Orthosomnia: Symptoms, Causes, Diagnosis, and Treatment

With the explosive growth of wearable technology that is able to collect basic health-related biometric data—including information about daily physical activity, step counts, heart rate, and sleep—the increased focus on optimizing these metrics may lead to unexpected problems. Sleep may be worsened by unhelpful changes, causing a condition called orthosomnia. What is orthosomnia? Learn how analyzing the quantified self with wearable fitness trackers may lead to increased anxiety and insomnia, and what to do about it.

Basics

Market research data suggests that some 60.5 million Americans will use a wearable device in 2019, and though users are more often younger than 35 years old, growth is higher among older adults.

These devices include fitness trackers like the Fitbit as well as smartwatches like the Apple Watch. Measurements may include assessments of movement, heart rate, oxygen levels, sleep, and other physical signs.

As this technology advances, and the ability to accurately measure health-related information improves, these devices will have a more central role in driving personalized medicine. The data collected will allow individualized recommendations to improve physical fitness, sleep, nutrition, and medical conditions such as high blood pressure, diabetes, and more. This data-driven digital health may represent an important tool in the future of medicine, but it is not without the potential for risks.

Sleep, in particular, may suffer when too much focus is placed on it. Efforts to improve sleep-related metrics—such as total sleep time, amount of deep sleep, amount of REM sleep, and so-called “sleep scores”—may actually make sleep worse and lead to insomnia. Sleep deprivation, in an effort to maximize sleep efficiency, may also contribute to increased daytime sleepiness and other consequences.

Researchers coined the term orthosomnia to describe the potential risks associated with people who become preoccupied with improving their wearable sleep data. This term comes from Latin roots that mean “straight or correct” and “sleep,” suggesting that the affected person is making efforts to obtain idealized, perfect sleep. This may be a fruitless pursuit.

Symptoms

When an excessive focus on improving sleep occurs, sleep itself may suffer. Some potential symptoms that could occur with orthosomnia include:

• Difficulty getting to sleep
• Difficulty staying asleep
• Difficulty getting back to sleep after waking
• Early morning awakenings
• Unrefreshing sleep
• Anxiety
• Depression
• Irritability
• Fatigue
• Excessive daytime sleepiness
• Poor concentration or attention
• Short-term memory problems
• Increased risk of errors or accidents
• Malaise (feeling unwell)
• Increased pain

Many of these symptoms will occur because of an excessive emphasis on getting the “right” amount, and type, of sleep. This perfectionism may be due to multiple potential causes and unhelpful changes in prior sleep habits.

Causes

In considering how biometric data from a wearable device might provoke changes that worsen sleep, let’s take a moment to consider what this technology actually measures. It will then be possible to understand how a focus on attaining idealized sleep can make matters worse.

Fitness trackers and smartwatches, apps using smartphone technology like microphones and accelerometers, and even products integrated into the internet of things (smart products like beds, speakers, alarm clocks, etc.) may all purport to collect and analyze sleep data. There are several important considerations when interpreting this data:

• How is the information collected?
• What are the limitations to the measurements?
• Are the sleep metrics accurate?
• What measurement variables are being used to determine sleep vs. wakefulness and specific characteristics (such as sleep stages)?
• Has the device been validated against the gold-standard testing within sleep medicine (actigraphy and diagnostic polysomnography) to ensure accuracy, and how well does it do?
• Are the details that constitute summary metrics (including “sleep scores”) disclosed?

Unfortunately, this information can be hard to ascertain. Many of these products have not gone through rigorous scientific evaluation and external validation studies. Experts within sleep medicine are just developing guidelines for this sort of assessment. Details may be elusive as these measurements and algorithms may be proprietary and the intellectual property is protected. These can be changed without notice, and new versions may vary greatly from prior ones. This lack of transparency, and general fluidity of technology development, interferes with research.

Generally, these devices may not accurately report sleep stages or be able to identify brief periods of wakefulness after sleep onset. Sleep metrics may be manipulated, and may not correspond to established sleep science. These devices may not be able to detect important sleep information, such as breathing difficulties or abnormal movements or behaviors.

Making Unhelpful Changes to Your Sleep Pattern

Regardless of whether a wearable device is accurate, or if it corresponds to the gold standards of sleep medicine, the information obtained may lead to unhelpful changes. Consider these examples:

• Someone who is trying to maximize their total sleep time may start spending more time in bed, squeezing out a modicum of additional sleep at the expense of increased wakefulness. Sleep may become lighter and more fragmented as the amount of time in bed exceeds the individual’s sleep need. If someone needs eight hours of sleep, but spends 10 hours in bed, they will have an average of two hours of wakefulness. Going to bed early, or staying in bed later into the morning, may make sleep worse. These perpetuating factors may lead to chronic insomnia.
• It can be difficult to increase the absolute amount of time spent in deep or REM sleep. Efforts to manipulate the stages of sleep may be of no effect. Advice may be provided based on population-based guidelines, yet this may be useless to an individual. Moreover, the characteristics of what might be considered “best sleep” may further vary across the lifespan.
• As the focus on sleep increases, the ability to sleep may decline. The more someone thinks about sleeping, the less able they may be to fall asleep. This may exacerbate anxiety and catastrophic thinking, both of which may prolong wakefulness as the sympathetic nervous system is activated.
• Interestingly, sleep can be misinterpreted as wakefulness. Stage 1 sleep, the lightest stage of sleep, is often experienced as being awake. The disconnection between the experience of sleep and the actual state of sleep (to say nothing about what the wearable’s biometric data may suggest), can be frustrating. Paradoxical insomnia may result.

Diagnosis

Orthosomnia may be recognized by someone who has been using a wearable or similar technology to track biometric data and who finds their sleep has worsened as they attempt to make changes to optimize the reported characteristics and get an idealized sleep.

Evaluation by a board-certified sleep physician, or a psychologist with specialized training in sleep, may help an individual to recognize how efforts to manipulate sleep have instead caused it worsen. Uncommonly, further testing for associated sleep disorders may be necessary.

Treatment

Before throwing out the wearable device, or simply abandoning a daily review of the sleep metrics, it might be possible to use the personalized biometric data in a more useful way. Consider following these general guidelines:

• Keep a consistent sleep-wake schedule, including on weekends.
• Get enough hours of sleep to meet your sleep needs (for adults, this is usually seven to nine hours), but don’t spend extra time in bed.
• Always go to bed feeling sleepy, and spend the hour before your anticipated bedtime engaged in relaxing activities to ease the transition to sleep.
• Optimize your sleep environment by charging your phone elsewhere overnight, reserving the bedroom as a space for sleep, and keeping the room quiet, dark, cool, and comfortable.
• Keep a consistent wake time and get 15 minutes of sunlight upon awakening to improve the circadian rhythm.
• Try to avoid naps.

If problems persist, consider participating in a cognitive behavioral therapy for insomnia (CBTI) program. In some cases, a consultation with a sleep physician may be needed to diagnose conditions like obstructive sleep apnea. Unrecognized sleep disorders may cause frequent awakenings, prolonged wakefulness, and excessive light sleep.

A Word From Verywell

It is possible to avoid orthosomnia. Certainly some people may want to abstain from the use of wearables that track this sort of health data. If you have an obsessive personality, with neurotic or anxious tendencies, this may be best. When sleep begins to unravel, especially in the setting of the use of these devices, consider whether unintentional orthosomnia plays a role. In some cases, you may need to reach out to a sleep professional to get yourself back on track.