We spend one-third of our lives sleeping. Or at least we should be. National Sleep Foundation guidelines, or really anyone you ask, advise that adults should get between seven and nine hours of sleep each night. This isn’t a tip made to throw you out of the game of life. Your body needs sleep: during sleep, it restores itself. When a person is deprived of this possibility, serious health problems arise. Sleeping less than recommended is a significant predictor of death by any cause. Overwhelming amount of research has linked lack of sleep to higher risk of multiple chronic diseases, including type 2 diabetes, heart disease, and obesity. It predicts various mental health problems; hinders social, motor, and cognitive skills; and increases the risk of catching infectious diseases, which we will come back to shortly.
Sleeping is vital. Yet, people just aren’t getting enough of it. It is especially true for the US citizens: in 2013, the average American slept 6.8 hours a night, and 40% of Americans slept less than six hours. Thirty percent of Americans have suffered from short-term insomnia and 10% suffer from chronic insomnia. In the UK, the situation with insomnia is similar: almost 1 in 5 have trouble falling asleep every single night. Besides health causes that play a role in this statistic, the workaholic, electronically lit up, Internet-obsessed culture of the twenty first century just makes it really hard to sleep properly.
How has COVID-19 altered sleep?
Pandemic arrived, and it bore some gifts: plenty of stress, less sunlight exposure, more screen time, working from bed, disrupted routine, lack of exercise, increased alcohol use. All these things contributed to decreased sleep time for a large number of people. The problems worldwide arised: in the UK, an August 2020 study showed that the number of people experiencing insomnia rose from one in six to one in four compared to the results of 2018/2019 survey. The problem was more prevalent among mothers, essential workers and Black, Asian and minority ethnic groups. In China, insomnia rates increased from 14.6% to 20% during peak lockdown. An “alarming prevalence” of clinical insomnia was found in Italy and in Greece. Google trends ― a sure indicator of what’s bothering the world at the moment ― showed that the word “insomnia” was Googled more in 2020 than it ever had been before. Interestingly enough, there were also studies that showed that overall sleep time increased for many participants, however, self-reported sleep quality decreased.
At the same time, it was discovered that insomnia and disrupted sleep increase the risk of catching COVID-19, worsen the course of the disease, and increase recovery time. Daily burnout, a likely addition to the lack of sleep, also increased the risk. Compared with those who didn’t report any burnout, participants for whom this was a daily occurrence were more than twice as likely to have COVID-19. They were also about 3 times as likely to say that the course of their disease was severe and that they needed a longer recovery period.
How to deal with sleep deprivation using mHealth apps?
Perhaps, the biggest problem with the lack of sleep is that people often choose to ignore it. They power through it in their everyday lives, surviving on coffee, energetics, and sugar. In the meantime, their health problems grow.
However, if a person consciously chooses to get more sleep, there are ways she can do this. And, whether it’s a serious case of insomnia or just a standard goal of falling asleep an hour earlier, there are apps that can help.
Right now, we’ll go through the most popular methods that help fight sleep deprivation and the apps that help to bring these methods to life.
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Sleep Hygiene
Ensuring sleep hygiene is usually the first thing doctors suggest to those who struggle to fall asleep. Having a strong sleep hygiene means creating a routine and an environment that promotes healthy sleep habits and encourages your brain to fall asleep in time. This includes keeping a stable sleeping schedule, reserving your bed for sleeping and sex only to build a strong association, avoiding bright lights before going to sleep (they disrupt melatonin production), cultivating healthy habits throughout the day, and so on.
If you are taking your sleep and your sleep hygiene seriously, you may want to look at sleep tracker apps, such as SleepScore, SleepWatch, and Pillow. First of all, they give you a clear picture of how you are really doing. Often, self-reported sleep time differs from objective sleep time. Secondly, they measure the quality of your sleep, which helps with the diagnosis and treatment. Sleep trackers analyze your sounds, movement, and behaviors during sleep; measure the duration and frequency of rapid eye movement (REM) sleep and note how often the user is disturbed throughout the night. They also keep track of your bedtime and wake time, giving you an accurate picture of your sleep routine (or lack of thereof). Sleep tracker apps can be connected to wearable devices, such as Apple Watch, which allows them to measure your heart rate and give more accurate results. SleepScore even produces a doctor’s report based on its analytics that points out concerns in your sleep, if there are any, that you can bring with you to a medical professional.
Often, sleep tracker apps (e.g., SleepWatch) have options for sleep hygiene management: the user inputs information on smoking, exercise, caffeine, alcohol consumption, etc. to keep herself aware and in control of behaviors that may cause sleep disruption. Some, like PrimeNap, encourage the user to keep a dream journal.
Sleep tracker apps make it easier and more fun to take care of your sleep. They gamify the process, encourage you to set goals, and nudge you to stick to them ― even if it means going to sleep an hour or two earlier.
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Relaxation techniques
Relaxation techniques include meditation, mindfulness training, breathing exercises, calming audio recordings, and guided imagery. They induce sleep by reducing the release of the stress hormones cortisol and adrenaline and slowing down heart rate and breathing.
Sleep apps deliver all these techniques and act as low-key therapists. For example, Slumber offers a range of sleep meditation practices, soothing stories that use guided imagery to involve you in the story, and soundscapes to help you relax your mind and fall asleep quicker. Headspace has meditation and mindfulness training, as well as audio recordings that help you visualize calming experiences, like a slow moving train or a walk through a garden. There is also Calm ― an app for guided meditations, breathing exercises, and stories read by people like Stephen Fry and Matthew McGonaughey.
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Cognitive Behavioral Therapy for Insomnia (CBT-I)
Cognitive behavioral therapy for insomnia (CBT-I) helps a person identify thought patterns and behaviours that are contributing to disrupted sleep and work to alter them, as well as make better sleep habits. It’s a structured and evidence-based approach used by psychologists worldwide. Often, doctors prefer it to medication, as CBT-I gets to the bottom of the problem ― the reasons for limited sleep that might include stress, depression, and anxiety.
In the past few years, many studies concluded that online therapy for insomnia is effective. A 2016 review of 15 online CBT-I trials showed that sleep improved across the board for participants and later another meta-analysis confirmed these findings. Apps that use CBT-I to help with insomnia include Sleepio and Somryst among others. Some apps, such as CBT-i Coach developed by the US Department of Veterans Affairs, are used in addition to face-to-face therapy. However, psychologists recommend using it on its own just as well. Unlike most apps, it’s free, and unlike what one might think, you don’t need to be a veteran to use it.
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Medications
Doctors often prescribe sedative-hypnotic medications when they diagnose insomnia or sleep deprivation. Some sleep medications can cause adverse effects or be habit-forming, so it’s important to be aware of this, consult with the doctor, and follow the doctor’s instructions.
If you are prescribed medications that should be taken at specific times of the day and you’re prone to forgetting them, there are apps that can help you stick to the schedule. These are prescription reminder apps, such as Medisafe Pill Reminder and MedMinder. The latter was designed specifically for the elderly and includes visual, audio and phone alerts.
Besides, even if you are taking meds, you can benefit from all the techniques, tips, and apps described above.When it comes to persistent insomnia, combining medication and non-medication treatment can bring the best results.
What are the limitations and challenges of sleep apps?
Sleep apps often seem like a life-saver for those unable to access therapy. These feelings are justified, especially in the times of COVID when visiting a doctor is more challenging and dangerous than ever before. However, it’s important to not get carried away: there are plenty of problems with sleep apps. Recently, Sleep Science published a review in which the authors outlined the limitations and challenges of sleep apps. Here they are:
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Lack of evidence-based medicine in many sleep apps
Before choosing a sleep app, it’s important to research the empirical evidence for whatever it offers and see if the app was developed with the clinicians’ input. Many of the apps lack both of these criteria. While researching, the user has to pay attention to the actual studies made and make conclusions regarding their scientific validity. This can be challenging for the regular user, and she may end up using an “entertainment” app that only claims to be helpful.
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Data privacy concerns
As with all mHealth apps, data privacy concerns are real. Apps often warn that data “may be shared” with business and marketing partners for the purpose of “research, analysis or administering surveys”. However, this information is usually hidden in the legal terms and conditions that most users don’t read. For example, Sleep Cycle collects data about sleep habits ― their privacy policy states that users consent to give the app access to their location if they use the app. Sleep habits, let alone recordings of snoring and sleep talking, all constitute sensitive information that can be used for targeted advertising or even be de-anonymized by online hackers (read Elinext’s case study on how to build a secure healthcare data anonymization platform).
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Impact on clinical practice
Since the beginning of the Internet, people have googled their symptoms and ran to doctors, unncessarily taking up much of their time. Sleep apps add to this problem: they often encourage the user to see the doctor even when there is no real cause for concerns. At the same time, clinicians may struggle to interpret data from sleep apps, as there is no universal standard for how it should be presented. They are also not able to integrate this data into patient health records, as, despite current technology trends in healthcare, most countries still lack fully-digitized health records. The UK’s national health service (NHS) is planning to reach the core level of digitization only in 2024, which still may be optimistic.
Final words (before I go to bed)
Before choosing a sleep app, it’s important to do your research and be aware of privacy concerns attached to using mHealth apps. But when chosen correctly, sleep apps can be helpful for anyone struggling with sleep: they assist with sleep self-management, offer many kinds of techniques that may help with falling asleep, and encourage the users to treat their sleep seriously. And they are not alone in their goal to make you happier, healthier, and well-rested. Stay tuned for the next article ― and we’ll tell you about other apps that can be just as beneficial for your wellness.
