The sleep epidemic

There is now a sleep epidemic, where 1/3 of us have a sleep problem, according to the CDC. The many angles of how companies are addressing the sleep epidemic was revealed in the session "Sleep: Personal, Intimate, Measured and Managed," part of the Digital Health Summit.
Shelly Ibach, President and CEO of Sleep Number, underscored the impact of sleep on our society: with insufficient sleep, we lower our trust and ability to empathize with others, and are more likely to act in ways which harm our relationships.  43% of business leaders today have too little sleep, so judgement and empathy is impaired as they make critical decisions for their companies. When sleep deprived, the emotional center of your brain reacts 60 times more strongly than when well rested.

Ouch! Now what?  And does CES hold some answers?

Solving the sleep problem

Discussing diagnosing sleep problems, Peter Hames, Co-founder and CEO of Big Health, Ltd., asked "How do you bridge that gap to millions of people who need the help?  Sleep clinicians are seeing a tiny fraction of the population."  This is where sensor systems could help - either wearables, or systems located in the bedroom.  They could provide feedback on sleep quality, and could potentially diagnose sleep issues.   Such systems will probably never be as accurate as the gold standard, getting a medical sleep study (a polysomnogram) where you (try to) sleep with a number of wires connected to your head.  But the advantage of the sensor-based approach is that one is able to sleep naturally.  And it can cover every night, not just one night. This makes the tracking of sleep trends possible.  A number of devices have been shown which 'stage' sleep (creating a running list of the sleep stages one goes through during the night).  These devices will also typically give an overall summary of how much of the time in bed was spent awake, and how much time was spent in light, slow-wave, or REM sleep.

There are mobile phone apps which claim to stage sleep.  These, as well as some wearable devices which sense only a person's movement, are not capable of accurately staging sleep: “Whether you’re moving or not is not going to tell you what stage of sleep you’re in.”

The SleepScore Max was one of the many interesting devices I saw at CES; it monitors your sleep from a bedside unit, sending weak radio waves to detect your breathing. They report "The results on its accuracy have been published in over 10 scientific peer-reviewed papers ... is undoubtedly the most accurate non-contact sleep tracker on the market today."  I must admit, this is not the first stand at CES where I saw that claim of being the most accurate...

There were also several devices which were in, on or under a mattress, such as Sleep Number, Nokio, EarlySense, Emfit, or Samsung SleepSense.  These sense breathing, and other physiological signals, and stage sleep based on those signals. All these bedroom-based products have the advantage that, once setup, the user need not think about them, and they are providing continuous monitoring.  This will permit amassing large amounts of data, which will help them improve over time. By giving feedback on the quality of your sleep, these device steer you towards improving and making better choices about your sleep.  I've been using a sleep monitor for years now, and I find I'm much less likely to cheat on my sleep because of it, and to be more responsible for the quantity and quality of sleep I get.

How to improve sleep

Several companies are working to help you fall asleep, remain asleep, or improve the quality of your sleep.

Will all these products have an impact on the sleep epidemic?  Clinical studies will need to be done to know for sure. The Verge thinks that When it comes to sleep gadgets, the ideas are moving faster than the research.  Some of these could have an impact, but will they slow the epidemic?
 

Putting it all together

At CES there are a number of products for assessing sleep and many more which hope to improve sleep quality.  I would rank the approaches most likely to have an impact on sleep quality it this order:

1. The well-researched approach of improving one's sleep hygiene: having a dark and quiet bedroom, maintaining regular sleep patterns, and avoiding stimulation before bed (exercise, caffeine, alcohol, screen time, blue light).  To this end, the systems which help control one's environment will be of use, such as the Nokio Sleep, which can be set up so that your lights go off and the temperature goes down in the room once you go to sleep, or to open the blinds when you wake up.

2. Sleep monitoring - being informed of the nature of your sleep, and getting recommendations on how to improve it, lets you better take control of the quantity and quality of your sleep

3. Devices which try to help you fall asleep, stay asleep, or sleep deeper may have some impact.  The jury is still out, and more testing will be needed to determine how big the effect is.

Colin Lawlor, CEO of SleepScore Labs, said that no one  company or scientist can impact our sleep problems.  His company has created a platform to permit the different players to collaborate.   As they become interconnected, what new synergies could become possible?  AI (artificial intelligence) will likely be at the center of this.  As numerous companies look in to this, I'm excited to see what next year's CES will bring to this area. It is clear that behavior changes are needed, which will require a shift in our notions about sleep.  Sleep tech has a role to play in these shifts.

Diagnosis?

Could any of these devices diagnose sleep issues?  Potentially. The bar is high - this would require FDA regulation, and thus would necessitate a clinical trial.  Most companies have been avoiding this level of effort, and regulation.  There is nothing fundamentally different that continuous monitoring used for medical diagnosis vs for health tracking.  For example, Early Sense uses the same sending technologies for medical Early Detection and to Proactively Monitor Your Health.  The FDA is shifting the line in the sand, to try to encourage more innovation; but there still remain hurdles for making devices which could give us early warning of health problems.  One can expect more companies to be jumping into this interesting area, bringing screening devices to the consumer, such as: Can wrist devices detect sleep apnea with lab precision? Early screening has the potential to improve our health, and reduce healthcare expenses.  Managing chronic diseases will also be a growing area. There is great potential for the systems which will be developed, which include novel sensors, encryption (personal data protection will become ever more critical), wireless communication and the gathering of data in the cloud, with machine learning to decode the amassing and valuable data.

Feel free to contact me to discuss further and explore how we can support your research and development projects.

Author
David Ritscher
Connected System Architect
With a focus on connected devices, consumer products, wearables, and implantable medical  devices; design of sensor systems, algorithms, DSP, machine learning; experienced in bringing new concepts from ideation to research and development through successful product launch