Don't Put Too Much Stock in Consumer Sleep Devices, Yet: Dr Christopher Depner

Christopher Depner, PhD, assistant professor of health and kinesiology, University of Utah, explored the various concerns, challenges, limitations, and more that are associated with advancements in wearable sleep technology in an interview with The American Journal of Managed Care^® (AJMC^®).

Earlier this summer, Depner presented on this research and more at the American Academy of Sleep Medicine and Sleep Research Society’s annual meeting: SLEEP 2024.

This transcript has been lightly edited for clarity and length.

Transcript

Consumer-oriented sleep trackers are not yet advanced enough to produce data that can improve health outcomes | image credit: Gefo - stock.adobe.com

AJMC: Are there any privacy and security concerns associated with the data collected by wearable sleep devices, and if so, how are they being addressed?

Depner: I think there is definitely concern there. And I think it's fair for people to be hesitant about their personal health information and who's getting access to that, and who's doing what with it. From my personal experience, on the research side of things, I think that most researchers, that I'm aware of, are really careful about that information and do a really solid job of keeping it private and not letting that get out. But I do think from more of a clinical, medical care provider type of a setting that there is concern over that.

There are a lot of devices that collect a lot of different information on people now, and it's not clear exactly what the companies might be doing with that data. And then, there's a lot of interest in integrating that data into people's electronic health records. There could be advantages to that. But one of the potential disadvantages is if insurance companies can get a hold of that information and potentially use it to change insurance premiums and determine how different people get insurance, etc. And so, it's a definite concern, and I think people are aware of it as we're thinking about entering that information into electronic medical records. But I will say, I think a lot of work needs to be done in that area to understand how that's going to be regulated, and who gets access to it and who doesn't, and how the actual user can have some control over that or not.

AJMC: How do wearable sleep devices integrate with other health monitoring systems, and are there any challenges that arise in creating a comprehensive health profile?

Depner: For research devices, specifically, so like watches or other sort of research devices—there's a lot of headbands now that can track sleep—those ones really don't integrate well with other devices. So, if you have a device that's monitoring your sleep on your wrist and a device that’s monitoring your physical activity, or sedentary behavior, or steps, essentially, on your thigh or your waist, those devices are not designed to communicate with each other. If you really want to integrate those very closely, there's a lot of challenges in actually doing that, not the least of which is just synchronizing the time and the date on those devices, which seems like it would be a straightforward thing.

From a consumer point of view, there certainly aren't a lot of devices. Even if you just look at your phone, and look at the health settings on that, or the health output on that, it'll tell you things about your heart rate, potentially your sleep, your activity across the day, if you log your food intake. That's all integrated in it. So, I think there's a lot of consumer devices that are trying to integrate all this stuff, even a simple Fitbit can integrate steps, sleep, heart rate, you can enter food intake into that. So that's really great.

I think the challenge is, on the consumer side, when you have all that information integrated, what does that mean? And if it's actionable, and if it's positive or negative, that's really not clear to consumers. Honestly, there's not a lot of research that's integrating that. I think part of where the field is trying to go is to more easily integrate from a research side of things and patterns across the 24-hour day. So, integrating the timing and amount of your food intake, with how that interacts with sleep and your physical activity, and your steps across the day, and ultimately linking all that with health outcomes like cardiovascular disease and diabetes. I would say right now, there's really not a lot of reliable information on how all that gets integrated together. It’s definitely an area for future research.

AJMC: What are the limitations of current wearable sleep devices in providing actionable insights and recommendations for improving sleep quality?

Depner: There's some people that equate a sleep device to the scale in your bathroom. So, you know, weighing yourself daily is not really a weight loss intervention. And so, tracking your sleep is not a sleep intervention. And I think there's a couple of challenges, one is with all the wearable devices, the consumer devices. I'm thinking things like Fitbit; they spit out a nightly sleep score for you. But it's really a bit of a bad black box as to what actually goes into those sleep scores and what they mean. You can certainly, sort of, game the system and try to figure out how to optimize that sleep score but that doesn't actually necessarily mean that your sleep is optimal. It just means you're optimizing this score from a Fitbit device or something like that, and it doesn't mean that you're actually improving your health. And so, those scores are really not validated against anything, and they certainly aren't shown to be linked with health outcomes.

That is one issue and the potential really big concern is that, “Oh my gosh! My device is telling me I have a bad night of sleep, now I'm gonna be really sleepy all day; I'm gonna have all these issues; I might have to take a nap; my sleeps not good.” It might be causing anxiety. And those realities might not be true. So I do think there's potential concern there.

The reality is, if you do have a sleep disorder, like obstructive sleep apnea or insomnia, there's clinical treatments that are validated for those types of things. Your wearable sleep device may or may not be picking that up. It might be telling you that you have bad sleep, but it might not be saying why you have bad sleep. And so I think there's a really big limitation as far as actionable things from the wearable devices from the consumer side right now. I do know there's companies trying to develop interventions that are based off of wearing their devices. But, you know, I think that's kind of an open area for research.

There's a lot of clinical trials going on right now where people are recruiting folks who have sleep issues, and they're trying to conduct interventions. Some of them are lasting weeks or up to months, and they’re seeing if those interventions are actually improving people's sleep, and if so, is it improving health outcomes like risk factors for diabetes and obesity and cardiovascular disease? So I think right now that's a pretty big gap in the field. But I know there's research in that area as well.

So, long story short, I wouldn't put too much stock in those simple outputs from the consumer devices right now.