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Blog Feature

By: Richard Rosenberg, PhD on January 17th, 2018

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Sleep Health – It’s Not Just About Treating Sleep Disorders

Key opinion leaders who worked with me to develop the Predictions for Sleep Technology Profession in 2018 e-book emphasized the role that wearable monitors might play in the future of sleep medicine. In addition, I recently wrote a blog on a preliminary study using wrist monitors to diagnose OSA. This got me thinking about the potential value of the information collected by these devices beyond sleep disorders. A pair of articles in the most recent Journal of Clinical Sleep Medicine is the focus of the January Journal Club. Surprisingly, neither of these articles focused on sleep disorders – instead, the focus was on sleep health.

The first article1 is an analysis of the accuracy of wrist and chest activity monitors in detecting sleep relative to sleep studies. Not surprisingly, there are some discrepancies and the correlations are not perfect. But there was no bias – they are, as we used to say, good enough for psychology. And the chest sensors add substantially to the accuracy.

The second article2 explores the exploding world of sleep apps. They collect a variety of measures, are fun to use, and have been downloaded a bazillion times. Most are free, which is a good thing because there is almost no evidence to say that they are worth anything.

So, we can measure sleep with a wearable device, and we can equip our device with an app to encourage more or less sleep. This leads us to the big question: how much sleep do we need? The AASM/SRS published a recommendation for seven hours of sleep3 to “promote optimal health.” Should we set our controls for seven hours of sleep? Do we have any evidence to support this magic number?

A companion article on methodology and discussion of the recommendation4 provides some interesting insight into the process. It used the RAND Appropriateness Method, something you use when you have to make a decision but you really don’t have much in the way of convincing evidence one way or the other. It’s a consensus process, and it depends on who you have in the room and how well they can convince the others of the weight of their opinion. There is an extensive literature review that says that less than seven hours is correlated with negative consequences. But isn’t there more to sleep than avoiding negative consequences? Is there an “optimal” amount of sleep that promotes health?

I’m going with the idea that one size does not fit all. Shorter sleep times may be optimal for some people. And, despite some minimal evidence that too much sleep may be bad for you, the consensus statement does not indicate an amount of sleep that is excessive. Some might need ten hours a night to be at their optimal level of alertness. The new technology allows us to measure our sleep with reasonably good precision. We can be the researcher and the study participant at the same time. We can determine through trial and error the benefit of specific amounts of sleep for ourselves and arrive at an amount of sleep that will “promote optimal health” for me, Rich Rosenberg, in all my patient-centered uniqueness.

I used to tell my patients to go on vacation and get as much sleep as they needed to wake up without an alarm. When you know that magic number of hours, decide when you need to wake up and count backwards. There may be some benefit to setting that time and having your Apple Watch tell you to stop watching cat videos and go to sleep. Of course, I don’t listen to my own advice. Those cat videos are addictive. And are cats really made of liquid?

If you are interested in a deeper dive into this topic, check out the January Journal Club.

  1. Razjouyan J, Lee H, Parthasarathy S, Mohler J, Sharafkhaneh A, Naja B. Improving sleep quality assessment using wearable sensors by including information from postural/sleep position changes and body acceleration: a comparison of chest-worn sensors, wrist actigraphy, and polysomnography. J Clin Sleep Med. 2017;13(11):1301–1310.
  2. Lee-Tobin PA, Ogeil RP, Savic M, Lubman DI. Rate my sleep: examining the information, function, and basis in empirical evidence within sleep applications for mobile devices. J Clin Sleep Med. 2017;13(11):1349–1354.
  3. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11(6):591–592.
  4. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med 2015;11(8):931–952.