specific location and it could detect wavelengths of brain activity during sleep, which then gets Bluetooth synced to your device, I think it’s there. And it’s probably going to be the intent of a manufacturer that pushes us past this, this necessity and it makes it actually implementable. I don’t see a research team doing it. But I do foresee that in the future the staging limitations will not be completely removed or reduced or washed, if you will. But I think they’ll be markedly improved for sure.

Jeff Mann28:39  I love technology as well, so I hope at some point there’s going to be something like that. I’m not for technology for technology’s sake, but just technology that going to have lots of practical uses, whether it’s in health, or research, some people using this stuff for biofeedback, meditation.

Jesse Cook28:56  Yeah. There’s a lot of companies out there nowadays that are utilizing EEG headbands of some sort and purporting that these devices are detecting alpha rhythms or assisting in augmenting alpha rhythms or whatever it may be. So it seems the technology seems available. It’s just translating it for the purposes of sleep tracking at this time.

Jeff Mann29:17  Okay. So you’ve seen in your studies and the body of work is quite limited, but there are a few of these devices that have been validated. You’ve seen them improve over the years, so there’s no doubt they’re getting better and better. Something I want to touch on briefly as well, a company called SleepScore and but they’re very much doing a commercial version of a validation system and rubber stamping sleep products based on their validation techniques. How do you think these kind of things fit in?

Jesse Cook29:56  Well I think first and foremost, I like to stress that we really encourage individuals taking an interest in their sleep in any form, whether it’s just jotting down thoughts about sleep or actually creating a diary where they monitor their sleep in that fashion to these apps. Most individuals tend to have better sleep because they’re now taking an interest in it and holding themselves accountable. So I think all that’s great when it comes to these like systems that tell you how quality your sleep was, how rested you are, how likely you are to perform optimally today, I get a bit squeamish because I want the individual to be able to assess their existence on their own and not be dependent upon a data point, telling them how they’re supposed to feel.

Jesse Cook30:55  So I can see a scenario where somebody looks at their output from one of these applications and it says that they’re at 80 out of a hundred on their overall score, whatever that means. And in truth, they actually may have gotten an appropriate amount of sleep and they feel really good. And if they hadn’t actually looked at that school where they would have felt that they were at a hundred. And they may be at a hundred or they may be at 80, that’s a complication. But I don’t want people to base their subjective experience, which is what really matters in a lot of ways, solely off of these unvalidated techniques and scores. And I think that’s happening more and more these days that people’s wellbeing’s are being derived. Their state of existence is being derived by a technological score that is largely unsubstantiated

Jeff Mann31:51  Just to try and round this off. I just want to try and give people a couple of takeaways. You know, people who are listening to this are probably interested in sleep tracking, and they hear all these negative or complicated point, and think, Oh God, what do I do now? But there are lots of good products out there and there’s stuff that’s getting better all the time. So what would you say, just broad advice for somebody who’s considering getting something to start measuring their sleep and I like your use of the, the term sleep estimation device as opposed to something that measures objectively your sleep.

Jesse Cook32:33  Yeah, I’m so overwhelmed by the sheer volume of models available. You know, it’s seemingly an unavigatable terrain when trying to figure out which sleep tracker to buy. When you type in Google ‘best sleep tracker in 2019’ and even within that, there’s still 20 recommendations. And those may or may not have merit to them but that kind of gets away from the point that as humans we have this challenge when we have a ton of options, it’s called the paradox of choice. The more options we get, the worst we get at making a decision. And this falls right into this issue with the sleep trackers, I think it relates really well. So I think the first thing you have to do if you’re thinking about purchasing one of these products is, think about its purpose in your life and who you are as an individual. If you’re an individual that just wants something that they can wear on their wrist, that measure steps, that can give you some heart rate feedback and has the ability to produce some estimations of sleep time and maybe even classify your sleep across stages and you could be looking at getting one of the low end devices that are $30 to $50 and feel pretty comfortable in what it’s producing relative to the more expensive products.

Jesse Cook33:59  It doesn’t have to be one of the more name brand products. You may get better technological support, IT support if you do go with one of the more name brand products. So that may be advantageous in that regard. Starting there and then as you get more thorough in your use. If you’re a training triathlete, if you do have some medical concerns and you want better, more reliable, more frequent estimations of heart rate monitoring while you’re exercising or while you’re going through your day to day, then doing some homework and typing into the Google machine, the specific characteristics you’re looking for, whether it be the ability to swim with the device or the ability to not have to charge the device for 20 plus days. Many of these devices only have a battery life of five to seven days. If you’re someone who doesn’t want to have to continually charge your device, maybe you should opt for one that has a longer battery life but doesn’t have all the bells and whistles that the five to seven days device has.

Jesse Cook35:05  If you’re a triathlete or are looking for fitness than maybe you want to prioritize the device that has been evaluated for its movement tracking abilities and heart rate sensing and GPS capabilities that are additional components to the sleep tracking. Because in a lot of ways these devices aren’t that unique in their abilities to track sleep. They are in my understanding, utilizing relatively similar technologies as their underpinnings. And again, as we’ve pointed out, I have no idea what their algorithms are doing so I can’t make any comments there. So it really comes down to the individual. There’s no panacea of the devices, meaning that there is no device that performs the best across every single domain of activity tracking, heart rate tracking, sleep tracking. And so figuring out what is the most important characteristic for you, how much you’re willing to spend, what having a name brand linked to your device means for your comfort level. If it makes you quote unquote sleep better at night, knowing that you have one of these main manufacturer products, then do that. But if you’re perfectly comfortable using one of the more knock off, low expensive, not necessarily lower grade products and it doesn’t disrupt your sleep in that fashion, I say do that as well. So it really just comes down to being comprehensive with what you want to utilize the device for

Jeff Mann36:39  And I know you wanted to mention as well, this whole idea of sleep tracker induced anxiety, this term orthosomnia.

Jesse Cook36:49  The last thing that we want to do as sleep researchers and individuals in the medical field of sleep is cause worst sleep, right? Our goal is to have everyone sleep optimally and it definitely occurs in some individuals where having more information, complicates things and actually causes problems. The orthosomnia terminology has become a topic and it actually was a seminar at the sleep conference last year and it definitely pertains to a certain subset of individuals, specifically those who have a propensity for elevated clinically significant levels of anxiety. And so if you’re one of those individuals who may be susceptible to having these data negatively maladaptively influenced your sleep quality, then that’s something you need to be honest about with yourself as well. And then maybe just don’t do it, maybe not have one of the sleep trackers. Or the other option is to address that component of your life and potentially seek help in developing novel cognitive techniques to help ameliorate those issues. But that’s an entirely different topic and one that I’m not an expert in. But that’s a big thing. But as I mentioned earlier, and it’s really important to point out, we tend to see that for most individuals who monitor their sleep in some fashion, their sleep improves. So that’s a stamp of approval there.

Jeff Mann38:20  Yeah. Somebody who actually takes the act of expressing an active interest in their sleep, that in itself is hopefully going to have some positive impacts.

Jesse Cook38:32  Yeah. For the most part it should.

Jeff Mann38:34  Yeah. So maybe unless you’re one of these people who thinks they might be worrying more, if you’re one of those people, then maybe don’t buy a sleep tracker.

Jesse Cook38:45  If you’re going to define yourself based on an output of a device that may or may not be truly reliable and accurate, then the sleep tracker may not be the best thing. I guess if you’re going to critically evaluate yourself, then maybe a sleep tracker is not the best decision for you to utilize. But again, most individuals don’t fall into that camp and they tend to be pretty useful at least in maintaining or improving sleep schedule consistency. That’s a big one we see. People going to bed at similar times and rising at similar times rather than having spontaneity in their sleep patterns and then recognizing what characteristics associate with better quality sleep for you.

Jesse Cook39:36  You know, as you mentioned earlier, Jeff, a couple beers, doesn’t improve our sleep quality. Maybe the fact that I wasn’t on my computer for the hours leading into bed. Well, oh man, my sleep score was better. Maybe I shouldn’t do that. And just being your own scientists in a way, and comprehensively evaluating your life in the context of not just the output of this device, but how you actually feel as well.

Jeff Mann40:00  Yeah. Okay. Awesome Jesse. Do you mind if I put you on the spot slightly?

Jesse Cook40:11  With trepidation? I say yes or no, I’m comfortable, I guess.

Jeff Mann40:16  We’ve covered an awful lot of ground in this conversation and I just wondered because I really think this is important, both for consumers and the business community, but also for science and for medicine. Would you be in any way be able to encapsulate the main overriding message from this review, which we’re basing a lot of these conversations on today and also from, from your experience?

Jesse Cook40:49  Sure I will help do my best Jeff in that regard. So the ability to objectively measure somebody’s sleep in their natural environment is really powerful and useful. Bringing someone into the lab is just not practical. It costs a ton of money. It costs a lot of time. It can be an artificial setting. We’ve touched upon those types of things. Actigraphy, actigraphs have existed as the medium utilized to facilitate this need for many decades.

Jesse Cook41:28  Recently, wearable consumer technology has provided another means, another medium, another lens that’s much more affordable and is extremely prominent in our public to facilitate the objective, quote unquote measurement or estimation of sleep and natural environment. At this time though, these devices, although improving from earlier generations when they advanced from single sensor to multisensory, are still limited in their abilities to truly and comprehensively estimate sleep.

Jesse Cook42:07  They have demonstrated the ability to produce estimations of sleep duration, so your total sleep time at at night that are comparable to clinical actigraphs. However, these estimations are still not congruent with our gold standard polysomnography. Meaning that they’re still biased in some fashion, they’re typically overestimating total sleep time. Additionally, their ability to classify sleep, so the light sleep, deep sleep, the REM sleep that’s output by the device seemingly is much less accurate than their total sleep time estimations.

Jesse Cook42:54  So although it’s very useful and very powerful to see that information, there needs to be at least a pause or hesitation in digesting that information at this time. Currently there are some major barriers, specifically around the proprietary nature of the devices, their algorithms, the raw data that truly complicate the integration of these devices and the progression of these devices for clinical and research purposes.

Jesse Cook43:28  However, myself, researchers, our governing bodies in the sleep field, they are all encouraged by the prospects of these devices going forward. Their ability to acquire large datasets is extremely unique. Again, they’re very advantageous with their realtime feedback, their affordability, the sleekness and design, their ever evolving technology and growth. These are all very advantageous characteristics and we just ultimately as researchers want the best products to be available and described in the most appropriate and transparent ways. Ultimately we see this happening in the coming years and we’re very encouraged by the horizon.

Jeff Mann44:13  Awesome. Well, thanks for that. Like you, I’m optimistic. People being able to take control of the lives, expressing an interest in their sleep and their health. If there’s companies out there who want to get into this space and want to push the boundaries, business and commerce is always going to move faster than science. So the two just have to come to a point where they meet. Hopefully we’ve contributed to this conversation, snowballing into something, you know, a better outcome in the future.

Jesse Cook44:52          Yeah, we put the sheets on the bed or something of that nature, so hopefully produce the best quality sleep for society.

Jeff Mann45:00  Fantastic. Thanks so much, Jesse. I’ll let you get on with the rest of your day and maybe when we’ve recovered from this conversation we can revisit some of these topics a later date.

Jesse Cook45:15  Absolutely Jeff, I really appreciate you having me on. This has been a true joy and it’s a very important area to dissect at this time. It’s very challenging and then I appreciate you giving me the time and the opportunity to discuss.

The great sleep tracker debate – Part 10

Download PDF Transcript

How accurate is your sleep tracker? Are consumer sleep wearables good enough to used for research and clinical purposes? Join us as we navigate the complex issues surrounding marketing claims, scientific validation, reliability, raw data and why ‘black boxes’ technology is an impediment to research.

In this first instalment of a 2-part episode, we talk about the rapid improvement that consumer sleep tracker have made in a short amount of time, and how, compared to expensive validated technology like actigraphy, could potentially unleash powerful new ways to advance sleep science.

For Part 2 of the discussion: https://sleepjunkies.com/the-great-sleep-tracker-debate-part-2

Skip to sections:
  • 2:48 Introducing Jesse Cook
  • 4:43 Discussing the review ‘Wearable Sleep Technology in Clinical and Research Settings’
  • 6:50 The lack of incentives for rigorous validation of consumer sleep trackers (CST)
  • 10:18 CST have great potential but they are ‘black boxes’
  • 13:29 Actigraphs and the first generation consumer sleep wearables 
  • 16:20 Newer generation sleep wearables are getting much more accurate
  • 21:52 Is it worth paying $1000 for a clinical actigraph?
  • 25:21 Comparing CST measurement techniques to polysomnography 
  • 31:32 REM sensitivity of CST has improved from 30% to 60% in only a few years
  • 32:40 The problem with detecting sleep from ‘motionless wake’
  • 37:02 Machine learning – the ‘low hanging fruit’ to improve accuracy of CST
  • 40:09 Challenge for doctors when patients report use consumer sleep trackers
  • 41:37 Fitbit, NIH and big data initiatives and future potential
This episode’s guest:

Jesse Cooke

Jesse Cook is a doctoral student within the Clinical Psychology program at the University of Wisconsin-Madison under the primary mentoring of David Plante, MD, PhD. Previously, he completed his undergraduate degree at the University of Arizona, whereby he assisted in projects directed by Dr Richard Bootzin.

Jesse’s research primarily focus on the assessment and treatment of persons with unexplained excessive daytime sleepiness. Additionally, he has published multiple papers evaluating the utility and ability of wearable consumer technologies as a sleep assessor, relative to PSG. You can reach Jesse by email at jdcook4@wisc.edu

Resources:

Jesse Cook Researchgate: https://www.researchgate.net/profile/Jesse_Cook3

Jesse on Twitter: https://twitter.com/SleepAndSports

Review: Wearable Sleep Technology in Clinical and Research Settings: https://bit.ly/2K4e9MV

Fitbit/NIH research collaboration: https://bit.ly/2RUzsDa

Orthosomnia: http://jcsm.aasm.org/viewabstract.aspx?pid=30955

Philips Actigraphy devices: http://www.actigraphy.com/solutions/actigraphy.html

Sleep tracking guide: https://sleepjunkies.com/the-ultimate-guide-to-sleep-tracking/

More Episodes:
Full transcript:

Jeff Mann: 02:18 Good afternoon. I’m joined here with Jesse Cook. Hi Jesse and thanks for joining us today.

Jesse Cook02:25 Thank you for having this discussion. I’m really excited to be here.

Jeff Mann02:29 I’m really excited. We had a brief chat earlier in the week and I could tell that you’ve got the same sort of passion and interest. Jesse’s a a graduate student at the University of Wisconsin, Madison, can you give us a little background to your academic life and how you got involved in sleep?

Jesse Cook02:49 Yeah, absolutely. So I was an undergraduate at the University of Arizona in Tucson and I joined the late Dr. Richard Bootzin’s sleep laboratory and spent a couple of years as a research assistant under his guidance and really fell in love with the field of sleep.

I didn’t realize initially how vast the topic was and the implications that it had on so many different aspects of life, whether it’s performance, health, your day to day mood, all sorts of things.

 It really just invigorated me to continue on. And so upon graduating, I took a job working alongside Dr. David Plante here in Madison, Wisconsin. That was back in 2013. We’ve been working alongside one another for now, the past six years. wow, that’s crazy.

03:44 And specifically we tend to work with patients who have unexplained excessive sleepiness. The diagnostic terminology is idiopathic hypersomnia. And we do a bunch of neurophysiological evaluations with these patients to try and figure out what’s truly going on.

But at the same time, I’ve found myself over the last few years really seeking out an understanding of the utility and ability of these commercial consumer sleep trackers and how useful they are, not just for research purposes and not just for clinical purposes as well, but just for an everyday user, and an individual in the population and whether they truly have merit.

Jeff Mann04:32 Well, this is the topic we’re talking about today, consumer sleep trackers and specifically we’re going to talk about wearables because there’s other types of sleep trackers, as I’m sure everybody’s aware of.

Jeff Mann04:44 I first got in touch with Jesse because, you peer reviewed a brand new review that’s come out. Correct me if I’m wrong, but I think this is probably the most comprehensive and certainly the most up to date look, we’ve had yet to do with the role of consumer sleep trackers and how they measure up in terms of accuracy and what the implications are for using these in clinical practice and also in research. And this was a colleague of yours….. um…

Jesse Cook05:18 Yeah… Max de Zambotti and his team, SRI International. They do a lot of work, similar to how we do it out here where it’s not their main objective, but they explore the ability of these devices in the context of research designs that evaluate them against the gold standard, polysomnography.

And this comprehensive review was the first to really not just fundamentally organize the existing data in a digestible manner, but also formulate an approach to evaluating these devices systematically going forward, which is a major challenge as various research teams have employed different techniques, different analytical designs, and these inconsistencies just further complicate the interpretation of the abilities of these devices. And as such, I must thank Max and his team for outlining such an appropriate structure and process in that sense.

Jeff Mann06:20 I’m not a scientist. I’m definitely a layman, but I read a lot of papers and I’ve got to say it’s quite a good read actually, and it’s very clearly laid out.

But there’s a couple of passages that I’ve highlighted that are very sort of pertinent to the discussion. And the reason I asked you on, Jesse to talk about this, I don’t think there’s a proper conversation going on about this issue of sleep wearables and their efficacy and validation.

06:48 There’s a couple of passages here. One of them says “there is a lack of incentives from both a scientific community and industry to perform dedicated scientific validation of sleep tracking wearables. Thus, the existing validation studies are frequently initiated by the curiosity of isolated researchers or research groups moved by the need to find affordable accurate and reliable alternatives to expensive medical grade devices for measuring sleep in natural contexts”

Jeff Mann07:18 And I guess you’re one of those guys, Jesse,

Jesse Cook07:22 I seem to have found myself in that camp. Yeah, that’s a major point of complication currently as ideally we want as researchers in the science realm to have a very symbiotic relationship with these companies, these manufacturers, in the sense that we think these products have merit across many different domains.

But we just want to make sure that they’re appropriately described and evaluated. And it does not seem that a lot of these companies are putting in the appropriate efforts to truly characterize their device in the context of other sleep measurement tools that have demonstrated validity and reliability.

And the problem that comes into play here, and as Max pointed out, the isolated researchers in groups, when you start involving the companies in your study designs, ie if they send you their products, if they fund the investigation in its own right, then you’re inviting their ability to suppress the output of the design, the results.

08:38 And so we have this kind of difficult balance beam situation where we want to have them involved, but we want to be transparent with what we find with the devices as well. So it’s just a challenging landscape there.

Doctor Plante and I, as Max pointed out, found ourselves starting to go down this road because of their affordability, because of prevalence in the society as a whole so far, because of their purported ability to classify REM sleep, which is really important for patients that we tend to work with.

These characteristics make these devices very advantageous on many levels. So understanding their true utility is very important in that sense. It’s just complicated to navigate as I mentioned earlier.

Jeff Mann09:27 Yeah, absolutely. So we’ll dive in a little bit. This is other short passage that I want to read out. And this for me kind of sums up this tension between the scientific community and the business community. And it says “for the scientific sleep community, the necessity of opening “black box wearable devices” is important for raw data access and standardization. But raw data access and cloud services do not come free. Within this scenario it’s unclear if a line of consumer products and platforms more focused on the needs of researchers and clinicians would fit the consumer wearable companies business model” And I think that really neatly sums up the difficulty that you just expressed.

Jesse Cook10:18 Yeah, absolutely and this opens up so many realms of conversation here. That’s currently the biggest challenge, the lack of raw data availability and transparency when it comes to their scoring algorithms, their staging algorithms. What actually these devices are doing.

Their main, I wouldn’t want to to say ‘competition’, but the sleep field relies upon something known as actigraphy. Clinical actigraphs that typically are about $1000. So markedly more expensive than these consumer wearables, that seemingly perform very comparably to these consumer wearables and in certain estimations of sleep, but allow easy access to the data in the sense that researchers can then manipulate the data to produce equations, functions that can help in the diagnostics process.

We call those distinguishing functions, where we can map onto certain diagnoses, disorders based on the data that’s available. And that just is completely inhibited at this current juncture with the consumer wearables. So it really comes down to what purpose these devices are going to have in our society.

11:36 If they’re strictly going to be utilized so that the average individual can have a better sense of how they’re sleeping, what their sleep patterns are like, their bedtime and rise time consistency and that in the context of their overall health, then that’s a wonderful product to be utilized and marked.

But once these companies start endorsing their products as medical grade equipment, which has happened previously, it becomes much more difficult in that regard to have the relationship that would be most optimal in that sense.

Jeff Mann12:10 Yeah, it’s a very muddy situation at the moment and there are a lot of complications, but there’s also huge, huge, massive potential as well.

Jesse Cook12:19 Absolutely.

Jeff Mann12:20 So let’s talk about the sort of brief history and we’re literally only going back about 10, 15 years at the most here, but I know you wanted to make this distinction that even in this short time, there’s been a progression and we’ve moved on from simpler technology to more advanced technology and it’s still on a very steep upward curve.

This technology’s getting better and better every year. So I guess the first thing that spurred a lot of people onto getting into sleep tracking were the apps, so we’ll skip over those. So you know, you can get an app and put it on his smart phone and people would put them under their pillow, and it’s tracking their movement, supposedly translating that into sleep data.

13:07 But where your involvement started, Jesse I believe, was looking at some of these simpler wearable wrist worn devices. The big companies like Fitbit that we’ve heard about. So do you want to explain how they work and you were involved in some proper validation studies of these early devices?

Jesse Cook: 13:29 Yeah, absolutely. I’ll kind of walk through briefly the history as you said over the markedly significant progression that’s occured in a relatively short time, which is seemingly standard for society these days with technology and whatnot.

So I mentioned actigraphy earlier. An actigraph is something that you wear that has a triaxial accelerometer in it and measures movement and from movement counts – it goes through a programmed algorithm that then outputs whether it’s sleep or wake when we’re talking about sleep classification here.

14:07 And the original models of these wearable consumer sleep trackers utilize the same technological principle in that it was strictly accelerometer based. We call those single sensor models.

And these models perform fairly poorly in their estimations of total sleep time. And they were limited in the sense that they couldn’t classify sleep, they couldn’t stage sleep beyond just sleep and wake, the dichotomous classification scheme that actigraphy is confined to as well.

Jesse Cook14:43 And a lot of these devices, the results were indicating overestimations of total sleep time around anywhere ranging from 30 minutes to an hour, which is a significant amount of time.

Jeff Mann14:58 That’s quite a lot in a night’s sleep,

Jesse Cook15:00 Yeah it has a vast complications – I guess it depends on how much you’re sleeping in a night – but it has vast complications when people start interpreting their data as well, which may get into.

But more recently these devices have added additional biosensors. Most have now incorporated heart rate tracking. There’s a fair amount of existing data out there that indicates that you can reliably stage sleep based on heart rate fluctuations throughout the night.

And so these devices are now pairing accelerometer based movement counts with heart rate data to determine the sleep wake classification as well as whether somebody is in light sleep, deep sleep or REM sleep during their sleep periods.

15:50 And what we’ve seen so far is that initially these multisensory models, were not performing any better than their single sensor models, although I will stress that no research investigation has been performed directly comparing a single sensor to a multisensor, so you kinda have to take that with a grain of salt.

But over the last few years, in particular, the data that’s come out of our laboratory as well as Max’s team and some other places as well, seemingly is indicating that these devices are getting much more accurate. Their bias and estimation is reduced quite a bit, especially when considering total sleep time, which may be their most useful attribute.

These devices are still really limited in their ability to classify sleep. And I can go into more detail about how we analyze those types of characteristics, but basically these devices are getting better it seems and the multisensory components are probably most attributal to that as we have no idea whether there’s been algorithmic changes -kind of going back to that black box issue earlier. Right.

17:01 So that’s encouraging, very encouraging in many aspects. And it’s gotten to a point, Jeff, where these devices from my data have actually seemingly suggest better performance than clinical actigraphs.

So you have to start asking yourself. Why pay the almost 10 times more increase in cost for a clinical actigraph versus these wearable sleep trackers? And there’s advantages and disadvantages to both of those measurement techniques that complicate the issue further.

But that’s kind of the branching off point. And so to truly evaluate these devices, going back to your kind of initial question, you want to have what we call concurrent evaluation with the gold standard, polysomnography.

So for my studies people, patients are in our sleep center, Wisconsin Sleep, they’re undergoing a full clinical polysomnographic evaluation. At the same time these individuals are wearing a consumer sleep tracker or wearable on their non dominant wrist. In some of my designs I also have a clinical actigraph as well so we can make comparisons there.

18:11 There’s some additional components whereby these devices need to be synchronized on the same network of computers so that you don’t have issues with time synchronization, things of that aspects. And then you do some analyses and your basic analyses are looking at congruence with PSG, polysomnography more or less in relation to the main outputs of the PSG variables. How do these devices perform?

And then the additional, kind of more important analyses that a lot of research teams advocate for are the epoch epoch comparisons, which directly evaluate the devices’ staging abilities.

What we call an epoch is a duration of time, a window where we stage usually 30 seconds of sleep, wake or some variation of sleep and how those are congruent or not congruent with the PSG staging. And this allows us to determine the sensitivity, the specificity and the accuracy of each device in the context of sleep versus wake classifications and the various stages of sleep.

Jeff Mann19:20 Okay. So just to break it down a little bit, there may be some people – I gave you a lot there – Yeah, that’s great, but they’re hearing a lot of terminology that they may not be familiar with.

So we’ve talked about actigraphs a little bit and these single sensor early wearables, let’s just use the generic term FItbit, you know, wrist worn activity trackers.

So initially this accelerometer, it’s a tiny little chip that sits inside these devices and they’re very cheap to produce, it’s tracking movement. So it knows when your wrist is moving, you can track the direction of movement. But these devices, they started out just to monitor and track activity and then the companies decided, okay, well maybe we can use it as a proxy for sleep and weight and this sort of dichotomous, either sleep or either wake.

20:19 And in a sense that’s where actigraphy is. Do we have any more complicated versions of actigraphs or are they all single sensor devices?

Jesse Cook20:30 To my knowledge, the most widely utilized actigraphs still exist strictly as a single sensor device. They may be paired in a clinical setting with some other devices to assess breathing and things of that nature as well. But for the most part, the actual actigraphic device is still strictly accelerometer, focusing on those movement counts.

Jeff Mann: 20:55 And how long have people been using actigraphy in research for sleep? It’s quite a while, isn’t it?

Jesse Cook21:02 Yeah. It’s got a very robust, longstanding history. Um,

Jeff Mann21:07 We’re talking decades here.

Jesse Cook21:09 Yeah, a very long time and it’s supported, for the estimation, the assessment of various sleep disorders by the American Academy of Sleep medicine. So it’s generally regarded as a useful tool to assess habitual sleep wake patterns in people.

Jeff Mann21:27 So we have a tool, an actigraph and some big companies out the Phillips making these. And as you said, it’s 1000 bucks or so to buy. You can buy one of these activity trackers from China now..

Jesse Cook21:42 Right, $30

Jeff Mann21:44 Under $10 I’ve seen them. There are just so many of them because they’re so cheap to produce. But in a sense, these really cheap devices, the technology in those is no different to an actigraph which costs 1000 bucks. Is that a fair comment?

Jesse Cook22:01 That is a reasonable comment. Certainly and in a lot of ways, even at that lower level, there are still the multisensory options as well. The difference doesn’t necessarily lie in the underlying technology that they’re utilizing – the triaxial accelerometer – but the validation of the scoring algorithm.

Just because it’s collecting the data in a similar fashion, doesn’t mean that it’s utilizing it in an appropriate fashion for either device.

Jeff Mann22:37 So this is what researchers such as yourself and other sleep researchers all around the world are paying for when they’re buying a $1000 Phillips Actigraph. Their paying for all the research and development and the ability to dive in, to have access to all that data. But in a sense, the actual thing on your wrist, it’s not worth 1000 bucks just on its own, isn’t it?

Jesse Cook23:02 You’re absolutely right in that sense. Just the, the comfort and the sustained relationship and the fact that, in my Philips Respironics manual I have the algorithm that they utilize to compute sleep versus wake. Makes, makes it a lot easier and more useful in that sense.

Jeff Mann23:25 So I just want it to, to rewind a little bit for people that, because they may not be familiar with the sort of standard practices that are going on. And it highlights what you’re talking about in the sense that this second generation of multisensory wearables where companies started to introduce heart rate sensors on their devices, holds, potentially a lot more promise in revealing things about people’s sleep behaviors than a simple single sensor, you know, a simple thing like an actigraph or one of the earlier versions.

But obviously these things aren’t validated. People don’t know how they work. It’s a black box. So it’s a frustration for the scientific community because they have something which might be better, but nobody knows if it’s better, but they can’t use it because there’s no way to get the data and, and it’s not tried and tested.

24:20 And the other thing I just wanted to underline a little bit as well is PSG -polysomnography, which is the gold standard, the accepted gold standard for measuring sleep.

And from my viewpoint, we’ve reviewed a lot of consumer sleep technology over the years and I’ve got boxes and boxes stacked on the shelves. And I’ll try them all out and I think, well that’s interesting. And it is really interesting looking at your data and seeing what these things can track.

But the end of the day, after getting over the novelty factor, even thinking about using them on an ongoing basis, my conclusions from using all these devices is, well, I’ve got a score here for my sleep and it’s telling me my sleep duration. Some of these are breaking down into sleep stages as well, but what is it based on?

And this is kind of the whole context of the discussion here. What are these devices actually telling us? And what you want is for these devices to be congruent with the PSG, the polysomnography.

25:32 And I just wondered if you could just explain briefly to people who may not know exactly what those measurements would consist of. So in the experiment you just described where you go into a lab and they’ve got a Fitbit, let’s say strapped on the dominant hand, they’ve got an actigraph on the other hand and they’re doing a PSG test as well.

What would that look like and what would they be measuring to compare to the wearable measurements?

Jesse Cook26:00 Sure, absolutely. So, oh your standard polysomnography is going to utilize electroencephalography – EEG as a main measurement technique that’s basically the ability to assess the electrophysiology of the brain during sleep.

And additional to that, we have EOG, EKG, respiratory belts, nasal canular, we monitor the biophysiology across many different domains.

And these data are then provided to certified sleep technicians. In most situations nowadays it’s becoming automated in some areas, but certified sleep technicians who are actively monitoring an individual who’s sleeping through these waveforms and these data and are staging the sleep, whether it’s wake, which I think I’m experiencing right now. And then there are three non-REM stages N1, N2 and your deepest stage, slow wave sleep, and then REM sleep, rapid eye movement, sleep.

27:16 And those five components are the stages that people go through during a night of sleep. And these devices are outputting nowadays the multisensory versions, calculations of your standard polysomnography variables such as total sleep time.

So the amount of time that somebody is actively sleeping during their sleep window, the period that they were in bed. A sleep efficiency calculation, which should be derived based on the total sleep time divided by the time in bed times a hundred calculation. Usually a sleep onset latency, which is how long it takes somebody to fall asleep.

And then potentially some sort of calculation of wake during sleep. We refer to that as WASO, wake after sleep onset. And then the more advanced models, they start trying to break down the actual sleep into light sleep, deep sleep and REM. And as you may have noticed from my characterization of sleep staging in the research and clinical domain, there are no technically, or there’s no one to one relationship between the terms light sleep, deep sleep and then N1, N2 and N3.

So there’s a bit of discongruency there, or incongruency. But for the most part these devices are trying to output similar estimations of sleep quantification and classification that you would get in a sleep centre. Does that answer the question?

Jeff Mann28:57 Yeah. So you know, I’m testing, I’m reviewing one of these devices and it gives me all the stats back, and it’s kind of interesting cause, let’s say I’ll go out at night and have a couple of beers, I may notice something, my REM sleep is less than it should be, or my sleep is more fragmented.

So there are lots of interesting things you can get from these consumer wearables. But my point has always been, if I measured that same night’s sleep in a sleep lab, how would that measure up in terms of, in terms of accuracy. And the gold standard, the sleep lab test, even though it may not be perfect and you know, there’s lots of downsides, obviously you’re in an unfamiliar environment, you’re wired up, you’re strapped up to lots of sensors. So your sleep may not be as natural as it should be, But that is the best we’ve got at the moment, isn’t it? That is the gold standard and that’s what we should measure everything by.

Jesse Cook29:55 Interestingly enough, Jeff, there’s actually a lot of data out there that suggests that there is no first night effect in a PSG environment. Meaning that people tend to sleep consistently as they would across multiple nights there.

A lot of people actually sleep better than they do at home because there’s no bed partners, there’s no dogs, there’s no kids, there’s none of that additional stuff that can, complicate sleep.

Kind of going back to what your main point here is. How are these devices actually doing when it comes to their light sleep, deep sleep and REM sleep outputs?

 30:39 When I first looked at the multisensory device, my 2018 paper, its sensitivity, so the ability of this device to detect true PSG labelled information, whether it be light sleep, whether it be deep sleep, whether it be REM sleep was very, very poor.

To give an example, that device could only reliably detect REM sleep 30% of the time in congruence with PSG. So that’s not very good. That’s worse than a coin toss.

Jeff Mann: 31:10 No, I mean if you bought something you know, a car and it said it was an off-roader, you would expect it to perform reasonably well off road. In the same way, if you buy a sleep tracker that says it detects REM, but it only does it 30% of the time, you’d be a bit disappointed wouldn’t you.

Jesse Cook31:26 Yeah, I think I should only pay 30% of what they’re charging me.

Jeff Mann31:31 There you go…

Jesse Cook31:31 But basically the newer models have gotten better. And that may have to do with more attention to their algorithms. It’s hard to really say. Improvements in integrating the heart rate sensors, who really knows, but that REM sensitivity is now up to about 65% in some of the more advanced models, which is encouraging.

Jesse Cook31:53 Again, that’s, that’s still leaves some room for improvement. But it’s at least trending in a direction that is encouraging. So I’m not going to say that these devices are perfect. As you noted, PSG’s not even perfect. Right. But they’re useful and they’re getting better and that’s definitely encouraging.

Jeff Mann32:18 Yeah. Okay, so we’ve sort of tracked the history of this, these early, quite primitive devices. They’ve been getting gradually better, introducing more sensors, heart rate, some of them do other stuff like measure your skin temperature.

Jesse Cook32:40 One thing that I think is important, Jeff, that I wanted to include. These devices, whether it be anything that relies on movement. So your actigraphy devices, your consumer sleep trackers, whatever you want to look at, they’re inherently limited by their ability to detect wake during sleep.

Because as you can imagine, you can lie perfectly, still, not moving, but be awake. and it will classify you as a sleep. Right. So the performance, the ability of these devices is likely to be vastly different among different characteristics of individuals. For instance, if someone has a disorder like Parkinson’s, a movement related disorder or they share a bed with a dog or they don’t share a bed with the dog or they have a bed partner, these can lead to wide variations in their estimations of sleep night to night because of that component.

Sleep specificity is what it’s called, the ability to detect true wake and right now for most of the models that are wrist worn and fundamentally accelerometer based, even with the heart rate, at best, you’re looking at a 40% ability in that regard. So very poor.

Jeff Mann34:01 Great point. Thanks for bringing that up. That’s mentioned in the review as well. One of the limitations of actigraphy is this inability to measure motionless wake.

And we’ve seen that a lot of. People complaining, they’re sitting on the couch and they decided to binge watch three seasons of Game of Thrones ‘Sounds like a good idea’ and they check their starts and it says that they’ve been asleep for 18 hours. But they haven’t. They’ve only been asleep for six hours, but their Fitbit tells them because they haven’t moved for so long that they’ve been asleep for that time.

34:42 So my question to you is, is it possible? And if it is possible, how would one of these wearables, let’s say just doing movement and heart rate, be able to detect motionless wake from sleep. Is that possible with this sort of technology – algorithms measuring heart rate variability,

Jesse Cook35:06 At their current state, I think they’re going to be very limited in this regard. I think they’re going to need to advance the current multisensory approach by incorporating more novel techniques. I don’t want to get too Brave New Worldy here, but I can see the potential of having self applied EEG sensors that can Bluetooth sync to these devices that can then provide some information on the brain activity that’s going on in an individual.

And if we can get some information with that, even if it’s crude and very limited that may be able to enhance their current limitations beyond this inability to truly detect wake. We know that when someone goes into the sleeping stages, their EEG, their brain activity fundamentally changes. And so if we can get a window into that to assist with these other components, the movement, the heart rate, you get a much more comprehensive lens of what the individual’s experiencing and thus we can make a better prediction or estimation of what state of being they’re in.

Jeff Mann36:19 Right, okay. These devices, because a lot of these are collecting behavioural data and they’re feeding it back into machine learning algorithms and maybe they eventually would be able to learn that you’ve got a pet in bed somehow, or you know you’ve got some kind of condition.

Maybe they could filter that out and detect that you truly are asleep or awake rather, even though you’re motionless. But without that clever artificial intelligence stuff, you’re saying there’s no real way for these devices as yet without any other other types of sensors, EEG, whatever. That’s pretty hard to do at the moment?

Jesse Cook36:56 That’s my belief. And fortunately there are much more brilliant people that me that exists that can help remedy that situation. But you brought up a good point there with the machine learning algorithms. I think that’s the most, maybe like the term low hanging fruit that could potentially progress these devices in the quickest amount of time.

You articulated it very well where we can see patterns of behavior or if we can link patterns of behaviour with certain un-normal irregular patterns of movement and heart rate and the algorithms can start adapting based on that individual, we might be able to increase the capabilities and reduce the estimation errors in these devices.

37:42 The problem that I see with that route is that it takes a lot of user involvement. You’re going to have to have the user fill out questionnaires that say, did you share a bed with a partner last night, please document the hours, like what happened during your hours and sleep. Things of that nature.

And although I think there are a lot of individuals out there that would be compelled to do such activities with their time, I also know that a lot of consumers do not want to do any sort of engagement in that regard.

Jeff Mann38:15 Yeah. That goes against the whole mass adoption thing isn’t it. People don’t want to, do stuff. People like easy solutions. Yeah. We’ve already gone off track. I’ll try and get on track again.

So we had this tech come in. The tech got better and as we’re all aware of, and I’m sure everyone listening to this podcast is aware there’s been a huge, massive interest in sleep, sleep awareness.

Jeff Mann38:43 Every publication you read is putting out stuff about sleep education. It’s a big trending thing. Now people are saying, right, I need to be concerned about sleep as a health factor. There’s also people who are also into fitness thinking they want to optimize themselves on a day to day basis. Exactly.

And all of this has fed into demand for, for wearables to the extent where now we’ve got people taking their Fitbit data to the doctor. We’ve got this term that came out last year -orthosomnia – a sleep tracker-related anxiety.

So it’s quite an important thing isn’t it? That the data that’s actually being reported back to them is, is actually got some, some sort of validation to it.

Jesse Cook39:30 Absolutely, and you harped on a lot of really important points there and I’ll do my best to try and navigate them.

First and foremost it’s amazing to see the boom in recognition and attention placed on sleep these days. We’re seeing the health benefits, proper sleep, proper sleep duration, continuity, consistency, depth and various medical ailments such as Alzheimer’s, cardiovascular illness. Simple just day to day optimization.

So I’m very enthused by how society’s latching onto this. And you know, you mentioned the nature of a patient showing up with sleep data to their doctor and how to best integrate there. It’s super challenging. As you mentioned earlier, there’s a myriad of devices available. We have only evaluated a small portion of these in appropriate manner within that regard. These were evaluated in a specific population usually that may not translate or generalize to everybody.

40:39 So what do doctors even do with this information. And that’s a major challenge and actually prompted the American Academy of Sleep medicine to come out with a position statement last year prohibiting the use of wearable sleep trackers, consumer sleep trackers for diagnostic purposes.

They did in that position statement highlight the potential of these devices. But at this current time, just based on what we don’t know about their abilities and how the abilities translate between manufacturers as well as within manufacturers and different models that they make are just the unknowns there, make it impossible to be utilized in a clinical sense.

So yeah, there’s just a lot, of ‘murkiness’ is the word I like to use going on in this domain. And it’s kind of unfortunate in the sense that these devices can be very powerful.

41:38 You know, we talked briefly a couple of days ago and we talked about how Fitbit has aligned with NIH to generate some, some big data. And these devices can be very useful in that sense to help get more information that would otherwise not be viable to obtain.

I mean, getting research participants to come to a a night of sleep in a laboratory. At best I can get 50 people over multiple years and a good amount of grant funding.

But if we’re able to get this real time data through these devices that can help us gain insight into population dynamics, the etiology and causation of certain disorders and complications, they have extreme utility in that regard.

So hopefully in the coming years we can ameliorate the complications burdening their true integration and we can start utilizing them for the purposes that could shed some insight for our issues.

Thinking Of Using A Weighted Blanket? Here’s What You Need To Know.0

Have you ever considered using a weighted blanket for sleep? Long used as a sleep aid and anxiety reducer for people with conditions including ASD, ADHD, and sensory processing disorders, weighted blankets have definitely caught the interest of the general public. I’ve had several patients ask me about how they work, and it seems like time to bring that conversation here.

Anxiety is a major problem for sleep. There’s an abundant body of research that demonstrates the anxiety-sleep connection. I see anxiety wreaking havoc with my patients sleep and I hear from many of you how stress, anxiety, and a “wired and tired” mind interfere with your ability to fall asleep and rest soundly at night. Anxiety can intrude on sleep at any age; kids have this sleep issue, as do many adults. It can occur for all kinds of reasons, from environmental and circumstantial stressors to physical and psychological conditions.

Some time ago, I began working with the company Remzy to develop a weighted blanked designed to help everybody feel more calm, more able to relax in comfort, and better able to sleep. To go along with the Remzy blanket, I also developed a special web-based sleep program specifically for Remzy users. The blanket uses high-density micro beads that provide just the right amount of weight, without a lot of additional thickness. Keeping the blanket on the thinner side helps keep sleepers from getting too warm, no matter where you live or what season it is. Remzy blankets come in different sizes and with removable duvet covers that make it easy to wash and keep clean. It’s a great product I’m really proud of—you can check it out, here: https://getremzy.com.

What’s it like to sleep under a weighted blanket?

A lot of my patients want to know. Many people describe the feeling of a weighted blanket as like being held in a gentle hug. Weighted blankets apply light, even pressure over the entire body. That can help keep you more still when you’re in bed, and provides the soothing sensation of being gently held, which creates for many people a deep sense of relaxation and calm that makes it easier to fall asleep—and may help you sleep more soundly, with fewer restless awakenings during the night.

Weighted blankets have an interior lining that’s filled with evenly distributed weight. Different blankets come at different weights, ranging from 4 or 5 pounds to 25 or 30 pounds. In our research, we determined that 12 pounds of evenly distributed weight was ideal for sleep and relaxation—without excessive pressure or the generation of too much heat (which can interfere with sleep).

How do weighted blankets work?

Think about how comforting and relaxing it feels to be embraced in a good, long hug from someone you love. Think about how soothed a baby is when swaddled, or a child is when snuggled in a parent’s lap. Think about how relaxed—and often sleepy—you feel after you’ve had a massage. Touch and gently applied pressure have powerful psychological and physical effects. Eliciting those effects is what weighted blankets can do.

The evenly distributed weight added to a blanket exerts what’s known as “deep pressure stimulation.” That’s the gentle, firm pressure that can also come from massage, or other physical contact. Deep pressure stimulation lowers arousal. As research shows, deep pressure stimulation decreases the activity of the body’s sympathetic nervous system—that’s the system that promotes alertness and vigilance, and responds to stressful stimuli. It’s the “fight or flight” division of the nervous system. At the same time, deep pressure stimulation increases activity of the parasympathetic nervous system, which is sometimes called the “rest and digest” system. When it’s activated, it lowers heart rate and blood pressure, and increases relaxation and feelings of calm.

A 2015 study examined the effects of deep pressure stimulation from weighted blankets, and found a 33 percent reduction in stress, as measured by a test of physiological signs of arousal. Among the participants, 63 percent reported feeling a decrease in anxiety, and 78 percent said they found using a weighted blanket a preferable way to increase their level of calm.

The changes to nervous system activity that come from deep pressure stimulation are accompanied by a cascade of changes to hormones, which also contribute to lower anxiety and generate feelings of calm. These hormonal changes can also be beneficial for sleep.

May stimulate oxytocin. This hormone can stimulate feelings of attachment and closeness, and generate a deep sense of calm (think about the relaxing feeling of a warm, welcome hug—that’s oxytocin at work). A highly versatile hormone with functions we’re still working to understand, oxytocin plays a number of roles in the body, from stimulating sexual arousal to encouraging social bonding and parent-child attachment, to reinforcing emotional memories.

Oxytocin also plays a facilitating role in sleep. This hormone is one of several that’s involved in regulating our sleep-wake cycles. Oxytocin levels go up during sleep, typically peaking during longer periods of REM deep into a night of sleep. A 2017 study found that increasing oxytocin during sleep can increase sleep time and sleep quality, and may reduce the symptoms of obstructive sleep apnea.

Can decrease cortisol. Research shows deep pressure stimulation reduces levels of cortisol, an alerting hormone that plays a central role in the body’s stress response. The stimulating effects of cortisol make it difficult to fall asleep and stay asleep throughout the night. An evening drop in cortisol is part of the body’s natural progression toward sleep—but feelings of stress, anxiety, and being wound up can interfere with that natural nightly drop. The gentle pressure of a weighted blanket may help your body with its natural nightly suppression of this stimulating hormone.

Can increase serotonin. Research also shows that deep pressure stimulation increases the hormones serotonin a “feel good” hormone that helps keep you in a more relaxed state, day and night. Serotonin helps to stabilize mood and regulate energy levels and also contributes to regulating sleep-wake cycles. A lack of serotonin can lead to depression and anxiety, and to disrupted circadian rhythms. Keeping serotonin levels healthy is one way to encourage healthy, restful, sleep routines.

Serotonin is what’s known as a “precursor” to melatonin, a key hormone that promotes our nightly rest. The body produces melatonin from serotonin through a chemical process; when serotonin levels are deficient, healthy, sleep-promoting levels of melatonin are also at risk.

Interested in learning more about how hormones and their timing affect sleep, and the best times to do everything from snooze to eat to have sex? Check out my recent TED Talk! It was so much fun to do.

How to use a weighted blanket 

The short answer is, just like you would any other blanket! When selecting a weighted blanket, you want one that’s heavy enough to exert the pressure you need, but not so heavy that it excessively restricts your movement, feels uncomfortable, or causes you to overheat in bed. Those effects can all be counterproductive to sleep. (That’s why we determined 12 pounds of blanket weight to be optimal for anxiety relief, relaxation, and sleep.)

You may find yourself more inclined to sleep with less clothing with a weighted blanket—go for it! I’m a proponent of sleeping in the nude. (Among other benefits, it may help you stay at a healthy weight, which I wrote about recently.) Go ahead and shed some layers, and let the blanket do the work of keeping you warm and swaddled.

Last point is this, and it’s an important one: DON’T slack off on the rest of your sleep hygiene. A weighted blanket can help you to de-stress, relax, and relieve anxiety. It can help you fall asleep more quickly and sleep better over the course of the night. But it can’t do ALL the work of a good night’s rest. You still need to pay attention to the basics, which are key for healthy sleep:

  • Sticking to a consistent sleep schedule, with regular bedtimes and wake times
  • Avoiding too much light exposure at night
  • Not eating too heavily at night and close to bedtime
  • Consuming alcohol only moderately, and ideally not within a few hours of bed
  • Getting regular exercise
  • Managing stress and supporting mood with relaxation practices, including meditation

Let me know what you think of the weighted blanket, and how it works to help you sleep better.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor™

www.thesleepdoctor.com

 

 

The post Thinking Of Using A Weighted Blanket? Here’s What You Need To Know. appeared first on Your Guide to Better Sleep.

Saying "Yes" to EVERYTHING!0

Have you ever fell into a spot in life where you over-commit? It normally happens one day when you are trying to find time to unwind and you realize there are no spots on the calendar. Before you know it your schedules are overlapping your schedule and your family is in disarray.

Treating Insomnia with Meds0

The Costs Associated with Untreated Insomnia

It is miserable to experience insomnia. Difficulty falling or staying asleep that occurs for at least 3 nights per week, for at least 3 months, is defined as chronic insomnia. More than 30 minutes is often spent awake at night, on average, but hours can be lost struggling to sleep. There are common symptoms associated with insomnia, including:

  • Fatigue
  • Decreased energy
  • Poor concentration
  • Short-term memory loss
  • Mood problems (anxiety or depression)
  • Headache or pain complaints
  • Feeling unwell (malaise)
  • Upset stomach (dyspepsia)

Beyond these complaints, insomnia can be associated with increased risks of drug or alcohol abuse, suicide, and other psychiatric disorders like bipolar disorder or schizophrenia. There may be higher rates of errors at work and accidents. The associated sleep deprivation may also lead to poor weight control, cardiovascular disease, immune dysfunction, and even cancer.

There is a high incidence of chronic insomnia: it is the most common sleep complaint seen in the primary care setting. Chronic insomnia affects approximately 10% of the population. It may occur more in certain groups, in particular among older people and women.

The costs associated with untreated insomnia are high. It is estimated that at least $10 billion per year is spent to treat insomnia in the United States. When factoring in the expenses to treat associated medical problems and lost work time and productivity, the figure climbs to a staggering $100 billion per year.

Not only does someone with insomnia suffer from poor, restless sleep—they are robbed of daytime function, productivity, and quality of life. This often leads to a desperate search for a solution.

An Empty Promise: Seeking Insomnia Relief with Sleeping Pills

When insomnia persists, the most commonly sought treatment is the use of over-the-counter or prescription sleep aids and sleeping pills. Though of modest benefit, there can be significant side effects and long-term harms associated with their use.

According to the Centers for Disease Control, it is estimated that between 2005 and 2010 about 4% of adults who were 20 or older had used a sleeping pill in the previous month (7). The number of prescriptions for sleeping pills is increasing. Yet how effective are these drugs, really?

Scientific research is able to provide some answers. Over-the-counter sleep aids often contain melatonin or diphenhydramine (sold as Benadryl, Tylenol PM, Advil PM, Aleve PM, ZzzQuil, etc.). Based on limited research, these medications reduce the time it takes to fall asleep by a mere 8 to 9 minutes. Moreover, the increase in total sleep time with the use of diphenhydramine is just 12 minutes.

The most commonly prescribed medication for the treatment of insomnia is the hypnotic drug called zolpidem (sold under the brand names Ambien, Ambien CR, and Intermezzo). It affects memory, making someone unaware of being awake, but only modestly enhances sleep. Research suggests that it reduces the time to fall asleep by 5 to 12 minutes, on average. It reduces the time spent awake at night by 25 minutes. As a result, the average increase in total sleep time is about 29 minutes.

Even the newest medication, suvorexant (or Belsomra), is somewhat underwhelming in its effects. Research suggests it only makes it easier to fall asleep by 8 minutes and increases the total sleep time by just 10 minutes.

Unfortunately, most prescription drugs are no better. These medications may affect the memory of wakefulness without substantially adding to sleep quantity or quality. Many times drugs used as sleep aids are incompletely effective, and if they do help, they seem to stop working over time.

Dangers of Using Sleeping Pills to Treat Insomnia

Beyond the lack of efficacy, there are significant side effects associated with these medications. Some effects may be harmless, such as an increase in the incidence of dreams or nightmares that occurs with melatonin use. Others may be more concerning.

All medications have potential side effects, and they may be somewhat unique to the agent used. Broadly speaking, research has demonstrated sleeping pills increase the risk of falls and resultant hip fractures, urinary retention, confusion or delirium, sleep-related behaviors, and morning hangover effects that may affect driving safety. More startling, these drugs seem to double the risk of overall mortality and are being linked to the development of dementia.

Cognitive Behavioral Therapy is making huge strides treating insomnia.  Alaska Sleep Clinic is proud to have our Cognitive Behavioral Sleep Specialist, Dr. Angie Randazzo helping Alaskans improve their sleep and their lives!  Find out more about ASC and Dr. Angie here.

 

 

Floor Sleeping?  Really?0

We have all been there. Restless nights tossing and turning until the clock reads 3 a.m. and 4 a.m. and before you know it, the alarm is going off for another day to begin.

As We Age, What Is “Normal” Sleep? Researchers Publish Meta-Analysis as a Reference0

Researchers at Sunnybrook Health Sciences Centre in Toronto, Canada, have characterized the structure of normal sleep. The findings of the study “Normal Polysomnography Parameters in Healthy Adults: A Systematic Review and Meta-Analysis” have been published in The Lancet Respiratory Medicine.

“Many of us believe that as we age, we lose sleep,” says Mark Boulos, MD, sleep neurologist at Sunnybrook and the study’s lead author, in a release. “What we discovered is that as people get older, their sleep doesn’t change dramatically.”

Brian Murray, MD, head of neurology at Sunnybrook, conceptualized the study. He says, “One very interesting finding is that the percentage of deep and dreaming sleep remains remarkably constant in healthy people over their lifespan.”

The researchers reviewed data from 169 published sleep studies that collectively examined 5,273 healthy adult participants.

“We looked at various sleep parameters, for example, how long it took a person to fall asleep, and the duration of different stages of sleep,” says Boulos. “Using our study data, we were able to determine the impact of age and sex on the various sleep parameters.”

Researchers analyzed the data to determine normal values for different age groups, which showed only a very slight decrease in sleep as healthy people got older.

Boulos explains that the brain circuitry involved in maintaining sleep may change over time, and some people are not able to stay asleep quite as long because of a change in brain health.

“As we get older, we’re likely picking up other medical disorders that impact sleep,” says Boulos. Examples include obstructive sleep apnea, or medical disorders that cause pain. Many common medications can also alter sleep quality.

While both men and women had some decrease in sleep quality at around 50 years of age, it was at age 65 years that women had a particularly more difficult time falling asleep. “It takes everyone longer to fall asleep at this age. For men, it took about three minutes longer, but for women it was 12 minutes longer compared to earlier in life,” says Boulos.

“The change for women could be due to a number of factors. It could be a hormonal change, such as menopause. Life changes, such as illness or death of a spouse or significant other can also play a role.”

The findings from this study were based on the latest sleep study scoring criteria, which were published in 2007. Boulos says the study findings will help provide doctors and researchers with a reference standard for normal sleep in the laboratory.

He adds the findings are also a benefit to patients and their families.

“We now have an understanding that sleep doesn’t actually change too much over time and if a person’s sleep is changing a lot, they should connect with their doctor to look at the possibility of other medical conditions that might be impacting their sleep,” he says.

New Evidence Supports Screening Neurology Patients for Sleep Disorders0

Cleveland Clinic researchers study links between seizure frequency and insomnia severity.

People with epilepsy are more likely than the general population to have insomnia and sleep apnea. The daytime sleepiness associated with both of these conditions could potentially aggravate the neurological condition, leading to more seizures throughout the day and night, diminishing the quality of life for people who live with this disorder. So why not screen every neurological patient for sleep disorders and treat them accordingly?

This is a question that the Cleveland Clinic’s director of the Sleep Disorders Center Nancy Foldvary-Schaefer, DO, MS, a neurologist and sleep specialist, will likely ask during her presentation at the American Academy of Neurology (AAN) meeting in May.

She will be presenting an abstract that she and a team of researchers from the Cleveland Clinic in Ohio wrote, looking at a correlation between the number of seizures per month that people with epilepsy experience and their insomnia severity.

It’s important work that provides evidence that perhaps insomnia symptoms can directly impact seizure control in people with epilepsy and, therefore, the next step would be to treat those insomnia symptoms to demonstrate that seizures decline when disordered sleep is remedied, Foldvary-Schaefer says.

In addition to the abstract presentation, Foldvary-Schaefer will also be teaching a course at the AAN meeting titled “Sleep-Disordered Breathing in Neurology Populations: From Lab to Clinic” on neurological disorders and their relationship to obstructive sleep apnea on Saturday, May 4. She hopes that the course and her presentation will spread awareness among neurologists about the prevalence and potential impact sleep disorders can have on the populations neurologists treat.

Sleep disorders and sleep problems are relatively common in people with epilepsy, and now there are strategies to address them, including cognitive behavioral therapy for insomnia (CBT-I), a proven way to treat insomnia by changing thought patterns and sleeping habits, Foldvary-Schaefer says.

There’s no reason why neurologists shouldn’t be screening their patients for sleep disorders, but not enough of these physicians are trained in sleep medicine. Just like there is now training for primary care doctors to recognize sleep apnea in their patient populations, there should be additional training in sleep education for neurology providers, a simple way to improve patient outcomes, says Foldvary-Schaefer.

“There should be some sleep screening in the care of all neurological patients,” she adds.

To further explore how treating sleep disorders can impact epilepsy, Foldvary-Schaefer and a team of researchers are currently working on a randomized controlled study using a smartphone app called Go! to Sleep , developed by the Cleveland Clinic, to administer CBT-I. The research will look at patients who experience both insomnia and epilepsy and how CBT-I can help ease their symptoms.

“It will be nice to show that an intervention will not only improve subjective sleep, but also quality of life, and maybe even reduce seizures in this population,” she says.

Lisa Spear is associate editor of Sleep Review.

Insomnia Has Been Genetically Identified And How To Sleep During Your Menstrual Cycle0

This week was filled with interesting research that I think can be very valuable for all of us. There were three sleep studies that I think you will enjoy and get great benefit from reading.

Looking at this first study, I thought it was fascinating that in patients who were above 60 and diagnosed with insomnia, 21% of them had to increase their blood pressure medications.

Unfortunately, we do not know which medications were being used.

Researchers think there may be a few reasons why this could be occurring. First is that when you use a pharmaceutical for sleep, many of them decrease your drive to breathe. This is called respiratory drive and it can be compromised when taking certain sleeping pills like Valium, Restoril, Xanax, etc. This can lead to sleep apnea, and undiagnosed sleep apnea can lead to an elevation in blood pressure. There was also discussion that some of these sleep aids can also affect the cardiac tissue itself.

Next, was another insomnia study that proved my theory of how a Dolphin Chronotype exists; it’s genetics. This is yet another study showing that insomnia has genetic underpinnings. In this study researchers from the UK, followed almost 86,000 people and measured their sleep with a Fitbit type of tech, and mapped their genomes. The researchers appear to have discovered 10 new genetic links to sleep duration and 26 with sleep quality.

WOW!

We are certainly getting closer to better understanding these genetics. If you think you may have insomnia or just restless sleep, be sure to take my quiz at www.thepowerofwhenquiz.com and learn your chronotype, and be sure to watch my newly published video from my TedX Manhattan Beach Lecture!

The final study looks at women’s health in particular, and how menstrual cycles affect sleep.

Researchers discovered that young women are more likely to experience sleep disruption in the days leading up to their menstrual period, according to a new study presented Saturday at ENDO 2019, the annual meeting of the Endocrine Society.

“Sleep is more disrupted in the several days directly prior to menses in young healthy women,” says Anne E. Kim, a medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, Ohio.

According to the National Sleep Foundation, 25% to 33% of menstruating women in the United States have reported more disrupted sleep during the weeks before and/or during menses. This study by Kim and colleagues validates these perceptions using objective measures, and further documents the negative impact of dieting on sleep.

So, what can you do about it?

Here are some of my tips for sleep if your menstrual cycle is not cooperating:

Increase your intake of liquids to help flush out excess sodium that causes water retention and bloating just before and during your period. This will help decrease any feelings of discomfort that make sleep difficult.

Take extra calcium. In a study commissioned by the manufacturer of Tums (an OTC antacid medication containing calcium carbonate), taking 1,200 milligrams (mg) calcium daily resulted in a 50 percent decrease in PMS symptoms. Bloating was reduced by 36 percent, food cravings by 54 percent, and psychological symptoms by 46 percent. In addition, calcium has sedating properties, which can improve sleep quality.

Take 400 mg magnesium. Studies show that magnesium affects mood by boosting the level of serotonin, the calming neurotransmitter in the brain. When combined with calcium, magnesium is a good muscle relaxant. Of course, being relaxed is important to falling asleep easily.

Take 100 mg vitamin B6, which also helps you produce serotonin. But be careful: In some people, B6 can have an energizing effect.

Starting at 2:00 p.m., eliminate all caffeine. Caffeine is a stimulant that can trigger anxiety, making it difficult to fall asleep.

Don’t drink alcohol within 3 hours of bedtime. PMS can cause your blood level of alcohol to get higher than at other times of the month. While drinking alcohol may make you feel sleepier, alcohol also keeps you out of the deep stages of sleep, which are important for feeling refreshed when you awaken.

Here are the interviews I did that were published this week:

In Defense Of The Nap – Pitt News
Find It Harder To Fall Asleep On Sunday Nights? Know Why It Happens – India Times

The post Insomnia Has Been Genetically Identified And How To Sleep During Your Menstrual Cycle appeared first on Your Guide to Better Sleep.