Sleep trackers can make insomnia worse

https://www.nytimes.com/2019/06/13/health/sleep-tracker-insomnia-orthosomnia.html

by bookofjoe • 7 years ago

115 137 7 years ago

nytimes.com

ex3ndr2• 7 years ago

For me Apple Watch with ECG caused panic attacks.

saagarjha2• 7 years ago

Why, did it report anything unusual?

derefr• 7 years ago

There’s a known correlation between increased https://en.m.wikipedia.org/wiki/Interoception and anxiety.

Part of how panic attacks work, for example is a feedback loop where you’re aware of the way your body is reacting to panicking (feeling your heart speed up, etc.), which makes you panic more.

serf• 7 years ago

I don't know about the parent poster, but apple watches have had a high rate of a.fib false positives.[0]

I'm not sure if that has been remediated yet.

[0] https://www.biospace.com/article/apple-watch-atrial-fibrilla...

taneq2• 7 years ago

Portable white-coat hypertension, yay!

StavrosK• 7 years ago

This reminds me of Goodhart's law:

"When a measure becomes a target, it ceases to be a good measure."

https://en.wikipedia.org/wiki/Goodhart%27s_law

max763• 7 years ago

I don't think this is a textbox example of Goodhart's law.

A healthy amount of sleep is a great target and measure, just like staying within a healthy weight range and lots of other biometrics.

I think Goodhart's law applies to people gaming the system or juking the stats to inflate a measured number causing the number to lose meaning. It doesn't matter what you do, getting enough sleep is important.

BurningFrog3• 7 years ago

Yeah, sleep is actually a good fundamental goal in itself, not a gameable proxy for something else.

sametmax• 7 years ago

I see your point, but this ignores anxiety, sleep quality and training yourself to answer your body signals.

First, targeting a metric may create a counter productive stress that can make you sleep less.

Second, the device, and the process, may induce a sleep of lesser quality.

Last, always targeting numbers doesn't force you to listen to your body, an ability that our society is losing more and more. You don't need "8h of sleep". You need to sleep at the time and duration that your feelings indicate to you. Failing to do that result in plenty of problems, including oversleeping, sleeping at bad hours, neglecting diet related to sleep, ignoring light, not adapting to punctual overloads, etc.

Now, yes, Goodhart's law is more about cheating a system. But it's kinda what you do: you try to bypass your natural way of calibrating with sleep and only see a metric. We do that for a lot of things: food, sport, work, etc. And because of that, we behave erratically.

0xcde4c3db• 7 years ago

Your argument would make sense if sleep processes were being measured via EEG or similar means, but virtually all "sleep trackers" are just movement trackers; they're absolutely measuring a proxy that can be gamed.

mikestew• 7 years ago

I think Goodhart's law applies to people gaming the system or juking the stats to inflate a measured number

Indeed, it is. From TFA: "In the case study on orthosomnia, researchers found that patients had been spending excessive time in bed to try to increase their sleep numbers, which may have made their insomnia worse." (emphasis mine)

taneq2• 7 years ago

Isn't this just the next level of "If I go to sleep right now I'll get 7 hours ... 6 hours ... 4.5 hours ... <panics>"?

vorpalhex• 7 years ago

I anecdotally found this to be true for myself. Especially on Sunday night I would start stressing about my sleep numbers.

Needless to say, if anyone would like to buy a used fitbit versa...

annamargot• 7 years ago

Just read “Why We Sleep”. Never had a problem getting to sleep until I started reading that book.

I started stressing hard if I didn’t get to sleep right away. Put it down for a few days and all is well again.

Excellent book, freaked me the f out.

Apocryphon• 7 years ago

That book is one of those hyped volumes on Hacker News which, while good, can have diminishing returns. When everyone claims to get benefits from it, a dissenting opinion can make oneself question one's lifestyle. "Deep Work" by Cal Newport is another example.

CommieBobDole• 7 years ago

This doesn't surprise me. When I have insomnia, it is invariably caused by being aware of and worrying about the process of sleeping.

SketchySeaBeast• 7 years ago

Yeah - the less I think about sleep the more likely it's going to happen. I also find that I can't care about not getting enough sleep - I used to do math in my head "ok if I fall asleep now it'll still be 4 hours" - I've learned that I can function on zero sleep for a day if I really have to, so it's no longer a threat to myself, and I don't worry about not sleeping because of it.

BurningFrog3• 7 years ago

Yeah, worrying about sleep trackers can make insomnia worse.

This is basic sleep hygiene, and I don't know that there any other way than through.

One of the first things to learn is that worrying about bad sleep is one of the major causes of bad sleep. Getting out of that riddle solved a substantial part of my sleep problems.

Once you're on the other side, having data is much better than not having it.

Avamander2• 7 years ago

I have about six years worth of sleep duration (and activity during sleep) data. There still isn't a single piece of FOSS software that would deal with that, I could import it into Postgres and view with Grafana, but I ain't no scientist or super interested in sleep science so there's very few conclusions I could make from it. Would love someone picking up this task :P

sjg007• 7 years ago

I’m pretty sure someone could take a raspberry pi with a battery power source and reconstruct a home sleep apnea device. If you just want to use an accelerometer you could probably do the same.

phonon• 7 years ago

What's wrong with Excel?

nitrogen• 7 years ago

There's an app I haven't tried called Fluxtream that is designed for the quantitative self: https://github.com/fluxtream

There's a hosted version but sounds like you'd want to run your own instance.

ianai4• 7 years ago

The best thing I’ve found for insomnia, other than medication/melatonin, is imagining myself flying. Basically going to silly fantasy land bootstraps a sleep state pretty reliably.

jimhefferon• 7 years ago

Me also. The fantasy land should be all visual, though, no talking. Weird,but that's how it is for me

ianai4• 7 years ago

Actually I agree. If I’m too interested in the story I won’t sleep. There shouldn’t be a story.

Steve442• 7 years ago

I try and build little worlds in my head and fly around them, working on adding details as I go. I think it works because it blocks everything out and requires zero physical effort.

ianai4• 7 years ago

It’s usually flying for me as well. It’s just interesting enough to not be too Beijing. But it’s completely independent of what happened during the day, will tomorrow, etc.

arethuza• 7 years ago

I used to spend a lot of time flying and, thankfully, I've always found it easy to sleep on planes.

However, a few years back a colleague was building a server on a desk near me and it sounded very like the inside of a plane and I became very drowsy almost immediately!

Angostura3• 7 years ago

I listen to BBC radio dramas - ones that aren't too dramatic. I usually manage to get in about 10 minutes before I fall asleep. Either that or the 531 podcast.

scarejunba• 7 years ago

Interesting. My bed tracks my sleep but I only get the report in the morning and not live. My phone isn’t near my bed and I only interact with the Internet using my Google Home when I’m in my bedroom. All the sleep tracker has done is let me know what my sleep looks like.

Most weeks it’s good but lately I’ve been doing poorly - sleeping too little.

newsbinator10• 7 years ago

For me the problem isn't getting to sleep or sleep duration- it's that my Xiaomi band reports consistently that I only get 10 - 30 mins of deep sleep in an 8 hour period.

And I consistently feel tired even before checking those stats, so I think they're accurate.

I can't seem to figure out how to solve this.

I'm average size (a bit under weight) and not a snorer. I stop eating by 7pm, stop screen time by 8pm, eliminate all light, and sleep in a cool, comfortable bed (that I only use for sleeping).

Aerobic exercise and morning sunlight don't seem to matter.

What else is there to do?

bongo6622• 7 years ago

Do you exercise consistently? Hows your diet?

newsbinator10• 7 years ago

I get decent aerobic exercise 3 times a week or more.

I should start lifting again.

My diet is mostly veggies, eggs, chicken, fiber cereal, nuts, berries, and chocolate.

knocknock• 7 years ago

How are you with Alcohol and Caffeine intake?

newsbinator10• 7 years ago

Zero alcohol for the last 10 years.

Zero caffeine for the last 3.5 years.

hnick2• 7 years ago

Have you done a sleep study? It can detect if you are waking and why. Even if you think you don't snore you might have airway issues.

Of course results vary, mine basically lead to the doctor saying I was a bit below normal and losing some weight (5-10kg) should help, but it didn't address the real issue which was that I take too long to get to sleep in the first place.

newsbinator10• 7 years ago

I have thought about it, although it is quite expensive ($1500 - $2000 out of pocket).

I am a few kilos under weight for my height, so it hasn't felt like an obvious move. But I do want to get to the bottom of my sleep issues- it affects every aspect of my life.

hurrdurr2• 7 years ago

Have you seen a sleep specialist or done a full sleep study?

Izkata• 7 years ago

Have you done any experiments with sleeping position?

On my back I usually have trouble sleeping, on my left side I'm well enough to get a full night's sleep (usually with some rolling around), but on my right side, with my arms in the right position (right arm under pillow and curled back under my head, left arm over pillow and reaching around towards the other arm's elbow), I'm usually completely out.

newsbinator10• 7 years ago

That's very interesting. I hadn't considered that at all. I do find I fall asleep on my side, and perhaps wake up when my hand falls asleep or something.

Good idea.

rashkov• 7 years ago

A few things you could try: taking a magnesium supplement, use a weighted blanket, add some exercise to your routine. Is there noise that might be waking you up? A white noise machine or earplugs could help. Are you sharing your bed with someone? Their tossing and turning could affect your sleep, so fixing your bed frame and getting a mattress which isolates motion could both help. Is your life stressful? That could be something else to address.

Finally, keep in mind that possibly, these wrist sensors may not actually be able to detect deep sleep all that well.

newsbinator10• 7 years ago

A lot of good things to consider there, thank you.

To start with, I'll try to add lifting to my routine and maybe a magnesium supplement. I might do the supplement first for a week, to see if it has any impact.

disordinary4• 7 years ago

I found it to be the opposite. I knew I wasn't getting enough sleep and so I would constantly look at my clock, phone, watch, etc. so that I could get an idea of how little I was getting. When I got a fitbit I stopped worrying about looking at my watch constantly to see when I fell asleep as it would tell me in the morning. I still have sleep anxiety and I'm only averaging 5 hours of sleep per night, if I have something I can't miss (like a flight) the next morning I still will often get none, but it's not as bad as it was.

shereadsthenews• 7 years ago

Isn’t that pretty common? If I know I have to get up unusually early I can never sleep. If I have to rise at 4AM to drive to a bicycling event that starts at 6 I can never sleep before that. Same for very early flight departures or anything out of routine. I’ve adjusted by just getting up so early every day that there’s no possibility of anything being extra-early!

disordinary4• 7 years ago

I don't think so. I travel regularly to Sydney for work, the flight we catch to get a full working day has a check-in at 5am. None of my colleagues who I travel with have this problem.

I try and deal with it by avoiding early flights if possible and flying the day before and staying the night but it's not always convenient with schedules, etc.

Johnny555• 7 years ago

I found that if I set two independent alarms (i.e. my phone and my alarm clock), I sleep much more soundly when I need to get up early -- the second alarm gives me reassurance that I won't oversleep even if my phone battery dies so I sleep better

mdgrech23• 7 years ago

I had the same. I'll just reply w/ a laundry list of things that helped me. Black out blinds and eye mask, eliminate all sources of light in the room. Keep the heat down about 64 in the winter, in the summer I sleep w/ a thin blanket and in my underwear. Go to bed at the same time and get up at the same time even on the weekends. Exercise daily. No coffee after 3pm. No eletronics 2 hours before bed. I also sometimes take melatonin.

disordinary4• 7 years ago

Thanks for that.

Unfortunately because I live in New Zealand for a global company I often have meetings in the middle of the night so the no computer before sleep is tough, I'm also worked up after those meetings and usually need to wind down somehow.

I do try and do most of the above, including no coffee after 12 (which is tough because I love coffee).

balfirevic3• 7 years ago

Black out blinds and eye mask, eliminate all sources of light in the room

Why do you need black-out blinds if you have an eye mask?

SmellyGeekBoy2• 7 years ago

Exercise daily.

Although daily might be a bit extreme, the effect of regular exercise on sleep is pretty profound, at least in my case. I've been sleeping longer and better (according to my Fitbit) since I started working out and running, and if I have to have more than a few days off my sleep really starts to suffer.

Steve442• 7 years ago

I would constantly look at my clock, phone, watch, etc.

I have a projection clock which displays a dull red digital clock on the ceiling. It means if I do wake up I can check the time without having to roll over, rind a bright clock etc. It’s so dull it doesn’t disturb my sleep and I find really useful to have.

zigzaggy• 7 years ago

My experience has been the opposite of making it worse. When I started using my watch to track sleep I was sleeping 3-4 hours per night then one long night of sleep (7-8 hours) once a week. I was basically crashing from exhaustion.

I started tracking my sleep, and used the app to find the best “go to sleep” time target. I’ve gradually increased my sleep time to just over 6 hours a night with one or two 8 hour nights on the weekend.

My watch has been a critical tool for improving my sleep.

Edit to add: I also use the “Sleep with Me” podcast to fall asleep. That guy’s mumbling are pretty easy to fall asleep to.

IronWolve2• 7 years ago

I have 2 sleep trackers, the beauty rest wifi unit that goes under the mattress and a fitbit. I have sleep apnea and wanted to watch my sleep for scores. I normally dont get much deep sleep after 4 hours, or 3rd cycle of sleep. Setting my alarm to wake up at 4 am, then go back to sleep, body resets for 1 more cycle with a short deep sleep cycle. Sleep Hacking.

bestnameever• 7 years ago

what time do you go to sleep?

IronWolve2• 7 years ago

10 most times, Midnight on occasion.

deepakhj• 7 years ago

It’s the opposite for me. With the tracker, I have solid evidence I got a few hours of sleep when I think I didn’t sleep at all. It makes me calm down and stops insomnia attacks from occurring.

durdleturtle• 7 years ago

Eh I just use the free program f.lux as it dims your computer screen's colours so that you aren't exposed to blue light before you sleep.

sschueller• 7 years ago

I wish my Samsung TV had such a feature.

anilakar• 7 years ago

Anecdote: My most exhausted coworkers are those who openly admit and talk about using sleep trackers.

I believe that the effect of sleep trackers is mostly psychological and they work in the same way all those self-help books do.

louhike• 7 years ago

It seems logical that the ones having difficulties sleeping use tools to sleep better. So I'm not sure I understand your point and comparison with self-help books.

masklinn2• 7 years ago

Anecdote: My most exhausted coworkers are those who openly admit and talk about using sleep trackers.

Having terrible sleep would be a good reason to get a sleep tracker.

That's why I got a tracker myself. Though it was so imprecise I stopped using it after a few weeks (to be fair I got a cheap one).

At the end of the day I guess a true medical sleep study is the only option if you're under the impression of not getting enough of restful sleep.

qntty2• 7 years ago

"all those self-help books"? Which ones? Are you implying that these self-help books don't work? It seems like the quality of self-help books can vary widely so it seems strange to generalize about all of them.

mlang232• 7 years ago

I have one golden rule: Where I sleep, there are no electronic devices. I am surrounded by techy stuff all day long. I want a break from all of it altleast 8 hours a day. I would never let a device track my sleep on a regular basis. Feels great, I sleep tight and feel restored in the morning.

balfirevic3• 7 years ago

Yes, people who sleep well and feel restful after sleeping have no need for sleep tracking devices.

mlang232• 7 years ago

I submit that people with a sleep disorder dont have a need for a speep tracker either. Just because there is technology to do something doesn't mean it is the best choice to use it.

krtkush• 7 years ago

I'm not sure about this.

I have no sleeping disorder but track my sleep via Fitbit. It helps me plan my sleep. So for example, if I find that I have not slept enough for the night I make sure I retire early the next day. Also, the days I find I have not had enough sleep I don't go for my morning runs so as to avoid injury. Of course relying on body's own signals would do the job but I find that the trackers augment the process.

In my experience my quality of life has increased because of sleep tracking.

whywhywhywhy• 7 years ago

Best thing for my insomnia has honestly just been finding a job where it doesn't matter if it turn up 10-30 minutes late whenever.

I came to terms that I have a night learning circadian rhythm and if I don't have to worry about being told off for turning up "late" I've slept so much better and consistently and no stressing in a panic that I can't sleep at 5am.

waterhouse2• 7 years ago

For the type of people who get anxious about tracking sleep, is reading this article going to cause them sleep anxiety anxiety? If so, should the authors of the article consider their responsibility in publishing it? I'm only about 40% serious here... but, rereading the opening sentence—"Are you sabotaging your sleep in your quest to improve it?"—that seems remarkably well-optimized to exacerbate the worries of an already nervous person.

Another question: among the people who act like hypochondriacs about their sleep trackers, how many of them would act like hypochondriacs about something else if they didn't have sleep trackers? (How many of them do this while also having a sleep tracker?) I think the null hypothesis is that being an orthosomniac is much more a function of the person (predisposed towards anxiety conditions) than of the device.

The only thing I see mentioned that (some) sleep trackers do that seems like it might specifically promote anxiety is this: "If you sleep poorly, the app will send a prompt asking what might have gone wrong. A late meal? Too much coffee? Too much to drink? Skipped the gym?" But if that were the point, the article would have a much different title.

nestorherre• 7 years ago

I started tracking the "Sleep as Android" app and it made my insomnia worse.

Someone recommended me a treatment called "Cognitive Behaviour Therapy for Insomnia" - or CBT-I, and it was just amazing. What worked out the most was Sleep Privation and not worrying about my sleep, I Highly recommend this to everyone who is struggling. (Note aside, the first days of sleep privation are an absolute hell, I wanted to literally die, but it's worth at the end).

qntty2• 7 years ago

Can you explain what sleep privation is? It's pretty hard to google.

softwaredoug• 7 years ago

I’m guessing he means sleep compression where you commit to a waking time, and start by sleeping just 6 hours or so, then slowly build up. The goal is to maximize sleep efficiency and minimize time spent in bed awake. Really makes you associate bed with sleep, and makes your sleep very efficient

slothtrop2• 7 years ago

A component of CBTi is sleep restriction, whereby you limit your hours in bed and wake at the same time every day. By both anchoring your circadian rhythm to that waking time and building sleep drive at night you can reduce sleep onset latency, and maintenance issues throughout the night.

If you spend 8h total, you can dial back to 7, or as low as 6, on a temporary basis. Once your sleep restructures itself (which doesn't actually take that long), you can increase your total time in bed back to 8.

Even sleep therapy apps are pretty useless as they just regurgitate what ought to be freely available information.

Genetikl33• 7 years ago

Sleep trackers helped me discover the cause of my constant day time fatigue. I discovered just how much I was snoring at night. I was able to self diagnose my sleep apnea and took steps to improve it. I use the tracker as a habit now, but only look at the number once a month or so to get a snapshot of my sleep health.

So overall for me, tracking sleep gave me priceless insights which I could improve upon.

balfirevic3• 7 years ago

How do you improve symptoms of sleep apnea without CPAP device?

brlewis3• 7 years ago

I work for Fitbit. Even though I don't speak for Fitbit, usually I try to keep my personal tone consistent with the friendly, positive tone Fitbit's branding wants to use. But I feel driven to respond to one part of the article in a way that's bluntly critical.

One cautionary tale from the case study: A woman came in reporting that she had an average sleep efficiency of only 60 percent, according to her tracker. She was given medication for restless leg syndrome, tested negative for disordered breathing, and underwent a formal sleep study. But after being told that she had slept deeply in the lab, she was not reassured.

“Then why does my Fitbit say I am sleeping poorly?” she asked.

The "cautionary tale" part seems to be saying that this is an example of irrational anxiety caused by home sleep tracking. That's a stupid assumption to make. A sleep study does a precise measurement of how well you sleep in a lab. The words "in the lab" are right there in the article. Did this article really have to be rushed to press so fast that nobody could take 2 seconds to realize that there could be issues present in her nightly sleep environment that aren't present in the lab? Her question is valid.

JulianMorrison• 7 years ago

It could be as simple as "you sleep badly because your cat jumps up on the bed". No cat in the lab.

ASalazarMX• 7 years ago

Or a bright blue LED of one of her bedroom appliances, noise, temperature, blanket, night owl neighbors, etc. Never had one of these studies, but I suppose the lab strives towards an ideal sleeping environment to identify pathological causes.

byset• 7 years ago

Yeah, it would be interesting if she had worn her Fitbit during the lab study, and we knew whether the Fitbit score during that time was the same or different. Otherwise it's kind of a meaningless anecdote. Maybe there's additional relevant detail that was not included in the article.

TheHwangover• 7 years ago

I got a solution. Ready? Marijuana

richardhod• 7 years ago

Useful sleep hack from the military. I tried it and it seems to work: https://www.independent.co.uk/life-style/national-napping-da...

Sleep trackers can make insomnia worse

Related Stories