Consumer sleep technology (CST), popularly known as sleep trackers, is designed to help individuals become aware of their sleep patterns and to promote better, healthier sleep. But these apps and devices create an ironic paradox: The very technology that is meant to improve sleep can, in some cases, worsen sleep, cause anxiety, result in obsessive behaviors, and even bring on insomnia. Orthosomnia, a recent concept, describes situations where an individual becomes obsessed with optimal sleep metrics, based on device-driven sleep data provided by CST, such as fitness trackers and mobile phone sleep apps. Essentially, some people literally lose sleep over the idea of losing sleep.
There are significant psychological and mental health implications here. Through the lens of illness anxiety, constant checking (or hypervigilance) of any bodily function is seen as maladaptive and unhelpful. Were an individual, for instance, to compulsively check their blood pressure or pulse rate, we might view this behavior as neurotic or hypochondriac. But we tend to be more lenient when it comes to the use of CST, perhaps because it has become so normalized and prevalent. Despite its wide acceptance and usage, CST affords the same unfortunate opportunity for over-checking, hypervigilance, and obsessive behavior. Smith et al. (2019) point out “that monitoring any biological body signal may create in some individuals a mental health concern of targeting perfection.”
Sleep is a natural bodily function, much like heart rate or respiration; our bodies know when sleep is needed and know how to go to sleep. When we begin to over-technologize these natural processes, we open the door to fixation, overthinking, and anxiety. In the case of CST, individuals end up more attuned to the data about their sleep than to the actual experience of sleep, and this can cause insomnia. Applying a perfectionistic, measurement-centric attitude to natural physical processes can cause undue anxiety and a host of other potential problems. A 2023 article written by a group of sleep experts concluded that individuals who have a perfectionistic view of their sleep were “likely to exhibit the following symptoms: difficulty falling asleep at night, waking up throughout the night, waking up too early, not feeling well-rested after a night’s sleep, tiredness or drowsiness during the day, anger, despair, or anxiety, difficulties paying attention, focusing on activities, or remembering, as well as an increase in mistakes or accidents.”
Health data apps and wearables are omnipresent, with a 2023 survey finding that 63 percent of adults had used a health tracking app in the past 12 months. With such a large portion of the population using this type of technology, there are certainly benefits (such as information about circadian rhythms or long-term sleep habits) to be gleaned, but the potential drawbacks can have serious implications for mental health. In terms of CST, the main risk is hyper-fixation, an anxiety-driven behavior in which an individual overfocuses on a single area while ignoring other areas. For sleep, this can mean rigidly focusing on the metrics and data provided by the app or tracker while ignoring the body’s natural cues for sleep or becoming overly anxious or stressed about feeling tired or not getting a good night’s sleep. Hyper-fixation can become all-encompassing, taking up much of a person’s mental capacity and detracting from other important parts of life.
The clinical implications of orthosomnia are still evolving: a 2017 study in The Journal of Clinical Sleep Medicine revealed that “there are a growing number of patients who are seeking treatment for self-diagnosed sleep disturbances such as insufficient sleep duration and insomnia due to periods of light or restless sleep observed on their sleep tracker data.” It is not surprising that anxiety related to orthosomnia is now showing up in the therapy office: Anxiety tends to evolve along with advances in technology and changes in the ways we live our daily lives. Therapists must be cognizant of these evolving trends that affect large portions of the population.
So, what is to be done about this emerging issue? Clinical psychologists Michael Breus and Kelly Baron point out three important reminders that can help those with orthosomnia:
Sleep trackers are not medical devices; therefore, their accuracy can be suspect. Overreliance on non-medical devices can exacerbate rather than soothe anxiety and, in the case of sleep, disrupt rather than promote healthy sleep.
Truly improving sleep quality, according to Baron, begins not with data or measurement, but rather with creating and adhering to a regular sleep schedule. Sleep trackers do not necessarily help us to create these healthy schedules and can, in fact, get in the way of a healthy sleep schedule.
Either taking a break from CST or moving to a written sleep diary may help individuals to rely less on devices and thus reduce sleep-related anxiety.
Though well-intentioned, sleep tracking apps and devices hold the potential to cause anxiety. In a world that is becoming increasingly steeped in data and measurement, it is helpful to remember that our bodies know how to sleep and have known how since long before the advent of this type of technology.