Sleeping pills
Sleeping pills are some of the most commonly prescribed medications; indeed approximately 12 million units are prescribed in the UK each year. Recent results from the Great British Sleep Survey indicated that 12% of those with chronic poor sleep currently take prescribed sleeping pills. With mounting evidence of their residual daytime side-effects and potential for long-term negative effects on health, it is becoming increasingly common for people to seek out alternative sleep aids in an attempt to improve their poor sleep.
Undoubtedly, pills can help people get to sleep, but they may not work long-term. Consequently, UK and international guidelines recommend that sleeping pills are only prescribed for short-term (a few weeks), or occasional use. They are not advised for people with a persistent sleep problem that has lasted for many months or years.
'Off-label prescriptions'
Sometimes people are given medications that are intended for another purpose but that, as a side-effect, cause drowsiness, making them suitable to be used as a sleep aid. These drugs might be anti-depressant drugs (intended for people who are depressed) or anti-histamine drugs (used to treat allergic reactions).
Antihistamines affect a neurotransmitter, a chemical messenger in the brain, called 'histamine' which works to promote wakefulness. In particular, a group of antihistamines known as 'first-generation antihistamines' have the effect of making some people feel sleepy by blocking histamine receptors in the brain. In contrast, anti-depressant drugs may be prescribed by doctors, either when poor sleep is believed to be a consequence of depression or, alternatively, for the sedative properties of a number of anti-depressant drugs. These medications may aid sleep through effects on serotonin, histamine or melatonin.
This is known as 'off-label prescribing' and some doctors prefer these kinds of drugs because they can prescribe them on a longer term basis.
Prescription sleeping pills
Nowadays, there are some drugs specifically licensed as sleeping pills. These include drugs known as benzodiazepines which were originally developed to treat anxiety (often ending with the suffix '-epam' [e.g. temazepam]), and a similar group (often beginning with the letter 'Z', e.g. zopiclone) which are a bit less habit forming, though they act on the same brain receptors These brain receptors, called GABA receptors, respond to the neurotransmitter, gamma-amino butyric acid (GABA), which is involved in the inhibition of arousal and promotion of sleep. Interestingly, there have been recent scientific reports that, in some patients with insomnia, there is a reduction in the levels of brain-GABA compared with normal sleepers.
Although not strictly a sleeping pill, melatonin (a hormone involved in the regulation of our body clock, and sleep-wake rhythms) is available on prescription for adults over 55 with chronic insomnia.
In every case you should follow your doctor's advice with regard to medication – starting, changing or finishing a course of medication can have serious effects. Ensure that you consult your GP if you have any questions on this.
Antidepressants and sleep
How do antidepressants affect sleep?
Antidepressants are principally prescribed for the treatment of clinical depression. However, given the strong bi-directional relationship between depression and insomnia, several research studies have assessed the effects of antidepressants on sleep continuity (sleep onset, wake after sleep onset, total sleep time, and sleep efficiency) and sleep architecture (stages of sleep). Indeed, many clinicians will often give out off-label prescriptions of antidepressants for poor sleep, rather than sleeping pills, due to the perception that they are less habit-forming – and so can be taken for longer – and that they have less potential for side-effects. It is important to note, however, that rigorous controlled trials of antidepressants for the effective treatment of insomnia are lacking and that current guidelines do not endorse their widespread use.
The extent to which an antidepressant will affect sleep is ultimately determined by the class of antidepressant being prescribed. This will influence the resultant pharmacologic effects on brain neurotransmitters like serotonin and noradrenaline, and receptor sites including histamine, serotonin, and adrenergic receptors. It is also important to note that effects on sleep can vary between and within classes of antidepressant medications, and will depend on whether one studies healthy participants or those with clinical depression (Wilson & Argyropoulou, 2005; Mayers & Baldwin, 2005).
In general, antidepressants tend to suppress REM sleep and increase the time taken to enter REM sleep. Both increased REM sleep density and reduced latency to REM sleep are characteristic of patients with depression and thus antidepressants appear to normalize these parameters. Indeed the amount to which antidepressants suppress REM sleep has been associated with enhanced overall antidepressant response (less severe depression symptoms). In some studies, selective serotonin reuptake inhibitors (SSRIs), like sertraline and fluoxetine, have been shown to disturb/fragment sleep. Tricyclic antidepressants (TCAs), like amitryptiline, and serotonin antagonist and reuptake inhibitors (SARIs), like trazadone, have been shown to have a sedative effect, improving sleep continuity and quality. Effective antidepressant treatment response, where mood is improved, may often be accompanied by improved subjective ratings of sleep; however, recent research data also suggest that poor sleep can frequently emerge as a consequence of antidepressant treatment, remaining even after successful remission of depression.
You should always consult your doctor for advice on medication – starting, changing or finishing a course of medication can have serious effects. Ensure that you consult your GP if you have any questions on this.
What is bright light therapy?
There is evidence that naturally occurring light regulates the human sleep-wake cycle, and that both exposure to natural light, and to artificial bright light (using a 'light-box') can have sleep phase altering properties. The greatest evidence for benefit, however, is with Circadian Rhythm Sleep Disorders, rather than with poor sleep. There are a few studies, indicating that bright light can be used along with CBT as part of a treatment program for poor sleep, but this is applies only when someone has a severe difficulty with getting to sleep every night, or wakes up very early every morning.
Insomnia cures
It is perfectly normal to encounter sleep problems at some point in your life but it's when the bad nights become more frequent than the good nights that you may find yourself reaching out for an 'insomnia cure'.
Years of research can help us differentiate so-called 'cures' for insomnia, which address the symptoms of poor sleep, from techniques which really can help you improve your sleep for the long-term.
It is broadly possible to divide insomnia cures into two categories: those that take a pharmacological approach and those that employ cognitive and/or behavioral techniques.
Pharmacological cures
Sleeping pills
When faced with insomnia, many are forced to reach for pharmacological cures first. The most common of these are hypnotic drugs, such as sleeping tablets.
Sleeping pills can be effective in relieving short-term insomnia and are often the first line of treatment offered to poor sleepers by their doctors. Unfortunately, pharmacological 'cures' often fail to address the underlying causes of insomnia, meaning that they are not recommended for persistent sleep problems.
'Off-label prescriptions'
As well as sleeping pills, people may be prescribed medications that were originally intended to cure other conditions but that, as a side effect, cause drowsiness. These often include antidepressant drugs (intended for people who are depressed) or anti-histamine drugs (used to treat allergic reactions).
This is known as 'off-label prescribing' and some doctors prefer these kinds of drugs because they can prescribe them on a longer-term basis.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) works by teaching techniques that address the mental (or cognitive) factors associated with insomnia, such as the 'racing mind', as well as the worry and other negative emotions that accompany the experience of being unable to sleep. Alongside this, behavioral techniques work to establish healthy sleep patterns and achieve a strong connection between bed and successful sleep
CBT has been shown to be a highly effective treatment for poor sleep which helps to reinstate natural sleepiness and enable people to both get to sleep more easily and stay asleep throughout the night.
Pharmacological interventions Vs. CBT for insomnia
Studies have consistently shown that, on the whole, patients with insomnia prefer approaches based on CBT compared to those that use medication and, despite the increase in prescriptions for sleeping pills and sales of over-the-counter sleep aids, research has shown that long-term sleep problems are helped most effectively by CBT.
Emerging research also shows that CBT techniques can have long-term benefits even when combined with pharmacotherapy, compared with pharmacotherapy alone.
In every case you should follow your doctor's advice with regard to medication – starting, changing or finishing a course of medication can have serious effects. Ensure that you consult your GP if you have any questions on this.
Sleep music
Throughout history, people have used music to alleviate stress, distress and even illness. Those experiencing sleep problems may find soothing music before bedtime helps them to relax and 'let go' and ultimately sleep more easily.
Choosing the right type of music to sleep to
Music choice is, of course, ultimately down personal preference, but here is our guide to sleep music.
Our top tip is to avoid your favorite songs as well as anything too uplifting, which might over-stimulate you before you go to bed, or once you are in bed. Instead, opt for music that blends into your sleeping environment and calms your mind.
Sounds of nature
Nature sounds, such as the sound of ocean or the sound of rain, are some of the most popular sleep-inducing sounds, and may help to 'transport' you to a more restful mental space.
The often monotonous repetition of sounds can even aid the onset of sleep by helping distract your thoughts and relax your muscles (Harmat et. al, 2008).
Ambient music
Sometimes inspired by sounds of nature, ambient music is a genre of music that can evoke calming mental images and emotions without being a distraction. As such, it may help to promote relaxation in your daily environment without distracting you from other tasks.
Classical music
Being predominantly instrumental, classical music is often thought of as sleep-inducing music. Whilst the upbeat fugues, concertos and other such options should be avoided, listening to relaxing classical compositions has been shown to promote good sleep in students and the elderly.
Audiobooks and podcasts
Of course, there are people who prefer to listen to voices, and choose audiobooks over music to relax before bedtime. Much like music to help you sleep, vocal tracks may help to quieten a racing mind and allow you to forget the day's events. We would not recommend opting for any exciting plot lines however; instead choose books that don't require too much mental effort on your part.
It must be noted, however, that one study found that listening to audiobooks for 45 minutes before bedtime did not improve sleep quality in students as significantly as classical music did. There is also the risk that, if music is left playing throughout the night, it may actually interfere with sleep by increasing the probability of arousals.
In any case, whilst music at bedtime won't help every poor sleeper, it does have a proven track record in the elderly population. Several research studies have shown that soothing music can help improve the quality of sleep in the older population by helping the onset of sleep, sleep duration and can lead to greater satisfaction with sleep. It is worth pointing out, however, that music therapy has no evidence to support the amelioration of chronic poor sleep in the long-term.
Reference:
Harmat, L., Takacs, J., Bodizs, R. (2008). Music improves sleep quality in students. Journal of Advanced Nursing, 62(3), 327-335.
Johnson, J.E. (2003). The use of music to promote sleep in older women. Journal of Community Health Nursing, 20(1), 27-35.
Lai, H.L., Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-244.
Sleep mask
Many people who are bothered by light at night find an eye mask very helpful. They can be particularly useful when traveling or if you find yourself sharing a bed with a partner who is afraid of the dark. Eye masks can also be a great tool for power nappers and shift workers who need to sleep during the day.
Fundamentally, masks will block visual stimuli, minimizing sleep disturbance caused by light. However, whilst a sleeping mask might limit light disturbance, it will not address a wide range of other potential sleep disturbances, nor the psychological causes of poor sleep.
Why use a sleeping mask?
According to the Great British Sleep Survey, 19% of those surveyed reported being disturbed by light levels before or during sleep.
Light can have a huge impact on our sleep-wake cycle as we have specialized cells in our eyes that respond to light waves and send signals back to the part of our brain which controls our body clock. It is, therefore, a good idea to keep your sleeping environment dark. Indeed, research has shown that leaving the bedroom light on during the sleep period can significantly delay the timing and peak secretion of melatonin during the night.
Exposure to darkness at night and light during the day, helps to keep our body clock on the 24-hr rhythm most of us need to live our lives. Often, it is not necessary to have a bedroom pitch-black and most good sleepers can sleep with some light coming through the curtains or under the door.
Of course there are individual differences in what people prefer, and sometimes people do prefer a very dark bedroom – our advice would be to experiment a little to see if a sleep mask can help you!
Lastly, research has shown that using a sleeping mask can improve one's sleep during a hospital stay, where one's sleep is all too easily disturbed.
Types of eye masks for sleeping
There are a whole range of eye masks available today – from the most basic fabric ones to those that can be heated or cooled. Why not try out a few and see if they could help you improve your sleep?
Reference:
Richardson, A., Allsop, M., Coghill, E., Turnock, C. (2007). Earplugs and eye masks: do they improve critical care patients' sleep? Nursing in Critical Care, 12(6), 278-286.
Melatonin and sleep
The use of melatonin as a sleep aid continues to be the subject of research studies worldwide. Findings thus far indicate that melatonin may be helpful for those suffering from disruptions to their circadian rhythm, or ‘body clock’.
What is naturally produced melatonin?
Melatonin, a hormone produced in the brain’s pineal gland, is responsible for the regulation of the body clock in each individual. Interestingly, the release of this hormone is largely controlled by exposure to natural light, or a lack thereof.
Melatonin production is first triggered in the evening, but the hormone continues to be released throughout the hours of darkness that follow (the conventional sleeping period). Levels of melatonin then drop with the breaking daylight and its production is suppressed until the next evening. Due to its dependence on a person being in a dark environment, melatonin is often referred to as the “hormone of darkness”.
It is precisely this link between darkness and melatonin, which informs advice to keep your bedroom dark and free from light-emitting electronics. Research has shown, for example, that both melatonin production and deep sleep phases are better maintained in the dark.
Melatonin and electric lighting
The introduction of electric light in the 19th century is often described as having had a negative influence on sleep. Before we had light bulbs and lamps in our homes, our circadian rhythms were dictated by natural light. People would wake with the first light of day and retire to bed early in the evening as the darkness fell.
The invention of artificial light however allowed people to make use of the evening after the sun went down. This change to our daily schedules is thought to have brought about changes in our sleep schedule, pushing our bedtime ever later.
Electric lighting continues to impact our sleep, not least because we are now free to work late into the evening and even throughout the night.
Melatonin sleep aids
Some research has suggested that melatonin supplements taken ahead of bedtime can help speed up the process of falling asleep and even improve sleep quality. There are limitations to this research however, having been conducted over a short time period. Thus far, this has prevented reliable conclusions being drawn about melatonin as a long-term solution for persistent poor sleep.
Additionally, sleep is influenced by other factors apart from melatonin production and, as with many other prescription and over-the-counter sleep aids, the benefits of melatonin supplements do not persist once people stop taking them. In the UK and parts of Europe, melatonin is licensed for those over the age of 55 with chronic insomnia, for whom it has shown evidence of sleep improvement.
Melatonin supplements are also commonly used as a “quick fix” by those who travel in an attempt to lessen the effects of jet lag. Further research is needed to establish whether melatonin supplements work any better than a placebo to minimize jet lag (Herxheimer and Petrie, 2002).
Do melatonin sleep aids have side effects?
Melatonin supplements are a relatively recent addition to the sleep aids market, having only gained popularity over the past decade or so. Research has therefore, only just begun to scratch the surface of the potential effects of melatonin, both negative and positive. It remains a future challenge therefore to answer questions such as when to take melatonin for sleep, or which melatonin dosage is best.
Melatonin is often seen as a ‘natural’ product when compared to prescription sleeping pills but this does not mean it escapes associated side-effects. So far, side-reported effects of melatonin include dizziness and headaches but long-term use of melatonin sleep aids has yet to be investigated.
Melatonin in older adults
Problems with sleep onset and maintenance in older adults are sometimes attributed to an age-related decrease in melatonin production. However, the results of research carried out to date has been mixed, meaning that further research is needed to establish whether age and melatonin production are indeed inversely proportional.
Reference:
Herxheimer, A., Petrie, K.J. (2002). Melatonin for the prevention and treatment of jet lag. Cochrane Database System Review, (2): CD001520.
Sleep solutions
One of the most striking findings of the Great British Sleep Survey 2012 was that an incredible 42% of those who reported taking sleeping pills had also had sleep problems for over a decade. This finding adds to existing clinical evidence that sleeping pills are not an effective solution for long term sleep problems. It also suggests that sleeping pills are being taken by those who, according to the UK’s National Health Service guidelines, shouldn't be – long-term poor sleepers.
Fundamentally, there are no shortcuts when it comes to improving poor sleep and it may be that you need to try a whole range of solutions before finding the one that works for you.
As far as sleeping solutions go, Cognitive Behavioral Therapy (CBT) has repeatedly been found to be the most effective intervention for poor sleep, regardless of age, gender or the severity of problem. Studies have also shown that, on the whole, patients with poor sleep prefer an approach based on the principles of Cognitive Behavioral Therapy compared with medication.
The most obvious explanation for this preference is that sleep is such a natural process that people feel they shouldn’t need to resort to pills or potions to address it. CBT represents just such a natural, long-term ‘sleep easy solution’.
A natural solution for poor sleep
Often, people looking for gentle sleep solutions prefer a cognitive-behavioral approach which, whilst requiring changes to your habits and lifestyle, does not include sleeping pills or other pharmacological aids.
CBT has been shown in numerous controlled trials to be more effective in addressing long-term insomnia than sleeping pills. Unfortunately, in the UK, sleep solutions such as CBT aren’t easily accessible due to a lack of trained therapists and the high cost of face-to-face therapy.
The Sleepio program however, is a clinically proven solution to this common and often untreated problem. The Sleepio solution acts directly on the way you think and behave in relation to sleep, training you to use techniques that address the mental factors associated with insomnia, such as the 'racing mind', and to overcome the worry and other negative emotions that accompany the experience of being unable to sleep.
In addition, CBT helps people with poor sleep establish a 'pro-sleep' routine and achieve a strong connection between bed and successful sleep, meaning that falling asleep and staying asleep in bed becomes more automatic and natural.
Pharmacological sleeping solutions
The pharmacological approach to solving sleep problems includes more than just prescription sleeping pills. Herbal remedies and supplements such as melatonin and magnesium are also available, although they are not as popular a choice.
Despite the increase in prescriptions for sleeping pills and sales of over-the-counter sleep aids, research has consistently shown that long-term sleep problems are helped most effectively by CBT.
If you are in any doubt about a specific sleeping solution, we would urge you to consult your doctor.
Sleep hypnosis
Hypnosis is a technique most-often used in psychotherapy with the intention of treating various disorders and habits. Smokers, for example, may turn to hypnosis to help themselves break the habit of smoking.
Hypnosis for sleep is sometimes thought to describe self-hypnosis, where you learn to hypnotize yourself to sleep. In fact, sleep hypnosis involves being led by a hypnotist into a state of relaxation by way of so-called ‘hypnotic induction’. In such a state people are said to be susceptible to the hypnotist’s suggestions – in this case regarding behavior and thoughts around sleep.
Much of the discussion around any supposed merits of sleep hypnosis focuses on whether it is truly able to address the psychological (influencing thoughts) and behavioral (changing habits) factors involved in the maintenance of sleep problems.
Hypnosis, sleep and Cognitive Behavioral Therapy
Despite the widespread use of hypnosis-based techniques for a variety of problems, researchers have theorized that hypnosis for sleep may only be effective when integrated within a broader cognitive-behavioral approach (Morin et al., 2006).
There is, however, no clinical evidence which would confirm that hypnosis can improve sleep, whether on its own or in combination with Cognitive Behavioral Therapy. The latter would be particularly difficult to determine as CBT employs a wide range of techniques, meaning that it would be difficult to attribute any improvements to hypnosis exclusively.
The Sleepio course, which is based on cognitive and behavioral strategies, incorporates the most effective of these, evidence-based techniques, including imagery and autogenic training which share some of the characteristics of hypnosis.
Self hypnosis for sleep
As with many face-to-face therapies, most people would struggle to access hypnosis, particularly when they are struggling to get back to sleep in the middle of the night! The benefit of cognitive-behavioral techniques however is that, once learnt, individuals can put them into practice anywhere and at any time.
People may also find the relaxation audio tracks included within many cognitive-behavioral approaches a good alternative to sleep hypnosis MP3 downloads. These relaxation tracks can be particularly useful when learning new techniques.
Reference:
Morin, C.M., Bootzin, R.R., Buysse, D.J., Edinger, J.D., Espie, C.A., Lichstein, K.L. (2006). Psychological and behavioural treatment of insomnia: update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414.
Mirtazapine and sleep
Mirtazapine is an antidepressant drug prescribed to treat Major Depressive Disorder, Obsessive Compulsive Disorder and a range of anxiety disorders. Alongside these, it may be prescribed ‘off-label’ to people experiencing prolonged periods of poor sleep.
Does mirtazapine help you sleep?
Research has shown that Mirtazapine, taken at bedtime, to have a positive impact on insomnia symptoms in people with clinical depression. It has also been shown to improve the percentage of time in bed spent asleep, decrease nighttime awakenings and increase total time spent asleep (Winokur et al., 2000, Schittecatte et al., 2003).
Taking mirtazapine for sleep
People with depression are often seen to experience increased REM sleep density and reduced latency to REM sleep. This, in turn, reduces the amount of time spent in the stages of slow-wave sleep, impacting negatively on sleep quality. The majority of antidepressants therefore, work to suppress REM sleep, and normalize these sleep parameters.
Mirtazapine however, is one in a line of antidepressant drugs that only modestly suppress REM sleep (Aslan et al., 2002) whilst still having a beneficial impact on sleep continuity and duration due to its anti-histaminergic effects. This has led to the drug being prescribed to people who do not suffer from depression but do have insomnia.
Mirtazapine’s sedative effects may help lessen the hyperarousal which prevents people getting to sleep, whilst increasing the stages of slow-wave, restorative sleep (Aslan et al., 2002).
Side effects of Mirtazapine
As with all antidepressants, there are certain side effects associated with Mirtazapine use. These include weight gain and, because the drug remains in one’s system throughout the course of the day, a person might also experience drowsiness.
Less common side-effects include producing or exacerbating periodic leg movements in young healthy men which may affect their sleep quality, although this side-effect has only been reported in a recent, small-sample study (Fulda et al., 2013).
Unfortunately, one known symptom of Mirtazapine withdrawal is insomnia. So, whilst Mirtazapine may help you sleep when you are taking it regularly, changing the dose or stopping the medication altogether may again have a negative effect on your sleep.
You should always consult your doctor for advice on medication – starting, changing or finishing a course of medication can have serious effects. Ensure that you consult your GP if you have any questions on this.
References:
Aslan, S., Isik, E., Cosar, B. (2002). The effects of mirtazapine on sleep: a placebo controlled, double-blind study in young healthy volunteers. Sleep, 25(6), 666-668.
Fulda, S., Kloiber, S., Dose, T., Lucae, S., Holsboer, F., Schaaf, L., Hennings, J. (2013). Mirtazapine provokes periodic leg movements during sleep in young healthy men. Sleep, 36(5), 661-669.
Winokur, A., Sateia, M.J., Hayes, J.B., Bayles-Dazet, W., MacDonald, M.M., Gary, K.A. (2000). Acute effects of mirtazapine on sleep continuity and sleep architecture in depressed patients: a pilot study. Biological Psychiatry, 48(1), 75-78.
Schittecatte, M., Dumont, F., Machowski, R., Cornil, C., Lavergne, F., Wilmotte, J. (2003). Effects of mirtazapine on sleep polygraphic variables in major depression. Neuropsychobiology, 46(4), 197-201.
Sleep apps
The latest statistics from Pew Research Center suggest that around 7 in 10 adults in the U.S. track at least one health 'indicator', such as sleep (Fox and Duggan, 2012).
Half of this group monitor their health, simply by keeping track in their heads, but 1 in 5 use some form of technology to do so. This might include anything from a simple spread sheet on your computer, to mobile phone apps and tracking devices such as Jawbone's UP band or BodyMedia's FIT band.
As the technology which drives these apps continues to advance, and access to smartphones rapidly increases, it is likely that very soon our personal devices will automatically track the steps we take, the calories we burn and the time we spend sleeping.
Android and iPhone sleep apps
Modern smartphones include devices called 'accelerometers', which measure movement. These are used, for example, to detect the phone's orientation to switch the screen between 'portrait' and 'landscape' modes.
Sleep recording apps use this same technology to monitor your movement throughout the night, gathering information about how long you slept and how many times you woke up, based on how much you moved.
Many sleep apps also feature a 'smart alarm'. Most often, these are intended to wake you up within a window of 'lighter' sleep, in order to minimize 'sleep inertia', the period after waking in which you may feel groggy and disorientated as you transition into wakefulness.
It is important to note however, that there are many factors that can affect how you feel on waking, and that the majority of mobile phone sleep apps have little to no clinical evidence behind them.
Wearable devices with sleep tracking
There is a wide range of wearable self-tracking devices available, many of which offer sleep tracking.
The devices are usually worn on your wrist or attached to clothing, and sync with mobile and/or web-based applications, which allow you to view the data these devices collect.
The majority of wearable devices use accelerometers, similar to those used in mobile phones, to track movement. Some also feature additional technology to track factors such as temperature, heart rate and skin conductance (galvanic skin response).
Traditional sleep monitoring
Sleep monitoring is usually carried out by experienced technicians, in sleep laboratories or sleep centers. A number of physiological parameters are assessed in this laboratory context.
Electrical activity in the brain is measured by electroencephalography (EEG), which is used to differentiate between wakefulness, sleep, and different stages of sleep.
Muscle activity is measured using electromyography (EMG), because muscle tone also differs between wakefulness and sleep.
Lastly, eye movements during sleep are measured using electro-oculography (EOG). This is a very specific measurement that helps to identify Rapid Eye Movement or REM sleep, during which we often dream.
This multi-assessment protocol is usually called polysomnography (PSG), and it remains the only clinically reliable sleep tracking tool. Despite this, the simpler tracking offered by devices and sleep recording apps can still help give people a better understanding of their sleep.
A recent study even suggested that some sleep tracking devices, which have the ability to record electrical brain activity relatively unobtrusively, may be “an accurate complement” to existing sleep measuring apparatus, such as the polysomnogram (Shambroom et al., 2012).
References:
Fox, S. & Duggan, M. (2012). Report: tracking for health. Pew Research Center. http://www.pewinternet.org/Reports/2013/Tracking-for-Health.aspx
Shambroom, J.R., Fabregas, S.E., Johnstone, J. (2012). Validation of an automated wireless system to monitor sleep in healthy adults. Journal of Sleep Research, 21(2), 221-230.