Sabra Abbott, MD, PhD, an assistant professor of neurology at Northwestern University, has been treating people with sleep disorders for more than a decade. But in recent years, she and her colleagues began to notice patients reporting a new type of sleep problem.
“We realized we had a number of patients coming in with a phenomenon that didn't necessarily meet the classical description of insomnia, but that was still keeping them up at night,” Dr. Abbott tells Health. “They seemed to have symptoms related to concerns about what their sleep-tracker devices were telling them, and whether they were getting good quality sleep or not.”
In other words, people were stressed out—and in some cases, their sleep was suffering further—because they weren't measuring up to their tracker’s definition of “good” sleep. “They were actually destroying their sleep by becoming so dependent upon these devices,” says Dr. Abbott.
After realizing this wasn't an isolated incident, Dr. Abbott and her coworkers wrote a case report on three of these patients, which was published last year in the Journal of Clinical Sleep Medicine. They dubbed the newly observed condition orthosomnia—a “perfectionist quest to achieve perfect sleep.” It’s similar to orthorexia, they note, which describes an unhealthy preoccupation with healthy eating.
So does Dr. Abbott recommend that we all ditch our tracking devices ASAP? Not necessarily. Smart-sleep strategies should be more nuanced than that, she says, and her advice is different for everyone. Here’s what she wants people to know.
Commercial sleep trackers don’t work that well
It’s estimated that 10% of U.S. adults use a wearable fitness and/or sleep-tracking device on a regular basis, Dr. Abbott and her coauthors wrote in their case report. But “despite the growing interest among consumers, sleep professionals have been wary of incorporating these devices in treatment,” they added.
Simply put, says Dr. Abbott, they’re not very accurate at distinguishing between time actually spent asleep versus time spent in bed. If you’re checking your phone in bed but you’re not actively tossing and turning, most commercial sleep trackers will record that as light sleep—even though you're still scrolling through Instagram.
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Focusing on the numbers can do more harm than good
In their case report, Dr. Abbott and her colleagues wrote about one 40-year-old man who complained of irritability, poor attention and memory, and fatigue during the day. “However, the patient stated that these symptoms would only occur on days he obtained less than 8 hours of sleep based on his sleep tracker record,” they wrote. His average sleep duration was reported as 7 hours and 45 minutes, but he stated feeling pressured to ensure that his tracker would display at least 8 hours every night.
In another case, doctors thought that a woman who had been treated for restless legs syndrome had shown significant improvement: In a laboratory sleep test, her results showed that her sleep quality was higher than average for her age. But at home, her Fitbit continued to tell her that her sleep was poor, and she continued to believe that she wasn’t getting enough “deep sleep.”
If patients really are waking up unrefreshed, waking up throughout the night, or feeling tired throughout the day, those concerns should of course be addressed by a physician, says Dr. Abbott. “But that’s not always what we see,” she says. “Sometimes, it’s hard to move these people away from what their device is telling them, and that becomes more important than what they actually feel.”
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More time in bed isn’t the answer
All three of the patients described in the case report made one big mistake when it comes to sleep hygiene: In an attempt to get higher numbers on their sleep trackers, they were spending excessive time in bed. By encouraging this practice, the doctors wrote, their devices may have served to reinforce poor sleep habits.
Doctors recommend getting out of bed and doing something else if it takes you longer than 20 or 30 minutes to fall asleep. “Spending stretches of time in bed while struggling to sleep negatively conditions the bed for sleeplessness,” Rubin Naiman, PhD, clinical assistant professor of medicine at Arizona Center for Integrative Medicine, told Health earlier this year, “which can cause future conditioned insomnia.”
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Sleep data can be useful—if you don’t obsess over it
Sometimes, a sleep tracker may bring to light an issue that its owner wasn't aware of. For example, the sleep data from one patient in the case report suggested periods of waking throughout the night. He was soon diagnosed with sleep apnea, and credited his tracker for alerting him to a potential problem.
“There are some patients who really benefit from having a device that points certain things out to them—even if those things should be obvious,” says Dr. Abbott. For example, if a person starts staying up later and later every night, a device that tracks time spent in bed might help them realize it more clearly.
For that reason, sleep trackers may be better at showing people how their sleep patterns change over time, rather than giving them minute-by-minute reports of their sleep stages. Knowing how you compare to other people your age may also provide some insight, says Dr. Abbott, but it can be a double-edged sword. “Anytime something tells us we’re below average, it can cause concern and anxiety,” she says.
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An old-fashioned sleep diary can help, too
Even before the advent of sleep trackers, doctors recommended that some patients monitor how (and how much) they slept with simple pen and paper. Keeping a paper sleep diary can give people a bigger picture of when exactly they’re going to bed, how they feel when they wake up, and what behaviors seem to affect—positively or negatively—their shuteye that night.
“Then again, there’s the other subset who finds even the act of filling out that sleep diary to be so stressful, they lie awake at night thinking that they have to make it perfect and they have to show improvement,” says Dr. Abbott. “Just like most things in sleep medicine, it really is a very patient-specific intervention.”
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Listen to your body—not your tracker
The use of wearable sleep trackers is increasing, says Dr. Abbott, and so it’s important that consumers understand what these devices can and can’t do. It’s also important that patients don’t let their sleep-tracker data get in the way of a doctor’s suggested treatment.
Overall, says Dr. Abbott, people need to decide for themselves whether tracking their sleep is harmful or helpful. “If you feel like it’s useful for you and you don’t notice any negative effects, there’s no reason to stop,” she says.
“But if you feel like it’s making things worse, maybe it’s time to make a change,” she continues. “Wear [your fitness tracker] during the day to track your steps, but take it off at night and see if things get better.”