Mr. R’s Struggle for the Perfect 8-Hour Sleep

Thirty-year-old Mr. R constantly worries about not getting a full eight hours of sleep. According to his smartwatch, his average sleep duration is 7 hours and 45 minutes.

To meet his sleep goals, Mr. R starts preparing for bed at 5:30 PM after work and wakes up at 6:00 AM. On days when he doesn’t get the full eight hours, he feels tired, irritable, and unfocused. He hopes his doctor can help him achieve his ultimate goal: “eight hours of deep sleep every night” (though he may not realize that deep sleep only constitutes 15–25% of total sleep for adults).

After diagnosis, doctors concluded that Mr. R suffers from “orthosomnia.”

Chasing Perfect Sleep

The term orthosomnia was first coined in 2017 by Kelly Glazer Baron and her team at Rush University Medical Center. It describes individuals who become overly focused on sleep tracking data and obsessively try to improve or achieve "perfect" results.

The word is derived from orthorexia, which refers to an excessive preoccupation with healthy eating, such as spending excessive time preparing meals or feeling guilty after consuming foods considered unhealthy.

Baron’s team reported three such cases of orthosomnia, one of which was Mr. R. While Mr. R’s sleep issues were partly due to poor habits, such as using his phone for work before bed, his obsession with sleep duration exacerbated his symptoms. The other two patients in the report had already resolved their sleep problems, but anxiety caused by smartwatch data brought them back to the doctor.

Even more concerning was that all three patients extended their time in bed in an effort to “perfect” their sleep data. Ironically, this worsened their sleep issues, as lying awake in bed for too long can increase anxiety. Doctors generally recommend getting out of bed and engaging in relaxing activities if unable to sleep within 30 minutes.

The report warned that wearable devices tend to overestimate sleep duration, potentially encouraging users to extend time in bed, reinforcing bad sleep habits. The growing popularity of these devices may lead to an increase in such cases.

Can You Trust Your Data or Yourself?

Can a small smartwatch really have such a big impact? Wouldn’t we already know if we slept poorly? Surprisingly, our perception of sleep quality may not always be accurate. Research shows that fake sleep reports can influence how we feel the next day.

A 2018 study published in the Journal of Sleep Research by Dimitri Gavriloff and colleagues at Oxford University tested this idea. They recruited 63 participants diagnosed with insomnia and randomly assigned them to a “high sleep quality” group or a “low sleep quality” group. The researchers pretended to monitor their sleep using a fitness tracker and provided fake reports each morning. They then asked participants about their feelings throughout the day and had them complete attention and alertness tests.

The results revealed that participants who were told they slept poorly felt more fatigued, had lower moods, and experienced greater daytime drowsiness, even though their actual sleep quality was the same as those in the “high sleep quality” group.

This suggests that sleep tracking data can shape how we perceive our bodies. But how accurate is this data?

How Accurate Are Wearable Sleep Trackers?

Accurate sleep assessment requires extensive data.

The gold standard for diagnosing sleep disorders is polysomnography (PSG), which monitors brainwaves, blood oxygen levels, heart rate, breathing, and body movements. However, PSG requires specialized equipment, making it impractical for home use.

In contrast, wearable devices primarily use actigraphy, which tracks wrist movements, and sometimes combines this with heart rate data to estimate sleep duration and efficiency (the percentage of time spent asleep while in bed). However, these devices struggle to differentiate sleep stages, as those are determined by brainwave patterns, not physical activity.

Since the algorithms behind wearable sleep trackers are proprietary, researchers and doctors can’t fully assess their accuracy. However, studies suggest many devices struggle to distinguish between wakefulness and sleep. For instance, insomnia patients often remain still while trying to fall asleep, which trackers may misinterpret as sleep. Conversely, conditions like restless leg syndrome or sleepwalking can cause trackers to mislabel sleep as wakefulness.

Interestingly, trackers tend to perform better for healthy individuals with “normal” sleep patterns. A study by Zhang Jun’s team at Peking University People’s Hospital found that wrist-based trackers were more accurate for younger, healthy participants with standard sleep patterns. They also noted that using a low-sensitivity mode improved accuracy.

Stop Tracking, Start Sleeping

As wearable technology evolves, its accuracy will undoubtedly improve. However, this raises another question: do we really need so much data?

From a public health perspective, wearable devices are groundbreaking. They offer a cost-effective alternative to PSG, enable large-scale sleep data collection, and help people monitor their activity levels or detect anomalies like irregular heart rates.

But for individuals, over-focusing on health data can lead to anxiety and depression. This has been well-documented: people may misinterpret normal data fluctuations, worry unnecessarily, and invest excessive energy seeking medical solutions. Sleep, in particular, is closely tied to emotions—anyone who has experienced insomnia knows the frustrating cycle of “the harder you try, the more awake you feel.”

If you’re feeling stressed about your sleep data, take a step back and consider:

• Did you start tracking because your sleep was poor, or did you “discover” poor sleep after starting to track it?
• What changes has this data prompted you to make? Were these changes positive (e.g., avoiding late nights, seeking medical help) or negative (e.g., increased anxiety, worsened insomnia)?

Hopefully, these questions will help you better understand what sleep tracking is bringing to your life.

While more people now recognize the importance of sleep health, we still have fewer tools and methods to address it compared to weight loss or fitness. Wearables like smartwatches can have a positive impact if used correctly, but remember: the goal of tracking sleep data is to sleep better. If you’re working hard just to “game” the data, you might be missing the point.