Sleep tracking devices can worsen anxiety in people with insomnia by increasing their focus on sleep quality, according to a new study.
Sleep tracking apps can cause stress for people with insomnia as they heighten awareness of sleep quality and monitoring, according to a new study.
Researchers from the University of Bergen in Norway found that while providing insights into sleep habits helped some users, those with insomnia experienced more negative effects.
“The rapid development of sleep app technology requires the scientific community to keep up with technological advances,” said Håkon Lundekvam Berge, first author of the study at the University of Bergen.
He added that the research found that younger adults were more affected by the apps’ feedback, and they reported more perceived benefits but also more worries and stress.
Sleep tracking has become a booming industry. The US sleep-tracking devices market generated about $5 billion (about €4.25 billion) in 2023 and is expected to double in revenue by 2030, according to market research firm Grand View Research.
Most apps rely on sensors embedded in wearable devices such as smartwatches and fitness bands, which track and report parameters such as sleep latency, sleep duration, and sleep efficiency.
The researchers surveyed over a thousand people in Norway, with an average age of 50. Participants were asked about the use of sleep apps, their current sleep health, and whether they experienced specific positive or negative effects.
The authors noted that age was the most influential factor in shaping users’ experiences. Younger age groups aged 18-35 and 36- 50 were more likely to report beneficial effects, such as improved sleep and a greater tendency to prioritise it.
However, the same age group also reported higher levels of stress and concern, suggesting that they may be more susceptible to the negative effects of digital health information.
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The risk for bad sleepers
The authors warned that an excessive focus on the app’s output can worsen sleep quality.
“We also found that people with insomnia symptoms were more susceptible to negative effects,” said Karl Erik Lundekvam, second author of the study.
He noted that feedback from the sleep apps was more likely to cause stress and worry in this group. People who suffer from insomnia often exhibit increased sleep-related attentional bias and worry, which monitoring devices can amplify.
“We would urge people who get more stressed by using sleep apps to learn more about which measures they use and how accurate they are,” Lundekvam said.
“If this does not calm your worries, you should consider taking off your sleep app device during night-time or turning off notifications”, he added.
The authors noted that users can rely on the feedback as motivation to create helpful sleeping habits, such as minimising screen time before bedtime.
An insomnia-intervention app can significantly reduce the incidence of depression in youth with the disorder by more than 40 percent, according to groundbreaking clinical research from Chinese University of Hong Kong and Peking University.
The top-tier institutions announced that the Digital CBT-I Intervention App, developed by the Li Chiu Kong Family Sleep Assessment Unit at CUHK, has shown remarkable effectiveness in improving insomnia and depressive symptoms in young people.
The breakthrough app could be a highly significant self-help tool for youth worldwide, with depression being a prevalent mental disorder affecting about 1.2 billion youngsters globally. The World Health Organization estimates that it impacts around 3.5 percent of youths aged 15 to 19, with rates in Hong Kong ranging from 3.9 to 5.2 percent.
From left: Lu Lin, Wing Yun-kwok and Chen Si-jing.
Lu Lin, an academician of the Chinese Academy of Sciences and president of PKU Sixth Hospital, said no research had been conducted in Asia on the effectiveness of this therapy. But to address this gap, a study was conducted between September 2019 and November 2022. It involved 708 participants from Hong Kong and the mainland, aged 15 to 25, who were experiencing insomnia and subclinical depressive symptoms.
The intervention group experienced a nearly 60 percent remission rate for insomnia disorders at the one-year follow-up, demonstrating a 42 percent lower incidence of depression compared to the control group.
No adverse events were reported.
Chen Si-jing, first author of the research and a postdoctoral fellow from the Department of Psychiatry at CUHK, said: "The study demonstrates that digital CBT-I is effective in preventing the future onset of major depression with satisfactory efficacy."
Wing Yun-kwok, chairman of the Department of Psychiatry at CU Medicine and director of the Li Chiu Kong Family Sleep Assessment Unit, indicated that future studies will focus on integrating digital insomnia intervention into clinical practice.
Fixating on sleep can make your sleep worse. But some people crave the connection online sleep communities provide
Insomnia is not just a personal issue that affects an individual’s health and wellbeing. It’s a public health issue, affecting public safety. It’s a socioeconomic issue, as poorer sleep is linked to a lower education and income. And, increasingly, it’s a commercial issue.
The global insomnia market is expected to reach US$6.3 billion by 2030, driven by increased diagnoses and therapy, as well as sleep aids, including sleep apps.
There’s an app for that
There are numerousdigital devices and apps to help people sleep better. You can buy wearable devices, such as smartwatches and smart rings or wristbands, to digitally monitor your sleep. You can download apps that record how long you sleep and where you can log your tiredness and concentration levels.
Some devices are designed to promote sleep, by generating white or brown noise or other peaceful sounds. You can also buy “smart” pillows, mattresses and a range of smart light-fittings and lightbulbs to help track and improve sleep.
Such technologies operate to “digitise” sleep as part of "the quantified self". They render sleep practices and bodily responses into data you can review. So these devices are promoted as offering scientific insights into how to control the disruption to people’s lives caused by poor sleep.
You can listen to “sleep stories” – bedtime stories, music or guided meditations meant to help you sleep. Then there are the sleep blogs, podcasts and social media content on TikTok, YouTube and Instagram.
Where there is social media content, there are social media “influencers” sharing their take on sleep and how to get more of it. These “sleep influencers” have accumulated large numbers of followers. Some have profited, including those who live-stream themselves sleeping or invite audiences to try to wake them up – for a price.
The global insomnia market is expected to reach US$6.3 billion by 2030. Photo: Ridofranz / Getty Images
Sharing and connecting can help
There may be benefits to joining online communities of people who can’t sleep, whether that’s in an online forum such as Reddit or a specially designed sleep improvement program.
Sharing and connection can ease the loneliness we know can impact sleep. And technology can facilitate this connection when no-one else is around.
We know social media communities provide much-needed support for health problems more generally. They allow people to share personal experiences with others who understand, and to swap tips for the best health practitioners and therapies.
So online sharing, support and feelings of belonging can alleviate the stresses and unhappiness that may prevent people from finding a good night’s sleep.
What is this fixation costing us?
But there are some problems with digitising sleep. A focus on sleep can create a vicious cycle in which worrying about a lack of sleep can itself worsen sleep.
Using sleep-tracking apps and wearable devices can encourage people to become overly fixated on the metrics these technologies gather.
The data generated by digital devices are not necessarily accurate or useful, particularly for groups such as older people. Some young people say they feel worse after using a sleep app.
There are also data privacy issues. Some digital developers do not adequately protect the very personal information smart sleep devices or apps generate.
Then, there’s the fact using digital devices before bedtime is itself linked to sleep problems.
Are we missing the bigger issue?
Other critics argue this intense focus on sleep ignores that sleeping well is impossible for some people, however hard they try or whatever expensive devices they buy.
People living in poor housing or in noisy environments have little choice over the conditions in which they seek good sleep.
Factors such as people’s income and education levels affect their sleep, just as they do for other health issues. And multiple socioeconomic factors (for instance, gender, ethnicity and economic hardship) can combine, making it even more likely to have poor sleep.
Sleep quality is therefore just as much as a socioeconomic as a biological issue. Yet, much of the advice offered to people about how to improve their sleep focuses on individual responsibility to make changes. It assumes everyone can buy the latest technologies or can change their environment or lifestyle to find better “sleep health”.
Until “sleep health inequalities” are improved, it is unlikely digital devices or apps can fix sleep difficulties at the population level. A good night’s sleep should not be the preserve of the privileged.
Up to 800,000 people could benefit from using Sleepio in England
AS MANY AS 800,000 people in England could benefit from a new digital app projected as an effective alternative to sleeping pills for insomnia patients, the national institute for health and care excellence (NICE) has said.
Now, NHS doctors can prescribe the Sleepio app, which uses artificial intelligence to provide people with cognitive behavioural therapy for insomnia instead of sleep medications, reports said.
Medicines such as zolpidem and zopiclone can be dependency forming and aren’t intended for long-term use.
According to reports, the app provides a digital six-week self-help programme involving a sleep test, weekly interactive CBT-I sessions and keeping a diary about sleep patterns.
The NICE said that the module, which costs NHS £45 per person, was more cost-effective as it led to fewer doctor’s appointments and prescriptions of sleeping pills.
Jeanette Kusel, acting director for MedTech and digital at NICE, has said that the new method will also reduce people with insomnia’s reliance on dependence forming drugs.
The effectiveness of the Sleepio app, compared to sleep hygiene and sleeping pills, was proved in twelve randomized controlled trials, the health agency claimed.
The Sleepio programme is designed to be completed in six weeks, but people have full access for 12 months. People can complete sessions at their own pace and revisit sessions, a statement said.
The sessions focus on identifying thoughts, feelings and behaviour that contribute to the symptoms of insomnia. Cognitive interventions aim to improve the way a person thinks about sleep and the behavioural interventions are designed to promote a healthy sleep routine.
According to the NHS, most people experience problems with sleep in their life, and a third of Brits will have episodes of insomnia at some point.
The causes can include physical conditions, psychological conditions (such as depression or anxiety) or a combination of both.
About 70 million people in the US suffer from insomnia every year. But thanks to medicine, there are a few efficient ways to tackle the problem of not being able to fall asleep while you’re lying in your bed.
Working out, simply relaxing an hour before going to bed, or just taking some pills are some of those ways to get yourself able to fall asleep while your brain wants something else. But today we’re glad to propose to you a more technological way to solve the issue.
The Sleepio app might be the key
The National Institute for Health and Care Excellence in the UK (NICE) recommends people to use the Sleepio app to get rid of their insomnia. Instead of relying on sleeping pills, the app-based treatment is a worthy alternative, according to the institute. And last but not least, using the app can also save you some money.
The Sleepio app inflicts tailored digital cognitive behavioural therapy for overcoming insomnia by using AI. The software will be on the lookout for whatever may be causing a person to have trouble falling asleep – certain thoughts, behaviours, or feelings. If that’s not convincing enough for you that the developers of the app know what they’re doing to get you rid of your insomnia, you should keep in mind that the app provides a self-help program that lasts for six weeks. That involves weekly interactive CBT-I sessions.
Our rigorous, transparent and evidence-based analysis has found that Sleepio is cost saving for the NHS in primary care compared with sleeping pills and sleep hygiene. It will also reduce people with insomnia’s reliance on dependence forming drugs such as zolpidem and zopiclone.
This is a good example of where a digital health technology can help the NHS. The evidence has shown using Sleepio reduces the number of GP appointments people with insomnia need and will also cut the number of prescriptions for sleeping pills delivered by pharmacists.
We run through the best sleep apps for a good night's rest
More than 5 million Americans struggle to get to sleep each night according to a 2019 study from Iowa State University, but after two years of COVID-19, the issue is becoming even more common. Research published in the journal Sleep Medicine in January 2021 revealed that during the pandemic the number of people with clinical insomnia (where sleeplessness occurs for at least three nights a week for three months or more) had risen by 37%, with prescription for sleep medications also rising by 14%. It’s now estimated that 30-35% of adults will suffer from insomnia at some stage of their lives.
It’s hardly surprising, then, that those struggling to get a good night’s sleep will try almost anything and everything to help them get some much-needed shut eye. From soothing music to sleep scripts, medication to meditation, there is a huge array of treatments available for people with insomnia, but many are now turning to technology to help them, and sleep apps are becoming increasingly popular.
We asked Michael J. Breus, nicknamed “‘The Sleep Doctor” — a clinical psychologist, fellow of the American Academy of Sleep Medicine — to talk us through some of the best sleep apps on the market.
SOMRYST
(Image credit: Somryst)
A groundbreaking app for chronic insomnia that uses CBTi (cognitive behavioural therapy), Somryst is a prescription digital therapeutic (PDT) that has Food and Drug Administration (FDA) approval.
Over a course of six to nine weeks, patients are given brain-training challenges, lessons and strategies to improve the way they approach sleep, while doctors can access real-time data on their patients’ progress. “If you can’t find a sleep therapist, or prefer self-study, this is the software for you,” Breus said. “It’s very straightforward too and has clinical data to show its effectiveness.”
In clinical studies of more than 1,400 adults with chronic insomnia, Somryst reduced the amount of time it took to fall asleep by 45% and the amount of time spent awake at night by 52%.
Available on iOS and Android. Check your medical insurance for cover.
REFLECTLY
(Image credit: Reflectly)
A kind of digital diary, Reflectly helps you to compile a virtual journal, prompting you with questions about your day and your feelings to help declutter your mind of any nagging thoughts that may stop you sleeping. Sleep diaries are often prescribed by medical professionals to more accurately assess the severity of a patient’s insomnia but Reflectly does it digitally. Simple to use and easy to navigate, it’s powered by AI, learning from your responses over time to provide more effective feedback and show you how fluctuations in your mood have affected your sleeping patterns.
Available on iOS and Android. Free to download. Premium subscription available from $10 a month.
MUSE
(Image credit: Muse)
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If the idea of meditating to help you sleep appeals but you don’t know where to start, then Muse, an electroencephalography (EEG) device worn in a headband with an accompanying app, is the perfect companion. Just connect your smartphone to the device (via Bluetooth), open the app and put your Muse headband on. Once you’ve closed your eyes, it will monitor your brain activity, translating it into the right kind ambience to help aid sleep. It also has a sleep-inducing feature the company calls a “Digital Sleeping Pill.”
Research shows that mindfulness meditation can help combat insomnia and it’s certainly worked for Breus. “I hate to meditate so this has been a lifesaver,” he said. “The real-time biofeedback results for my own meditation practice has been inspiring too. In fact, I’ve just discovered I have logged over 7,000 minutes of meditation.
“There is no question it helps my sleep.”
Available on iOS and Android. Free to download. Muse 2 Headband and Annual Premium Subscription from $207.98.
SLEEPSCORE
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(Image credit: SleepScore Labs)
Sleepscore uses sonar technology to track your sleep; the app sends sonar waves from your phone to measure everything from your breathing patterns to how long you were awake at night. By tracking your light, deep and REM sleep, the app is able to give you a sleep score each night, which you can then work to improve. It also measures the no, while the Premium version offers unlimited sleep tracking and will even compile a sleep report that you can share with your doctor.
Available on iOS and Android. Free version, or premium version at $7.99 per month.
OURA
(Image credit: Oura)
Oura is a ring that’s worn on a finger. Oura’s impressive range of monitors ensures you keep tabs on everything from your heart rate to your body temperature, but its ability to track your sleep is perhaps its best feature. Not only will it accurately assess the quality of your sleep in each stage of the night (light sleep, deep sleep and REM sleep), but it will even kick in when you steal a nap in the afternoon.
Once it learns how and when you sleep, the app will then offer optimised advice as to how you can best prepare for sleep each night. “I use this to accurately track my sleep daily,” Breus said. “It has the most reliable accuracy data of any tracker on the market, and with the long battery life and easy-to-wear ring, it’s really easy to access that critical data you need for a good night’s sleep.”
Available on iOS and Android. Free to download. Ring costs $299.
PZIZZ
(Image credit: Pzizz)
Pzizz uses the power of sound, or “psychoacoustics,” to create soundtracks of music, rhythms, sounds and spoken words, or ‘dreamscapes’, to help you fall asleep and wake up feeling refreshed. Tailored to the various stages of your sleep cycle, it uses clinically tested techniques as such heart rate and diaphragmatic and variability breathing, mindfulness meditation and muscle relaxation to help create the ideal conditions for sleep.
The app has three settings — Sleep, Nap and Focus. Select Sleep or Nap, and you can choose the length of the dreamscape you prefer, as well as picking the speed of the soothing music or narration you’ve decided on. A wake-up function is also available that aims to bring you around in the best possible mood. Pzizz also features ‘focuscapes’ in Focus mode, for those times when you need something to help you concentrate during the day.
Available on iOS and Android. Free version or Premium subscriptions from $9.99 a month.
HEADSPACE
(Image credit: Headspace)
Headspace is another app that aims to help with meditation, as well as potentially improving sleep. “Headspace also has really gotten the meditation thing down to a science for many, but it’s also really great for sleep,” Breus said. Download the app for free and you’ll get limited access to a range of audio experiences, or “sleepcasts” that aim to help users to relax, unwind and ease into sleep.
There are also hours of soothing soundscapes that help to create a tranquil setting for a great night’s sleep. Access to the full range of Headspace’s content, with over 40 tailored meditation courses, including ones for sleep and stress, requires a subscription.
Available on iOS and Android. Free to download. A 14-day free trial is available.
SLEEP CYCLE
(Image credit: Sleep Cycle)
It may sound sinister, but Sleep Cycle listens to you while you sleep, recording everything from your snoring levels to the ramblings made when you’re deep in dreams. It will then track your night’s sleep in graph form, putting the audio soundtrack over it so you can see what was happening at various stages of the night.
The beauty of Sleep Cycle is that it’s also fully integrated with Apple Health, so you can exchange data seamlessly, and it doesn’t require any additional equipment or wearables – just place your phone next to your bed, turn on the app and drift off.
Just be careful what you say in your sleep.
Available on iOS, Android and Huawei. $9.99 per month or $39.99 per year. Free trial available.
This article is for informational purposes only, and is not meant to offer medical advice.
