How the Pursuit of Perfect Sleep Can Keep You Awake

Sleep-quality scores, magnesium supplements, white-noise recordings — what was once a simple process has turned into a maze of recommendations and technologies. The pursuit of optimizing sleep by every possible means has become known as “sleepmaxxing.” But taking these efforts too far can lead to orthosomnia, a term specialists use to describe an obsessive preoccupation with achieving perfect sleep.

Orthosomnia is not officially recognized as a separate disorder in the United Kingdom. However, doctors told the BBC that they are increasingly seeing signs of it in patients. Some people come to appointments with data from fitness trackers and other sleep-monitoring devices, convinced — often incorrectly — that they have a sleep disorder. According to doctors, becoming overly focused on these metrics and trying to sleep “perfectly” can ultimately make sleep worse.

How and why has sleep become such a complicated task? And if sleepmaxxing does not help, what is the elusive secret to a good night’s sleep?

The first commercial fitness tracker with sleep-monitoring capabilities was the Fitbit Classic, released in 2009.

Since then, sleep tracking has become available on many other wearable devices, including gadgets from Garmin, Whoop, and Apple, as well as smart rings such as Oura, Ultrahuman, and RingConn.

The capabilities of these devices vary, but they generally provide users with a report on the previous night, breaking sleep down into different stages: wakefulness, light sleep, deep sleep, and rapid eye movement (REM) sleep. Many devices also give users a so-called “sleep score.”

However, the very concept of such a score is “completely made up,” according to Dr. Alanna Hare, a sleep medicine specialist at Royal Brompton Hospital in London.

“There is no universally recognized measure called a ‘sleep score’ in sleep science,” she says. “It was simply invented by device manufacturers.”

Hare says she has noticed that tracker data can cause anxiety among her patients.

“I’m seeing more people coming to me with data from various trackers and lots of questions about sleep that are probably contributing to their sleep problems in the first place,” she says.

According to Hare, even when medical tests show that there is no reason for concern, this does not always help patients overcome their anxiety.

“It’s good that sleep is now receiving more attention as an important component of health,” she adds. “But sleep is very difficult to optimize to perfection.”

A class-action lawsuit filed against Oura in San Francisco last month alleges that the company’s rings cannot accurately determine sleep quality and sleep stages. According to the plaintiffs, the devices instead rely on AI-generated estimates whose accuracy is comparable to “flipping a coin.”

Oura responded by saying that it is “confident in the scientific validity of its research and claims about the accuracy” of its devices.

“We strive to clearly explain which metrics Oura actually measures, which ones it estimates, and how users should interpret this information,” the company added.

Research also suggests that sleep trackers can affect a person’s well-being and performance during the day, even when the data they provide are inaccurate. In one Oxford University study, participants were given trackers that provided them with a sleep-quality score every morning.

However, these scores were generated randomly and had nothing to do with how well the participants had actually slept.

That is exactly what Jess Hill noticed after buying a Garmin watch several years ago.

“I started treating the watch almost like a Bible that determined whether I had slept well or not,” said the 32-year-old human resources professional from London.

“I would think, ‘I slept terribly, so today is going to be really difficult,’ when in fact I had probably slept perfectly well. And if the watch said I had slept really well, I convinced myself that I had to be at my best — and even if I felt tired, I would force myself to keep working,” Jess says.

Her “obsession,” as she describes it, with achieving a high sleep score lasted three years. The situation changed only at the beginning of this year, when Jess began noticing that the watch’s readings did not correspond to how she had actually slept.

“Recently, I didn’t sleep for four hours during the night, and the watch gave me something like, ‘Wow, great sleep!’ I was literally awake from 1 a.m. to 5 a.m.,” she says.

Sleep expert and author of How to Sleep Well, Dr. Neil Stanley, believes that turning sleep into a kind of game based on metrics and targets only creates additional problems.

“When you track sleep, you get a specific number, and that means you have a target,” he says. “As a result, you get caught in a vicious cycle and start worrying about the quality or duration of your sleep based on those numbers.”

Stanley says that about 40 years ago he conducted research into actigraphy, a method of monitoring sleep using devices worn on the wrist.

Modern commercial trackers have become somewhat more sophisticated, but their basic principle remains largely the same: they analyze a person’s movements. Therefore, many of the same limitations remain, he says.

“If you want to measure sleep, you need to measure brain activity,” Stanley adds. “If you are not recording brain activity, you are not measuring sleep itself.”

Hare recommends:

• Keep the bedroom cool, dark, and quiet — but without becoming obsessive about it. “It doesn’t mean the room has to be pitch black, exactly 16°C, and completely silent,” she says. “It’s enough for it to be relatively cool, dark, and quiet.”

• Spend more time in bright light in the morning. This helps regulate circadian rhythms, the body’s internal biological clock.

• Get some light physical exercise and follow “a healthy Mediterranean-style diet with a wide variety of plant-based foods.”

Follow NEWS.am Medicine on Facebook and Twitter