A slew of wearable devices from rings to wrist-worn trackers hit the market in 2019, claiming to help people learn more about their sleep.
They’re serving a big market, with research showing that more than 60 million Americans suffer from some kind of sleep disorder. The so-called “exhaustion economy” is thriving globally, as consumers and even their employers are starting to pay for consulting services, special mattresses, and more.
I’ve never been diagnosed with a sleep condition, but I’ve long wondered whether there are steps I could take to optimize my shuteye. I’ll typically have at least one night per month where I’m up until the wee hours of the morning staring anxiously at my clock. And there are certainly days where I hit the wall at 4 p.m., and feel like curling up in a corner.
So at the advice of a friend, I met with the team at Oura, which makes a sleep-tracking device, in their San Francisco offices to see if I gain any new insights. Oura, which bills itself on its website as the “most accurate sleep and activity tracker,” sells its ring for $299 and up, which puts it on par with the Apple Watch.
Oura, like other sleep trackers, isn’t an official alternative to a doctor-ordered sleep study in the lab, which involves monitoring a person’s brain waves, oxygen level, heart rate and other factors. But it does look at users’ activity at night using its built-in accelerometer and gyroscope, and it incorporates sensors tracking other relevant metrics like heart rate, respiratory rate and body temperature.
Another reason I chose it: Oura, unlike its competitors Fitbit and Apple Watch, is super focused on sleep so it is designed to have fewer entertainment features and therefore a longer battery life.
While getting fitted for the device, which comes in a variety of sizes, Oura’s CEO Harpreet Singh recommended that I spend at least two weeks tracking my sleep so I could start to see patters and trends in the data. I took his advice, and started in late October of this year by sliding the silver ring on my index finger. (I’ll note that some women with very slim fingers might find that even the smallest-sized ring is too large.)
The ring I wore, which is a second-generation design, is far thinner than the previous one, which would have engulfed my finger. I liked the ring better than wrist-worn devices because it’s so unobtrusive — I didn’t really notice it after a while. Stylistically, though, it looks a little weird if you’re already wearing a wedding ring — even if you put it on the opposite hand.
Oura shows the three major sleep stages: Light sleep, deep sleep and REM sleep (for rapid eye movement). There’s also some detail about sleep latency, meaning how long it takes for a person to go from fully awake to asleep, as well as restlessness and total hours of sleep.
These sleep phases are important for different reasons. Deep sleep is known to be a particularly restorative time, while REM sleep is thought to stimulate the areas of the brain that are essential to learning and making memories.
Sleep cycles are typically about 90 minutes and a person will need four of five of those to get a really good night’s sleep. It’s common to see more REM sleep in the final hours of sleep, while deep sleep tends to happen earlier.
The Oura data indicated that I typically fall asleep before midnight, experience more REM sleep starting around 3am, and drift into a deep sleep-heavy cycle around 1 or 2am. I averaged out at about 7 hours of sleep per night.
I felt fairly happy about the amount of sleep I was getting, as it fell within most recommendations of 7 to 9 hours. But most mornings, when I checked my data in the Oura app, I did notice that either my percentage of both REM and Deep Sleep were in the red, and in a few cases, both.
Oura breaks down your sleep into categories.
To find out if I should worry, I turned to Dr. Seema Khosla, who sees patients at the North Dakota Center for Sleep.
After reviewing a few nights of my sleep data, Dr. Khosla said she wasn’t worried. She noted that many of her patients, who have sleep conditions like sleep apnea, will have levels of REM sleep in the low single digits, while most of mine hovered around 15 to 25 percent, as well as a lot of interrupted sleep. So in her view, the app could have given a bit more leniency to sleepers like me to avoid any unnecessary anxiety.
She also wondered whether I would have scored higher if I had gone to bed earlier, but she couldn’t necessarily recommend that. As she points out, everyone’s circadian rhythm is different. And for me, getting up a little earlier isn’t necessarily going to lead me to be more productive the next day. Unlike morning people, I get bursts of energy in the afternoon and through the evening.
She also noted that the accuracy with sleep trackers in general is somewhat suspect. Oura might be better than some apps and devices, in that it tracks a lot more than most, but it’s still not as thorough as a sleep study. So while the trends might generally be right, she advised that I take the data with a grain of salt.
Anxiety about sleep tracking
There was also one major caveat I should share: Once I started using the Oura, I noticed that I took off the tracker on nights where I knew I wouldn’t sleep well.
It’s a bit embarrassing to admit, but I started to get caught up in achieving a perfect sleep. And it turns out I’m not alone. There’s a condition called othosomnia, which involves some people with sleep trackers getting lower-quality sleep because they’re anxious about achieving a better score.
On nights where I tossed and turned and didn’t wear my Oura, I was more successfully able to convince myself that I got more sleep than I actually did. And that helped me get through the day.
In fairness to Oura, they never tell you that you got bad or poor-quality sleep, and instead present a so-called “readiness” score.
But seeing the data made it very hard for me to tell myself that I must have gotten more sleep than I actually had.
And that’s one reason why sleep experts like Khosla will often advise patients to write down how they’re really feeling in the morning before they consult their sleep tracking app.
Patterns and insights
Once I had all this information, I pulled up my calendar to look at times that I was traveling, arranged drinks with friends or guzzling down more coffee than usual.
Some possible patterns emerged:
- Booze isn’t great. I saw a connection between the nights that I had a few glasses of wine, and the nights where I got fewer hours of deep sleep.
- My cats seem to wake me up a fair amount. I’m quite a restless sleeper, and it doesn’t help when they’re moving around at night.
- The first night of travel is particularly icky: Apparently I don’t sleep all that well in hotels.
- Exercise helps, but not too late in the evening. It turns out that exercise probably bolsters my sleep quality, but if I work out too late, I noticed that it will take me longer to fall asleep.
- I should probably sleep a little more and earlier (that, I knew).
- By far the coolest thing Oura: I noticed a slight bump in my body temperature one morning, and a few days later came down with a cold. I didn’t get an alert that I might be getting sick, but it did give me a heads up to take it easy for a few days. (And I’m not alone).
But after realizing all of this, it wasn’t totally clear what I should do about it. It’s hard to avoid travel altogether, and I do enjoy a glass of wine or a cocktail from time to time. Giving up coffee might be another noble goal, but I genuinely enjoy a morning cup and I doubt I’d stick to it for long.
And that brings us to behavior change. Here’s where it all gets tricky.
Dr. Khosla generally felt I got about enough sleep. I’d often make up for a poor night or two of shuteye during the week by taking it easy and prioritizing my rest on the weekend.
That said, Khosla suggested ways I could improve my sleep hygiene. She will often recommend her patients go to bed just 15 minutes earlier, and report back to her if they saw a difference. And if so, move their bedtime incrementally earlier until they’ve hit the sweet spot.
Another recommendation I got from Dr. Khosla, but not the Oura app: Put away phones and laptops earlier. She suggested finding a way to wind down that doesn’t involve browsing the Internet or being reminded of tomorrow’s tasks, like a magazine or an audio book.
In my case, she noted that I could try keeping the cats out of the bedroom for a few nights to see if it helped.
But that important feedback loop between a patient or consumer and a (ideally human) health coach was missing from the Oura experience. If you’re not totally self-motivated, it will be hard to put your insights into action.
All in all, I got more tangible information and ideas out of A 15-minute conversation with a doctor than two weeks of hard data. I walked away thinking that sleep tracking needs to evolve to meet the needs of a population that isn’t deriving value from information alone. Some people might spot trends on their own, and game out how to make improvements. But others will need more insights and more coaching, based their unique lifestyles and everyday habits.
“Ultimately I think we’re still figuring out what the purpose will be of all this new technology,” said Dr. Khosla. “For that reason, lot of my patients will show up with this data, wondering what an earth they’re supposed to do with it.”