There’s a very old joke about a guy in the hospital who can’t sleep. When he finally manages to fall asleep, a nurse wakes him up to give him a sleeping pill.
The joke resonated with people because hospitals are thought of as difficult places to get sleep. Patients discharged from the hospital may sleep better at home, but many continue to have difficulty sleeping for several reasons including pain and side-effects of medication.
America is Sleepy
Sleep disturbances are common even in people who haven’t been in a hospital recently. Population based studies consistently measure the rate of insomnia in the US at around 30% of the adult population1. This means that almost one out of three Americans reports difficulty falling asleep or staying asleep. For individuals with post-traumatic stress disorder (PTSD), the problem is much worse: as many as 70% of people with PTSD report chronic sleep disturbances2. Twenty-first century lifestyle changes are also partially to blame. The widespread use of electronic screens on cell phones and tablets plays a role as well. The type of light emitted by screens has been shown to inhibit production of melatonin3, the hormone that helps regulate sleep-wake cycles.
Wearables for Sleep Monitoring
Technology may take away sleep, but technology can also help fix sleep problems.
Wrist-band based wearable devices are tools that insomnia sufferers and their doctors can use to help diagnose and treat several sleep problems. These devices detect movement, a measurement referred to by the scientific community as actigraphy. The ancestor of this technology is the pedometer, designed to count steps. Today, actigraphy and movement detectors are combined in tiny devices that fit on adjustable wrist bands, including the FitBit4. Most of these devices allow individuals to set sleep goals and to receive feedback on the amount and quality of their sleep.
Sleep specialists have taken advantage of wearable technology to create applications that can help diagnose and manage patients’ sleep problems. The combination of wearable devices and cell phone-based applications creates a powerful tool that provides benefits for a number of conditions, not least the sleep problems associated with PTSD5.
Sleep specialists stress that the wearable device itself is not enough to diagnose and treat a sleep problem6. In combination with sleep diaries and application-based coaching, however, the wearables become a much more powerful tool. Conditions such as obstructive sleep apnea must often be diagnosed in hospital-based overnight sleep labs. Now, with a combination of wearable devices and home-based sleep testing devices7, obstructive sleep apnea may be diagnosed at home, where the patient feels most comfortable and is better able to reproduce their usual nightly sleeping pattern.
Sleep and Chronic Disease
Wearable sleep devices also have benefits for individuals in long-term care facilities as well as those with chronic diseases living at home. Some sleep problems that are often dismissed as being a natural part of aging are actually likely to be related to the effects of chronic disease8. The relationship between chronic disease and insomnia is a two-way street: studies suggest that insomnia has a negative impact on quality of life and use of health care resources in patients with chronic disease9.
For patients suffering from chronic diseases such as congestive heart failure and type II diabetes, healthy sleep may be an enormously helpful, non-pharmaceutical way to improve quality of life and reduce health care costs. Discharge planners and case managers might consider including use of wearable devices for sleep monitoring as part of their care plans for patients going home after hospitalization. Insurance plans do not yet cover wearables as durable medical equipment, and physicians cannot yet write prescriptions for them. Fortunately, many of these devices are reasonably priced.
It remains an open question as to whether wearable devices can help people struggling to sleep in the hospital. For the foreseeable future, their only option may be the nurse waking them up to take a sleeping pill. If wearable technology becomes ubiquitous, people may forget why the old joke was ever funny.
- Insomnia: Definition, Prevalence, Etiology, and Consequences | NIH
- How Does Post-Traumatic Stress Disorder (PTSD) Affect Sleep? | Verywell Health
- The latest on blue light and sleep | The Sleep Doctor
- CBT-i Coach | U.S. Department of Veterans Affairs
- Wrist Actigraphy | NIH
- Are at-home sleep studies performed using portable monitors (PMs) as effective at diagnosing obstructive sleep apnea (OSA) in adults as sleep laboratory-based polysomnography (PSG)? | NIH
- Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey | Journal of Psychosomatic Research
- The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness | The American Journal of Managed Care