consumer sleep tracking technologies - cloud object ...€¦ · smartwatches • encompass ......

© Associated Professional Sleep Societies, LLC 1

Consumer Sleep Tracking Technologies Sara Nowakowski, PhD, CBSM

C11: Actigraphy and Fitness/Sleep Trackers in Adults and Children: Fundamentals and Application


Conflict of Interest Disclosures for Speakers

X 1. I do not have any relationships with any entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, OR

2. I have the following relationships with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Type of Potential Conflict Details of Potential Conflict

Grant/Research Support

Consultant

Speakers’ Bureaus

Financial support

Other

X 3. The material presented in this lecture has no relationship with any of these potential conflicts, OR

4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references are provided as support for this lecture:

1.

2.

3.


Consumer Sleep Technologies (CST)

• CSTs: increasingly popular computer-based systems available to the general public

• Purpose: improving or self-monitoring sleep

• OTC: Mostly available w/out Rx or clinical guidance

• Be aware: Patients may request interpretation of derived data


Some Stats• Highest funded health device on Kickstarter

was a sleep monitor ($2.4 million in financial backing)

• 500+ sleep-related apps on Apple iTunes

• 1 of top 5 iTunes paid apps in 2014 was a sleep tracker and alarm clock

• Some sleep apps have 5+ million downloads


Delivery Platforms1. Mobile devices platforms

e.g., Sleep Cycle, Entrain

2. Wearable platforms e.g., Fitbit, Apple Watch

3. Embedded Platformse.g., Tanita Sleep Scan

4. Desktop or Website Platformse.g., SleepMapper, MyAir

5. Accessory Appliance Platformse.g., Resmed S+, Withings Aura


Mobile Device Platforms• Mobile apps that run on smartphones or tablets• Most popular CSTsAdvantages

+ convenience & ease of use+ device capability & flexibility+ app accessibility

Disadvantages- reduced processing power - media input/output capabilities- sleep disruption from noise or light of app- if require device placement on mattress, may not be accurate if multiple individuals on mattress, differences in mattress texture & material introduce artifact


Mobile Device PlatformsSleep Cycle

• 1 of 5 top selling Apple paid apps

• Best-selling paid health app on Google Play

• Track “sleep trends” over time

• Place mobile device on sleep surface to use built-in accelerometer to measure movement as a surrogate indicator of sleep/wake

• Smart alarm clock preset time range triggered when app senses “light sleep”


Mobile Device PlatformsSleepBot

• 1st place winner NIH 2011 “Go Viral to Improve Health” competition

• App measures movement to estimate “sleep cycles”

• Records ambient sound (snoring, sleep-talking)

• Bedtime alert reminders• Smart alarm• Graphs track sleep

patterns (hours of sleep, “sleep debt”) over night(s)


Mobile Device PlatformsSunriser

App sets a wake-up alarm to exact time the sun rises using user’s geographic location


Mobile Device PlatformsEntrain

• App encourages timed light exposure to reduce jetlag

• User specifies: - time zone change- arrival time- arrival date

• App creates a pre-trip personalized schedule of timed light and dark exposure to preemptively shift user’s circadian rhythm


Wearable Device Platforms• Attachment or sensor placed on body or clothing• Track wearer’s body movement Advantages

+ increased accuracy (presumed) via direct contact with wearer

Disadvantages- discomfort- limited battery life- potential to misplace- sensor damage &

inaccuracy from frequent use


Wearable Device PlatformsFitbit

• Simple clip-on pedometer to high-end wristband, smartwatch, and designer jewelry

• Accelerometer & wireless biometric sensor

• Certain models automatically detect sleep

• Estimate “sleep efficiency” • Vibration for silent alarm


Wearable Device PlatformsFitbit


Wearable Device PlatformsJawbone UP

• Wristband or clip-on• Accelerometer & other

biometrics• Senses “light” and “dark” sleep• “Smart” alarm• Vibration for silent alarm


Wearable Device PlatformsBasis Peak

• Smartwatch • Accelerometer purports to

sense:– Light– Deep– REM

• Also measures:- Heart rate- Perspiration- Skin temperature


Wearable Device PlatformsMisfit

• Clip-on to clothing• Or worn as jewelry

(bracelet, pendant) • Accelerometer • Waterproof


Wearable Device PlatformsSmartwatches

• Encompass several devices:Apple Watch - No built-in sleep tracking capabilityAndroid Wear - Download/purchase of sleep tracking appMicrosoft Band - Built in sleep tracking software

• Limited by short battery lifedue to multimedia capabilities

• Limits functionality as sleep tracker


Wearable Device PlatformsMimo Baby Tracker

• For infants 0-12 months• Bodysuit• Accelerometer to measure movement & position• Respiratory sensor• Temperature Sensor• “Turtle” shaped Bluetooth transmitter sends info to

online data cloud & caretaker’s mobile device


Embedded Platforms• Non-wearable device embedded into sleep environment

Advantages+ unobtrusive+ increased functionality

Disadvantages- privacy concerns due to easy concealment (e.g., sensor embedded into mattress, camera embedded into wall)

- additional cost- space required


Embedded PlatformsTanita Sleep Scan & Sleep Number x12

Tanita Sleep Scan- mat placed under the mattress - “vibration microphone” - Records: breathing, heart rate, movement

Sleep Number x12‐ remote to control mattress firmness‐ elevate head or foot of bed in event of snoring‐ independent control of each side of mattress


Desktop or Website Platforms• Computer programs or websites designed to run on a full

desktop operating System (e.g., Windows, Mac, Linux)

Advantages+ increased processing power+ larger data storage capabilities+ more robust visual and auditory experience+ improved input/output interface

Disadvantages- high cost- decreased portability- large platform variability


Desktop or Website PlatformsSleepyHead

Allows user to view:- own CPAP machine nightly usage- Residual AHI- Air leak

Supported CPAP Machines:- Philips Respironics System One- Resmed S9 and S10 series- 3 other brands


Desktop or Website PlatformsRespironics SleepMapper

Allows user to view:- own CPAP machine nightly usage- Residual AHI- Air leak

Supported CPAP Machines:- Philips Respironics Systems


Accessory Appliance Platforms• Physically separate or accessory device• May or may not interface with mobile devices

or the internete.g., novelty alarm clocks, electronic sleep accessoriesAdvantages

+ feature design flexibility+ improved functionality

Disadvantages- financial cost of purchasing standalone device- diminished economy of space


• Biofeedback device• Facilitates sleep onset using self-

relaxation• Measures wearer’s pulse with a thumb

sensor or ear clip sensor• Provides visual and audio feedback • Guides user through breathing

technique combined with positive thinking

Accessory Appliance PlatformsemWave


Sensors:- Light- Temperature- NoiseTracks:- Breathing- “Light” & “Deep” sleep- “REM” sleep• Integrates mobile device app• Provides nightly “sleep score”

& sleep advice“Relax to Sleep” = rhythmic computer-generated nature sounds programmed to match user’s own respiratory rate prior to sleep then gradually slows breathing to induce sleep“Mind Clear” = scheduled worry

Accessory Appliance PlatformsResmed S+


Accessory Appliance PlatformsAnd others…


Comparison of price, features, and software

Russo et al, 2015


Comparison of Sleep Architecture

PSG

Actigraphy

Russo et al, 2015


Stages of Sleep Monitor Validation


Fitbit vs PSG & AW-64 in Adults (ages 19-41)

Montgomery‐Downs et al, 2012

N = 24


Fitbit vs AW-64 Sensitivity & Specificity

Montgomery‐Downs et al, 2012


Commercial Sleep Monitors vs. BodyMedia SenseWear

Ferguson et al, 2015


PSG Normal Sensitive

Fitbit vs PSG in Children & Adolescents

• Overestimated sleep (42 min) in Normal mode

• Underestimated sleep (109 min) in Sensitive Mode

Meltzer et al., 2015


Normal Sensitive

Fitbt vs. Actigraphy in Children & Adolescents

• Neither mode provided a consistent, comparable result

• Normal mode overestimated and Sensitive Mode underestimated sleep and SE

Meltzer et al, 2015


Jawbone UP & PSG outcomes in Adolescents

De Zambotti et al, 2015


Fitbit Charge & PSG outcomes in Adolescents




Fitbit Charge vs PSG in Adolescents


Reliability?

Baroni et al, 2016


Sleep Monitor Comparison Study

Institute for Translational Sciences

• Do these things actually work?• Lab and lifestyle measures

– Brief lab protocol, compare to gait measurement system

– Wear for 7 days to measure sleep and activity compared to research-grade accelerometer (Philips Respironics Actiwatch2)

• N=40 Adults (ages 18-75)


Lessons learned

Behavior change techniques


Is it reliable?Many participants were not always successful at “tapping” Fitbit Flex into sleep mode.


If missed getting into sleep mode – can enter manually via web interface, but where do you obtain “enter bed” and “left bed” from?


What are they measuring?What is “REM” “Light sleep” “Deep sleep”


How is sleep efficiency calculated?

“Actual sleep time” (TST)= 7hrs 40 min

“You were in bed for” (TIB) = 8hrs 13 min

“Your sleep efficiency” = 96%

I calculate 460/493 x 100 = 93% How about the “Sleep goal”?


What’s up with the algorithms? Companies do not publish/publicize how they calculate sleep variables.


Data from commercial devices does not usually export into useable databases (e.g., excel, SPSS)

Thus, recording from app or web interface is required and increases chances of errors in data entry.

Also, most devices do not allow users to send their data to their provider.


Things can change, a lot, in just a few years


• Many patients will be semi-knowledgeable about wearable devices.

• Check wrist to see if your patient is wearing one & inquire if used to monitor sleep.

• Educate! Many patients don’t know how accurate monitor is or what is meant by “deep” or “light” sleep.

• Insomnia patient may risk hypervigilance & catastrophizing sleep resulting in increased worry & effort about sleep.

• Patients may rely to heavily on monitor feedback instead of trusting in their bodies.

• Ask insomnia patient not to wear device or not to look at app/web feedback during treatment.


Technology is a means, not an

end

Corollary: it is not always the

best means

consumer sleep tracking technologies - cloud object ...€¦ · smartwatches • encompass ......

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