Obsessed with getting good sleep? That could be making it worse

Omega Chen purchased a Garmin watch to track his heart rate and other metrics when he exercised, but it also measured things like his resting heart rate and “sleep score” every day and night. Yet no matter what he did to get a better night’s rest, he could not improve his numbers. Week after week, he watched them plummet.

“It was driving me crazy trying to isolate all of these variables and trying to get all of my recovery scores up, but nothing would happen,” Chen, a 37-year-old software engineer in San Diego, California, told Salon in a phone interview. “I was wigging out about it, and I realized this was not healthy and I needed to take a break from this watch for a few months and detach from the numbers.”

But Chen is far from alone in tracking these metrics. Roughly one-third of Americans have used an electronic sleep-tracking device and close to 70% of those people have changed behaviors because of the data they were presented with, according to a 2023 survey from the American Academy of Sleep Medicine. However, these devices are imperfect in their measurements, and a subset of people become so hyperfocused on them that they actually end up getting stressed out and sleeping worse.

In fact, there is even a newly proposed term to describe the phenomenon: “orthosomnia,” defined as an unhealthy preoccupation with achieving perfect sleep, often fueled by the use of sleep trackers, such as fitness rings or smart watches.

“In some cases, this can lead people to engage in behaviors that are not healthy for their sleep, like spending more than an hour laying in bed,” said Dr. Kelly Baron, a psychologist at the University of Utah who researches sleep. “When you have trouble sleeping one of the things we say is, don’t lay there and toss and turn, [but they are] trying to squeeze out more minutes of sleep.”

At least two dozen brands of sleep trackers are on the market, with some of the most commonly used products coming from companies like Oura, Apple, Fitbit and Garmin. These devices do help many people track patterns in their sleep and make changes that help them sleep better. Getting sufficient and quality sleep is considered the bedrock of health, having been associated with a host of positive health benefits ranging from boosting the immune system to reducing anxiety to improving memory. On the other hand, lack of sleep is an indicator of all-cause mortality — practically any illness or condition is made worse by poor sleep.

Perhaps because of these benefits, people have been particularly galvanized to improve their sleep in recent years, and increasingly willing to sacrifice other things to get a better night’s rest.

“I think the enormous interest in sleep tracking and the explosion of interest in sleep-related products and services are indicators of this collective awakening to the importance of sleep,” said Rebecca Robbins, a sleep scientist at Brigham and Women's Hospital and an assistant professor of medicine at Harvard Medical School. 

However, tracking sleep can become a problem when people prioritize metrics instead of listening to how they feel, said Dr. Cathy Goldstein, a neurology professor at the University of Michigan who studies sleep. This preoccupation extends beyond sleep: People are increasingly tracking their steps, heart rate and other metrics sometimes to a point of obsession.

Baron published the first case reports on orthosomnia in 2017, in which patients essentially reported that if they didn’t get their seven hours of sleep recorded on their sleep tracker their day was “going to be horrible,” she said. In another report, people said that they missed outings with friends to watch TV at home so they didn’t lose “points” on their tracker and that they developed a dependence on the device. A third report found that some people found the numbers motivating, but others found it frustrating when the numbers didn’t match how they felt.

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“When we see these devices to be a potential risk of worsening sleep, particularly in people with insomnia or anxiety, is when they become overly focused on parameters that we know are not necessarily accurate or precise,” Goldstein told Salon in a phone interview. “That’s when we have people break up with their devices for a while."

Although the devices have become increasingly accurate, their reliability still varies, and many have not been validated against polysomnography, the gold standard for sleep measurement. 

One 2023 study comparing 11 different sleep trackers reported that most wearables generally overestimate sleep because they may not be able to distinguish between a person lying in bed at rest and a person sleeping. Still, most of the wearables tested were fairly accurate even at predicting various stages of sleep.

Most sleep trackers use an accelerometer to measure movement in sleep and track when the user is at rest. Some devices also include photoplethysmography sensors which use light to measure how the volume of blood vessels changes. From those data points, the device calculates your heart rate, which is used to estimate how much time you are spending in various parts of the sleep cycle.

However, these are proxy measurements. In medical settings, the sleep cycle is measured through electroencephalograms, which track people’s brain waves over the course of the night, Goldstein explained.

Because of this, sleep trackers are better at measuring when a person is asleep or awake rather than specific phases of sleep, like rapid-eye movement sleep, Goldstein said. A variety of metrics are typically used to measure REM sleep, including eye movement.

“People get really excited or upset about how much REM sleep they are getting or how much deep sleep they are getting and if that matches up to what they are ‘supposed’ to be getting,” Goldstein said. “Cardiac changes that mimic what typically happens in those stages is not the same thing [as what the ECG shows], so we can’t just extrapolate what we know from brain waves to sleep based on estimated motion and cardiac activity.”

Sleep trackers may also be less accurate when measuring data from people of color because the photoplethysmography sensors used have been shown to be less accurate on darker skin tones. They may also be less accurate for people with obesity because skin thickness impacts their readings as well. 

“We had a research subject who had a tattoo on your wrist that can mess these up,” Goldstein said. “And if you're not wearing a device securely and it's moving around, it's also another reason that these might not work very well.”

Still, with more than 100 million Americans having used these devices, they can provide sleep researchers with an unprecedented quantity of data to help them better understand how people sleep at home. Traditional sleep research is gathered in labs, where people with sleep problems are hooked up to machines. But sleep trackers provide data on people in a more naturalistic setting, and can even be used to study how things like earthquakes or the Super Bowl impact sleep at the population level, Baron said.

“It has the potential to really be a treasure trove in really understanding how people sleep in their daily lives and in their home environment,” she told Salon in a phone interview.

Nevertheless, whether a sleep tracker helps improve sleep is ultimately up to how it's used by the individual.

“Overall, just wearing a device generally does not improve people’s sleep,” Baron said. “It’s really about whether people review the data and make changes.”

Chen returned to using his watch after a break and was able to detect long-term patterns in his energy levels after using the device for over three years. The declines in his scores he once thought were a result of not sleeping or exercising enough, he now recognizes as natural fluctuations of his body.

“I’m relatively detached from the outcomes,” Chen said. “I look at the scores out of curiosity, but I focus more on how I feel rather than what the watch is telling me.”