I personally believe that one single night of a sleep study is not enough data to understand how someone's sleep patterns are, whether that's a home test, hooked up to a sleep watch, a loaned out...
I personally believe that one single night of a sleep study is not enough data to understand how someone's sleep patterns are, whether that's a home test, hooked up to a sleep watch, a loaned out sleep kit, or at a clinic being monitored. Not every night is the same, especially for AFAB people whose hormones fluctuate throughout the day, let alone nightly or daily. What part of a cycle you're on can drastically change how your sleep is.
I took two at home sleep studies 4 years apart with the exact same equipment and got drastically different results. The only differences between the two times were 1. me (I am female, and aged 4 years from that point) and 2. I added a few more medications to my nightly list, none of which should disrupt sleep or change my sleep patterns. Neither test was really conclusive either, and my doctors essentially threw out the results of both tests.
I know my own data is anecdotal. I still firmly believe it, unless someone can show me data to disprove it.
As a trans woman - I can also verify you are absolutely correct. Not only is the field medicine heavily tailored towards cis male bodies[1] - sometimes even for things concerning women's health -...
Exemplary
Not every night is the same, especially for AFAB people whose hormones fluctuate throughout the day, let alone nightly or daily. What part of a cycle you're on can drastically change how your sleep is.
As a trans woman - I can also verify you are absolutely correct. Not only is the field medicine heavily tailored towards cis male bodies[1] - sometimes even for things concerning women's health - but, absolutely, I can confirm first-hand how different hormone levels and their fluctuations have affected my sleep patterns - especially in the case of progesterone[2] which is naturally metabolised by the body into neurosteroids like allopregnanolone[3] , which have shown direct correlation with sleep quality among other effects.
Myself, I have observed very noticeable and highly repeatable differences between my sleep quality and sleep patterns in the four distinct stages I've myself experienced: an androgen-dominant endocrinal system; a post-menopausal-like endocrinal system; an estrogen-dominant endocrinal system, and an estrogen+progesterone-dominant endocrinal system. In case #1, my sleep was overwhelmingly light, stable, often lacked dreams, and - if I woke up - I found it easy to fall back asleep easily. In case #2, my sleep was shit in all regards. In case #3, my sleep was deeper (albeit shorter) and more restful than case #1, and with very real-feeling dreams, but I found it really hard to fall back asleep again if I woke up. In case #4, my sleep quality is the best it's been, because it gives me all the benefits of #3 without any of the negative parts of #3.
But also, hell - [most] AFAB women's bodies go through a lot every month. Although it's something I will sadly never get to experience myself[ᵃ], y'all know how harsh menstruation can be on your bodies both physically and mentally, even if the experience differs a lot from person to person. If that wouldn't affect your sleep, what would‽
You're welcome! And, hey, I genuinely don't mind any negativities in sleep patterns in my "preferred" endocrinal states; life without the "correct" sex hormone(s) was no life at all. For whatever...
For whatever it's worth, each and every one of my (surprisingly many) cis friends diagnosed with severe polycystic ovary syndrome has more or less felt the same, even prior to their official diagnosis and/or medication.
Sleep post-menopause is actually an interesting ride for me. I wake up at 2 or 3 a.m. regularly, read for an hour, and fall asleep again for a couple of hours. Average total sleep time is still...
Sleep post-menopause is actually an interesting ride for me. I wake up at 2 or 3 a.m. regularly, read for an hour, and fall asleep again for a couple of hours. Average total sleep time is still 6.5 to 7 hours as before, it just takes more time in bed and completely messes with sleep tracking.
For me, at least my perception, the real thing that sleep studies are good for is determining if apnea is an issue. And that's something that could certainly be figured out in one study,...
For me, at least my perception, the real thing that sleep studies are good for is determining if apnea is an issue. And that's something that could certainly be figured out in one study, potentially at least. But it's possible that's more variable than I'm aware of?
For me the take-home test was to check for the possibility of sleep apnea. After it showed negative, then I went in for the overnight sleep test with the multiple sleep latency test the next day....
For me the take-home test was to check for the possibility of sleep apnea. After it showed negative, then I went in for the overnight sleep test with the multiple sleep latency test the next day. That ruled out narcolepsy type 1 and 2 but I was given the diagnosis of idiopathic hypersomnia. In the MSLT's 5 nap sessions I fell asleep quickly enough each time but never hit the REM stage. Even though it was assumed that apnea wasn't the issue they still had to rule it out with the take-home test.
Got it, yeah the rest sounds so much more complex that I can see it being particularly silly to try to diagnose it with a single night. I was going to make a somewhat bitter joke about being told...
Got it, yeah the rest sounds so much more complex that I can see it being particularly silly to try to diagnose it with a single night.
I was going to make a somewhat bitter joke about being told to lose weight by a doctor rather than getting treated for the actual problem but then I remembered I was talking about apnea and I sighed.
Could be, I thought the "not breathing" part was more likely to be an obvious binary yes/no, where the "cause of poor sleep" might be far more complex? But I'm not a doctor
Could be, I thought the "not breathing" part was more likely to be an obvious binary yes/no, where the "cause of poor sleep" might be far more complex?
Yeah, as a lifelong insomniac, I was hopeful when my family got me a Fitbit to track my sleep. However, after many miserable nights and Fitbit congratulating me on said night of sleep, I lost...
Yeah, as a lifelong insomniac, I was hopeful when my family got me a Fitbit to track my sleep. However, after many miserable nights and Fitbit congratulating me on said night of sleep, I lost trust in a lot of the easy tests.
I still do need to at least try the official test. Maybe it will help, only time will tell. But I haven't had the money or time recently to look into it.
For any body measurement, I think the most important question to ask is: what is the natural human sensation for this measurement, when can the reading from the device and human feeling diverge,...
For any body measurement, I think the most important question to ask is: what is the natural human sensation for this measurement, when can the reading from the device and human feeling diverge, and is that a useful signal?
For sleep, I don't think we have studies indicating it is. We all have some sense of how well we slept. When you wake up and feel like dying, that's pretty obvious not good. So the two scenarios at play are
You feel great in the morning, but your fitness/sleep tracker says you slept poorly.
You feel awful in the morning, but your fitness/sleep tracker says you slept well
I don't think there's much science for either case being particularly useful. For 2), most of the ways we tell if we slept well or not are pretty practical. Who cares if your apple watch says you slept well if you have a terrible migraine?
For 1), I don't think there's any scientific evidence that there are circumstances where your watch knows better than you do, that there are circumstances where you feel sharp but you are actually suffering in some unknown way that your sleep tracking is helping you with.
As a result, I think just noting down your subjective feeling every morning is perhaps a more useful exercise if you're trying to adjust your sleep schedule.
To contrast with some "good" uses of metrics, resting heartrate is one. We just don't have a good sense of our resting heartrate. If it's 50 or 90, is going to feel the same to people. If it's 90 you probably need to do more cardio, though.
Fever temperature is another one. We can feel when we are sick, but it is difficult to give it an objective level in the same way body temperature measurements do. This is useful to tell if the fever is worsening or abiding.
This is my problem with the "body battery" Garmin recently added. My watch isn't compatible thankfully, but my wife's is and she's constantly going on about how it says her body battery is low but...
This is my problem with the "body battery" Garmin recently added. My watch isn't compatible thankfully, but my wife's is and she's constantly going on about how it says her body battery is low but I ask her how she feels and usually she feels just fine. But for some reason she wants to believe the Garmin knows something she doesn't or it's tracking a trend she can't see, etc. It just feels more gimmicky to me than anything and I don't know that I trust it.
I also don't really trust my sleep tracker because I know I have sleep issues and it will often state I had a great 8 hours of sleep when in reality I know I was awake for 3 of those hours. Other times it will do the opposite.
Garmin is great at location services. Now that I've had a Garmin watch for a year and a half, I can say anecdotally that they suck at calorie calculating (like to an embarrassing degree, depending...
Garmin is great at location services. Now that I've had a Garmin watch for a year and a half, I can say anecdotally that they suck at calorie calculating (like to an embarrassing degree, depending on the activity), the body battery thing, and sleep tracking. It definitely can't tell if I'm awake or asleep if I'm reading near bedtime, for example.
Garmin seems to do pretty okay with heart rate, though. I was tachycardic when I was sick recently and didn't really think about it (my resting heart rate is normally 60-70; it was 120-130 those days). I went to urgent care and they sent me to the ER to get my fever broken to slow down my heart (and get every test on planet earth). After the ordeal, I went into my Garmin's history, and it had been logging it all pretty accurately, based on what the monitors said. I was just too sick to realize.
My experience mirrors yours - though my device is going on 8 years now and the heart rate tracking is showing its age. In the winter it will often get stuck at 140bpm during a run - slowing down...
My experience mirrors yours - though my device is going on 8 years now and the heart rate tracking is showing its age. In the winter it will often get stuck at 140bpm during a run - slowing down or speeding up doesn't change it at all, only stopping will actually see a change. It also doesn't correctly register the beginning of a run, showing a near 50bpm instant increase, sustained for 2 minutes, then drops down to 75bpm. Seems like a software problem that probably won't be addressed due to its age.
When I got COVID a few years ago, my resting heart rate was about 15-20bpm above average even a day before I started showing symptoms and carried through the week. So at least that worked well.
All in all, I've been quite happy with it - 8 years is a long time in today's quick fashion and vapid tech world.
I've been happy with Apple's offering for ~3 years. The Apple Watch, paired with the third party Auto Sleep app, never has false positives when I'm awake and seems accurate enough with tracking...
I've been happy with Apple's offering for ~3 years. The Apple Watch, paired with the third party Auto Sleep app, never has false positives when I'm awake and seems accurate enough with tracking sleep. Heart rate and blood oxygen always seem to line up when I have visits to doctors.
It's also caught anomalies for me. Like when I was taking a medication for a few weeks that had a side effect of lowering my blood pressure, I had a beer without thinking about it while sitting at a movie theater. It caught that my heart rate was abnormally high at rest and notified me.
The ambient noise monitoring is also an essential for me now too.
Newer models have an actual feature designed to detect trends that may indicate apnea and alert you, but I don't have any experience with that. (My issues, anyway, are more with falling asleep in the first place and sounds waking me up easily.)
I think it really depends on the person. Two of my friends told me about their Garmin watch, one was going through quite bad covid (needed hospitalisation and oxygen in the end, pre vaccination)...
my wife's is and she's constantly going on about how it says her body battery is low but I ask her how she feels and usually she feels just fine
I think it really depends on the person. Two of my friends told me about their Garmin watch, one was going through quite bad covid (needed hospitalisation and oxygen in the end, pre vaccination) and told me how the body battery was accurately tracking the gradual worsening of his symptoms. That's easy though, because it was a severe situation. Other friend told me her watch tells her "you might be coming down with an illness" based on I guess slightly higher resting heart rate, slight changes in temperature and possibly other things, and it's usually accurate. This sounds like a killer feature because any accessible interventions against viral illnesses only work well when used as soon as possible, in an ideal situation before any symptoms even start.
Perhaps if it's like that long term, but when my resting heart rate changed from 60 to 90 due to a chronic illness it was one of the first things I noticed. It didn't feel terrible overall, but I...
We just don't have a good sense of our resting heartrate. If it's 50 or 90, is going to feel the same to people.
Perhaps if it's like that long term, but when my resting heart rate changed from 60 to 90 due to a chronic illness it was one of the first things I noticed. It didn't feel terrible overall, but I did almost immediately think "huh, my heart rate shouldn't be this high when I'm sitting down."
I don't know about the specific "body battery" mentioned in these comments, but I do want to address one comment you made There's a lot of evidence out there that HRV (heart rate variability) is a...
I don't know about the specific "body battery" mentioned in these comments, but I do want to address one comment you made
I don't think there's any scientific evidence that there are circumstances where your watch knows better than you do
There's a lot of evidence out there that HRV (heart rate variability) is a high quality indicator on immediate short term health. We've been using it in competitive sports training for quite some time to tailor when to push and when to rest, but it can surprisingly accurately predict when someone is under stress for other reasons, such as when one is beginning to get sick. HRV often isn't a thing people are actively aware of and it's absolutely something that devices like halter straps and watches and smart rings can monitor and measure. It's a general measurement of bodily stress, however, and isn't a silver bullet of any sort - but if you're feeling well otherwise and went out the night before, it could let you know to rest to avoid getting sick. Or if you pushed yourself on a workout the day before, or have an impending stressful deadline, it can also be a signal to take it easy so you don't invite illness with a weakened immune system.
HRV is just about the only thing I pay attention to on my sleep tracking device (and with previous activity tracking devices) and I've anecdotally found it quite useful to stave off illness.
My sleep tracker (smart ring) is pretty accurate in how it tracks my sleep, but in general, I usually sleep pretty well, so it's not actually that useful. On the nights when I don't sleep well,...
My sleep tracker (smart ring) is pretty accurate in how it tracks my sleep, but in general, I usually sleep pretty well, so it's not actually that useful.
On the nights when I don't sleep well, it's interesting to look at why it thinks I didn't sleep well. Usually it's either because I ate/exercised/drank alcohol too close to bedtime, or because I was sick, or because I had a newborn and woke up a lot. Each of these things were expressed with different parameters (respectively: heart rate, body temperature, and wake ups). It does occasionally tell me I'm sick about a day before I'm aware of it, and while that's interesting, it's not particularly useful or actionable.
Ultimately, it's not that useful for sleep tracking, because I could easily figure these things out on my own. Mostly I just use it as an easy way to track the data. When my ring battery eventually degrades too much, I probably won't replace it.
There are OTC antiviral medications that work against respiratory viruses, but their one downside is that you have to take them asap, in an ideal world before you get any symptoms, because with...
It does occasionally tell me I'm sick about a day before I'm aware of it, and while that's interesting, it's not particularly useful or actionable.
There are OTC antiviral medications that work against respiratory viruses, but their one downside is that you have to take them asap, in an ideal world before you get any symptoms, because with viral illnesses at the moment when you get first symptoms the virus is already widely multiplied, it's just the immune response that's delayed. Taking them a day early would likely significantly increase the chance of avoiding the illness completely.
The ones I know off:
Life Extension Enhanced Zinc Lozenges: specific forms of zinc lozenges block replication of various rhinoviruses and coronaviruses that cause common cold. Not effective against covid I don't think. Only works as a lozenge (which creates a high concentration locally), standard zinc pills have zero effect of this type.
VirX nasal spray: currently not available in most places, but it works against the flu and covid as well.
Antihistamine nasal sprays based on Azelastine: recently confirmed to have broad antiviral effects, widely available, known to be safe and well tolerated since it's an off-label use of a popular medication
I don't have the name right now, but nasal sprays based on a compound isolated from a specific type of seaweed, which kills viruses and also creates a protective layer in your nasal passage that reduces the chance of getting ill. That one is relatively cheap and available as well.
Interesting. As a smart watch and ring user I wonder if it might be worth it to keep some of these on hand to enable a swift response. The main concern would probably be with the shelf life of the...
Interesting. As a smart watch and ring user I wonder if it might be worth it to keep some of these on hand to enable a swift response. The main concern would probably be with the shelf life of the products.
Azelastine spray that I'm using has a year long shelf life before it's opened and since it costs about 8€ here, that seems fine. Zinc lozenges iirc last longer, but those are not ideal (they don't...
Azelastine spray that I'm using has a year long shelf life before it's opened and since it costs about 8€ here, that seems fine. Zinc lozenges iirc last longer, but those are not ideal (they don't work for covid and they're just less pleasant to use). I think the spray made of seaweed may work better than azelastine, but I have no further information on that (specific efficacy or shelf life), you'd have to look it up yourself.
That's interesting. I didn't know anti-virals had gotten to that point that they could be used almost preemptively. I'll need to investigate this further, but my first quick look has found a...
That's interesting. I didn't know anti-virals had gotten to that point that they could be used almost preemptively.
I'll need to investigate this further, but my first quick look has found a surprising lack of side effects, which is actually kinda worrying, because if they're that safe and effective, I'd assume everyone would know about them already.
This is actually the easiest way. I have no formal education in medicine, but I believe one of the reasons why antivirals are so difficult to do is that we're mostly interested in ones that are...
I didn't know anti-virals had gotten to that point that they could be used almost preemptively.
This is actually the easiest way. I have no formal education in medicine, but I believe one of the reasons why antivirals are so difficult to do is that we're mostly interested in ones that are useful for severe illness, but at that late stage several things are happening at once and just killing the virus (which is quite difficult on its own with oral medication) does not help that much.
Killing viruses locally is much easier, but it only works as prevention or before the illness develops fully. Azelastine was tested specifically as a prevention (that people continued to use if they did get sick, it shortened the illness). And the zinc lozenges, when used after you start feeling sick, do not remove the symptoms, but they basically freeze them. Instead of a fully developed cold (which for me is normally sore throat -> runny nose + sinus pain -> coughing -> end) I got 3 days of the symptoms I already had before I started taking it.
One "side effect" that happened to me with zinc and VirX, so it may be common to all of them, is that when I used them to successfully stop an illness, I had to still stay calm and relax as if I was sick for about 3-4 days, otherwise I felt really tired (as if partially sick) for more than a week. No full illness though.
If you measure a single variable, it should be SpO2, a.k.a. Peripheral oxygen saturation. Easy, non-invasive, tells you if you stop breathing. Other conditions are quite more involved to measure....
If you measure a single variable, it should be SpO2, a.k.a. Peripheral oxygen saturation. Easy, non-invasive, tells you if you stop breathing.
Other conditions are quite more involved to measure. But a lot of people suffer from apnea. It would be cool if they knew.
I suppose this is something that needs to be said out loud at least once, but I figured as much when they announced it. And the last week or so has proven that intuition to be true. I'll get a...
I suppose this is something that needs to be said out loud at least once, but I figured as much when they announced it. And the last week or so has proven that intuition to be true. I'll get a score of 92 and feel lousy that day. But then I can get a score of 94 and feel great. Clearly, there are a lot of factors at play and the scoring of the three categories makes a lot of assumptions.
But for a quick glance at whether my bedtime is regular, the duration of recorded sleep, etc., it's fine. Taking it as anything other than an extremely rough metric is ludicrous.
Going along with the article's theme that it's hard to evaluate sleep quality, I'm pretty sure that how you feel in the morning is also sometimes not the best indicator of how well you slept on a...
Going along with the article's theme that it's hard to evaluate sleep quality, I'm pretty sure that how you feel in the morning is also sometimes not the best indicator of how well you slept on a given night.
I've noticed that when the amount of sleep I get is irregular, I'll often feel fine the morning after not getting enough sleep. Then the following morning after getting more sleep, I'll feel terrible. So it seems that it sometimes takes a day to feel the bad effects from missing sleep. If that's the case, if I'm getting ~7 hours a night and I feel tired some morning, I wonder if it's because I didn't sleep well that night, if I didn't sleep well on the previous night, or if I'm systematically getting mildly bad sleep over the past week that's slowly catching up to me. On the other hand, sometimes I don't get enough sleep and feel it right away.
Anyway, I've found that I sleep poorly when I have a bulky watch on my wrist, so there goes sleep tracking for me. I've thought about trying a ring, but those don't have the best reviews in terms of accuracy or consistency.
I’ve had no problems sleeping while wearing an Apple Watch. I usually know whether I’ve had a good night’s sleep or not, too. The number is just a glanceable in the morning. I either think “I do...
I’ve had no problems sleeping while wearing an Apple Watch. I usually know whether I’ve had a good night’s sleep or not, too. The number is just a glanceable in the morning. I either think “I do feel rested” or “Well that’s funny” when I look at the score. With the occasional “That seems right” when the score reflects how awful I feel.
My situation is such that I know my sleep is temporarily lousy, and as a result I rarely have delayed effects of bad sleep, i.e., I feel lousy most days. What I do like seeing is the sleep chart that shows roughly what sleep stages I was in and when.
But to the main point, someone that actually requires a real evaluation of their sleep probably shouldn’t rely on a consumer device that has no approvals for diagnostic sleep tracking. That tracks pretty easily.
I used to wear more than one ring, but smart rings have held zero allure for me. While I’ve not looked into it, I do wonder if there are slimmer single purpose devices for tracking sleep.
I personally believe that one single night of a sleep study is not enough data to understand how someone's sleep patterns are, whether that's a home test, hooked up to a sleep watch, a loaned out sleep kit, or at a clinic being monitored. Not every night is the same, especially for AFAB people whose hormones fluctuate throughout the day, let alone nightly or daily. What part of a cycle you're on can drastically change how your sleep is.
I took two at home sleep studies 4 years apart with the exact same equipment and got drastically different results. The only differences between the two times were 1. me (I am female, and aged 4 years from that point) and 2. I added a few more medications to my nightly list, none of which should disrupt sleep or change my sleep patterns. Neither test was really conclusive either, and my doctors essentially threw out the results of both tests.
I know my own data is anecdotal. I still firmly believe it, unless someone can show me data to disprove it.
As a trans woman - I can also verify you are absolutely correct. Not only is the field medicine heavily tailored towards cis male bodies[1] - sometimes even for things concerning women's health - but, absolutely, I can confirm first-hand how different hormone levels and their fluctuations have affected my sleep patterns - especially in the case of progesterone[2] which is naturally metabolised by the body into neurosteroids like allopregnanolone[3] , which have shown direct correlation with sleep quality among other effects.
Myself, I have observed very noticeable and highly repeatable differences between my sleep quality and sleep patterns in the four distinct stages I've myself experienced: an androgen-dominant endocrinal system; a post-menopausal-like endocrinal system; an estrogen-dominant endocrinal system, and an estrogen+progesterone-dominant endocrinal system. In case #1, my sleep was overwhelmingly light, stable, often lacked dreams, and - if I woke up - I found it easy to fall back asleep easily. In case #2, my sleep was shit in all regards. In case #3, my sleep was deeper (albeit shorter) and more restful than case #1, and with very real-feeling dreams, but I found it really hard to fall back asleep again if I woke up. In case #4, my sleep quality is the best it's been, because it gives me all the benefits of #3 without any of the negative parts of #3.
But also, hell - [most] AFAB women's bodies go through a lot every month. Although it's something I will sadly never get to experience myself[ᵃ], y'all know how harsh menstruation can be on your bodies both physically and mentally, even if the experience differs a lot from person to person. If that wouldn't affect your sleep, what would‽
1: https://www.goodreads.com/book/show/41104077-invisible-women (part IV, IIRC?)
---2: https://pubmed.ncbi.nlm.nih.gov/18676087/
3: https://doi.org/10.2174%2F138955712802762167
a: Some trans women, myself included, have reported experiencing some physical and mental cycle-like behaviour on a monthly basis, but this phenomenon is highly understudied. It could be happening exclusively because of the hypothalamus, or it could be happening due to other endocrinal reasons, but there's no definitive answer yet.
Thank you so much for replying. I appreciate the information, and I'm so sorry that your hormones also affect your sleep the way they do.
You're welcome! And, hey, I genuinely don't mind any negativities in sleep patterns in my "preferred" endocrinal states; life without the "correct" sex hormone(s) was no life at all.
For whatever it's worth, each and every one of my (surprisingly many) cis friends diagnosed with severe polycystic ovary syndrome has more or less felt the same, even prior to their official diagnosis and/or medication.
Well you have another cis friend with PCOS. <3
Sleep post-menopause is actually an interesting ride for me. I wake up at 2 or 3 a.m. regularly, read for an hour, and fall asleep again for a couple of hours. Average total sleep time is still 6.5 to 7 hours as before, it just takes more time in bed and completely messes with sleep tracking.
For me, at least my perception, the real thing that sleep studies are good for is determining if apnea is an issue. And that's something that could certainly be figured out in one study, potentially at least. But it's possible that's more variable than I'm aware of?
For me the take-home test was to check for the possibility of sleep apnea. After it showed negative, then I went in for the overnight sleep test with the multiple sleep latency test the next day. That ruled out narcolepsy type 1 and 2 but I was given the diagnosis of idiopathic hypersomnia. In the MSLT's 5 nap sessions I fell asleep quickly enough each time but never hit the REM stage. Even though it was assumed that apnea wasn't the issue they still had to rule it out with the take-home test.
Got it, yeah the rest sounds so much more complex that I can see it being particularly silly to try to diagnose it with a single night.
I was going to make a somewhat bitter joke about being told to lose weight by a doctor rather than getting treated for the actual problem but then I remembered I was talking about apnea and I sighed.
I feel like the false positive rate of apnea when other things are at play would be really high.
Could be, I thought the "not breathing" part was more likely to be an obvious binary yes/no, where the "cause of poor sleep" might be far more complex?
But I'm not a doctor
Yeah, as a lifelong insomniac, I was hopeful when my family got me a Fitbit to track my sleep. However, after many miserable nights and Fitbit congratulating me on said night of sleep, I lost trust in a lot of the easy tests.
I still do need to at least try the official test. Maybe it will help, only time will tell. But I haven't had the money or time recently to look into it.
I hope you can look into it soon. Sleep is so important, and we just never get the chance to really make sure we're getting the best sleep we can.
For any body measurement, I think the most important question to ask is: what is the natural human sensation for this measurement, when can the reading from the device and human feeling diverge, and is that a useful signal?
For sleep, I don't think we have studies indicating it is. We all have some sense of how well we slept. When you wake up and feel like dying, that's pretty obvious not good. So the two scenarios at play are
You feel great in the morning, but your fitness/sleep tracker says you slept poorly.
You feel awful in the morning, but your fitness/sleep tracker says you slept well
I don't think there's much science for either case being particularly useful. For 2), most of the ways we tell if we slept well or not are pretty practical. Who cares if your apple watch says you slept well if you have a terrible migraine?
For 1), I don't think there's any scientific evidence that there are circumstances where your watch knows better than you do, that there are circumstances where you feel sharp but you are actually suffering in some unknown way that your sleep tracking is helping you with.
As a result, I think just noting down your subjective feeling every morning is perhaps a more useful exercise if you're trying to adjust your sleep schedule.
To contrast with some "good" uses of metrics, resting heartrate is one. We just don't have a good sense of our resting heartrate. If it's 50 or 90, is going to feel the same to people. If it's 90 you probably need to do more cardio, though.
Fever temperature is another one. We can feel when we are sick, but it is difficult to give it an objective level in the same way body temperature measurements do. This is useful to tell if the fever is worsening or abiding.
This is my problem with the "body battery" Garmin recently added. My watch isn't compatible thankfully, but my wife's is and she's constantly going on about how it says her body battery is low but I ask her how she feels and usually she feels just fine. But for some reason she wants to believe the Garmin knows something she doesn't or it's tracking a trend she can't see, etc. It just feels more gimmicky to me than anything and I don't know that I trust it.
I also don't really trust my sleep tracker because I know I have sleep issues and it will often state I had a great 8 hours of sleep when in reality I know I was awake for 3 of those hours. Other times it will do the opposite.
Garmin is great at location services. Now that I've had a Garmin watch for a year and a half, I can say anecdotally that they suck at calorie calculating (like to an embarrassing degree, depending on the activity), the body battery thing, and sleep tracking. It definitely can't tell if I'm awake or asleep if I'm reading near bedtime, for example.
Garmin seems to do pretty okay with heart rate, though. I was tachycardic when I was sick recently and didn't really think about it (my resting heart rate is normally 60-70; it was 120-130 those days). I went to urgent care and they sent me to the ER to get my fever broken to slow down my heart (and get every test on planet earth). After the ordeal, I went into my Garmin's history, and it had been logging it all pretty accurately, based on what the monitors said. I was just too sick to realize.
My experience mirrors yours - though my device is going on 8 years now and the heart rate tracking is showing its age. In the winter it will often get stuck at 140bpm during a run - slowing down or speeding up doesn't change it at all, only stopping will actually see a change. It also doesn't correctly register the beginning of a run, showing a near 50bpm instant increase, sustained for 2 minutes, then drops down to 75bpm. Seems like a software problem that probably won't be addressed due to its age.
When I got COVID a few years ago, my resting heart rate was about 15-20bpm above average even a day before I started showing symptoms and carried through the week. So at least that worked well.
All in all, I've been quite happy with it - 8 years is a long time in today's quick fashion and vapid tech world.
I've been happy with Apple's offering for ~3 years. The Apple Watch, paired with the third party Auto Sleep app, never has false positives when I'm awake and seems accurate enough with tracking sleep. Heart rate and blood oxygen always seem to line up when I have visits to doctors.
It's also caught anomalies for me. Like when I was taking a medication for a few weeks that had a side effect of lowering my blood pressure, I had a beer without thinking about it while sitting at a movie theater. It caught that my heart rate was abnormally high at rest and notified me.
The ambient noise monitoring is also an essential for me now too.
Newer models have an actual feature designed to detect trends that may indicate apnea and alert you, but I don't have any experience with that. (My issues, anyway, are more with falling asleep in the first place and sounds waking me up easily.)
I think it really depends on the person. Two of my friends told me about their Garmin watch, one was going through quite bad covid (needed hospitalisation and oxygen in the end, pre vaccination) and told me how the body battery was accurately tracking the gradual worsening of his symptoms. That's easy though, because it was a severe situation. Other friend told me her watch tells her "you might be coming down with an illness" based on I guess slightly higher resting heart rate, slight changes in temperature and possibly other things, and it's usually accurate. This sounds like a killer feature because any accessible interventions against viral illnesses only work well when used as soon as possible, in an ideal situation before any symptoms even start.
Perhaps if it's like that long term, but when my resting heart rate changed from 60 to 90 due to a chronic illness it was one of the first things I noticed. It didn't feel terrible overall, but I did almost immediately think "huh, my heart rate shouldn't be this high when I'm sitting down."
I don't know about the specific "body battery" mentioned in these comments, but I do want to address one comment you made
There's a lot of evidence out there that HRV (heart rate variability) is a high quality indicator on immediate short term health. We've been using it in competitive sports training for quite some time to tailor when to push and when to rest, but it can surprisingly accurately predict when someone is under stress for other reasons, such as when one is beginning to get sick. HRV often isn't a thing people are actively aware of and it's absolutely something that devices like halter straps and watches and smart rings can monitor and measure. It's a general measurement of bodily stress, however, and isn't a silver bullet of any sort - but if you're feeling well otherwise and went out the night before, it could let you know to rest to avoid getting sick. Or if you pushed yourself on a workout the day before, or have an impending stressful deadline, it can also be a signal to take it easy so you don't invite illness with a weakened immune system.
HRV is just about the only thing I pay attention to on my sleep tracking device (and with previous activity tracking devices) and I've anecdotally found it quite useful to stave off illness.
My sleep tracker (smart ring) is pretty accurate in how it tracks my sleep, but in general, I usually sleep pretty well, so it's not actually that useful.
On the nights when I don't sleep well, it's interesting to look at why it thinks I didn't sleep well. Usually it's either because I ate/exercised/drank alcohol too close to bedtime, or because I was sick, or because I had a newborn and woke up a lot. Each of these things were expressed with different parameters (respectively: heart rate, body temperature, and wake ups). It does occasionally tell me I'm sick about a day before I'm aware of it, and while that's interesting, it's not particularly useful or actionable.
Ultimately, it's not that useful for sleep tracking, because I could easily figure these things out on my own. Mostly I just use it as an easy way to track the data. When my ring battery eventually degrades too much, I probably won't replace it.
There are OTC antiviral medications that work against respiratory viruses, but their one downside is that you have to take them asap, in an ideal world before you get any symptoms, because with viral illnesses at the moment when you get first symptoms the virus is already widely multiplied, it's just the immune response that's delayed. Taking them a day early would likely significantly increase the chance of avoiding the illness completely.
The ones I know off:
Interesting. As a smart watch and ring user I wonder if it might be worth it to keep some of these on hand to enable a swift response. The main concern would probably be with the shelf life of the products.
Azelastine spray that I'm using has a year long shelf life before it's opened and since it costs about 8€ here, that seems fine. Zinc lozenges iirc last longer, but those are not ideal (they don't work for covid and they're just less pleasant to use). I think the spray made of seaweed may work better than azelastine, but I have no further information on that (specific efficacy or shelf life), you'd have to look it up yourself.
That's interesting. I didn't know anti-virals had gotten to that point that they could be used almost preemptively.
I'll need to investigate this further, but my first quick look has found a surprising lack of side effects, which is actually kinda worrying, because if they're that safe and effective, I'd assume everyone would know about them already.
This is actually the easiest way. I have no formal education in medicine, but I believe one of the reasons why antivirals are so difficult to do is that we're mostly interested in ones that are useful for severe illness, but at that late stage several things are happening at once and just killing the virus (which is quite difficult on its own with oral medication) does not help that much.
Killing viruses locally is much easier, but it only works as prevention or before the illness develops fully. Azelastine was tested specifically as a prevention (that people continued to use if they did get sick, it shortened the illness). And the zinc lozenges, when used after you start feeling sick, do not remove the symptoms, but they basically freeze them. Instead of a fully developed cold (which for me is normally sore throat -> runny nose + sinus pain -> coughing -> end) I got 3 days of the symptoms I already had before I started taking it.
One "side effect" that happened to me with zinc and VirX, so it may be common to all of them, is that when I used them to successfully stop an illness, I had to still stay calm and relax as if I was sick for about 3-4 days, otherwise I felt really tired (as if partially sick) for more than a week. No full illness though.
If you measure a single variable, it should be SpO2, a.k.a. Peripheral oxygen saturation. Easy, non-invasive, tells you if you stop breathing.
Other conditions are quite more involved to measure. But a lot of people suffer from apnea. It would be cool if they knew.
I suppose this is something that needs to be said out loud at least once, but I figured as much when they announced it. And the last week or so has proven that intuition to be true. I'll get a score of 92 and feel lousy that day. But then I can get a score of 94 and feel great. Clearly, there are a lot of factors at play and the scoring of the three categories makes a lot of assumptions.
But for a quick glance at whether my bedtime is regular, the duration of recorded sleep, etc., it's fine. Taking it as anything other than an extremely rough metric is ludicrous.
Going along with the article's theme that it's hard to evaluate sleep quality, I'm pretty sure that how you feel in the morning is also sometimes not the best indicator of how well you slept on a given night.
I've noticed that when the amount of sleep I get is irregular, I'll often feel fine the morning after not getting enough sleep. Then the following morning after getting more sleep, I'll feel terrible. So it seems that it sometimes takes a day to feel the bad effects from missing sleep. If that's the case, if I'm getting ~7 hours a night and I feel tired some morning, I wonder if it's because I didn't sleep well that night, if I didn't sleep well on the previous night, or if I'm systematically getting mildly bad sleep over the past week that's slowly catching up to me. On the other hand, sometimes I don't get enough sleep and feel it right away.
Anyway, I've found that I sleep poorly when I have a bulky watch on my wrist, so there goes sleep tracking for me. I've thought about trying a ring, but those don't have the best reviews in terms of accuracy or consistency.
I’ve had no problems sleeping while wearing an Apple Watch. I usually know whether I’ve had a good night’s sleep or not, too. The number is just a glanceable in the morning. I either think “I do feel rested” or “Well that’s funny” when I look at the score. With the occasional “That seems right” when the score reflects how awful I feel.
My situation is such that I know my sleep is temporarily lousy, and as a result I rarely have delayed effects of bad sleep, i.e., I feel lousy most days. What I do like seeing is the sleep chart that shows roughly what sleep stages I was in and when.
But to the main point, someone that actually requires a real evaluation of their sleep probably shouldn’t rely on a consumer device that has no approvals for diagnostic sleep tracking. That tracks pretty easily.
I used to wear more than one ring, but smart rings have held zero allure for me. While I’ve not looked into it, I do wonder if there are slimmer single purpose devices for tracking sleep.