Measuring sleep and sleepiness with mobile devices
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1 Measuring sleep and sleepiness with mobile devices Rebecca M. C. Spencer, PhD Personal Health Monitoring University of Massachusetts, Amherst
2 Sleep IALS Why measure sleep? Memory Decisionmaking Stress management Clean brain waste Emotion regulation Immune function
3 Sleep IALS Why measure sleep? Aging Social/economic factors Parenting Psychological disorders Adolescents Neurodegenerative diseases Memory Decisionmaking Stress management Clean brain waste Emotion regulation Immune function
4 Wake after sleep onset (mins) IALS Sleep is treatable behaviorally Drugs Sleep Hygiene Pre- Post- e.g., Jacobs et al., Arch Int Med, 2004 McClusky et al., Am J Psychiatry, 1991
5 WAKE REM nrem1 nrem2 SWS 11:00 1:00 3:00 5:00 nrem1 SWS REM nrem2 -transitional sleep stage -memory consolidation -glymphatic function -emotion regulation -creativity and decision making -plasticity -particularly motor learning
6 WAKE REM nrem1 nrem2 SWS 11:00 1:00 3:00 5:00 Key points Sleep is not homogenous and all stages serve a unique function SWS may be particularly essential in neurodegenerative diseases given the role in glymphatic clearing
7 Key features of sleep that impact quality of life Sleep quantity more sleep, more of all of these functions Sleep quality less time wasted awake in bed improves function Sleep sufficiency Does it meet sleep need?
8 Polysomnography IALS Sleep measurement Actiwatch Spectrum (Respironics) Non-dominant wrist EEG EOG EMG Actiwatch Portable amplifier
9 Sample recordings Week 1 Week 2
10 Sample recordings Sleep onset Night waking Slow wave sleep REM Wake
11 Polysomnography Take home message: EEG is necessary to identify sleep EMG/EOG is necessary to identify sleep stages
12 Polysomnography A montage: EEG (electroencephalography) EOG (electroculography) EMG (electromyography) Can also have (for sleep disorder dx): Leg EMG Snore sensor ECG (electrocardiogram) Pulse oximetry Plethysmography
13 Key features of sleep that impact quality of life BMD proxy for sleep quantity Total Sleep Time (TST) = Sleep period* (SOL+ WASO) SOL: Sleep onset latency WASO: Wake after sleep onset BMD proxy for sleep quality Sleep efficiency (SE) = TST/ Sleep period* x 100 Often called a sleep score *Sleep period=time in bed
14 Actigraphy What is measured by devices? Research-based actigraphs ActiWatch (Philips Respironics) ~$800 ActiGraph ~$200
15 Actigraphy Contains triaxial accelerometer Provides an estimate of the sleep/wake cycle via movement (or absence of). Based on many assumptions. Summarizes the frequency of motions into epochs of specified time duration and stores the summary in memory
16 Actigraphy
17 Actigraphy research-based actigraphs Advantages: Objective (compared to questionnaires, observation) Can be worn over multiple days/weeks Correlation between actigraphy- and PSGdefined sleep estimates Disadvantages Accuracy is lower for some groups Cannot score sleep architecture Scoring data is tedious Validated data requires simultaneous diary
18 Comparison of commercial BMDs Basis Fitbit (Flex) Misfit Research actigraph (Spectrum) Withings
19 Total Sleep Time
20 Sleep Efficiency (sleep score)
21 Deep & Light Sleep
22 Other current devices Smartphone apps Sleep Cycle, Sleep Time, SleepBot, MotionX Beddit
23 Challenges part 1 Actigraphy-based sleep measures are generally reliable for total sleep time and sleep efficiency However, most studies are Limited to healthy young adults Focused on night-time (supine) sleep Inactivity v. napping v. sleepiness mid-day is indistinguishable BMDs do not capture sleep stages accurately. Given that SWS may be key and nrem1 of limited use, total sleep time may not be enough. How to improve: Portable polysomnography? Actigraphy + (EEG, EMG)
24 Commercial BMD usability Battery length Auto-detect sleep Bluetooth upload Waterproof? Fitbit Misfit Moov Withings Flex Charge Flash Shine Ray Pulse 2 weeks 5 days 6 months 6 months 6 months 6 months 2 weeks No* Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Resistant? Resistant? Up to 30 m Up to 50 m Up to 50 m 3 meters No Face value Price $80 $109 $25 $37-56 $100 $60 $76 iphone compat? Android compat? Other Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Can be word w/ watch Extreme work out feedback
25 Challenges part 2 Must limit opportunities to take it off Battery life limits Waterproof limitations Self-monitoring requires interpretable information Is the sleep score enough? What is the value of a sleep score without knowing how to change it?
26 Healthy sleep hygiene s ACTIVITY: Exercise! BANS: Eliminate caffeine, evening light/stimulation CONSISTENCY: Nap only if consistently; Bedtime +/- 1hr D, MELATONIN & SUNLIGHT: Set your body clock NVIRONMENT: Quiet, cool, and dark room
27 Thanks. Work by: Nick Gravel Janna Mantua
28 Thanks. Work by: Nick Gravel Janna Mantua Rebecca Spencer, PhD Psychological & Brain Sciences
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