Can Tech Help You Sleep Better?

AsianScientist (Nov. 08, 2024) – Michael Chee spends most of his waking hours studying sleep. As a researcher, he is concerned about an invisible health crisis that disproportionately affects Asians. “Generally, Asians sleep anywhere from 30 to 60 minutes less on weekdays than their colleagues in Europe and Oceania,” Chee, director of the National University of Singapore’s (NUS) Sleep and Cognition Center, told Asian Scientist Magazine.

A 2023 study by consumer research firm Milieu Insight revealed that 46 percent of Southeast Asians suffer from a range of sleep problems at least a few times a week, with people in Vietnam and the Philippines struggling the most—at 80 and 79 percent, respectively. The most common sleep problems the study cited were difficulty falling asleep, waking up often at night and irregular sleep and wake cycle. Additionally, the study noted that 59 percent of the population in Southeast Asia gets less than seven hours of sleep.

Trying to fix this issue for themselves, many Southeast Asians are turning to technology. These tools, which often come in the form of smart wearables, can measure sleep duration, timing, efficiency and regularity. Some of these devices are linked to apps spouting a “sleep score,” giving users a quick overview of how well or badly they slept the night before. According to Coherent Market Insights, an India-based global marketing intelligence and consulting firm, the market for such sleep monitoring apps is expected to grow by 13.2 percent between 2024 and 2031 in Asia-Pacific.

Twenty-seven-year-old Angeli Reyes in Metro Manila is one such user of sleep trackers. Reyes told Asian Scientist Magazine that she has been struggling to get good sleep since her teenage years. Some days, even when she is exhausted after a day full of activities, she tosses and turns in her bed until 2 am. Most mornings, she gets up feeling drained. The cycle continues to repeat itself.

CAN ONE RELY ON SLEEP WEARABLES?

Objective sleep data is primarily gathered in two ways: one inside a sleep laboratory (also known as polysomnography) and another using actigraphs. Considered the gold standard for measuring sleep, polysomnography records brain activity, airflow, heart rate and muscle activity, among other vitals, allowing it to objectively measure a person’s sleep architecture. Actigraphs, on the other hand, are medical-grade, wearable devices that track body movement.

While such devices can’t exactly measure sleep, they register lack of movement as sleep. Since its discovery in the 1970s, actigraphs have long been held as an alternative to polysomnography, which can be expensive for a single study. Actigraphs can be used over long periods of time and are approved for research and clinical use, making the technology a viable option for continuous sleep-wake cycle monitoring.

But consumer-grade sleep wearables, like the ones Reyes uses, entered the market only in the early 2010s as part of the digital health revolution across the world. Their origins are closely intertwined with that of fitness trackers, which were initially created to monitor movement and physical activity alone.

Over the years, as society learned to embrace the benefits of personal health tracking, consumer devices from smartphones to watches began to integrate sleep sensors.

While there is some debate about the accuracy of the data generated by these sleep wearables, findings from a 2023 paper published in Sleep Health Journal by Chee and his colleagues showed that iteratively improved, high-quality consumer grade sleep wearables, such as the Oura Ring Gen3 and Fitbit Sense band, generated accurate sleep data relative to a lab-based sleep study.

“These tools are fit to be used for longitudinal studies involving healthy sleepers without highly disordered sleep,” said Chee. Consumers who desire the highest sleep quality measurement will also benefit from the use of these tools, he added. Reyes, who gets her sleep quality data from a built-in tracker in her smart watch, said that seeing the data guides her to make better decisions about her sleeping habits. “I noticed it says my sleep quality is bad whenever I sleep past 1–2 am, so when I can, I try to sleep earlier,” she said.

While consumer-grade wearables have the ability to show indicators of a disordered sleep, like in the case of Reyes, Chee clarified that the data should not be mistaken as a replacement for a lab-based sleep study, if the consumers continue to experience disordered sleep.

“To be clear, sleep wearables don’t help people fall asleep,” said Chee. “If you use [a tracker] and see a discrepancy in your subjective and objective [sleep] assessment, go see a sleep specialist because there is something that’s amiss there.

DISORDERED SLEEP

If sleep is naturally ingrained in our system, why do people struggle with it? “Poor sleep hygiene is a major factor affecting our ability to sleep well,” Liza Lomigo, a sleep specialist based in Manila, told Asian Scientist Magazine. Having an irregular sleep schedule, consuming caffeinated drinks and alcohol and using blue-light emitting devices prior to bedtime can interfere with sleep quality, which explains why some people don’t feel well rested despite getting the recommended seven hours of sleep, Lomigo said.

Sleep problems also vary across different age groups. A 2019 study by researchers from Flinders University in Australia showed that young adults aged 16–30 years across the world have experienced a steady decrease in sleep duration over the years. According to the study, while young adults in Europe slept a little more than seven hours, those in Asia had the shortest sleep duration at six hours and 30 minutes.

Meanwhile, due to increasing age, older adults tend to develop an advanced sleep-wake phase disorder that causes early morning awakening and fragmented sleep. They may also be prone to insomnia due to medications and comorbid conditions, said Lomigo.

Cultural factors may also affect how much or how little a person sleeps. A 2023 study published in Scientific Reports revealed that socio-cultural factors, such as gross domestic product and individualism, may have an effect on sleep quantity and quality. Countries with high collectivism—a practice of prioritizing groups over individual self—and low individualism scores, for example, may have stronger social obligations at night, potentially leading to shorter sleep duration. The study showed that Spain and Japan were the two countries with the highest collectivism scores.

Hence, people living there had the most delayed bedtime schedules. A separate sleep study conducted by researchers from NUS Sleep and Cognition Center and Finnish sleep-tech startup Oura Health supports these findings. The team discovered that people in Asia tend to sleep less on weekends in comparison to those in Europe.

“In Europe, weekends are generally considered time for relaxation and social activities with friends and family. In Asia, however, people may use the weekends to catch up on work, do the things they didn’t have time for during the week or attend to more family responsibilities,” Adrian Willoughby, senior research fellow at NUS Sleep and Cognition Center, said in a press release. Expanding Willoughby’s statement, Chee said, “Some people make up [for a lack of sleep] by napping, say falling asleep in the office or in trains and such, but as many of us observe, this is clearly a deficient sleep.”

TRANSFORMING SLEEP MINDSETS

For sleep researchers like Chee, the sleep crisis cannot be solved without implementing structural changes. Most people don’t get adequate sleep because of lifestyle choices—some of which they can control, while some are harder to change because of sociocultural and economic factors.

For example, in the Philippines, much needs to be done to raise public awareness of sleep health. “Most Filipinos have a low health-seeking behavior when it comes to their sleep health,” said Lomigo.

“Countries in the West like the US and Europe have recognized the significant impact of sleep disorders in their economy and healthcare utilization. But in Asia, it’s still a work in progress,” she added.

The Philippine Society of Sleep Medicine, an association that Lomigo is a part of, helps people understand the importance of good sleep. Since its founding in 2002, the society has organized multiple symposiums, conferences and seminars to educate healthcare professionals in recognizing and managing sleep disorders.

In 2023, a Philippine bill was filed to establish a sleep disorder awareness and education program to address the lack of data on sleep disorders in the country. It mandated the Department of Health to implement programs that help identify patients with sleep disorders, increase public awareness of such disorders and train educators on treating and preventing them.

In Singapore, the NUS Sleep and Cognition Center published a study in 2023, based on the readiness score provided by Oura ring, a device the study participants wore. The device collects data about a person’s sleep, activity, stress and heart health and converts these data into readiness score. The score essentially tells us how ready a person’s body is to face the challenges of the day. The study showed that longer sleep durations among students corresponded to better moods, higher motivation and lower sleepiness.

“Society as a whole has to recognize that [sleep health] is very important. If you want to work towards improving health, wellbeing and performance in a serious way, you’ve got to pay attention to sleep,” said Chee.

Though consumer-grade sleep trackers have much to improve on, they provide a new means for researchers to gather sleep data for further studies and for regular folks to make informed choices and take better control of their health.

“Sleep has been described as the ‘new health frontier.’ Little was known about it until recent times,” said Lomigo. “It is a very exciting time for sleep medicine as new research and technologies are being discovered.”

—