The rise of orthosomnia
The term orthosomnia was coined in a research paper in 2017, and I’m definitely seeing patients presenting with it. Similar to orthorexia, which is an unhealthy obsession with eating healthily, orthosomnia is an unhealthy focus on good quality sleep. In my clinic, I now see a lot of people who are too focused on health in general, going to the gym multiple times a week, taking wheatgrass shots, completely avoiding all caffeine, alcohol and sugar. Those people wouldn’t have previously presented to a sleep clinic, because they don’t actually have a sleep problem.
The problem with sleep trackers
Sleep tracking devices are providing people with a lot more information about their sleep, but it’s not necessarily good quality or helpful information. Studies have compared the data you get from these trackers with devices we use in clinic practice, known as actiwatches, and the correlation is very poor. The data you get from a watch or a phone compared with a proper sleep study using a polysomnogram is even worse. Often though, even if we do our own study and show someone the data, and how badly it correlates to their watch or app, they still tend to believe their tracker.
Most trackers work on movement, some pick up on light and dark, and the more sophisticated ones also include some pulse data. To put that in context, we would use 20-plus channels of physiological data recording in a sleep study. To determine what stages of sleep you’ve been in, we measure everything from your oxygen levels to your pulse rate and the flow of air. All that trackers can tell you is whether your arm was still and if it was dark in your room!
Because trackers are giving people sleep scores, telling them that they aren’t getting enough good-quality sleep, they’re spending more time in bed. But if you are in bed awake for long periods your brain starts to associate bed with wakefulness and frustration. It’s a conditioned response. Good sleepers are conditioned so that when they get into bed their blood pressure, pulse rate and body temperature drops and they are ready physiologically and mentally for sleep. When your brain starts to associate bed with wakefulness, when you approach it, your blood pressure doesn’t drop, your heart rate doesn’t drop, your temperature doesn’t drop and you’re not mentally or physically prepared for sleep. You start to develop a problem with insomnia which was never there, because you’ve started to mistrust your body and your brain, thinking you have to do something to make sleep come, when you don’t.
Making sleep effortless
When I’m looking after people with sleep problems, the first thing I do is get clocks out of the bedroom, because they create anxiety. Obsessively checking a screen during the night is even worse because you’re getting blue light which tells your brain to switch off melatonin [the ‘sleep’ hormone] and get up. It’s normal to wake during the night for brief periods, but if you’re not falling back to sleep within about quarter of an hour, get up and do something quiet and relaxing until the sleepy feeling returns.
If you’re looking at sleep data without a sleep specialist to advise you, you’re going to run into all sorts of problems. Dr Google will bring up nonsense from people who don’t know anything about sleep, and lots of it will be contradictory. You try one thing, but it stops helping after two nights so you try another, but you get into the territory of effortful sleep. But when you’re a good sleeper, it’s effortless: you get into bed, wake up and get on with your day. I practise mindfulness with my individuals with insomnia, teaching them to focus on the here and now.
Trust your own body
If you’re feeling worried, I would advise you speak to an expert who can give you some helpful strategies. Anything that involves you limiting your enjoyment of life because you’re overly focused on sleep isn’t a healthy way to live and is a huge orthosomnia red flag. I see people not going out with friends in the evening because they’re so concerned they won’t get good quality sleep. That’s just not right.
People are recognising that they don’t just have to accept being a ‘bad sleeper’ and that’s a great thing. But no good sleep physician uses phone data. The first thing we will do is ask you to keep a two-week sleep diary on paper. Writing down how you feel you slept, how you felt when you woke up and what’s going on in your life is so much more revealing.
I like trackers when they reveal helpful patterns. People might say, ‘That night I had eight hours sleep I felt better compared to when I have six,’ which can be useful, but any more of a focus than that and it starts to become unhealthy. If you feel that you’ve become overly preoccupied with your sleep tracker, leave it for two or three nights, and instead wake up and reflect on how you feel, then just get on with your day. Treat each night as a brand new one, and rather than using data to inform how you feel, check in with your own body. Your intuition is a far better measure of your sleep than any device.
Dr Alanna Hare is a consultant at the Department of Sleep and Ventilation at the Royal Brompton Hospital, London. She helps patients manage insomnia, narcolepsy and many other sleep-related disorders, and regularly delivers seminars and workshops.