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One expert thinks it might be a good thing that Apple's smartwatch does not have a sleep tracker.
Apple was supposed to announce a sleep tracker yesterday. It was going to be the latest in wearables makers moving further and further into healthcare. But with or without the announcement, there is a problem with the difference between improving performance with digital solutions, and addressing a clinical problem, and it’s not just semantics.
A survey from Rock Health found that while most of those using wearables focus on being physically active or on fitness training, the percentage focused on wearables for fitness or performance is starting to decline. The percentage using wearables for physical activity fell from 54% in 2017 to 44% in 2018. Similarly, the percentage looking to wearables for fitness training dropped from 51% in 2017 to 43% in 2018. But those using wearables to manage a diagnosis rose from 20% in 2017 to 30% in 2018. People seeking help from wearables to address sleep problems rose from 22% in 2016, to 24% in 2017, and then 31% in 2018.
It’s no wonder Apple was rumored to be taking a closer look at tracking sleep with their new offerings. In the end, there was no Apple sleep tracker announced yesterday. That’s just as well if it was to be the same approach, that might be appealing for tracking activity and fitness, but doesn’t necessarily do what’s needed for a medical problem.
A gym and a trainer are not the same as a sleep clinic and therapist. I know, because after being a varsity college tennis player I helped pioneer fitness technology for trainers and gyms. Technology that serves a real health need for people tackling a disorder needs to be more than easy to use; it needs to be committed to a scientifically driven and comprehensive process.
This discussion is only going to get louder. If the numbers Rock Health has identified continue, we may see the trends intersect this year or next with health taking a front seat for wearables users, superseding fitness and activity. Users are moving beyond novelty and performance and are seeking to solve real health problems.
But can wearables provide true help? If they’re just wearables and not the kind of comprehensive approach that scales real clinical care, maybe not.
Let’s look deeper into sleep. There is a popular sleep health movement in the U.S. today, replacing the myth of the productive and successful individual who doesn’t need sleep. There are trackers and apps that try to support better sleep habits. But this is a popular movement, which is to say, it’s geared to appeal to everyone whether they have a sleep disorder, or just want to get an extra edge.
Bad sleep is a trillion-dollar healthcare problem that impacts the mental wellbeing and physical health of over a third of the world’s population. Eighty percent of poor sleep remains undiagnosed and untreated, in part because of the cost of diagnosis and the lack of trained experts to deliver adaptive treatments.
For people with sleep disorders, the popular movement falls short. Celebrity evangelists, however well meaning, and despite the genuine good they do in tackling toxic myths, aren’t sufficiently steeped in the science or have the direct personalized solutions to cross that final mile. Similarly, researchers tell us trackers that only monitor movement don’t tell you enough to have an impact on a sleep disorder.
Trackers that record brain waves using an electroencephalogram (EEG) are better, but alone are not enough without coaching. Cognitive behavioral therapy for insomnia (CBTi) has become the standard for therapy, and a safer option than sleeping pills, but it’s also limited on its own without EEG tracking to inform the right solutions, and the accessibility and convenience that consumers need.
A healthcare professional can pull these things together, but it’s a lot of mixing and matching which pushes a great deal of labor on over-worked therapists. The trackers and CBT apps that are out there are accumulating a great deal of data, but they’re not sufficiently tapped and they don’t augment a healthcare professional’s practice. I hear all the time about doctors who refer patients to standalone technologies, only to never know of the outcomes.
A comprehensive approach that scales clinical care can help. But what qualifies?
Well one, it should not be a grab-bag of solutions. An approach to scale only works when it is designed to advance what works in a practice today and focuses on digital technology’s ability to augment what works, while improving the quality of care. For sleep, clinical consensus is that good therapy includes accurate data. It includes CBT. It should include an expert.
Technology brings these together. In fact, it’s not a question of building a better EEG, but rather allowing it to more seamlessly integrate with digital coaching, and to make both mobile and something to do from a person’s home. A scalable approach should make existing work by therapists and patients easier, not add a cloud of more data and steps in existing processes. Perhaps most importantly, this type of hub needs to sew together data that can be integrated into the greater healthcare ecosystem. You can’t really build solutions that are intuitive without doing the work.
It is not necessarily the engineering of the solution, as much as informing that solution something like a million nights of sleep, in terms of insomnia, and running the artificial intelligence program necessary to build a smart and intuitive interface.
But if we build solutions the right way, so they can scale, and by putting these better more powerful tools in the hands of sleep health professionals and individuals, we can explore new potential to truly make a dent in unmet health needs. These solutions are not just wearables that make your morning workout quantifiable or allow you to track how you moved around in the bed last night. We need to tackle real healthcare problems, the ones that are the barrier between you and getting free of a debilitating sleep disorder.
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