The Best Sleep-Tracking Devices to Mind Your Z’s

Notes from Dr. Norman Blumenstock

How good are the personal tracking devices for sleep? The Wall Street Journal did a comparison of the available devices.

“The sleep-cycle data you get from these are at best approximations,” said Lawrence J. Epstein, an instructor at the division of sleep medicine at the Harvard Medical School. “The information you get is most accurate in telling you how long you’ve slept and if you are following a good sleep pattern.” 

Can Collecting Data About How You Sleep Lead to a More Restful Night?

By JOANNA STERN \ Updated Oct. 7, 2014 7:12 p.m. ET

The best night of sleep I had in the past two weeks was last Saturday night.

Maybe it was the soft new Gap pajamas or the fact that I didn’t have any wine or coffee before bed. Or maybe I had finally gotten used to sleeping with a heart-rate monitor strapped to my chest, a sensor-equipped mat underneath me, a chunky band on my wrist and a variety of other gizmos in and around my once-comfy bed.

All I know is, during that eight hours and 45 minutes of shut-eye, I must have done something really superb because my smartphone told me I scored a 90% in overall sleep quality. A pie chart showed my work, too, color coding the various stages of dormancy: REM sleep, light sleep and deep sleep.

Say good morning to connected sleep, a tech boom that is attempting to turn our movements, heart rate and respiratory information into data we can review on our smartphones when the sun rises. While an overabundance of sleep data sounds amazing, figuring out what it all means is not. The information for now just isn’t as helpful as the developers of these products want you to think.

 “The sleep-cycle data you get from these are at best approximations,” said Lawrence J. Epstein, an instructor at the division of sleep medicine at the Harvard Medical School. “The information you get is most accurate in telling you how long you’ve slept and if you are following a good sleep pattern.”

For us busy adults, the recommended goal is a consistent 7½ to 8½ hours a night. “We don’t try and make you get a certain type of sleep,” Dr. Epstein said. “We try to improve sleep by lengthening it.”

After sleeping with more than 10 sleep-tracking systems over the past few weeks, five very different products—positioned in various locations on my body, bed or nightstand—stood out. While many could help me become more aware of overall sleep patterns, the best products go further, suggesting how I could improve my sleep. And my favorites didn’t get in the way of a good night’s rest—kind of important, don’t you think?

On the Wrist

Basis Carbon Steel Edition watch ($150)

The Basis Carbon Steel’s heart rate and motion sensors collect sleep data superior to other popular fitness trackers from Fitbit, Jawbone and Misfit, which rely on only motion sensors.

After you’ve synced it to your iPhone or Android phone, the Basis app displays your overall sleep score, how long you slept and time spent in each stage of sleep. While the sleep-cycle data wasn’t always in line with the more sophisticated tracking systems I tested, the total sleep time was. It also let me set an 11:30 p.m. in-bed goal and track my progress in the app, which I found useful.

The Basis addresses Dr. Epstein’s biggest concern with these gadgets: pre-bed screen time. He said the “blue and white light” from a phone or tablet you look at moments before you close your eyes can suppress the body’s production of melatonin and alter our circadian rhythm. The Basis and the Withings Aura are the only products among my picks that didn’t need to be told (with some taps on a smartphone) that I was going to sleep.

That said, sleeping with a thick watch-like gadget—referred to by one friend as a house-arrest bracelet—isn’t ideal. A new Basis Peak, coming out next month, will provide the same sleep features in a thinner, more stylish package.

On the Chest

SleepRate app with Polar H7 heart-rate monitor ($100)

Chunky as it is, the Basis feels like fuzzy socks on a cold night compared with the clammy Polar H7 heart-rate monitor SleepRate uses to determine your sleep cycles.

It really destroyed my relaxing bedtime routine. Every night I had to wet the band’s electrodes, strap the cold band to my chest, then make sure the app was synced via Bluetooth to it.

That big, uncomfortable sacrifice made for some of the most informative and useful sleep data. Not only does it go deep on sleep stages, it cross references that information with any loud sounds your smartphone picks up when you sleep. Though I don’t remember it, the data shows a siren woke me up momentarily one night.

After the service has analyzed five nights (and you’ve filled out some waiting-room-like questionnaires), it begins to recommend a detailed sleep improvement plan. Since some of my issues might stem from frequently going to sleep after midnight, SleepRate suggested I try to get to bed earlier. 

Obvious, perhaps, but the data-driven advice was the most substantial I received all week.

On the Mattress

Withings Aura base and mattress pad ($300)

Instead of wearing a device, the Withings Aura has a pad you place beneath your bedding to monitor body movement, breathing cycle and heart rate, transferring data to your phone. There’s also a base for your nightstand that cycles through a selection of sounds and lights, which you can program for a before-bedtime routine and a wake-up call.

Hearing crashing waves as I drifted off was quite relaxing, but the reddish-orange lights, intended to increase melatonin, brought back memories of a past lava-lamp collection.

As a sleep tracker, the Aura falls behind the others. While it provides comparable information and an overall sleep score, it lacks context or advice on how to improve. I also had technical problems: It would frequently drop the Bluetooth connection or pick up my spouse’s sleep when she rolled over to my side of the bed. And it’s only compatible with iOS for now.

Aura wasn’t half as bad as the $149 Beddit, a similar under-the-sheets sensor. Beddit repeatedly told me I slept only four hours a night. The company explained it was likely because I am a restless sleeper, however the app didn’t provide ample data to back up the claim.

On the Nightstand

ResMed S+ monitor ($150)

The ResMed S+ takes a different approach: The milk-carton-size contraption sits on your nightstand aimed at your chest as its sensors collect information not only about your movement and respiration but also the room’s temperature, light and sound levels. All that information makes the ResMed S+ my top pick—and it only got in the way of my glass of water.

In addition to an attractive post-sleep report each morning, the system analyzes your environment and tells you what to fix for a better night’s sleep, including adjusting the lighting or temperature. It can also synchronize soothing audio sounds to your breathing rate, another cool, pre-emptive feature. And ResMed also suggested I go to sleep earlier and take more time to unwind before bed to increase time in REM.

I only wish I didn’t have to put the ResMed into sleep mode every night. It’s so good at watching me sleep, shouldn’t it just know when I nod off? Or maybe it’s just being respectful of my privacy since beds aren’t just for sleeping. (And speaking of privacy, these monitors register any voluntary physical activity simply as “awake” time.)

On the Bed

SleepCycle App (99 cents)

Smartphone apps like SleepCycle and SleepBot make the argument that you don’t need to buy a whole sleep system. Your phone already has an accelerometer and a microphone so you can just tuck it under the sheets and track your sleep behavior.

SleepCycle is the best stand-alone app for tracking time in bed and stages of sleep. It even has white noise and a feature that lets you log your mood when you wake up. However, the information often diverged from the others, a possible indication that a phone’s sensors alone aren’t accurate enough to tell the difference between being in bed and actually sleeping.

To truly get a good picture of sleep, you need to measure more than just movement. “The more things you add, like heart rate, respiration, eye movement, the closer the approximation gets to the actual measurement,” Dr. Epstein said.

While a 99-cent app like SleepCycle is a good place to start for those who want to get into sleep tracking, don’t forget that it does violate the sleep doctors’ cardinal rule: looking at that screen before closing your eyes.

—Write to Joanna Stern at joanna.stern@wsj.com or follow her @JoannaStern

Notes from Dr. Norman Blumenstock

Data previously published in the American Journal of Epidemiology show that the estimated prevalence rates of obstructive sleep apnea have increased substantially over the last two decades, most likely due to the obesity epidemic. It is now estimated that 26 percent of adults between the ages of 30 and 70 years have sleep apnea.

September 29, 2014

New studies highlight destructive nature of obstructive sleep apnea and benefits of continuous positive airway pressure therapy. Credit: AASM

Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep Awareness Project. Several new studies highlight the destructive nature of obstructive sleep apnea, a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke and depression.

"Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the last two decades," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "The effective treatment of sleep apnea is one of the keys to success as our nation attempts to reduce health care spending and improve chronic disease management."

Data previously published in the American Journal of Epidemiology show that the estimated prevalence rates of obstructive sleep apnea have increased substantially over the last two decades, most likely due to the obesity epidemic. It is now estimated that 26 percent of adults between the ages of 30 and 70 years have sleep apnea.

Findings from new studies emphasize the negative effects of sleep apnea on brain and heart health; however, these health risks can be reduced through the effective treatment of sleep apnea with continuous positive airway pressure therapy:

• A neuroimaging study in the September issue of the journal Sleep found that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas, which was accompanied by impairments to cognition, mood and daytime alertness. One year of CPAP therapy led to an almost complete reversal of this brain damage.
• A study published online ahead of print Sept. 21 in the journal NeuroImage found functional and anatomical changes in brainstem regions of people with sleep apnea.
• A study in the October issue of Anesthesiology shows that diagnosing sleep apnea and prescribing CPAP therapy prior to surgery significantly reduced postoperative cardiovascular complications - specifically cardiac arrest and shock - by more than half.
• A study published online ahead of print Sept. 19 in the Journal of Hypertensionfound a favorable reduction of blood pressure with CPAP treatment in patients with resistant hypertension and sleep apnea.
• A Brazilian population study published online ahead of print Sept. 23 found that nocturnal cardiac arrhythmias occurred in 92 percent of patients with severe sleep apnea, compared with 53 percent of people without sleep apnea. The prevalence of rhythm disturbance also increased with sleep apnea severity.

Common warning signs for sleep apnea include snoring and choking, gasping, or silent breathing pauses during sleep. The American Academy of Sleep Medicine, Centers for Disease Control and Prevention, Sleep Research Society and other partners in the National Healthy Sleep Awareness Project urge anyone with signs or symptoms of sleep apnea to visit http://www.stopsnoringpledge.org to pledge to "Stop the Snore" and talk to a doctor about sleep apnea.

How to Use Data to Get Better Sleep

Notes from Dr. Norman Blumenstock

All sorts of fitness trackers and bed sensors say they quantify sleep. But once you collect data, what do you do next? PC Magazine reports.

Published on September 29, 2014

All sorts of fitness trackers and bed sensors say they quantify sleep. But once you collect data, what do you do next? PC Magazine reports.

Collect Additional Data to Correlate


The problem is that knowing what times of night you tossed and turned, or how much time in bed you spent asleep or awake, isn’t enough information to guide you to make changes that will help you sleep better.

You need to collect other data about your life, too, that can affect sleep so that you can look for correlations and test hypotheses about what affects your sleep.

Get the full story at www.pcmag.com

More Sleep, Less Medicine: Sleep Disorders Center Breaks Insomnia’s Grip

Joint program of Rutgers and RWJ University Hospital offers range of sleep studies and treatment options for patients of all ages

By Robin Warshaw Friday, September 12, 2014

Patients suffering from insomnia find relief through a joint program through Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital.

For more than 30 years, Donna* believed her chronic insomnia was something she and medical science couldn’t change. Most nights, she had difficulty falling asleep and staying asleep. Her doctors prescribed various medicines that did little to help.

Donna pushed her way through an ever-present blanket of fatigue to succeed in her career and raise three children. Yet the insomnia took its toll. “I was exhausted, I was irritable,” she says. “I somehow managed to have energy for things I needed and wanted to do, but I was sleep deprived. It was part of my life.”

When an acquaintance mentioned that a sleep specialist might help, Donna wasn’t interested at first. “I thought I had already been on everything,” she says. Realizing she had never seen a sleep expert, she went to the Comprehensive Sleep Disorders Center, a joint program of Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital. To her surprise, “they had a completely different approach,” including patient education, behavioral changes and sophisticated testing.

5 Ways to Put Insomnia to Rest Advice

 

Advice for defeating insomnia, from physicians at the Comprehensive Sleep Disorders Center, Robert Wood Johnson University Hospital, New Brunswick:

 

1. Take anything with a screen out of your bedroom – TVs, cellphones, tablets, laptops. Use your bedroom for sleep or sex only.

 

2. Go to bed only when sleepy. To relax, take a hot shower, meditate or do yoga.

 

3. Get up at the same time every day, Monday through Sunday, no matter how little you’ve slept.

 

4. If you wake during the night and  cannot go back to sleep after 15 minutes, get out of bed and do something restful and calming. Read or listen to music. Do not watch television or get on the computer. Do not go back to bed until very sleepy.

 

5. Do not nap, even on weekends

Chronic insomnia, such as Donna experienced, is common and may be increasing due to 24-hour connected lifestyles, says Anays M. Sotolongo, medical director of the sleep center.  Unlike acute insomnia, a short-term condition caused by a stressor such as giving a speech, chronic insomnia produces troubles that last a month or more.

Most with insomnia symptoms get too little sleep. Some sleep all night, but have undiagnosed disorders – acting out dreams, sleep talking, sleep apnea – that affect restfulness. “They sleep seven to nine hours, but they feel awful,” says Sotolongo, who is an assistant professor of medicine in the division of pulmonary/critical care at Rutgers Robert Wood Johnson Medical School.

Sometimes, insomnia patients come looking for a quick fix and are not always happy, notes Sotolongo, when told the solution will take time. “Part of the process is to develop a sleep debt, to make them sleepy. It’s like going on a diet – they have to learn to feel hungry again.”

Sleep center physicians take patients’ medical histories and conduct full physical examinations to determine the source of the problem. Donna also had an overnight sleep study in the center’s sleep laboratory. That’s unusual for insomnia patients, but is used to identify any physiological causes, such as sleep apnea or seizures, Sotolongo explains. The center conducts about 1,500 sleep studies annually.

In the lab, patients sleep in a private room as skin sensors measure body functions and a trained technician monitors the study. “I was mildly nervous about it,” says Donna, who admits feeling “awkward” about having someone watch her sleep. “I wasn’t resistant to doing it because of the possibility it could be helpful.”

The study showed no physical cause for Donna’s chronic insomnia. Her sleep center physician, Jagadeeshan Sunderram, educated her about sleep health, had her change her sleep habits and reduced her medicine. “Nothing else had ever worked,” she says, “so I did what he told me.”

Her sleep improved gradually during the first year, and continued to improve. Donna lost her anxiety about not sleeping and stopped “night eating,” a habit she had used to get back to sleep. “As I began to sleep better and wake less, it went away,” she says.

Now, several years later, Donna generally follows the behaviors she learned, but not as strictly. When she has significant sleep disruptions, “Dr. Sunderram reminds me to go back to the basics.”

*Patient requested anonymity; name has been changed

Can Sleep Apnea Predict a Heart Attack?

By Eric Cohen, MD Published Sep 8, 2014

Many of the patients I see who complain about sleep issues have some level of obstructive sleep apnea (OSA). In fact, as many one in five adults have at least a mild form of sleep apnea. People with obstructive sleep apnea are also more likely to have hypertension, high blood pressure, and cardiovascular disease.

Now, as a result of the latest research, when we test for sleep apnea we also examine and focus on the state of a person’s heart.

The link between sleep apnea and cardiovascular disease has been studied for several years. In 2013 it was announced that this link even includes the possibility of heart attacks related to obstructive sleep apnea. The head of a long-term study, Apoor Gami, MD, a cardiac electrophysiologist at Midwest Heart Specialists-Advocate Medical Group in Elmhurst, Ill., notes, “The presence and severity of sleep apnea are associated with a significantly increased risk of sudden cardiac death.”

There are a number of causes behind this association. Sleep apnea can cause you to stop breathing several times a night. When this happens, your blood oxygen levels go down, which can cause your heart rhythm to flutter. This is a heart complication that also occurs at the time of sudden cardiac death.

The problem is huge. In the United States alone, more than 450,000 deaths are caused each year by sudden cardiac death. 

These figures illustrate why anyone presenting with symptoms such as loud snoring, daytime fatigue, waking with a sore throat, hypertension, high blood pressure or cardiovascular disease should be tested for sleep apnea. One positive from the study on sleep apnea, and recognizing the link between sleep apnea and heart problems, is we have found that improving obstructive sleep apnea may dramatically improve the health of your heart. The longer your symptoms go untreated, however, the higher your chance for heart disease, stroke, or cardiac arrest.

The good news is there are ways to improve your sleep without surgery. Here are six recommendation I give to my patients who want to improve the quality of their sleep:

1. Avoid caffeine in the evenings.
2. Avoid excessive alcohol consumption: Too much alcohol can affect a person’s sleep.
3. Create a regimen of regular physical activity.
4. Arrange your bedroom into a calming, sleep-inducing environment.
5. Establish a pre-sleep routine (bath, herbal tea, reading a book, etc.).
6. Keep a consistent sleep cycle; this helps your internal clock stay regulated.

If you’re over 60, obese, and constantly tired or fatigued, make sure you are tested for sleep apnea. Older women especially should be tested for sleep apnea, and your doctor should also be evaluating you for signs of heart disease. Tests can show weak spots, and if caught early, this could save lives. Now, as we know more about the connection between sleep apnea and the heart, doctors can get more accurate results regarding any sleep troubles you may be experiencing.

Sleep Apps in the Spotlight

Another sign that sleep health is going more mainstream every day is the proliferation of smart phone applications (apps) being designed for the consumer market. Hayley Tsukayama, consumer technology beat reporter for The Washington Post, writes that there are “dozens” of sleep apps in Apple and Google’s app stores.

Some offer meditation tips or even play soothing white noise. “Perhaps most intriguing of all, there’s also a whole class of apps devoted to sleep analysis,” she writes, “and apps that you leave up on your phone’s screen while you snooze that monitor your sleep based on your movements and the sounds from the room.”

Tsukayama tried four of these apps over a period of a few weeks: Sleep Cycle, SleepBot, Pillow andSleep Time. All are sleep-tracker and alarm apps, which are designed to help track sleep, as well as read sleep patterns, to wake up at the best possible time. To use them, “just call them up on your phone, keep the phone on and plugged in so the app can register your movement, and make your way to dreamland.”

Tsukayama concludes that “I did learn some things about my sleep patterns that were useful. For one, no matter how early I try to go to bed, I found it’s rare that I actually fall asleep before midnight…I found out that I tend to wake up every hour or so unless I’ve had a good workout that day, in which case I sleep a lot better.”

Source: Washington Post

Is Exercise Bad for Your Teeth?

By GRETCHEN REYNOLDS SEPTEMBER 24, 2014 12:01 AM

Vigorous exercise is good for almost all of the body — except perhaps the teeth, according to a surprising new study of athletes. The study, published in The Scandinavian Journal of Medicine & Science in Sports, found that heavy training may contribute to dental problems in unexpected ways.

There have been hints in the past that athletes could have a heightened risk for cavities and other oral issues. In a studypublished last year in The British Journal of Sports Medicine, dentists who examined 278 athletes at the 2012 Summer Olympics in London reported that a majority displayed “poor oral health,” including high levels of tooth decay, often in conjunction with gum disease and erosion of the tooth enamel. The athletes came from the United States and Europe as well as less-developed parts of the world, and most had access to good-quality dentistry, although many had not visited a dentist in the last year.

The study didn’t examine why the athletes were at such high risk of dental problems, although many of us might assume that sugary sports drinks and bars would be a primary cause. Other studies, however, have found little if any link between consuming sports drinks and developing cavities.

So to better understand what is going on inside the mouths of athletes, researchers with the dental school at University Hospital Heidelberg in Germany and other institutions recruited 35 competitive triathletes and 35 age- and gender-matched healthy adults who were not athletes.

All of the volunteers visited the hospital’s dental lab for a full oral examination, including collection of their saliva after they had been sitting quietly. They also completed questionnaires about their diets, including consumption of sports drinks and other beverages, their normal oral hygiene routines, and their exercise habits, if any.

Fifteen of the athletes also completed an increasingly strenuous run of about 35 minutes on an outdoor track, during which their saliva was collected several times.

Then the researchers compared the groups’ teeth and spit, which turned out to be different in telling ways.

Compared with the control group, the athletes showed significantly greater erosion of their tooth enamel. They also tended to have more cavities, with the risk increasing as an athlete’s training time grew. Over all, the more hours that an athlete spent working out, the more likely he or she was to have cavities.

The researchers found no correlation, however, between consuming sports drinks or any other elements of the athletes’ diets and their oral health.

They also found no differences in the amount or chemical make-up of their volunteers’ saliva after the athletes and the non-athletes had been at rest.

But that situation changed when the athletes worked out. During their experimental runs, the amount of saliva that they produced progressively lessened, meaning that their mouths became drier, regardless of whether they consumed water or other beverages during the workout. The saliva’s chemical composition also shifted, growing more alkaline as the workout continued. Excess alkalinity in saliva is thought to contribute to the development of tartar plaques on teeth and other problems.

The extent of the changes in the athletes’ saliva during a workout were something of a surprise, said Dr. Cornelia Frese, a senior dentist at University Hospital Heidelberg, who led the study.

“We had thought sports drinks and nutrition might have the most detrimental influence on dental decay,” she said, “but we saw no direct link” between them. Instead, it was the changes in saliva during exercise that differentiated the athletes’ mouths from those of the control group. Since saliva “has a very protective function” for teeth, Dr. Frese said, having less of it or a chemically different version during exercise could be problematic.

But, she cautions, this study was small, short-term and in many ways unrepresentative of the oral risks most of us would likely face from exercise. “The athletes participating in our study had a mean weekly training time of nine hours,” she said. They were, in technical parlance, hard-core.

“All we can say” based on the data from this group, she said, “is that prolonged endurance training might be a risk factor for oral health.” Whether less frequent or intense exercise would likewise affect oral health is uncertain but unlikely, Dr. Frese said.

Still there are a few precautions that anyone who exercises and has concerns about their oral health might want to take, she said. Drinking water during workouts could be a start, although the connection between hydration and oral health is not scientifically established, Dr. Frese said. More generally, brush and floss, as you know you should. And if you’re a serious endurance athlete, consider visiting a dentist with a specialty in sports dentistry, she said. The goal is to ensure that your teeth remain in as good shape as the rest of you.