It is estimated that 10% of US adults use a wearable fitness/ sleep tracking device on a regular basis, and 50% would consider purchasing one. This includes brands such as Fitbit, Apple Watch, Nike Fuel Band, and Jawbone Up. Despite the growing interest among consumers, sleep professionals have been wary of incorporating these devices into treatment because of low concordance with polysomnography and actigraphy.

The use of wearable sleep tracking devices is rapidly expanding and provides an opportunity to engage individuals in monitoring of their sleep patterns. However, there are a growing number of patients who are seeking treatment for self-diagnosed sleep disturbances such as insufficient sleep duration and insomnia due to periods of light or restless sleep observed on their sleep tracker data.

The patients’ inferred correlation between sleep tracker data and daytime fatigue may become a perfectionist quest for the ideal sleep in order to optimize daytime function. To the patients, sleep tracker data often feels more consistent with their experience of sleep than validated techniques, such as poly-somnography or actigraphy.

The challenge for clinicians is balancing educating patients on the validity of these devices with patients’ enthusiasm for objective data. Incorporating the use of sleep trackers into cognitive behavioral therapy for insomnia will be important as use of these devices is rapidly expanding among our patient population.

Case Study

Ms. B, a 27-y-old woman, was initially referred for a sleep medicine evaluation from internal medicine due to difficulty initiating and maintaining sleep in the setting of symptoms of restless legs syndrome. She presented her sleep tracker data in the initial evaluation to demonstrate the severity of her sleep problems. Her sleep tracker reported frequent restless sleep and an average sleep efficiency of only 60%. She thought these data were consistent with her subjective experience of her sleep. She even completed a sleep diary in which she scaled and pasted in the printout from her sleep tracker

During her evaluation the client was tested in multiple areas. She was tested for sleep apnea which was negative. She was sent for a additional sleep studies that where showing a deep normal sleep. The patient was started on medication for the restless leg syndrome which proved helpful. Despite all the positive testing the client still complained of feeling fatigued. Despite hearing that she slept deeply on the in-laboratory polysomnogram, the patient asked, “Then why does my Fitbit say I am sleeping poorly?” It was recommended that she follow up for a course of Cognitive Behavioral Therapy.

When it comes to sleep, that enthusiasm for the devices may overshadow what they can deliver. “It’s great that so many people want to improve their sleep. However, the claims of these devices really outweigh validation of what they have shown to be doing,” says the report’s lead author, psychologist Kelly Glazer Baron, PhD, MPH. “They don’t do a good job of estimating sleep accurately.”

I am all for using the latest technology to help improve our well-being. However these findings are a reminder that even the most well-intentioned technology may have unintended consequences. If sleep trackers have helped you get better rest, that’s great. But if you’re lying in bed awake at night nervous that you won’t live up to the standards a device has set for you, it might be time to truly unplug and recharge.

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