How you’d sleep last night? There’s a hefty chance it was not so good. According to the Centers for Disease Control and Prevention, one-third of the American public is suffering from insomnia. Whether this number sounds like a lot or a total understatement probably depends on whether you’re the one tossing and turning at night. Insomnia can make everyday life hard—that is, difficult to function during the day at work and scary to get behind the wheel of a car. In addition to fatigue, too little sleep impacts mental and physical health in a variety of less immediate ways, making us more likely to be depressed, sick and overweight.
For years, doctors have been telling sleep-deprived patients to practice good sleep hygiene, for example, cutting back on coffee, nicotine, alcohol, naps and bouts of vigorous exercise right before bedtime; and creating a cool, quiet, dark and comfortable sleep environment in the bedroom. If those commonsense recommendations don’t do the trick, there are high-tech tools that offer some relief—for a price.
Perhaps the most familiar kind of sleep technology are sleep trackers. These products (think Fitbit) use sensors to track sleep quality and offer feedback. Some people swear by them; roughly 60 percent of users are satisfied with the technology. But customer surveys aside, how well do such devices really work in diagnosing and solving sleep problems? For the moment, the answer is probably, not well enough.
In 2015, Jeon Lee and Joseph Finkelstein of Johns Hopkins University School of Medicine published the journal article Consumer Sleep Tracking Devices: A Critical Review. They examined studies and product information for six types of wearable sleep trackers: BodyMedia Fit, Fitbit Flex, Jawbone Up, Basis Band, Innovative Sleep Solutions SleepTracker and Zeo Sleep Manager Pro. Their conclusion? There was “a critical lack of basic information about the devices.” In a similar vein, a letter to the journal Sleep in 2016 noted that while more and more patients are using wearable sleep trackers, “clinicians are often befuddled when asked to interpret these data because there are no accepted guidelines or standards. ”
All of which is to say that when you go to your doctor brandishing a smartphone and a mound of data, he or she may not know quite what to do with that information—yet. Part of the problem is that every company in the market is creating its own proprietary product; industrywide standards don’t exist. Still, sleep trackers have their uses, if only to make users more aware of how their sleep quality might change from night to night and over time. In fact, the American Academy of Sleep Medicine has developed an online telemedicine portal AASM Sleep TM that facilitates communication between doctors in patients. In a nod to the potential usefulness of and the popularity of sleep tracking, users are encouraged to sync their Fitbit data.
Still, if the jury is still out on sleep tracking, there are sleep tech solutions that may have come closer to realizing their promise. For example, in the January 2017 issue of JAMA Psychiatry, researchers studied a product called SHUTi, which stands for “Sleep Healthy Using the Internet.” SHUTi is based on cognitive behavior therapy for insomnia (CBT-I), a form of therapy traditionally performed in an in-person setting, and widely recommended by experts for insomnia sufferers.
Daniel J. Buysse, M.D., a professor at the University of Pittsburgh School of Medicine, uses in-person CBT-I with patients and is currently doing a National Institutes of Health-funded study using SHUTi. (He’s also a paid consultant for BeHealth Solutions, LLC, which markets the commercial version of SHUTi). Like the JAMA authors, Dr. Buysse notes that the number of trained CBT-I practitioners is dwarfed by the number of insomnia sufferers, which is why online delivery systems have become so appealing.
According to Dr. Buysse, unlike traditional cognitive behavior therapy, CBT-I tends to focus more on the behavioral than the cognitive aspects of insomnia. Patients are asked to monitor and record their experiences, such as the amount of time they spend in bed asleep and awake. The online program can offer automated recommendations based on self-reported behavior (such as 10 hours spent in bed, with only seven hours sleeping).
One great advantage of CBT-I is the fact that it provides help with few downsides. Still, the negatives are real. Both in-person and online versions of therapy can have mild side effects: patients can experience increased sleepiness initially, since they might be asked to tweak their sleep habits, resulting perhaps in fewer hours spent in bed. What’s more, increasing scrutiny of one’s own sleep patterns does sometimes make it harder to relax. Furthermore, according to Simon Rego, Psy.D., chief psychologist at the Montefiore Medical Center in the Bronx, not every sleep program that claims to offer the benefits of CBT-I rigorously adheres to the protocol. He says, “it’s like baking a cake—don’t vary the ingredients, or you won’t get the same results. Each program is only as good as the people who have programmed it.”
Side effects and shortcomings aside, we’re probably only beginning to realize the promise of sleep tech. When used properly, it can not only help us make sense of, say, a short-term bout of insomnia, but also educate us about the science of sleep. As Jennifer Martin, Ph.D., a clinical psychologist and UCLA associate professor, notes, most people know a fair amount about their nutritional needs, but far less about their bodies’ need for sleep and how to attain it. “We all need a higher sleep I.Q.,” she says.
Trackers and online therapy don’t offer quick fixes; they require serious investments of time, money, and effort. SHUTi, for example, requires an initial investment of $135 and a 16-week commitment. (A Fitbit carries a similar price tag). For those who are willing to work more to sleep better, it may be worth it, since losing even a few nights’ sleep can do a number on mind and body. Looked at that way, $135 seems a small price to pay; a good night’s rest is priceless.
Rachel Paige King is a freelance writer whose work has appeared in Salon, Atlas Obscura and JSTOR Daily.