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Don’t Hit the Snooze Button on Sleep Technology

Watches, headbands and more to track your zzzzs and maybe sleep better


Fitbits and Apple watches. Headbands that track sleep cycles. Devices designed to help you fall asleep faster; others that measure your blood oxygen levels through the night.

The sleep tech business is exploding.  According to Global Market Insights, it’s projected to be a $27 billion industry by 2025, about three times what it was in 2018.

One of the drivers has been the sleep struggles of aging populations in many developed countries, a trend only expected to grow. Sleep deprivation has been linked to a higher risk of numerous conditions — from diabetes and depression to heart disease and obesity.

But how effective all this technology has been in actually improving sleep habits and reducing sleep maladies is a matter of conjecture. Many of the devices have not received Food and Drug Administration (FDA) approval, and to avoid potential liabilities, are categorized simply as “lifestyle” or “entertainment” products.

Nonetheless, doctors who treat sleep disorders acknowledge that all the middle-of-the-night data that people are gathering are drawing attention to an often-neglected part of their health.

Sleep Scores Can Be Conversation Starters

“The technology is so pervasive now,” said Dr. Seema Khosla, chair of the technology committee of the American Academy of Sleep Medicine. “I love that it’s making people more aware of their sleep. Sleep is a relatively young field, and it’s suffered from a lack of urgency. If you have chest pains, you go to the ER. But how many people go to the ER for snoring?”

“I try to find out, when they tell me about the quality of their sleep, if they’re basing it on what Fitbit told them or if they are making that determination based on how they actually feel.”

For Khosla, sleep scores and the like, while not clinically credible, can be useful conversation starters. She’ll often ask patients why they’ve started tracking their sleep — if it’s simply because they got a cool device for Christmas or if they have real concerns about how they’ve been sleeping. Then, she’ll use the data as a way to dig more deeply into their sleep habits.

“I try to find out, when they tell me about the quality of their sleep, if they’re basing it on what Fitbit told them or if they’re making that determination based on how they actually feel,” she said. “And sometimes that little nuance makes a big difference in being able to focus on their situation.”

Dr. Rachel Salas, a Johns Hopkins University associate professor of neurology who specializes in sleep medicine, has had similar experiences. She said that when patients bring up their sleep data, she reminds them that it’s not coming from clinical devices, but will also look for meaningful information to discuss.

“You can point to inconsistencies in their sleep-wake schedules,” Salas said. “You can talk about how the data is showing them going to bed at different times. I try to utilize it in explaining things to them.”

The Technology Is More Sophisticated

One of the risks, however, is that people can become obsessed with what their devices are telling them. That’s actually a condition called orthosomnia. Salas gave the example of people developing insomnia after a device suggested they weren’t getting enough REM sleep.

“It’s this self-perpetuating cycle,” Khosla noted. “You’re so freaked out about your sleep that you don’t sleep well.”

But Khosla and Salas agree that sleep technology is becoming more and more sophisticated and that it’s only a matter of time before it can be used for legitimate medical diagnosis — particularly when it comes to sleep apnea. That’s the disorder characterized by disruptions in breathing while sleeping, typically after loud snoring

“Our old model for addressing sleep apnea has left eighty percent of the cases undiagnosed,” said Khosla. “These devices are giving us validation data, and why wouldn’t we want to make things easier for our patients to be tracked in their own homes?”

Here’s a sampling of the sleep technology now available:

Sleep Apnea

As Khosla pointed out, one of the more notable advances in the field has been its use in addressing sleep apnea. This is done through pulse oximeters — sensors which measure your blood oxygen levels — included with fitness trackers and smart watches.

Earlier this year, for instance, Fitbit began enabling the pulse oximeters on several of its devices, including the popular Charge 3 fitness tracker ($150) and Versa  watches (The Versa 2 costs $200). It’s not as accurate as a medical device taking a reading from your finger, which has more blood vessels than your wrist, but it can give you a good sense of when your oxygen levels may have fluctuated during the night.

Meanwhile, Withings unveiled its new ScanWatch ($250) at the Consumer Electronics Show in January. In addition to the typical health tracking — physical activity, heart rate, etc. — the ScanWatch checks for heartbeat irregularities when you’re not moving, and charts any dips in oxygen levels while you sleep.  It also creates a report that can be sent to your doctor. Withings is awaiting FDA approval to promote the ScanWatch as a medical device, but hopes to have it on the market within the next few months.

Other options are Garmin health devices, including the Vivosmart 4 tracker ($130), and the Vivoactive 4 smart watch ($350), both of which have oximeters (although you may have to turn them on), and the Phillips Nightbalance ($450), which takes a different approach to dealing with sleep apnea. Launched last fall, Nightbalance allows people diagnosed with the disorder to avoid wearing a mask or mouthpiece and instead use a belt that vibrates when they move to sleep on their backs, which can exacerbate breathing problems.

Sleep Tracking

Features that compile and illustrate a wide range of data about a person’s sleep habits have recently become standard on most smart watches and fitness trackers. They not only provide a daily record of how many hours you’ve slept and when you fell asleep and woke up, but also estimate how much time you’ve spent in the different stages of sleep — light, deep, or REM — based on your movements and heart-rate patterns. Usually, they’re accompanied with an app for your smartphone.

The Apple Watch ($499 with GPS and cellular, but older models start at $199) is an exception. Because it’s meant to be charged overnight, the Apple Watch doesn’t have a built-in sleep monitoring component. So, you would need to download a third-party app. Among the top choices are AutoSleep ($3), Pillow (free), SleepWatch (free), and SleepScore (free).

Features that compile and illustrate a wide range of data about a person’s sleep habits have recently become standard on most smart watches and fitness trackers.

An alternative to wearing a device on your wrist is a sleep-tracking ring. The Oura ring ($299), which has been around for several years, uses multiple sensors to evaluate your sleeping and provide you with a “readiness score” each morning. Other options are the Motiv ring ($200), which compiles more basic data about your night’s sleep, and the less stylish SleepOn’s Go2Sleep ring ($130), which evaluates your sleep and vibrates when your blood oxygen level gets too low.

For those who don’t want to wear a tracker, there’s SleepScore Max, ($150), a small monitor that sits on your nightstand and compiles data based on your movements and breathing during the night, then provides advice on how you can improve your routine.

Another approach would be to rely on a pad or strap that goes on your bed and uses sensors to feed sleep data to your phone. Among the choices are the Beddit 3 Smart Sleep Monitor ($150) and Sleepace RestOn, ($160), both thin strips that fit under the bedsheet, or Withings Sleep ($99) and Beautyrest Sleeptracker ($175), pads that slide under the mattress.

Sleep Aids

Finally, there are more and more devices that focus on helping you sleep better.

There are high-end products such as Philips’ SmartSleep Deep Sleep Headband ($400), which detects when you’re in deep or “slow wave” sleep, and emits soft audio tones that can extend that restorative state. Or the Muse S ($350), another headband that provides brain activity feedback and “Go to Sleep” audio experiences that enhance a meditative state when going to bed.

Then there are more moderate options, like the 2breathe Sleep Inducer ($170), a belt and accompanying mobile app that fosters slower breathing.

Or simpler, lower-end devices, such as the Dodow Sleep Aid ($60), a light system that projects a rhythmic glow that helps you concentrate on slowing your breathing or the Dohm Classic White Noise Machine ($45).

By Randy Rieland
Randy Rieland often writes about aging and technology for the Innovations blog on Smithsonian.com. Previously, he was in charge of digital media for the Discovery Channel.  He is based in Washington, D.C.

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