Are sleep trackers making your insomnia worse?

For some people, possibly. Sleep clinicians have described patients whose worry about their tracker score became part of the problem, and a controlled experiment showed that a low sleep score alone can worsen how people with insomnia feel the next day, even when the score is made up. ^[1][2] The evidence is limited, and no trial shows that trackers cause insomnia.

What the research says

The evidence is suggestive, not settled. Sleep clinicians have described a growing number of patients arriving with self-diagnosed sleep problems based on light or restless sleep on a tracker, in what the authors call a "perfectionistic quest for the ideal sleep". ^[1] The key experiment is small: 63 people with insomnia disorder wore a wrist device and were randomly told that their sleep had been good or bad, when the feedback was invented. Those given bad news (32 people) reported worse alert thinking (effect size d = 0.79) and more evening sleepiness and fatigue (d = 0.55), though reaction-time performance and attention to sleep-related cues did not differ. ^[2] Two related findings fit: people with insomnia often report much less sleep than recordings show, a gap with little research into its causes or treatment, ^[3] and watching a clock while trying to sleep raised pre-sleep worry and overestimates of time taken to fall asleep. ^[4] In plain terms, a number about your sleep can change how you feel, separately from how you actually slept.

The studies behind this

• Orthosomnia (Baron, 2017): a clinical report describing a growing number of patients seeking treatment for self-diagnosed sleep problems based on light or restless sleep seen on their trackers. The authors describe a "perfectionistic quest for the ideal sleep", and note that tracker data often feels more consistent with patients' experience than validated measures do. ^[1]
• Sham feedback experiment (Gavriloff, 2018): 63 people meeting criteria for insomnia disorder wore a wrist device and were randomly given either positive or negative next-day feedback about their sleep. It was made up. The negative group (32 people) reported worse alert thinking (effect size d = 0.79) and more sleepiness and fatigue (d = 0.55) in the evening. Reaction-time performance and attention to sleep-related cues did not differ. ^[2]
• Sleep misperception (Rezaie, 2018): people with insomnia often report much less sleep than overnight recordings show, and the gap is larger than in other insomnia subtypes. The authors note little research on its causes or treatment. ^[3]
• Clock monitoring (Tang, 2007): in experiments, watching a clock while trying to sleep increased pre-sleep worry and overestimation of time taken to fall asleep. ^[4]

Why might a sleep score backfire?

The cognitive model of insomnia proposes that worry about sleep raises arousal and directs attention to signs of poor sleep, leading to overestimating the deficit. ^[5] A nightly number is an easy target for that attention. The Gavriloff experiment is consistent with this: the score changed how people felt, independent of how they actually slept. ^[2] The clock experiments point the same way, ^[4] and we go into them in what to do when you cannot sleep.

The idea that a score can backfire is our interpretation of experimental and clinical findings. It is not proof that your device is harming you.

Are trackers accurate?

We did not find a device-level accuracy comparison that we could verify for this article, so we do not give numbers. The Baron report notes that clinicians face a balancing act between explaining what these devices can and cannot validly measure and respecting patients' enthusiasm for data. ^[1] The European insomnia guideline does not recommend actigraphy (wrist-worn movement monitoring) for routine evaluation of insomnia, and relies on interview, questionnaires and sleep diaries, with overnight studies for suspected other disorders. ^[6]

How to use a tracker without letting it use you

These are suggestions based on the findings above, not tested rules.

• Ask what you get from the number. If checking leaves you more anxious, that is useful information. ^[1][2]
• Notice mismatches. If you feel fine and the score says otherwise, the European guideline assesses insomnia through interview, questionnaires and diaries rather than tracker scores. ^[6]
• Consider a break. Whether stopping tracking helps has not been tested in a trial we could find. A clinician may suggest one as part of CBT-I; the Baron authors say that working trackers into CBT-I will be important as their use spreads. ^[1]
• Do not self-diagnose from a score. Light or restless sleep on a tracker is not the same as insomnia disorder, ^[1] and some waking at night is normal.

When should you talk to a doctor?

• Sleep difficulty lasting months, with daytime effects.
• Loud snoring, breathing pauses or other symptoms of a different sleep disorder. ^[6]
• Anxiety about sleep that is spreading into the rest of life.

Where the evidence is thin

• Baron et al. is a clinical report, not a trial. ^[1]
• Gavriloff tested one night of feedback in 63 people. Long-term effects of wearing a tracker are unknown to us. ^[2]
• Effects on people without insomnia, and between different devices, were not examined in the sources we cited.

CBT-I treats the worry and habits that keep insomnia going, and does not depend on a device. Small Hours is built around a simple nightly diary. You can sign up at trysmallhours.com.

General education, not medical advice.