Mr. R, 40, is fretting every day about not being able to sleep enough for 8 hours. According to the results of the smart bracelet monitoring, his average sleep time is 7 hours and 45 minutes.
In order to achieve the standard sleep duration, Mr. R usually starts to go to bed at 5:30 p.m. on weekdays and gets up at 6:00 a.m. On days when he doesn't sleep enough for 8 hours, he feels tired, irritable, and inattentive. Mr. R hopes that the doctor can help him solve this problem, and eventually "sleep deeply for 8 hours per night" (he may not know that deep sleep in adults only accounts for 15% to 25% of sleep duration).
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After some diagnosis, the doctors believe that Mr. R suffered from "perfect sleep disorder".
"Brush" out the perfect sleep
In 2017, Kelly Glazer Baron et al. of Rush University Medical Center in the United States first proposed the concept of perfect sleep disorder (orthosomnia) to describe patients who pay too much attention to their sleep monitoring results and try to improve or even brush out perfect data.
The term comes from orthorexia, which refers to symptoms of over-focusing on healthy eating, such as spending too much time preparing food, feeling guilty about eating foods that you think are unhealthy, and so on.
Baron et al. reported 3 such cases of "perfect sleep", and Mr. R was one of them.
Mr. R's poor sleep quality does have its own problems, such as the fact that he often processes work information with his phone before going to bed, but excessive attention to sleep time aggravates his symptoms. The sleep problems of the other two patients have been well controlled, and the doctor believes that the smart bracelet monitoring data has caused their anxiety.
What worries doctors even more is that in order to "brush" the perfect sleep data, all three patients have increased their bed rest time, which may lead to worsening sleep problems, because lying in bed for a long time without falling asleep will only make people more anxious. If you have been in bed for more than 30 minutes and have not been able to fall asleep, the doctor will generally recommend getting up and doing some relaxing activities, and then go back to sleep when you are sleepy.
"Considering that such devices tend to overestimate sleep time, they may encourage users to stay in bed longer, thereby reinforcing poor sleep habits," the doctors noted in the paper. They also warn that the popularity of wearable smart devices could make such cases more common.
Believe in the data or believe in yourself? Really bad
Is the impact of a small watch data that big? Didn't I sleep well? Don't be surprised, our perception of the quality of our sleep is not necessarily accurate. Experiments have shown that false sleep monitoring reports are enough to affect our mental state the next day.
In a 2018 study published in the Journal of Sleep Research, Dimitri Gavriloff et al. of the University of Oxford in the United Kingdom recruited 63 participants who met medical diagnostic criteria for insomnia and randomly assigned them to the "high sleep quality group" and the "low sleep quality group." The research team pretended to monitor their sleep with an exercise bracelet, sending them false monitoring reports every morning, while asking them how they felt at different stages of the day through questionnaires and asking them to complete tests on attention, alertness, and so on.
Experiments have found that people who learn that they have not slept well are in a lower mood, think more slowly during the day, and have a stronger sense of drowsiness. Those who received good monitoring results showed the opposite trend. However, there was no difference in the true sleep quality of the two groups.
Such results show that the monitoring data of the smart bracelet affects how we feel about our own body. We care so much about bracelet data, but must the bracelet data be accurate?
The more you don't need it, the more accurately the bracelet is measured?
A comprehensive assessment of sleep status requires a lot of data.
In medical diagnosis, the authoritative method for detecting sleep disorders is polysomnography (PSG), which requires monitoring of brain waves, blood oxygen levels, heart rate, breathing, eye and leg movements, etc. Correspondingly, this method also requires the use of a full set of professional equipment, and it is obviously unrealistic for ordinary people to configure a set at home.
In contrast, the monitoring method of smart bracelet is much simpler. Such products mainly rely on wrist actigraphs, and some will combine other data such as heart rate to measure people's sleep time and sleep efficiency (that is, the percentage of time spent asleep in bedtime). They don't really distinguish between different sleep stages very well, because sleep stages are mainly divided according to the laws of brain waves rather than the activity of the body.
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Smart bracelet-specific sleep monitoring algorithms are not public, which has caused confusion among researchers and doctors who cannot judge the accuracy of specific products. However, in general, many products cannot accurately distinguish between wakefulness and sleep status, and it is easy to misjudge sleep time.
For example, insomniacs often stay still and try to fall asleep, which may be misjudged by the bracelet as having fallen asleep. Another extreme is related to limb movement in dreams, such as sleepwalking, restless leg syndrome, etc., when the bracelet may misjudge the sleep state as awakening.
In fact, staying still doesn't necessarily work, it can make muscles tense and harder to fall asleep. We have made a simple bedtime relaxation tutorial that we hope will be useful to you
However, for healthy people with "standard sleep", the smart bracelet is quite accurate. Zhang Jun's team from the Department of Neurology of Peking University People's Hospital conducted a small study to assess whether the monitoring results of the watch-type sleep monitor and the PSG results were consistent. They found that in people who slept normally and at a younger age, the watch-style sleep monitor measured more accurately. They also compared the monitoring results at different low, medium and high sensitivity levels and found that the low sensitivity mode was better.
Don't brush the data, sleep well
Of course, with the development of technology, the accuracy of such wearable devices will continue to improve. This begs the next question: Do we really need that much data?
From the perspective of sleep research and even public health, wearable devices are great inventions. Smart bracelets cost much less than PSGs, making it possible to collect large amounts of sleep data. It can also help people track their activity and even detect some abnormal symptoms (such as irregular heart rates) in time.
But for individuals, excessive attention to health monitoring data can lead to anxiety and depression. This has been validated by research: people can misread normal data fluctuations, generate unnecessary worries, and spend too much energy seeking medical attention. The quality of sleep is closely related to emotions, and everyone who has experienced insomnia knows the feeling of "the harder you try, the more awake you get".
So, if you're also worried about your sleep monitoring data, don't worry about how to "brush" the data up, think about it:
Did you start monitoring because you didn't sleep well, or did you "find out" that you weren't sleeping well after you started monitoring?
What changes have you made in this data? Are these changes positive (e.g., no longer staying up late, getting a doctor in time) or negative (e.g., worsening anxiety or insomnia)?
Hopefully, the above questions have helped you better understand what sleep monitoring actually brings you.
Today is World Sleep Day. Nowadays, more and more people have recognized the importance of sleep health, but compared with weight loss and fitness, there are too few methods and tools we can rely on in the matter of sleep. Tools like smart bracelets, when used properly, can certainly have a positive impact, but remember: we focus on sleep data to sleep better, but if we try to sleep in order to "brush" out the good-looking data, we put the cart before the horse.
As long as it is not tested, the data will not be wrong | Giphy
bibliography
[1] Baron KG, Abbott S, Jao N, Manalo N, Mullen R. Orthosomnia: are some patients taking the quantified self too far? J Clin Sleep Med. 2017;13(2):351–354.
https://jcsm.aasm.org/doi/full/10.5664/jcsm.6472?fbclid=IwAR1KxcxhdpG9CSoB-72R4cOA_o5iVidnDecoeh8-yzRsf-uhkf42WIPx9qw&
[2] Gavriloff, Dimitri, et al. "Sham sleep feedback delivered via actigraphy biases daytime symptom reports in people with insomnia: Implications for insomnia disorder and wearable devices." Journal of sleep research 27.6 (2018): e12726.
https://onlinelibrary.wiley.com/doi/10.1111/jsr.12726
[3]https://theconversation.com/are-sleep-trackers-accurate-heres-what-researchers-currently-know-152500
Huo Yang, et al. "Comparison and Correlation Analysis of Sleep Parameters of Watch-type Sleep Monitor and Polysomnography Monitoring" Journal of Peking University (Health Sciences) 53.5 (2021): 942.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517689/
[5] Perez, Marco V., et al. "Large-scale assessment of a smartwatch to identify atrial fibrillation." New England Journal of Medicine 381.20 (2019): 1909-1917.
https://www.nejm.org/doi/full/10.1056/nejmoa1901183
[6] Rosman, Lindsey, Anil Gehi, and Rachel Lampert. "When smartwatches contribute to health anxiety in patients with atrial fibrillation." Cardiovascular digital health journal 1.1 (2020): 9-10.
https://www.researchgate.net/publication/343942681_When_smartwatches_contribute_to_health_anxiety_in_patients_with_atrial_fibrillation
Author: Maya Blue
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