The objectives of this review were to evaluate the use of consumer-targeted wearable and mobile sleep monitoring technology, identify gaps in the literature and determine the potential for use in behavioral interventions. We undertook a scoping review of studies conducted in adult populations using consumer-targeted wearable technology or mobile devices designed to measure and/or improve sleep. After screening for inclusion/exclusion criteria, data were extracted from the articles by two co-authors. Articles included in the search were using wearable or mobile technology to estimate or evaluate sleep, published in English and conducted in adult populations. Our search returned 3897 articles and 43 met our inclusion criteria. Results indicated that the majority of studies focused on validating technology to measure sleep (n = 23) or were observational studies (n = 10). Few studies were used to identify sleep disorders (n = 2), evaluate response to interventions (n = 3) or deliver interventions (n = 5). In conclusion, the use of consumer-targeted wearable and mobile sleep monitoring technology has largely focused on validation of devices and applications compared with polysomnography (PSG) but opportunities exist for observational research and for delivery of behavioral interventions. Multidisciplinary research is needed to determine the uses of these technologies in interventions as well as the use in more diverse populations including sleep disorders and other patient populations.

The use of wearable sleep tracking devices is rapidly expanding and provides an opportunity to engage individuals in monitoring of their sleep patterns. However, there are a growing number of patients who are seeking treatment for self-diagnosed sleep disturbances such as insufficient sleep duration and insomnia due to periods of light or restless sleep observed on their sleep tracker data. The patients' inferred correlation between sleep tracker data and daytime fatigue may become a perfectionistic quest for the ideal sleep in order to optimize daytime function. To the patients, sleep tracker data often feels more consistent with their experience of sleep than validated techniques, such as polysomnography or actigraphy. The challenge for clinicians is balancing educating patients on the validity of these devices with patients' enthusiasm for objective data. Incorporating the use of sleep trackers into cognitive behavioral therapy for insomnia will be important as use of these devices is rapidly expanding among our patient population.

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Background: Bright white light therapy (LT) can improve fatigue in several disease states but has not been studied in multiple sclerosis (MS).Objective: To determine whether controlled home-based LT is feasible, tolerable, and welladhered to in MS-associated fatigue.Methods: A randomized, controlled trial of twice-daily 1-hour bright white LT (BWLT) (10,000 lux, active arm) versus dim red LT (DRLT) (<300 lux, control arm) was performed. Adults with MS-associated fatigue were enrolled for 10 weeks: two-week baseline, four-week intervention, four-week washout.Results: 41 participants were enrolled; 35 were randomized (average age 42 years, 80% female; BWLT n=20; DRLT n=15). 31 were in the intention to treat analysis. The average duration of LT sessions was similar between groups (BWLT: 60.9 minutes, DRLT: 61.5 minutes, p=0.70). The most commonly reported adverse event was headache. There were no events that led to discontinuation. Baseline fatigue was severe in both arms (each 53/63 points on the Fatigue Severity Scale (FSS), p=0.92). FSS was lower following BWLT (FSS 45.8 post-LT, p=0.04; 44.9 and post-washout, p=0.02 intra-group compared to baseline FSS) and DRLT (FSS 46.7 post-LT, p=0.03; 43.9 post-washout, p=0.002 intragroup compared to baseline FSS). There was no difference between BWLT and DRLT groups in the magnitude of reduction of FSS scores (p=0.81 after LT; p=0.77 after washout for between group comparisons). Similarly, MS quality of life metrics improved in both arms but were not significantly different between groups after LT (p=0.22) or washout.Conclusions: LT is safe, feasible, and well-tolerated in people with MS-associated fatigue.Improvement in both light spectra likely indicates a strong placebo effect for the DRLT group.