Benca Sleep Gadgets 082520 - UCI MIND

SleepGadgetsRuthM.Benca,MD,PhD

DepartmentofPsychiatryandHumanBehaviorUCISleepCenter

Disclosures

Ihavenocommercialrelationshipstoanyoftheproductsorcompanieslisted,andinclusioninthistalkdoesnotrepresentanendorsement.

Typesofgadgets

• Wearablestotrackyoursleep• Devicestohelpyousleep• Appsandinternetbasedapproaches

Wearables• Allbasedonmeasuringmovements• Usuallywornonthenon-dominantwrist

Whatdoactivitymonitorsdo?• Trackrest-activitypatterns,withsoftwaretoquantitatemovementandsleep• Somewithprogramsthatestimatetypesofsleep(e.g.“deep”sleep,REMsleep)• Advantages

• Capableofmonitoringmultiplephysiologicalparameters(e.g cardiacrhythm)tomonitorclinicalconditions

• Technologycontinuestoimprove• Datacanbefedintointernet-basedtherapiesforinsomnia• Atapopulationlevel,theyincreaseawarenessofsleephealth

Caveatsaboutusingactivitymonitors

• Dataarenotnecessarilyaccurate;sleepstagedatanotreliable• Mayincreaseanxietyaboutsleepandthusworseninsomnia• Increasefocusonminutesofsleepratherthanqualityofsleep• Manydevicesonthemarket,fewhavebeenproperlyvalidated

Bluelightblockingglasses• Thecircadianclockinthebrainismostsensitivetobluelight;exposureatnightshiftssleeponsetlaterinthenightaswellasincreasingactivation• Wearingamberlensesfor1.5- 2hoursbeforebedimprovedsleepinindividualswithinsomnia(bothsubjectivesleepandactigraphydata)insomestudies

WhiteNoiseMachines• Emitcalming,monotonoussounds(e.g.,wind,rushingwater)• Usefultodrownoutintermittentenvironmentalnoises(e.g.,traffic,snoring,householdnoise)• Mayalsoaidindividualswithtinnitus

Coolingdevices

EbbSleepCap

Chilipad cube

BedJet

Rationale

• Coolingthebrainordroppingcorebodytemperaturereducesneuralactivityandpromotessleep• Brainandbodytemperaturecoolduringsleep,particularlyduringNREMslowwavesleep• Headcoolingdevicescausedropsinbothbrainandbodytemperature• Evidenceforimprovedsleepwithbraincoolingdevice• Minimaldataforothercoolingdevices

Stimulatingslowwavesleepthroughtones

Dreem Headband(Rhythm)

SmartSleep DeepSleepHeadband(Philips)

SleepShepherdBlue(SleepShepherd)

Rationale

• Slowwavesareprevalentindeepeststagesofnon-rapideyemovement(NREM)sleep• Slowwavefunctionsincludelearningandmemory(likelythroughnormalizationofsynapses),clearanceoftoxicsubstancesfrombrain(amyloidandtauproteins)

Howitworks

Evidenceforeffects

• Devicesincreaseslowwavesduringsleepinnormalsubjects• Effectsgreaterinyounger(<40yrs)thanolder(>40yrs)adults• Noeffectontotalsleeporsleepstageamounts• Effectsoncognition,daytimefunction,physiologyunclear;moreresearchneeded

Electromagneticstimulationofslowwavesusingpulsedelectromagneticfrequency(PEMF)

SR1PEMFSomniresonance Oska Pulse

CranialElectrotherapyStimulation(CES)

Alpha-Stim

Rationaleandresults

• Deliversstimulationtothebrain,PEMFlikemildtranscranialmagneticstimulation(TMS);CESlikeverymildelectroconvulsivetherapy“ECTlight”• Therapiesdevelopedformooddisordersandpainrelief• TMSandECTincreasewakingbrainactivitywhichresultsinincreasedslowwavesleep--??Ifthisisthemechanism• CEScausesdeactivationofbrainafterapplication• Veryminimaldataonsleepeffects;somestudiessuggestimprovedsleeponselfreport.OnestudythatmeasuredsleepinlabshowednoeffectofCES

Newerapproachesunderdevelopment• Transcranialelectricalstimulation;transcranialmagneticstimulation[TMS]• “Topdown”;canbetargetedtospecificbrainregions• MaybeabletotargetvariousbrainEEGwaveforms

• Otherformsofsensorystimulation(e.g.,auditory,olfactory,visual,somatosensory,visual,vestibular)• “Bottom-up”;lesslocallyspecific

Clocks

SmartSleep WakeUpLightTherapyLamp– PhilipshOmelabs SunrisealarmclockBiobrite Sunriseclock

Rationale

• Lightwavelengthandintensityentraincircadianrhythmsandhavedirectalertingeffects• Circadiansystemmostsensitivetobluelight• Light-emittingclocksimulatesundownandsunrise• Shifttoredspectrumanddecreasingintensityintheevening• Shifttobluespectrumandincreasingintensityinthemorning

• Usefulforhearingimpairedindividuals

CognitiveBehavioralTherapyforInsomnia(CBT-I)• Usuallyprovidedbytrainedtherapist• Computer-basedformsavailable• Meta-analysisof6RCTsofcomputerizedCBT-I1• Treatmenthadgoodacceptability(78%completed)• Estimatedthat1in4patientswillrecoverfromchronicinsomniawithcomputerizedCBT-I

• Examples:• Sleepio www.sleepio.com• VACBT-i Coach(free)https://www.ptsd.va.gov/appvid/mobile/cbticoach_app_public.asp)

1.ChengSKandDizon J,Psychother Psychosom (2012)81:206-216.

Questions?