March 27, 2019 -- Sharon Thomas is often tired and knows it’s because she’s not getting enough sleep. Cutting back on screen time would help her get to bed earlier, she says, but she wonders whether the smartwatch she wants, a new bed, and a weighted blanket might help her get better rest.
But before buying any product, Thomas says, she’ll read online reviews, consider price points, and look at the products’ return policies.
“You always wonder, like, if this is a fad or does this have scientific proof that it really works,” says Thomas, a 41-year-old claims adjuster from Houston. “One product may work for someone, but it may not work for me.”
Sleep medicine experts may take heart in knowing that Thomas may not take the products’ claims at face value. For them, the surge in sleep-health technology is a double-edged sword.
On one hand, they’re grateful that white-noise machines, smart beds, gadgets that claim to track sleep, and other products have increased awareness of the importance of sleep in overall health. On the other, they argue, the vast majority of them don’t have the data to back up the claims their developers are making.
Some worry that people using apps or wearables may get wrong information about their sleep and stress over a problem they don’t have. Michael Grandner, PhD, director of the Sleep and Health Research Program at the University of Arizona College of Medicine, is among researchers and clinicians who worry that people with insomnia, sleep apnea, and other sleep disorders will turn to increasingly popular consumer products to treat a medical condition.
“It’s hard to know what a person in the general public should do [to properly vet products],” says Grandner, a member of a scientific advisory board for Fitbit, Nightfood, and other companies. “If you feel you need to rely on these things, know that there are other options out there.”
The Business of Sleep
The surge of sleep-health technology appears to coincide with the increase in studies on sleep and its connection to heart disease, diabetes, dementia, and other chronic conditions. Recent research suggests that in industrialized countries such as the United States, people aren’t getting a good night’s sleep.
According to the CDC, more than a third of American adults say they get less than 7 hours of sleep. CDC data from the last two decades show sleep apnea and insomnia have become common sleep disorders among American adults.
No surprise then that the sleep-health industry is big business. In a 2017 report, the consulting firm McKinsey & Company estimated the global sleep-health industry is worth $30 billion to $40 billion and will continue to grow at about 8% a year.
That may help explain why many sleep specialists are in the dark when it comes to the inner workings of the devices, apps, and other products consumers hope will help them sleep more and better.
Because the technology in the products is considered intellectual property, independent clinicians and researchers don’t have access to it to gauge if and how it works, says Seema Khosla, MD, medical director of the North Dakota Center for Sleep in Fargo. That also makes it difficult to assess whether the data products collect are accurate, says Khosla, who sees patients with insomnia, sleep apnea, and other disorders.
“We’re expected to put faith in an algorithm that we don’t understand,” says Khosla, chair of the technology committee of the American Academy of Sleep Medicine and the lead author of the academy’s position statement on sleep technology. “When we have this technology hidden in a black box, how much can I trust that?
Goal: Make Products That Help, Weed Out the Others
Sam Nicolino is the founder and chief executive officer of Adaptive Sound Technologies Inc., a Silicon Valley company that makes sleep sound machines. The electrical engineer says his company has done informal testing of his products but hasn’t participated in a clinical trial because they are expensive and time consuming.
“At some point, it really doesn’t make a lot of sense to go a whole lot further unless there’s a big opportunity, unless there’s a reason,” Nicolino says.
But Nicolino says it was important for sleep technology developers to collaborate with sleep specialists to create products that help people sleep -- and weed out the ones that don’t. He says he’s seen more efforts among his peers to reach out to sleep experts since he started the company 11 years ago.
As the industry keeps churning out new apps, blankets, aromatherapy products, beds, and more, Grandner and Khosla say they hope it does a better job at policing the marketing language. “Nobody really knows what they’re doing yet,” Grandner says. “We’re still figuring it out.”
Khosla says she’ll continue to keep up with products coming out because they are popular among her patients. But she says everyone should “focus on what makes sense: ‘I need to pay more attention to my sleep, I need to follow those proper sleep hygiene rules.’ It’s important for us to listen to what our bodies are telling us.”
That’s the sort of advice Thomas says her primary care doctor would give her. She says she should eat healthier, exercise more, not drink sodas at night, and make other changes to get more hours in bed and sleep well.
Perhaps her parents have been right all along.
“You know parents,” Thomas says. “They encourage me not to stay up so late.”