In the last week of February 2020, South Africans went to bed earlier than people in every other country, on average at 22h47. They were the second earliest risers, at 06h12, beaten only by Guatemalans, who were up 13 minutes earlier at 05h59.

Those are stats provided by Sleep Cycle, a sleep-tracking subscription app and “alarm clock [that] tracks your sleep patterns and wakes you up during light sleep” that costs R399.99 a year. According to the website, since its launch in 2009, the app has been downloaded by 37.4 million people around the world.

Sleep Cycle is just one of many digital sleep aid products born of the capacity of digital devices to track and quantify our bodily functions. According to a 2017 McKinsey report, “The sleep-health industry is collectively estimated to be worth between $30-billion and $40-billion and has historically grown by more than 8% per year, with few signs of slowing down.” The report combines traditional bedroom furniture and mattress industries, the bathroom sleep aids segment, literature on sleep and therapeutic treatments for sleep with the increasingly popular digital sleep aids.

“The relevance of sleep is becoming evident for health insurance, for public health and for safety,” says Hannes Kruger, a psychologist and CEO of Sleepfit, a South African company bringing SleepImage, an American “clinical” sleep monitoring device to South Africa.

“The whole industry of sleep is becoming a massive burning platform because of the risk that is associated with lack of sleep and the fact that, in the modern times of 24-7 living, people have become conditioned to devalue sleep,” adds Kruger, who is working with Sleepfit director Dr Neale Lange, a sleep specialist for the past decade in the US.

In addition to smartwatch and smartphone sleep tracking apps and alarms, one can use smart mattress covers, such as the Luna, which is controlled via an app. According to Luna co-founder and CEO Matteo Franceschetti, the smart cover learns a person’s sleeping patterns and adjusts the temperature of the mattress to the optimum for sleep before one gets into bed. It also promises to track heart rate and breathing patterns during sleep. It connects to home smart devices such as lights, television and coffee machine, so they can be automatically switched on or off and co-ordinated with usual sleeping and waking hours.

On the non-digital end of the market, products such as weighted duvets, which are claimed to help with sleep by pressing against the user, aiding relaxation and reducing anxiety, have become popular.

Clothing maker Under Armour says of its futuristic-sounding bioceramic pyjamas: “The soft, bioceramic print on the inside of the sleepwear absorbs natural heat and reflects Far Infrared back to the skin, helping the body sleep better and recover faster.”

But how reliable are these aids, the ubiquitous digital trackers in particular?Scientists and researchers in the field of sleep aren’t quite certain.

According to a December 2019 article by Dr Katherine Dudley, director of the Cambridge Health Alliance Sleep Medicine Program and an instructor at Harvard Medical School, “It is worth noting that the software algorithms that decide what is sleep and what is wake are a bit of a ‘black box’. These are proprietary, owned by the various companies that make the devices, meaning sleep doctors and researchers don’t know exactly how the programmers decided to make these determinations. Between different brands, or even different devices within a brand, the software code, and therefore sleep interpretation, could vary.”

Dudley also notes the potential for erroneous readings by tracking devices and apps: “There’s even less data on how these devices are impacted when there is a co-existing sleep or medical condition, or by medications. Consider a patient with insomnia who meditates when he can’t sleep and lies still in bed. This absence of movement and steady breathing could easily be misinterpreted as sleep by a wrist-based device.”

However, she doesn’t completely discount the gizmos. Although inscrutable to medical opinion, they could help us gain insight and help us reflect on our sleeping patterns, she says.

There is little independent research on the efficacy of sleep trackers and similar views to Dudley’s abound.

Alan Schwartz, MD, director of the Sleep Disorders Center at Johns Hopkins Bayview Medical Center says, “They don’t measure sleep directly. Most sleep-tracking devices make some ‘guesstimate’ as to how much you’re actually sleeping. Just take the numbers with a grain of salt.”

According to Sleepfit’s Lange, electrocardiograms (ECGs) combined with breathing monitors offer an accurate way to measure sleep: “By looking at the relationship between breathing and the heartbeat we can tell what state the brain is in; whether it’s awake or sleeping. If it’s sleeping is it a light or deep sleep? And what is the overall quality of sleep? And we go one step further; if the quality is poor we can find out why.”

Lange says the SleepImage device coupled with its diagnostic software is the only US FDA-approved consumer sleep monitoring system. That is not to say other trackers like smartwatches have been rejected. The FDA simply does not review them for approval as they are not considered medical diagnostic tools.

While decades of research confirm the importance of sleep to health and daily functioning, with a recommendation of seven to nine hours of sleep a day for adults, the last word is yet to be uttered on the efficacy of the current wave of non-clinical consumer products. What is largely considered the gold standard of sleep study, polysomnography, “measures brain waves, muscle tone, breathing and heart rate, while a technician supervises, often in a hospital setting”.

This is a time- and labour-intensive process out of reach for many people because of cost. So, accessible, over-the-counter options are attractive to consumers.

Even as the sleep aid industry continues to grow, sleep professionals like Dudley counsel patients to review their sleep data with a grain of salt.

“It’s just one piece of the picture to incorporate and doesn’t substitute for a quality sleep log or other forms of sleep assessments,” she says. “The benefit is that the collection of this data is fairly passive and can be done for longer stretches of time to gain insight into patterns. Keeping in mind how these wearables measure sleep helps us know what they can and can’t do.

“Though the wrist devices don’t substitute for a medical opinion or sleep study in a hospital, if they help us reflect on our sleep and how much (or little) we’re getting, they may have a role if used carefully.” ML

If you would like to share your ideas or suggestions with us, please leave a comment below or email us at e[email protected] and [email protected] and we will reach out.

Sign up for our newsletter to get the best of Maverick Life delivered to your inbox every Sunday morning.