Falling Asleep and Staying Asleep: combining wearable technology and neuroacoustic feedback for combating Insomnia

Insomnia: Prevalence, Causes and Impact on Health

Insomnia, characterised by difficulty falling asleep, staying asleep, or both, is one of the most prevalent sleep disorders globally. Acute insomnia occurs over a short period, typically lasting a few days. Chronic insomnia, on the other hand, is diagnosed when these symptoms persist for at least three nights per week over a duration of more than three months ¹. The Centers for Disease Control and Prevention (CDC) recommend at least seven hours of sleep per night for adults, yet nearly one-third of adults in the US fail to meet this benchmark. According to the STADA Health Report in 2022, 35% of Europeans struggle to get a full night’s rest- an increase of 15% from 2021. People in the UK, France (43% each) and Spain (42%) have the poorest quality of sleep ². The American Academy of Sleep Medicine (AASM) reports that about 30-35% of adults experience acute insomnia symptoms, while 10% suffer from chronic insomnia ³. Furthermore, recent studies indicate that up to 75% of older adults experience symptoms of insomnia ⁴.

Although the exact pathophysiology of insomnia is unknown, there are a number of complex processes that interfere with regular sleep cycles. Sleeplessness may be brought on by factors such as depression, anxiety, persistent pain, hormonal fluctuations, substance abuse, diet, and a host of other factors ⁵. For instance, anxiety might lead to hyperarousal, a condition of increased mental and physical alertness that interferes with falling and staying asleep. Travel-induced jet lag breaks the circadian rhythm, which controls the sleep-wake cycle, making it difficult to get quality sleep. Additionally, hormonal and neurotransmitter imbalances, which involve chemicals that affect the homeostatic sleep drive, have also been implicated as potentially contributing factors towards the onset and persistence of insomnia.

The United Nations' Sustainable Development Goals (SDGs) aim to reduce premature mortality rates from non-communicable diseases by a third by the end of 2030 ⁶. However, sleep disorders such as insomnia not only hinder quality of sleep but also are risk factors that increase the prevalence of non-communicable diseases and decrease quality of life. A lack of sleep directly increases the risk of obesity and type 2 diabetes mellitus ⁷. Chronic insomnia also triggers cognitive impairments with symptoms such as altered attention spans and episodic memory ⁸. Moreover, insomnia significantly impacts overall quality of life, as demonstrated by studies indicating a strong correlation between sleep disorders and decreased life satisfaction and daily functioning. A 2005 US National Health and Wellness Survey reported a significant decrease in physical and mental quality of life, higher work productivity loss, as well as greater activity impairment in association with insomnia ⁹. An international study by RAND in 2023 estimated that workers who experience any symptoms of insomnia miss 14 days of work every year and spend another 30 days at work not being fully productive. Chronic sufferers were estimated to be absent for up to 18 days and present but not productive for up to 54 days annually. The UK loses 1.3% ($41.4 billion) of its output every year. France loses around $36.3 billion each year whilst Australia and Canada both lose more than $19 billion per year ¹⁰. This emphasises the social and economic importance of early identification and treatment of insomnia to mitigate these adverse outcomes.

Since sleep is continuum, for most people subtle early signs are often missed making future treatment and rehabilitation more complex. Therefore, it is very important to gather real-time, continuous data to explore the exact causes of insomnia.

Wearables for continuous health data: findings from the Ultrahuman database

The user base of Ultrahuman Ring AIR primarily consists of individuals who invest in health optimization. Early sleep disorders lurk even among people with high commitment to wellness. We analysed sleep patterns across the entire Ultrahuman user base to evaluate the prevalence of poor sleep patterns as characterised by low sleep duration, frequent sleep disruptions in terms of awake episodes and lower sleep efficiency- the percentage of time spent asleep in a given sleep session. We identified a section of users with poor sleep signatures for at least two months indicating that these users grapple with potential sleep deficits on a regular basis. In addition, we observed sporadic (10-15 day periods of poor sleep) to be more prevalent.

Comparing the sleep profiles of these two groups revealed interesting trends as shown in Figure 1. Since sleep profiles change with age, we also segmented the population based on age ranges (20-40, 40-60, 60+ years). Overall we found comparable sleep volumes suggesting that most users experienced acceptable sleep quality. In contrast, users with poor sleep exhibited significantly lower sleep scores across all age categories amounting to a regular ~30% sleep deficit. In concert, the resting heart rate was elevated (5-6 bpm) across all age groups among the poor sleepers. Elevated sleep heart rate has been linked to impaired recovery and repair, which if persistent long-term can lead to many chronic conditions ¹¹.