By Jeffrey S. Durmer, MD, PhD

This is an excerpt from the fall 2017 edition of NightWalkers, the Foundation's quarterly magazine. To get your subscription to NightWalkers and to enjoy other benefits, become a member of the Restless Legs Syndrome Foundation today!

Please note: The RLS Foundation does not endorse or promote any goods, products or services. The opinions and suggestions in this article are of the author only, and not of the RLS Foundation, its employees or its Board of Directors.

A paradox about sleep is that it only happens when we stop trying to do it. And when it arrives, we are generally unaware until it’s over. For some, this evokes feelings like, “I have no control over my sleep,” which is a common experience, especially for those who suffer with insomnia, sleep-disordered breathing, and restless legs syndrome. With the advent of widely available personal technology to measure the ethereal state of sleep, many now can begin to take control using the science of sleep. And it could not be more timely, as our generational sleep loss in the US continues to accelerate.

Home sleep apnea testing and portable sleep monitoring is decidedly replacing laboratory polysomnography throughout our healthcare system. The use of medical-grade mobile sleep technology began in the 1990s, and now the growing industry of sleep tech has pivoted directly to consumers. With the introduction of sophisticated heart-rate, temperature sensing, geoposition, wrist-worn accelerometers and ballistocardiography backed up by complex algorithms; the length of wake cycles, length of sleep cycles and depth of sleep can be measured each night at home on a continuous basis. Many different platforms support various forms of smartphones, tablets, laptops, watches, and even clothing to collect data in real time. For some, these high-tech metrics foster a new relationship with sleep and can even help identify medically relevant sleep conditions. For others, sleep-based technologies do nothing but invite potential sleep loss due to novelty and light, which impedes and overcomplicates the simple act of sleep.

In my opinion, the use of sleep tech is a personal choice. Every individual has a different circumstance and a different set of sleep issues and/or goals. Technology can be a useful tool for those trying to enhance sleep, but also a distraction if taken too far. Here are some examples of unique sleep tech devices that could enhance one person’s sleep sanctuary, or inadvertently turn another’s bedroom into a torture chamber.

For the bed or bedroom

IntelliBED: A bed made with a novel matrix of gel to allow airflow around your body while you sleep. The unique waffle-like structure of the gel creates a support that conforms to the curves of the body without the typical pressure and movement of a traditional mattress.

ChiliPad: An innovative bed pad with micro-channels that allow circulating water from a thermostat-controlled bedside cooling/heating circulator. Users can choose the temperature of their sleep surface and thermostatically maintain it without changing the room temperature.

Dreampad: A pillow with integrated transducers that gently stimulate the inner ear through the skull using low frequency sounds. The resultant activation of the parasympathetic nervous system helps to reduce arousal and induce sleep. Research with conductive auditory systems like this have demonstrated significant benefits for children and adults who have hyperarousal conditions.

LumiFi: A circadian rhythm, technology-based design firm that implements hour-to-hour transitional lighting systems using wavelength and amplitude modulation to enhance arousal throughout the day, and prepare the brain and body for sleep. Lighting Science HealthE lights: A series of LED light bulbs designed to enhance wake and sleep based on the neurobiology of wavelength and amplitude modulation of the circadian rhythm system.

If you want to improve your sleep, here are some tech devices and tech-enabled programs to consider:

Dodow: A bedside breathing trainer designed to activate your parasympathetic nervous system to calm your physiology in preparation for sleep. It projects a subtle light on the ceiling to slow your breathing cycle and induce a calm state before sleep.

Calm.com: A mobile application with mindfulness meditation programming, sleep stories and multiple daily relaxation practices that train you how to calm your nervous system before sleep or any time throughout the day. (They even have a program to help reduce road rage while commuting.)

Whil.com: An online series of mindfulness, resilience and sleep practices that are tailored to an individual’s needs using algorithmic assessments and personalized recommendations. Programming includes multiple sleep practices, as well as a new four-week, neuroscience- and psychology-based program to synchronize the mind and body for better sleep.

Sleepio: A well-validated online cognitive behavioral therapy program for insomnia. This is an interactive, six- to eight-week clinical training program for individuals who suffer with insomnia or who want to improve their sleep using clinically proven techniques. Originally developed by Dr. Colin Espie, a wellknown sleep psychologist and researcher, the program has been the subject of many research studies, as well as adopted as a standard in clinical sleep practices.

SHUTi: A well-validated online cognitive behavioral therapy program for insomnia, similar to Sleepio. Developed by researchers at the University of Virginia and Dr. Charles Morin, a famous sleep researcher and clinician, this six- to eight-week program is noted to treat insomnia and depression.

If measuring your sleep is your thing, here are a few of the most interesting devices available:

Emfit QS: A ballistocardiography device that is placed under the mattress to detect movement, breathing and heart rate, and provides sleep stage classification. It tracks and measures heart rate variability, recovery and stress levels – all of which can be viewed by the accompanying web application. It is best known for its use by athletes in the fitness industry and professional sports world due to its ability to track heart rate variability and the impact of training.

Beddit 3 Sleep Monitor: Also a ballistocardiography device that is placed under the mattress with similar features to the Emfit QS. It comes with an iPhone application to detect snoring and provides an automated sleep score based on algorithms that integrate a wide range of data collected from a sleeping individual.

In addition to the ballistocardiography devices, which live in your bed, there are many wrist-worn accelerometers and smartphone apps on the market. These devices claim to measure various “levels” of sleep (deep, light and normal) as well as “stages” (REM sleep) and even “restless sleep” and wake. The variability of values and differing sensitivities of these devices is quite wide ranging. (For an interesting, though not scientifically valid, comparison of devices, see sleep.cs.brown.edu/comparison.)

The fact that 33 percent of adults and 67 percent of high school students in the US do not even get the appropriate amount of sleep, let alone have any knowledge about their quality of sleep, underscores the potential importance of this technology. Scientific validation or not, might consumer sleep tech help a generation turn the tide on the American sleep deficit? Time will tell. But now, at least we can measure what’s behind the wall of sleep.

Jeffrey S. Durmer, MD, PhD, is an adjunct professor at Georgia State University and a co-founder and chief medical officer of FusionHealth, a healthcare workflow technology company that provides solutions for people with sleep disorders and sleep problems.

Dr. Durmer's current work focuses on applying the neuroscience of sleep and circadian rhythm biology to workplace fatigue and wellbeing programs, as well as the use of technology-enabled population sleep-health delivery systems. Among his past achievements is development of the first standardized clinical interview tool for pediatric RLS. Dr. Durmer is a member of the RLS Foundation Scientific and Medical Advisory Board.