Orthosomnia: Are Some Patients Taking the Quantified Self Too Far?

Abstract

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.

About the Accuracy and Problems of Consumer Devices in the Assessment of Sleep

“…Especially the revealed misjudgment in estimating key features of sleep such as SE, SOL, and WASO are worrisome as they are important diagnostic criteria for quantifying clinically relevant bad sleep and sleep disorders such as insomnia [17]. On the contrary, by providing such inaccurate information, these consumer devices might even risk contributing to worse sleep and life quality as the users may be concerned by the sometimes-negative outputs highlighting bad nights of sleep [5].…”

“…These devices have the potential to overcome the bias induced by laboratory settings as they are designed to assess sleep outside the laboratory with minimal effort from the user. Before this is realized, it is essential to scientifically test and validate these devices against the “gold standard” to ensure that such devices and applications do not provide inaccurate information to the naïve end-user, resulting in “unintended effects on sleep beliefs and behaviors” [5]. The adherence of such devices and applications to the gold standard ensures that their reliability and validity upholds the ethical standards before they are advertised by the industry.…”

Sleep and the athlete: narrative review and 2021 expert consensus recommendations

“…Some athletes may become preoccupied with their sleep monitor data, which may increase anxiety around sleep and result in worse sleep. 169 Another important consideration is privacy, as sleep monitoring device apps may contain personal and sensitive information; it is important to consider who has access to this information. 170 Practitioners must weigh both the pros and cons of using sleep monitoring technology for the athletes they are working with.…”

Worsening of Self-Reported Symptoms Through Suggestive Feedback

“…The present study was limited to a sample of healthy university students and we focused on a limited number of symptoms. Our algorithm paradigm may seem far removed from clinical practice, yet there are case studies illustrating, for example, that suggestive feedback from wearable sleep trackers may encourage people to believe that they have a sleep disturbance (Baron, Abbott, Jao, Manalo, & Mullen, 2017). In future, researchers may want to address how iatrogenic interventions such as extensive symptom exploration may worsen symptoms in vulnerable people (e.g., people with psychopathology and/or low education).…”