Have you got orthosomnia? How your sleep tracker could be making your insomnia worse 

Insomnia Diaries Miranda Levy

Insomnia Diaries is a column by Miranda Levy in which she shares her experiences of living with chronic sleep problems. It is published every Monday at 7am

Because everything has to have a new and fancy label these days, why should struggling with a night’s sleep be left out? Plain old insomnia is so ‘early 2010s’: now we have flashy, scientific-sounding ‘orthosomnia’. 

The phrase originated in a 2017 report in the Journal of Clinical Sleep Medicine, after an American neurologist and her colleagues noticed ‘a perfectionist quest to achieve perfect sleep’. The phrase orthosomnia mirrors that of orthorexia, which has been used for the past 20 years as a buzzword for obsessively healthy eating.

"We realised we had a number of patients coming in with a phenomenon that didn’t necessarily meet the classical description of insomnia, but was still keeping them up at night," said Sabra Abbott, an assistant professor at Northwestern University. A quick noodle around online shows that people have identified with the phrase and its oppressive perfection. On QI's Facebook page, DL wrote: “Thanks.. now I will lose sleep trying to remember the name of why I can’t get a good night’s sleep” and CG: “THERE’S A NAME FOR IT?????” 

So, why this problem, and why now? The answer is – largely – because of Fitbit and other related sleep tracking devices. “Our patients seemed to have symptoms related to concerns about what their sleep-trackers were telling them, and whether they were getting good quality sleep or not,” said Dr Abbott. In other words, people were stressed out – and in some cases, their sleep was suffering further – because they weren’t measuring up to their tracker’s definition of ‘good’ sleep. “They were actually destroying their sleep by becoming so dependent on these devices,” said Dr Abbot. As well as becoming baffled by new terminology such as sleep debt percentages, and obsessed with graphs of sleep disruptions.

Guy Leschziner is a consultant neurologist who runs the Sleep Disorders Centre at Guy’s Hospital in London. He is also the author of The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep (Simon and Schuster). “About four or five years ago, we started noticing that patients were turning up to their appointments with sleep trackers, which they used to report how much sleep they’d had the night before,” he says. “We weren’t entirely surprised, because of the developments in devices that counted people’s steps, or how many calories they had consumed that day."

Leschziner agrees with the American researchers’ concerns that the pursuit of bedtime perfection can be a problem. “For starters, Fitbits, Jawbones and the like are not accurate,” he says. “Yes, they can monitor the time you have spent in bed, based on your movement. Some of the more sophisticated can tell you how long you have been asleep. But what they cannot do is tell the quality of sleep; what stage you are at a certain time, or how many times you have woken up during the night.” 

And this is bad because? “Anything that draws attention to sleep can make it worse,” says Dr Leschzinger. “This is why people fall asleep while watching TV or reading a book. They are distracted. We’ve seen it happen that people – some of whom sleep perfectly well – pick up a book on insomnia and develop the condition. Sleep trackers can have the same effect.” He continues: “If you know you have poor quality sleep, and the tracker confirms this, it won’t help, but will only increase your anxiety.” 

The original orthosomnia researchers agreed. They found that patients had been spending more time in bed to improve their ‘sleep numbers’, which may have made their insomnia worse.

And so far we’ve been taking about people who, on the whole, sleep pretty well. But what about those who already suffer with insomnia? Surely sticking a plastic ‘watch’ on them is bad enough? (I tried a FitBit for three nights at some point in 2018, then threw it off in discomfort and frustration.) But then to have their worse suspicions confirmed, or perhaps distorted, because of inaccurate data?

In the interests of fairness, let’s give sleep trackers a right of reply. Earlier this year Conor Heneghan, a research director for Fitbit, maintained that few people experience extreme sleep anxiety. “What we’re trying to do is give people a tool to understand their own sleep health,” he said. Heneghan went on to say that tracking sleep can drive home the importance of a consistent bedtime and wake-up time well as underscore the effects of factors like alcohol (bad) and exercise (good) on sleep patterns.

Should you bin the sleep tracker? “If a device like this can help make positive lifestyle changes, then it can’t be a bad thing,” says Guy Leschziner. “But sleep trackers do not contribute to the treatment of insomnia. In fact, they may do significant harm.”

Meanwhile, brace yourself for the new generation of Apple smart watches, Beaurests and Emfits. In the words of Dr Seema Khosla, chairman of the technology committee of the American Academy of Sleep Medicine: “People will shell out $200 for some sleep device. But we are not willing to just shut off our phones and go to bed.”

Do you use a sleep tracker? Does it impact your sleep for better or for worse? Tell us in the comments and on Twitter using #InsomniaDiaries.