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The science (and business) of sleep

Tech companies have joined the multi-billion dollar rush to help us get a better night’s rest. Are they making a difference?

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Defining a good night’s rest can be as elusive as getting one. Just ask Russell Foster. A professor at the University of Oxford who runs the school’s Sleep and Circadian Neuroscience Institute, he’d say if you get up without an alarm clock, don’t crave a nap in the afternoon, and can function before inhaling a few cups of coffee, you’re getting a solid night’s rest. Not exactly the jargon-laden, erudite answer you’d expect from an academic.

But as Professor Foster revealed in his TED talk on the topic, while we most agree sleep is a vital, restorative process modern man rarely gets enough of, science still doesn’t know all the details. He could lecture you on recent discoveries about how perception of light influences our sleep-wake rhythms. But Foster will also readily admit that understanding sleep is seemingly simple yet maddeningly complex.

While our knowledge of sleep’s true workings may be incomplete, our realization that we’re not getting enough sleep is prevalent in society, to put it mildly. Poor sleep is a problem the United States spends billions of dollars on each year. According to technology research firm BCC, the global market for sleep aides is expected to hit $76.7 billion by 2019, with the anxious and sleep-deprived in the United States making up more than 60 percent of the market.

Sleep apnea, stress, and an inability to put down digital devices (and accompanying distractions) have created a bull market for those offering a solution. Sleep labs, where clients seek diagnosis of sleep disorders, became a $7.1 billion industry last year. It’s also propelled researchers to spend even more time studying the subject.

"The science has exploded over the last few years, and the scientific and sleep communities have done a great job of publicizing the information and increasing public understanding," Foster says.

And, in typical 21st-century fashion, tech companies have entered the arena, promising to use this new knowledge and apply a combination of algorithms, human-centered design, data analytics, and wearable technology to make us more quantified and efficient sleepers. Rarely has so much effort been applied to get so many people to act in the pursuit of, literally, doing nothing.

But can high-tech mattresses and wearable technology make a difference? Bogi Palsson, the CEO of SleepImage, a Colorado-based company that markets a device used by doctors and clinicians to measure patient sleep habits, admits that science hasn’t caught up with our curiosity.

"In general terms, it’s amazing how little is know about sleep, and how sleep medicine is in its infancy compared to a lot of other parts of medicine," he admits. "What is known is that it’s the only thing we’re supposed to spend about a third of our time doing."

"The world’s mindset on sleep is really shifting," says Neil Parikh, co-founder & Chief Operating Officer at Casper, the $100 million online mattress giant. "Ten years ago, it was cool to sleep four hours a night, talk about how you were crushing it, and have that investment banker mentality. It’s not like that today. We’ve got Whole Foods, Lululemon talking about getting out there and exercising. The world really cares about sleep now."

Parikh, a 27-year-old who exudes the optimism of a young startup exec, says his generation has lived through this cultural shift. Sleep was seen as a necessary evil, something to try and avoid—kids are sent to their room to go to sleep early as a punishment—and it’s just starting to get viewed as a resource and fuel.

He believes the journey towards a more sleep-positive society is just beginning (Casper even runs an online publication, Van Winkle’s, focused on sleep and pop culture). He compares it to Nike in its early years; it took a few decades for a shoe made for athletes to be considered everyday wear by the masses.

"What’s been fascinating about sleep is that it’s been mostly an academic study for the last 150 years," says Parikh. "But what’s published in sleep studies is people in a lab filled with sensors, basically data from someone in an uncomfortable place. In terms of natural sleep studies that measure the practical nature of sleep, we’re only 5 percent of the way there. We’ve only really begun looking at this stuff in the last 5 years."

Others in the sleep technology world believe the cultural shift goes hand-in-hand with changes in how we view technology, specifically the quantified self movement, a focus on data and efficiency elevated with the help of mobile technology.

"Society has changed and awareness has grown," says Heikki Raisanen, CEO and co-founder of Emfit, a Finnish firm that builds non-contact vital sign monitors that can help measure sleep. "With the quantified self movement, which started a decade ago, there’s been a growing awareness of monitoring health."

These factors have created a boom in new products for improving and monitoring sleep. There’s been an increase in wearable technology and sleep-monitoring apps—from Beddit, an under-the-sheet sensor that monitors functions such as heart rate, noise, and motion to create sleep reports (a New York Times reviewer says the program offered "attractive and detailed sleep information) or the Oura Ring, a general fitness wearable that measures pulse waveforms and your body’s physiological responses during sleep. Smart lighting systems and audio services, such as Sleep Genius, a top-selling app. help lull users to sleep. Apple has even included a Bedtime Tab with its iPhones as part of its expanded HealthKit service.

But, by and large, the wearables seeking to alter sleep behavior all accomplish the same thing: providing a rough estimate about sleeping patterns, tracking them, and producing reports and analysis to change the way you approach bedtime.

"This is a generalization, but most of the wearable technology out there measures activity, or in this case, a lack of it," says Foster. "They assume inactivity equals sleep, and measure body position and lack of activity. It assumes when you’re still, you’re sleeping. Compare that to, say polysomnography, the reference standard for clinical sleep measurements, which is a quite invasive and expensive way to measure muscle movement and brainwaves that usually requires a hospital environment. That’s pretty impractical for the general public."

Foster doesn’t necessarily fault activity trackers, since awareness is often the first step towards changes habits and behaviors. Like a high-tech sleep journal, these devices draw attention to an issue, which can be half the battle for those trying to get more rest or keep to a more regular schedule.

"People feel there is nothing you can do about your sleep, and having a semi-objective way to measure your sleep, broadly speaking, is extremely powerful," Foster says. "Broadly speaking, they are good at figuring out when you woke up and when you went to bed. When they start saying here’s a measure of deep sleep or power sleep, you can’t trust that data."

The promise of simplicity and better design has helped Casper and its competitors reshape the mattress business

In addition to the flood of apps and monitors, a new breed of high-tech, savvy mattresses seek to capture consumer sentiment towards wellness and present a fresh angle on an established industry, with online ordering and free home trials. From big players such as Sealy’s, which offers mattresses with its SleepIQ monitoring system, to digital upstarts, such as Tuft & Needle, it’s rapidly reshaping the industry.

It’s instructive to look at how two startups, New York-based Casper and its rival, Helix Sleep, both attempt to solve similar problems in radically different ways. Both want to disrupt the traditional process of buying a mattress in a store by offering a well-designed, affordable product available online. As Jerry Lin, a co-founder of Helix Sleep, puts it, "Why should the process of buying a vital product, something we spend a third of our life with, have to be so unpleasant and expensive?"

But how they build their mattresses, and their approach to improving you sleep, are very different. Casper took a one-size-fits all model. Their design team, as part of a goal to optimize materials and devise a better sleeping experience, created a unique covering, which combined latex and memory foam to offer a supportive surface that offered more circulation, preventing overheating, a common complaint discovered during testing.

While most of the new breed of mattress companies proclaim they offer a better product resulting from thoughtful design and testing, Casper makes the human element a massive selling point. The Casper Lab program has enrolled 25,000 volunteers/"hyper evangelists" to talk about the product, and every new product roll out from the company, from pillows to dog beds, first undergoes lengthy rounds of testing and feedback.

Helix’s approach involves more customization. Drawing from research into biomechanics, Helix creates made-to-order mattresses (based on the results of a 10–15 question online quiz) that correct spinal alignment, which improves REM sleep. Mattresses can even be created with two customized halves to accommodate a couple (or a median setting for those who like to cuddle). According to Lin, the company has measured a 30 percent increase in sleep quality, based on subjective feedback from its user base, suggesting to him that "the concept of personalized sleep is resonating with our consumer base."

Both companies view a mattress as an important starting point. Helix plans to branch out into pillows, utilizing the same data-driven approach to extend its product line ("the pillow can be as important as the mattress when it comes to position"). The grand vision is a transparent system with personalization technology, allowing consumers to customize their rooms.

Casper, which has already expanded into pillows, has developed a custom set of sheets, which eschew the typical measure of thread count, an arbitrary measure of quality which leads to denser coverings that trap heat. Parikh says the company has many other additions in development, helping to achieve that goal of being at the center of an "ecosystem of sleep."

"How can you build behavior change around sleep?" he wondered "If we can’t get people to lose weight or stop smoking, this is going to be a big battle. The first thing is getting them to care, so then they’ll change their behaviors. But what will people do as they learn more? Will they change their lifestyle, or buy all the products that help them passively sleep better?"

While product designers and researchers agree that our incomplete knowledge of sleep requires more work, they all feel important breakthroughs, increased consumer awareness, and advancing technology, will only lead to a bigger sleep-industrial complex. Technology may not be able to give us a perfect night’s rest, but it will continue to unravel the mysteries of sleep.

The near future may just offer more self-awareness; after all, even the best mattress can’t alter an overbooked schedule or eliminate workplace stress. Raisanen says his company is working on monitoring technology and smart algorithms built into a bed that can automatically track sleep patterns without any external monitors, sensors or physical attachments. A patient’s sleep history, built up over weeks, months, and years, can be analyzed without them noticing, slowly gathering data that can be used to modify habits and create the perfect environment for sleep.