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Guide to Sleep Tracking

Written by Jocelyn Zakri MPH, RRT, RPSGT, RST


Does this sound familiar? You have to tear yourself out of bed in the morning. When you get to work, everyone seems a lot less groggier than you. Meanwhile, your partner complains of poor sleep thanks to your incessant snoring.

If any of that resonated with you, you may not be getting enough sleep. You might even have a sleep disorder.

What’s your best route for diagnosing the problem? Sleep tracking.

Sleep tracking comes in many shapes and forms, from DIY wearables and smartphone apps to overnight studies done in a sleep lab. Below we’ll review the importance of tracking your sleep, and your many options for sleep tracking.

Why track your sleep?

Sleep is vital for daily functioning. Sufficient, quality sleep (7 to 7.5 hours of uninterrupted sleep daily) keeps your immune system in tip top shape, your moods balanced, and your thinking clear.

Unfortunately, over a third of Americans get fewer than 7 hours of sleep on a regular basis, and between 50 to 70 million adults have a sleep disorder. It’s no wonder the CDC declared sleep deprivation a public health epidemic.

At its most basic, tracking your sleep helps you ensure you’re getting enough sleep. If you think you have a sleep disorder though, like sleep apnea, insomnia, or something else, sleep tracking is critical to receiving a proper diagnosis.

Paying attention to your sleep is the first step to getting better sleep. About half of people who use technology to track their sleep patterns say they’re sleeping better and feeling healthier, Sleep Review reports.

Sleep tracking methods

Doctors use diagnostic sleep studies to analyze a patient’s sleeping patterns. These sleep tests involve a patient questionnaire along with overnight lab testing to monitor your brain, breathing, heart rate, and more while you sleep.

Below we review the five main types of sleep testing methods doctors use to diagnose sleep disorders.

1. Polysomnography

A polysomnogram is an overnight sleep study performed in a sleep laboratory. This is the prototypical “sleep test” you see at your typical sleep clinic. When you arrive at the lab, sleep technologists attach sensors to your body to monitor the following while you sleep:

  • Brainwaves
  • Heart rate
  • Eye movements
  • Limb movements
  • Chest and stomach movements
  • Air flow from your nose and mouth
  • Your blood oxygen level

While you sleep, technicians monitor the activity from the various devices as the data is pumped into a computer. Once you wake up in the morning, you’re free to go about your day. Afterwards, the doctor will analyze the results and discuss them with you.polysomnogram

2. Multiple Sleep Latency Test (MSLT)

Occasionally a doctor will order a Multiple Sleep Latency Test (MSLT) after a polysomnogram, since MSLTs require patients to have slept for 6 hours the night before.

A MSLT is designed to measure how quickly you can fall asleep during the day, in a quiet, non-stimulating environment after a “normal” night’s sleep. During the test, the technicians attach electrodes to your chest, head, and face while you sit in a chair or lay down. Then the technician watches how quickly you fall asleep, and may even wake you up a few times.

A normal healthy adult who isn’t sleep deprived will take longer than 10 minutes to fall asleep. A MSLT result shorter than that can be indicative of a disorder, along with any other abnormal movements or recordings the technologist observes. These exams are expensive and help doctors diagnose sleep disorders – such as narcolepsy, periodic limb movement disorder, or excessive daytime sleepiness.

3. Electroencephalography (EEG)

An electroencephalogram measures electrical activity in your brain while you sleep, via electrodes attached to your scalp. It sounds scary, but is totally painless.

The different stages of sleep exhibit different types of brain waves. Through an EEG, doctors can measure how much time you’re spending in each stage of sleep and asses whether it’s normal. Sleep technicians oversee these exams to help diagnose sleep disorders.

4. Actigraphy

Actigraphy measures your movement while you sleep.

The most common method is wrist actigraphy, where doctors attach an actigraph device to the patient’s wrist or ankle to monitor motor activity. Patients will wear the device for at least 1 week so doctors can fully analyze their sleep-wake cycle.

While actigraphy data is not as reliable as polysomnography, in many cases it is an adequate alternative for measuring certain diagnostic criteria, such as overall sleep time and efficiency.

Actigraphy is the common sleep tracking method used by wearable devices.

5. Accelerometry

LIke actigraphy, accelerometry measures movement while you sleep. This is the common sleep tracking method used in smartphones.

Because they only monitor movement, sleep tracking apps and devices that rely on accelerometry alone are unable to accurately measure sleep stages, since your body movement is fairly similar among deep and light sleep.

Best sleep tracking apps

Before paying to see a sleep doctor, it can be helpful to gather your own data points on your own first. Sleep tracking apps, devices, and bedding accessories are all designed to help you do this.

However, doctors across the board advise that consumers remember that the same scrutiny applied to medical devices are not applied to fitness trackers for consumer use, so be thoughtful about how much trust you put in their marketing claims.

Sleep tracking smartphone apps

Pros Cons
Wide availability
Easy to use
Limited analysis due to accelerometry
Reliance on movement can result in inaccurate data

Sleep tracking smartphone apps are popular because they’re so affordable, easy to use, and help with a variety of problems. These apps use your phone’s accelerometer to monitor your breathing and body movements while you sleep. Many claim to be able to determine what stage of sleep you are in, so they time your alarm to go off within a 30-minute window when you are most likely to be in a light stage of sleep (making you less drowsy upon waking).

Experts generally agree that these do a decent job at tracking your total sleep vs. wake time (although not as well as a polysomnogram or MSLT does), but they’re unable to accurately assess your sleep stages. These sleep tracking apps rely solely on accelerometry, and since you make similar movements during deep and light sleep, there’s no way the phone can tell what stage of sleep you’re in. Plus, if you share the bed with a partner or pet, their movements can interfere with your data.

However, these devices are a useful first step in determining whether you need to see a doctor about a potential sleep problem in the first place. Here are our recommendations:

1. Sleep Cycle Alarm Clock (Free, iOS and Android)

sleep tracking smartphone appsThis free app always makes the top of the app lists. Besides accelerometry, the app also lets you use your phone’s built-in microphone instead to monitor your breathing as a proxy for sleep. This helps avoid the unreliability of using movement alone, making it a preferred option for couples. Analytics and additional features are included in a paid subscription version.

2. Good Morning Alarm Clock ($4.99, iOS)

This integrates the accelerometer data with Apple’s weather and Health apps to provide additional insight into what else is affecting your sleep, such as too much or too little exercise or changes in weather. The app also notifies you when you’re racking up sleep debt.

3. MotionX 24/7 ($0.99, iOS)

This app claims to use similar Sleeptracker patented technology used by sleep clinics. Besides the accelerometer, the app also uses your microphone to record audio while you sleep, helping diagnose snoring or sleep apnea.

4. AutoSleep ($2.99, iOS)

This app works on both your iPhone or your Apple Watch, seamlessly syncing data across the devices. Integration with the watch allows the app to monitor your heart rate, too.

5. Sleep as Android (Free, Android)

This free app integrates with several smartwatches as well as the Android Health app. It also includes recording capability for sleep talking, snoring, or apnea.

Sleep tracking wearable devices

Pros Cons
Track more than just sleep
Widely available
Don’t eat up phone battery
More expensive
Standalone clip or wristband device

Sleep tracking wearables may take the form of a small, clippable device you attach to your clothing, or a separate wristband or smartwatch. Because these devices track other important health metrics in addition to sleep, such as your daily step total and heart rate, wearables provide a more holistic view of your overall health and wellness. As such, they are more expensive than a simple smartphone app. They also require you to introduce another device into your life.

Pricier options may rely on both actigraphy as well as accelerometry, but be wary of any claims that pricier upgrades include sleep stage analysis. Unlike a polysomnogram, some researchers have found that these trackers are easy to confuse. For example, in comparison to a polysomnogram, a 2011 study found that a Fitbit overestimated sleep by 67 minutes, while a 2013 study found it underestimated it by 109 minutes. However, some doctors have said sleep tracking wearables can be a suitable alternative to traditional actigraphy.

Here are our recommendations:

1. Jawbone ($10 and up)

All of the Jawbone UP trackers include sleep tracking. The Jawbone UP Move does require you to opt-in each night to turn on sleep tracking mode; otherwise it won’t record this data. You don’t have to wear the UP Move on your wrist, although it is recommended.

Alternately, the UP2 automatically enters sleep mode and tracks data, but you do have to wear it on your wrist for it to work.

2. FitBit ($99 and up)

fitbit sleep trackerFitBit sells a variety of sleep trackers. The Fitbit Charge and Charge HR wristbands include automatic sleep tracking, and the Charge HR includes heart rate tracking as well.

The Fitbit Alta HR’s heart rate data claims to use this to distinguish between and track amount spent in REM, light, and deep sleep.

3. Apple Watch ($249 and up)

The Apple Watch does not provide sleep tracking out of the box, but it gets an honorable mention because many sleep tracking apps integrate with it, such as AutoSleep, Pillow, and Sleep Tracker.

More sleep tracking products

Pros Cons
Always on
Monitor external conditions
More expensive
Fewer options
No-contact setup can limit reliability of data

Understandably, some people only want themselves, their sleep partners, and their bedding in their bed. That’s why some companies have designed fully non-intrusive sleep tracking options to help you monitor your sleep – and your bedroom.

Because they focus on more than just you, these devices can provide advice for improving your sleep environment, such as lowering the temperature and lighting conditions. Another benefit to these devices is that they are constantly on, so there’s no need to remember to turn on an app or wear a fitness tracker. However, with the exception of the Emfit QS below, the majority of these devices focus only on sleep, unlike fitness tracking wearables.

Here are our recommendations:

1. Beddit ($149.95)

Beddit no-contact sleep tracking deviceNow owned by Apple, the Beddit is an ultra-thin mattress cover and cable that you place beneath your sheets. While you sleep, it monitors noises like snoring, temperature and humidity in the room, and tracks your movements and heart rate for integration and analysis with their iOS and Apple Watch apps.

2. Emfit QS ($299)

Emfit is another sleep tracker that lies underneath your sheets. Besides sleep, it focuses on improving sleep for athletes especially by monitoring heart rate variability, helping them adjust their training and recovery program based on what the data shows.

3. Resmed S+ ($33.95 and up)

resmed s+ sleep monitorThis no-contact device sits in your room, monitoring noise, light, and temperature. Its motion and respiratory sensors also detect your movements and breathing during sleep.

4. SleepScore Max Tracker ($149.99)

Founded by the folks behind Resmed in partnership with Dr. Oz, SleepScore Max Tracker is another no-contact device that sits in your bedroom. The device sends data to an iOS app, sharing recommendations on how to improve environmental conditions like pillows and lighting. It also includes a smart alarm function.

Pen and paper

Of course, there’s always the manual route. If you prefer to keep things as tech-free as possible, try a sleep diary. For each day, note the following:

  • When you went to bed
  • When you woke up
  • Total time spent asleep
  • Any naps
  • Other information, such as exercise, diet, energy level, feelings of fatigue, or naps taken

Get started with this simple worksheet from The New York Times.

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