Sleep Tracking? No. Now It’s Sleep Training

You can train to run a marathon. You can train yourself to recognize Chopin. But can you train yourself to sleep (or train yourself not to have insomnia)?

Michael Schwartz, creator of the Sleep On Cue iPhone app, says yes.

Insomnia sufferers may learn how to sleep with this iPhone appYou can train to run a marathon. You can train yourself to recognize Chopin. But can you train yourself to sleep (or train yourself not to have insomnia)?

Michael Schwartz, creator of the Sleep On Cue iPhone app, says yes.

Sleep training “appears to work via conditioning,” Schwartz said in a recent email exchange. “People ‘learn’ the act of falling asleep. I have found it to be helpful for those who struggle to fall asleep initially and/or struggle to return to sleep during the night.”

But why do insomniacs need to learn to sleep when for most people sleep is effortless?

Intensive Sleep Retraining

The idea of sleep training is based on intensive sleep retraining (ISR), an insomnia treatment originally developed by sleep researchers in Australia. It grew out of sleep studies showing that many insomniacs fall asleep more quickly and sleep longer than we think we do.

Schwartz has observed this phenomenon firsthand in his work as a registered sleep technologist in the United States.

“It seems [that insomniacs] who are taking a traditional hypnotic . . . tend to overestimate sleep time,” he says. “Then if the insomniac begins a tapering of the medication, it swings to an underestimation of sleep time.”

Unlearning and Relearning Sleep

The question of why so many insomniacs tend to underestimate sleep time has not been definitively answered. ISR proponents suggest that insomniacs’ trouble sleeping is conditioned, resulting from poor sleep habits, worry about sleep loss, and negative beliefs about sleep. Eventually we lose touch with what falling asleep actually feels like.

So the goal of treatment is to retrain insomnia sufferers in the experience of falling asleep. Proponents claim that sufficient practice (within the prescribed protocol) will make our perceptions more accurate (i.e., more in sync with objective sleep tests, which indicate we’re sleeping longer) and restore confidence in our ability to sleep.

The Challenge and the Payoff

The ISR treatment as originally prescribed is short but onerous. You spend 25 nearly sleepless hours in a sleep lab. Every 30 minutes, you get a chance to fall asleep (and if you fall asleep, you’re woken up). At the end of the 25-hour period, you’ve had lots of practice falling asleep . . . and you’re very sleep deprived.

But after the initial 25 hours the benefits of ISR are immediate. With loads of sleep pressure built up by the next night and instructions on how to proceed, insomniacs who undergo ISR have experienced improved sleep starting at Day 2. The gains continue, research has shown, for at least 6 months.

A Sleep Training App

An insomnia treatment that involves wiring patients up in a sleep lab and round-the-clock supervision by sleep technicians is very expensive (which may be the reason nobody’s doing ISR in the United States). So when a call came out to get ISR out of the lab and make it available to insomniacs at home, Schwartz went to work.

“After reading the ‘call to action’ article by the notable insomnia researchers, I began thinking about how to detect sleep onset without expensive amplified EEG recording,” Schwartz said. He came up with several ideas before landing on the idea of an iPhone app.

“My ‘ah-ha’ was to realize that a call (tone) and response (slight movement) with a smartphone might be the ticket,” Schwartz said, “and it seems to work well.” Here’s how:

  • You lie down in bed holding your iPhone. Each time the phone emits a tone, you shake it slightly.
  • If the app doesn’t detect a shake, it assumes you’re asleep and vibrates to wake you up.
  • A message then comes on the screen: “Do you think you fell asleep?” You press yes or no.
  • You’re then instructed to leave the bed for a few minutes. The phone vibrates again to indicate when to return to the bed for the next sleep trial.
  • You decide when to end each training session. The screen then displays a graph with information about your sleep ability and your awareness of your sleep.

Modified ISR

The Sleep On Cue protocol is very similar to the ISR protocol, allowing for repeated, short sleep onset opportunities with sleep–wake estimation and confirmation. But Schwartz felt he needed to make ISR more palatable for home users.

“So I decided to reduce each sleep trial time slightly after each successful sleep attempt, as well as to prompt the user to leave the bed for just a couple minutes between sleep trials,” he said. “These two features allow more sleep trials in a shorter amount of time.

“I suggest . . . that sleep training should be done around bedtime for a couple of hours following any poor night of sleep. So maybe 10 sleep trials. Put the phone down and go to sleep when done, review the summary graph in the morning.”

Testimonials on the Sleep On Cue website suggest the app has been helpful for users, including users coming off sleeping pills. According to Schwartz, tests verifying the accuracy and clinical effectiveness of a modified version of the app are under way in Australia right now.

“The best user of my app is someone who is committed to sleep training,” he said, “who can grasp the idea of ISR and how it can help.”

If you try this app, let us know how you fare.

Insomniacs: Beware the Lure of Gadgetry

The Zeo Sleep Manager, a sleep-tracking headband capable of reading brainwaves and transmitting the data to a smartphone or beside monitor, came on the scene in 2009. But last week Zeo, Inc., creator of the Zeo Sleep Manager, went belly up.

Sleep trackers often promise more than they can deliverEver wish you had a picture of what’s going on inside your brain at night?

The Zeo Sleep Manager, a headband capable of reading brainwaves and transmitting the data to a smartphone or beside monitor, came on the scene in 2009 equipped to give you just such a picture and offer tips on how to improve your sleep. But last week Zeo, Inc., creator of the Zeo Sleep Manager, went belly up.

The announcement took me by surprise. Zeo had loads of satisfied customers.

“Works like a dream.” “It’s made a massive difference in my quality of life.” “Using the Zeo, I began to establish better sleeping habits, resting more soundly and getting something closer to a healthy night’s sleep.”

To Buy or Not to Buy

I came close to buying a Zeo myself. When sleep is a problem—and for me it has been over the years—it’s natural to wonder about the causes. Is it that I’m not getting any deep sleep? Just how many times am I actually waking up?

The Zeo was affordable ($99 to $149) and the bar graphs it produced were colorful (I’m a sucker for colorful bar graphs!). At a sleep conference, I picked up a handout announcing the results of a study comparing the recording of brainwaves produced by the Zeo to those produced by polysomnography—the test you undergo in a sleep lab. The data recorded by the Zeo tracked closely with the data from the polysomnograms. So why not buy one and see what it could tell me about my sleep?

For starters, I was skeptical that the Zeo would be as accurate as claimed. The study cited above had only 10 subjects—none of them with sleep complaints. The Zeo might work fine for normal sleepers. But would it work for a person with insomnia?

I looked at customer reviews and saw that the Zeo worked like a charm for people whose sleep was basically OK to begin with. Their graphs showing sleep stages looked fairly normal, and the advice provided by Zeo—lower the temperature of your bedroom, keep your sleep on a regular schedule—enabled them to tweak their sleep so that it was sounder and gave them more energy. Sort of like runners who hire coaches to help them fine-tune their stride.

Another Kind of Experience

But insomniacs and people with other sleep problems often found the Zeo wanting. Accuracy was the biggest problem.

“Although I’m a 59-year-old insomniac,” one user complained, “the machine was giving me the “Z score” [a Zeo rating of overall sleep quality] of a 20-year-old olympic athlete!”

“I’ve had two medical sleep studies done,” another user wrote, “and have been diagnosed with minor sleep apnea. I wake up several times an hour, and Zeo is only sensitive to big wake ups, like getting out of bed to go to the bathroom. But there were a couple of instances where it didn’t even capture that.”

People also criticized the coaching component of the Zeo.

“Frankly,” wrote a third user, “all the advice can be compressed into a thin, 8-page ‘sleep hygiene’ booklet, condensed from any book on insomnia.”

Postmortems are blaming this company’s failure on several things: a poor business model, failing to explain the device to consumers, charging too much for replacement headbands, and more. But surely another factor in the demise of the Zeo is that for those of us most likely to have an interest in using it, it couldn’t do what we needed it to do.

Think twice about buying devices such as Fitbit, Lark and UP (which also have sleep tracking capabilities). They may be great at recording the number of steps you’ve taken and the calories you’ve burned. But they’re less sophisticated than the Zeo at showing what could be wrong with your sleep.