Part II: America’s Obsession with Sleep, Sleep Gadgets, and Sleep Apnea?
Introduction: At first I thought I would just tweet a link to this article by Molly Wood from the NY Times about consumer related sleep tracking devices, but it made for a more interesting read than expected and led to part II of the sleep and OSA series for this blog. After the first series on Sleep, it became more apparent that we really can not talk about OSA without talking about sleep in general, both from a consumer standpoint and from a more scientific approach. Lay articles like the one reviewed here not only reflect current consumer buying trend, but can help shed light on the bigger picture which is the medical diagnosis and treatment of OSA, and the current wave of controversy it raises in safety sensitive employees like commercial truck drivers, train conductors and airline pilots. Why, for example, at this very moment, while we are in the midst of a OSA screening and treatment controversy that americans in general are so concerned and even obsessed with sleep and willing to drop hundreds and even thousands of dollars in non-medical sleep monitoring devices and applications. Is it a fascination with tech and gadgets or a desire to spend just for the sake of spending? There is of course no shortage of companies ready to capitalize on this trend. Some of these companies are not just sporting good or tech companies selling smart watches but companies selling real medical devices like CPAP machines. Many of these consumer sleep tracking devices are actually quite interesting, and some not only track, and monitor your sleep, but can also help you sleep better. Part II of this series will focus on some of these devices. Of course none of the devices are meant to diagnose or treat sleep disorders like OSA, but they do help illustrate both our fascination and perhaps obsession with sleep, sleep apnea and technology.
The article: In her NY Times article “ Bedside Technology for a Better Night’s Sleep” Molly Wood summarizes the various devices and technologies out there that help consumer track their sleep activity and pattern. Besides the head band and chest strap accessories that comes with some of these devices to record respiration and heart rate, there are even multi thousand dollar beds available that track your sleep pattern and even adjust your bed for you. None of these devices as mentioned, are capable of diagnosing sleep disorders, but it stands to reason, that if you are that sleep obsessed or concerned, a real sleep study might prove more worth while. Nevertheless these consumer devices can be useful and a fun way to track your sleep pattern and may satisfy our endless thirst and fascination with new technology and gadgets. The downside, is you may have to strap an iPhone to your head (just kidding, not strapped but placed close to it like a device from Bedditt that records your snoring that way), and you can spend anywhere from fifty dollars to hundreds or thousands of dollars. One of the he most interesting (from a medical standpoint) is from RestMed Inc. RestMed is an actual medical equipment company from Australia that creates devices to treat sleep disorders, with an emphasis on continuous positive airway pressure devices (CPAP) . They have come up with what they call the first non- contact sleep monitoring system that transmits short pulses of radio waves weaker than bluetooth to monitor body movement during sleep called the ResMed S+. It’s reportedly similar to echolocation used by bats to hunt insects. Nintendo apparently plans on getting in on the action by collaborating with ResMed to develop their own product. This comes after controversial health claims made by Nintendo with their Wii Fit Balance board device seen in articles from Huffington Post and Web MD. The most scathing criticism of the Wii Fit product was not even from a medical site like Web MD, but by the video game reviewer Polygon, who in 2013 not only stressed it’s inaccuracies but also of the possible risks of repetitive stress injuries from using it. At least Web MD acknowledged that any activity beyond simple “thumb” motion is more beneficial to sedentary folks, even though they preferred that these folks actually dropped their joy stick and picked up an actual tennis racket and go to a real gym (I guess it’s also less embarrassing to tell your doctor that you got injured playing a real tennis game as opposed to the Wii). Another problem with devices like the Wii Fit that was brought out by both the Web MD and Polygon articles is the scores they give you to determine your level of fitness with the so called Wii Fit age. How exactly accurate or useful is the Wii Fit age is another matter of controversy, as well as the method used to calculate the fitness age itself. Hey, what do we expect from the makers of Donkey Kong and Mario Zelda.
Which brings us back to the sleep tracking devices, especially the Resmed S+. While not making direct health clams, ResMed does make a strong statement, such as this one from their website:
“The S+ technology’s ability to accurately measure sleep patterns has been published in a number of scientific papers. Specifically, this technology has been tested and proven against expert manually scored data of patients gathered in several accredited sleep laboratories”.
This is coming from a real medical device company known for making CPAP machines amongst other things, and not just from a consumer oriented sports fitness company like Nike with their Nike Fuel wristbands. I certainly would love to see the studies behind the claims for the ResMed S+, but it certainly makes sense to me why Nintendo would team up with them.
Another interesting device is Withing’s Aura (they also make baby monitors, blood pressure monitors, and weight and BMI/body composition monitors that can be linked to your iPhone), that monitors and help improve your sleep through a contact free sensor tucked under the mattress. It uses special light and sound programs to promote the onset of sleep. In fact, Withing’s website actually sounds a lot like a medical website. They start of with telling us about the importance of sleep ( that we spend 1/3 of our lives sleeping, that sleeping 5 hours or less per night increases our risk of disease, death and accidents by 15% and that in the U.S. 1 out of 5 motor vehicle accidents is related to sleep deprivation). Also they cite scientific data to support their lighting program, which makes use of the correlation between certain wavelengths of light and the secretion of melatonin to modulate sleep wake cycles.
Other devices include the more expensive mattresses sensing devices that go beyond the sleep IQ ones we see on television that automatically adjust firmness for comfort. These newer mattress oriented tracking devices also track your respiration, heart rate and body movements and relates all that to your smartphone to give you a picture of your sleep pattern, for a mere $4,500. Molly Wood in her article does make a good point that people who live alone don’t always know why they get up at night and that these devices (some expensive, some not), may also act like a sleep diary or journal that can help them track trends in their sleeping pattern that may be indicative of more serious problems like sleep apnea, restless leg syndrome, or sleep walking. She does emphasize in her article, with input from Dr. Clete A. Kushida (a sleep director from Stanford University for Sleep Science Medicine) that although these devices help you sleep better and track your sleep patterns, they come very short of an actual consultation by a physician.
Conclusion: Sleep disorders including OSA are complicated medical conditions that require careful evaluation to be accurately diagnosed by certified sleep professionals and physicians. According to the American Academy of Sleep medicine (AASM) clinical guidelines on the management and long-term care of OSA in Adults, Polysomnagraphy (PSG) remains the gold standard for diagnosis. It should be performed in a certified sleep laboratory with EEG (electroencephalogram), EOG (electrooculogram), chin electromyogram (EMG), airflow, oxygen saturation, respiratory effort, and ECG (electrocardiogram) as well as leg/extremity EMG to monitor body position. As far as portable monitors (PM) go, they should at minimum record airflow, respiratory effort and blood oxygenation and should only be performed in conjunction with a careful sleep study. Like PSG, they should be supervised by a qualified or board certified physician in sleep medicine. The use of actigraphy (measures gross body motor activity) alone is not indicated for the routine diagnosis of OSA, but can be useful with PMs to look at rest activity. This AASM practice guideline and other evidence based reviews and synthesis such as the FMCSA commissioned studies on the screening, diagnosis, and treatment of OSA will be the focus of future blogs.