Why we sleep
German, Albrecht Vorster, 2019
«Data from wearables means you can skip the sleep clinic»
2/12/2023
Translation: Julia Graham
If you sleep badly, you’re not alone. In an interview with sleep researcher Dr Albrecht Vorster, I learn that as many as 30% of people suffer from sleep disorders. And wearables can play an important role in diagnosing them.
I prepared really well for this interview. For starters, I took a close look at the sleep data on my Apple Watch. I even visited a mattress factory. I found out I fall asleep sober just as well as I do after a glass of wine. And I read Albrecht Vorster’s book, which gives a clear and entertaining take on why we sleep.
In our interview, however, things go in a bit of a different direction than I’d anticipated. By the end, I know which gadgets and wearables I’ll be testing next. You can find the list at the bottom of this article. I also discovered that my colleague Patrick wasn’t writing about some exotic ailment in his report but about a common illness.
But before my preliminary remarks cause you to fall asleep from boredom, let’s get started.
Albrecht, what would be the most boring question I could ask you to start with because you’ve heard it so many times before?
Albrecht Vorster: That’s an easy one: how did you sleep last night?
And why is this question boring?
Because the answer isn’t very exciting. My sleep is pretty standard. By that I mean I don’t have any sleep conditions – unlike 20 to 30% of people.
Wait, as many as 30% of people suffer from sleep disorders?
Yes, in research and medicine, that’s the figure we work from based on population surveys. And we’re not talking about a stressful day that might make it difficult to fall asleep.
What do most people suffer from?
Sleep apnoea, which consists of mostly undetected interruptions in breathing during sleep. This can lead to secondary illnesses, such as falling asleep during the day, high blood pressure, heart attacks, strokes and even depression.
Can I diagnose sleep apnoea myself? Would a smartwatch such as an Apple Watch be able to tell if I suffered from this?
Smartwatches aren’t the best tool for this, to be honest. While it’s good to measure vital signs on the wrist, a paper score would be most effective to start with.
A what?
In theory, I can determine fairly accurately if you suffer from sleep apnoea by getting you to answer a simple, eight-question survey. We also ask your age, weight, neck circumference and gender. If you’re male, overweight and slightly older, you’re in the at-risk category. Anyone can fill this in and find out for themselves (site in German).
OK, but what if I’d rather do it with technology?
Then use your smartphone. Most people usually have theirs lying next to their bed at night. The sensors and microphone installed in them are now so good that apps to record and analyse this data can provide good diagnoses.
Is there an app you’d recommend in particular?
Yes, the Snorefox app. By the way, I don’t get any financial kickback for recommending this. Its risk screening method is medically validated. And spending a few euros or francs to do the test at home is also a lot cheaper than going to a sleep clinic.
What about smart rings that you wear on your finger?
One I’m aware of is the Circul ring (site in German). It measures oxygen saturation via your finger, which is more accurate than on the wrist. That’s why it’s able to provide good, very useful data. If you want, you can also put a sensor under your mattress. For about 150 euros or francs, you can get a device that records your breathing rate, heartbeat and how calmly you sleep or how much you toss and turn. I know there’s a Swiss company considering installing sensors like these in their mattresses as standard.
For some people, all of this might feel a bit Big Brother-esque.
(laughs) That may well be, but mobile phones collect a lot more fascinating information elsewhere. Data that’s much easier and better to market. Information generated from your bed is the most boring type for the likes of Google.
What’s the legal situation?
Obviously, I’m not a lawyer. But the fact is the latest wearables, such as fitness trackers, could provide very meaningful data on a person’s health. And yet, it’s a bit problematic from a legal point of view. If they were classified as medical devices, someone could sue the manufacturer if information was incorrect. In the US in particular, people are quite keen to go down the legal route.
So a lot more could be possible with tech?
Yes, a lot of things could be easier if we made better use of the opportunities. There are T-shirts that can take an ECG if you wear them at night.
So, is there any need for sleep clinics at all?
Put it this way, we wouldn’t have the capacity to look after everyone with sleep disorders anyway. That’s why it actually benefits us that the smartphone triggered a technical revolution. Although it’s only been around in this form since 2007, an incredible amount is possible today. For example, the app Your sleep, your day: Dein Schlaf, dein Tag – sorry, another app – uses sonar technology to ascertain a sleep assessment.
It sounds a bit like it could put doctors out of a job.
Don’t worry. There’s already plenty for us to do. The new devices and apps will support diagnosis in the future and relieve some of the burden on sleep clinics, but doctors will still have to provide treatment. Within the field of sleep medicine, there are differing views on how modern opportunities should be dealt with. Those who have been working in respiratory medicine for a long time fear that there will be a lot fewer expensive diagnoses required in future if wearables can do the job just as well.
But surely that’s a relief for patients.
Definitely. In the vast majority of cases, it means no one needs to wait three or even six months to be seen by a sleep clinic. But our healthcare system still rewards expensive technology, which is why it’s used in diagnostics – and billed accordingly. And yet, a doctor is actually at their most valuable when their time can be spent thinking. Or when they’re able to use their experience to achieve the best results by talking and listening to their patients. However, «talking medicine» of this kind isn’t financially viable. On its own, it’s not enough to finance a specialist department, which is why so many examinations that aren’t actually needed take place.
Then the likes of Apple and Google would soon have to open clinics and doctors’ surgeries, wouldn’t they?
They’d probably not be in the slightest bit interested in that. Lifestyle devices are making inroads into the medical sector, yes, but it’s not so much Apple or Samsung that are the exciting element for me. Ultimately, it’s the software that interprets this data from devices, uses algorithms and derives diagnoses. There are a few exciting start-ups achieving amazing things. The focus is on how the large amount of data can be used even better for medical purposes. Big tech companies aren’t particularly interested in this area because they’re specialist applications.
Bedrooms are home to other gadgets besides just smartphones. What do you think of light alarm clocks, for instance?
First off, I have to point out that these light alarm clocks aren’t medical devices; they’re wellness products. If you have a sleep condition, they don’t help you rest any better. But it’s certainly nicer to wake up to something like this than an annoying radio alarm clock. You also need to be aware that the strongest daylight alarm clocks only have a fraction of the lux that’s available outdoors.
And daylight lamps?
When used correctly, these can have an impact. And by that I mean you have to sit close enough and the light needs to come from diagonally above. That’s why the devices we use with our patients are on stands. It doesn’t necessarily look aesthetically pleasing, but it’s more effective and pleasant.
Why?
Our eyes expect daylight to come from diagonally above, i.e. from the sun. Ultimately, this signals to the body that it’s daytime.
And what about in the evening? Is it really that bad if I use my smartphone for a long time before going to sleep?**
The light itself isn’t the problem. Christian Cajochen from Basel carried out an excellent study which showed that people who use their smartphone in bed fall asleep only one or two minutes slower than those who don’t use it at all (https://www.nature.com/articles/s42003-023-04598-4). Ultimately, the few lux that the screen gives off are practically irrelevant.
So what’s the problem?
When we take our smartphone into the bedroom, we take our emotions with it. We can’t finish the day properly because we feel as though we need to quickly read this e-mail or reply to that WhatsApp message. This could be a reason for poor sleep. Homes used to have a landline and that was it. Nobody usually called after 8 p.m., which meant we could relax.
In that case, I hope our readers aren’t looking at this article on their smartphone in bed. Thank you, Albrecht, for this fascinating conversation.
Gadgets for tracking your sleep
In the interview above, Albrecht Vorster mentions some gadgets that let you gather data on your sleep behaviour. For instance, this one from Withings goes under your mattress:
When it comes to light therapy lamps, it’s important that the light falls on our eyes from above. That’s why devices that go on a table are better than those that shine up at you from below.
And then there are light alarm clocks and sunrise simulators, which are more like wellness products but can at least make getting up more pleasant.
I conducted this interview with Albrecht Vorster by phone. The products in the last section of the article aren’t explicit recommendations from me or Albrecht. They’re merely products that may be suitable due to their design or specifications. As Digitec Galaxus editors, we aren’t bound to any manufacturer and it’s not our job to increase sales. Our product reviews and tips are always critical and independent. | Header image: Jens Fischer/Bico
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Martin Jungfer
Head of Content
Martin.Jungfer@digitecgalaxus.chJournalist since 1997. Stopovers in Franconia (or the Franken region), Lake Constance, Obwalden, Nidwalden and Zurich. Father since 2014. Expert in editorial organisation and motivation. Focus on sustainability, home office tools, beautiful things for the home, creative toys and sports equipment.