#116 - Improving Sleep With Science: Practice What You Preach - Part 1
“Would you like one MG?”
I had my eye on the chocolate mini cupcake, but the white-frosted one Tahlia was offering me was a good start. After all, what could go wrong during an Honours meeting when sweets are around?
I thought I might add to the merry atmosphere by shoving the whole cupcake in my mouth - and it had the desired effect with both of my Honours students laughing as I chomped.
And it was a really tasty cupcake.
Strangely, it tasted a bit like salted caramel … even though the icing was white.
And then there was a second wave of flavour…
Rust.
I stopped chomping.
And started uncontrollably salivating.
WTF?
After 1 minute of everyone in the room laughing - except for me - the practical joke was revealed. Tahlia had injected Vegemite into the centre of my cupcake.
Why am I starting this blog this way?
Because that cupcake was synonymous with the experience I had yesterday when reading an article by the CEO of an established sleep tech company …
Chief Executive Officer, Colin Lawlor
Irish-born CEO, Colin Lawlor, heads a great sleep company in California called SleepScore Labs.
And one of their leading inventions is the SleepScore Max.
The SleepScore Max houses novel technology, with the ability to be able to measure one’s sleep, without the use of the person wearing anything (eg, watch, ring or headband).
The cool thing is that in early 2021, the SleepScore Max was independently studied against 6 other sleep trackers - including the FitBit and Garmin (Chinoy et al., 2021).
And the stats for SleepScore Max were quite good - especially against the other popular wearables.
As background, for years we have been using scientific-grade wearables known as wrist activity monitors. They weren’t pretty, but they did their job of giving us another perspective of how someone sleeps.
But there were some advantages of the SleepScore Max, including:
its affordability,
measuring not only sleep but stages of sleep (eg, deep sleep, REM sleep), and
being a non-wearable (we lost wrist monitors over the decades in swimming pools and washing machines).
We started using one in our Sleep Clinic, especially for those clients who misperceived their sleep (ie, reported they got less sleep than what they actually got).
And we were keen to use these in some upcoming research studies.
But I’m guessing you wanna know how this relates to Vegemite Cupcakes?
Forbes Article - The Icing
This week, Colin Lawlor wrote an article for Forbes about how the health and wellness industry has been unregulated for decades - and thus many people have been making unsubstantiated claims.
And he stated that this has also occurred in the sleep industry.
Yes! Finally this issue is getting attention.
This is exactly what we’ve seen at WINK. And it doesn’t just stop at sleep products, but also sleep books and a gazillion webpages that state the blue light from screens can make it difficult to sleep.
But at least now, some regulation has emerged.
The article provides an example where the MyPillow company was fined USD$1,000,000 for making false claims about their pillow.
Indeed, Colin’s article provides a link in his article to the FTC (Federal Trade Commission), where they have put 700 companies ‘On Notice’ for consumer deception - including reviews and endorsements that lack evidence.
This is welcome news given the spread of misinformation.
As Colin’s article puts it:
“To impact consumers positively, the sleep space should base every claim on data and scientifically proven research. Companies that cannot meet that bar should be pushed to the fray. Consumers deserve proof. Given how sleep directly impacts physical and mental wellbeing, sleep wellness is too precious to not be held to an incredibly high standard”
Here’s Comes The Vegemite …
There was a moment in Colin’s article where I paused my scrolling:
What is likely meant here is the comparison between subjective measurements of sleep (via self-reported surveys, or sleep diaries) and objective measurement of sleep (eg, wrist activity monitors, the SleepScore Max).
But I disagree with the last 2 sentences - which I will now breakdown:
“We’re unconscious when we sleep, so our perceptions of our own sleep quality are based on fairly unreliable data.”
The Forbes article links to a scientific study comparing wrist activity monitors to sleep diaries and a popular self-report survey called the Pittsburgh Sleep Quality Index (PSQI). This study shows biases in the subjective measures of sleep.
Here’s the catch though - the researchers used wrist activity as the ‘gold standard’ - thus assuming, it is the better measure of sleep of the 3 measures.
And I should say that the above quote is prefaced by providing the reader with Colin’s sleep expertise - explaining that he’s been in the sleep industry for a long time, starting way back in 2009.
When he entered the sleep space in 2009, our research team were in the thick of completing the largest study of teenager’s sleep using wrist actigraphy. And we noticed that this ‘gold standard’ objective measure of sleep wasn’t as great as everyone was claiming.
So the PhD student on the project - Michelle Short - took the brave action of speaking about this issue - by publishing it.
And since then, we’ve been publishing about the measurement of sleep, circadian rhythms and daytime performance using subjective and objective measures, as well as comparing them.
I guess we better back this claim, hey? …
In summary, our wealth of peer-reviewed studies has led us to believe that wrist actigraphy measures movement.
So much so that if you see the title of the last publication in the picture above, we couldn’t even claim that we were measuring sleep - we had to say ‘motor activity’ (aka, movement).
Indeed, regardless of whether the objective measure of sleep is a wearable, a nearable or even the gold standard polysomnography - all of them will report movement as ‘awake’.
All of us - including you - move in during sleep. Every night. Multiple times. The thing is, you don’t remember all of those movements.
And this is why we’ve seen - on average - that people will report getting about an hour more sleep than a wearable.
And there’s gender differences too - with boys moving more during the night than girls (eg, Short et al., 2012) - regardless if it’s measured with a wearable on the wrist or via a computerised camera above a baby’s crib.
Our conclusion is that subjective reports of sleep are more important than objective measures - especially when it comes to the final sentence …
“Objectively measured sleep is what enables us to know what interventions truly have an impact on us.”
If you were to look deep into virtually every sleep intervention, they use subjective measures of sleep.
Two of the best measures to use are a sleep diary, and/or the Insomnia Severity Index.
But another important point is raised in this final sentence - which is the impact sleep interventions have on us. This is often measured - again - with self-reports of how people feel during their day.
For instance, if you paid attention to our list of published studies above, we’ve been researching daytime feelings like daytime fatigue and sleepiness - and seeing how our sleep interventions affect people’s anxiety and depression levels.
So it’s time to spit out the Vegemite - there’s significant scientific data to demonstrate that subjective measures can enable us to truly know that sleep interventions have an impact on us.
Which means - ironically - Colin’s article cannot back-up its own claim.
Conclusions?
Don’t get me wrong. I really like what Colin has done with SleepScore Labs and I really like the SleepScore Max. Furthermore, I’m really happy that Colin raised awareness of this important issue of science-backed claims in the sleep space.
But Colin is not a sleep scientist* - and he is not an expert at improving sleep. I’ll wager that he hasn’t had a person sitting in front of him who he has single-handedly helped to improved their sleep - year-in, year-out.
So I long for the day when CEOs in the ‘sleep improvement space’ actually employ qualified health professionals who have improved people’s sleep - and they are also sleep scientists. Like what I see happening at Nox Health (for example).
My guess is that I won’t be headhunted by SleepScore Labs anytime soon.
And the nail will certainly be in the coffin when Part 2 of this blog comes out next week … and only those who subscribe are going to be able to read that one (Hint: see the screenshot below).
Nevertheless, we have to practice what we preach.
Prof MG
*2 Letters to the Editor in the Journal of Clinical Sleep Medicine do not maketh a sleep scientist.
