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19 September 2018

Why using an app to track your sleep could make your insomnia worse

Achieving “good sleep” is becoming a new source of stress, which has been termed “orthosomnia”.  

By Ian Leslie

Sleep is the obsession of the self-improving classes. Best-selling books, dense with science, insist on the importance of sleep to physical health and cognitive acuity, and tell us that hardly anyone is getting enough of it. We are said to be living through a catastrophic sleep-loss epidemic, created by the pressures of modern life. It’s enough to keep you up at night.

Silicon Valley entrepreneurs who once regarded sleep as a waste of good coding time now see opportunity. By 2020, consumers will collectively spend $80bn on devices and apps that quantify our sleep in granular detail. We are being encouraged to think of sleep as a form of exercise, and as an activity – or rather inactivity – enhanced by fastidious accounting.

The data-driven pursuit of better sleep may be counterproductive, however. In a paper published in the Journal of Clinical Sleep Medicine, a group of US clinicians who specialise in sleep disorders argue that self-monitoring can get out of hand. They tell the story of Mr R, a 40-year-old man, who had been sleeping poorly for years. Since this made him irritable and unable to concentrate, his girlfriend bought him a wrist-worn device that sent information on his sleeping patterns to his smartphone. Now he thought about little else. “According to my data,” as he put it to his doctor, he required eight hours of deep sleep, yet was getting only seven hours, 45 minutes. He admitted to feeling pressure, every night, to meet his target.

Achieving a precise measure of “good sleep” is becoming a new source of stress, say the doctors, and thus sleeplessness. Mr R is one of three case studies in the paper. “They were actually destroying their sleep by becoming so dependent on these devices,” one of the authors, Sabra Abbott, told Health magazine. The researchers coin a new term, “orthosomnia”, to describe a disorder caused by the quest to achieve perfect sleep.

In naming the disorder, the clinicians were alluding to the existing condition of “orthorexia”: an unhealthy preoccupation with healthy eating. Self-tracking apps are one of the big successes of the smartphone era. There are apps for tracking your productivity, mood, menstrual cycle, even your digestive system (Cara, a “poop tech” start-up, raised $2m in funding last year). While these apps can be useful, they are creating new ailments of perfectionism.

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Apps do more than simply collect data. They nudge us towards goals, often quite arbitrary ones. Different individuals require different amounts of sleep, and the amount itself varies depending on whatever else is going on in their life. The apps reduce all this complexity to a number.

Data objectifies our vague worries, makes them more concrete, and more urgent. Give someone a goal and they can decide whether or not they’ve achieved it; give them a number and they know when they have not. Walking 9,999 steps in a day isn’t enough. Unless you make the ten thousandth, you feel like a failure.

The effect is potent regardless of whether or not the data is reliable. Kelly Glazer Baron, the paper’s lead author, told me that some sleep apps rely on flawed assumptions and crude measurements, and that even the more advanced ones have not had their data validated in scientific trials. Yet to the user, every bar graph represents a judgement from on high.

By measuring something, we assign it value, and consequently devalue whatever we are not measuring. In a blog post, Candice Lanius, a lecturer in communications at the University of Alabama, recounts how her self-tracking led her to start avoiding “unquantifiable” situations. She gradually stopped running in forests or pathways where her watch could not pick up a GPS signal. She found herself declining a friend’s homemade brownies because she couldn’t be sure which ingredients to put into her nutrition app and didn’t want to ask.

If your aim is to curb bad habits, self-tracking makes sense. For instance, most university students put on weight in their first year (you can probably guess why). Several scientific studies have found that if students simply weigh themselves every day, they are less likely to get heavier. But unlike excess weight or excess beer, sleep is good for us. What’s more, it tends to go better when we’re not thinking about it.

Worrying over one’s inability to sleep is a long-established cause of insomnia. Sleep scientists employ the word “rumination” differently to its ordinary usage. Rather than describing deep thought, it refers to the recursive mental loops that can rile the brain when we’re trying to get some rest. We lie awake because we can’t stop thinking about how much we need to sleep. These loops now pass through our phones, where they get supercharged.

Glazer Baron told me she often has chief executives coming to her practice. Accustomed to being able to organise and plan every minute of their day, they can be bewildered by the way sleep eludes command. Self-tracking apps create the illusion that we are the chief executives of our own lives; that we can regiment and master our bodies and minds. Sleep is a nightly lesson in humility. “Sleep is a process that just has to happen,” Glazer Baron told me. “You can get the circumstances right but there’s always an element that is out of your control.”

Recursive loops are, by their nature, hard to escape. A spokesperson from the Sleep Foundation, an American non-profit, recently advised people to monitor any anxiety caused by analysing their sleep data: “You should become very clever with checking for early warning signs, and manage it before things get out of control.”

In other words, you should self-track your self-tracking. There must be an app for that. 

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This article appears in the 19 Sep 2018 issue of the New Statesman, Corbyn’s next war