A Simple Plan for Rest

You can find a drug-free strategy for better sleep in the palm of your hand

BY FRANCINE RUSSO

IF YOU’VE CAUGHT WIND OF THE RECENT research suggesting that screen time may be to blame for your poor sleep, you’d be forgiven for rolling your eyes at the following advice: One of the more effective treatments for your sleep problem might actually be your smartphone.

That’s because when it comes to science-backed strategies for treating sleep disturbances, the gold standard recommended by the National Institutes of Health and the American Academy of Sleep Medicine is something called cognitive behavioral therapy for insomnia (CBT-I). CBT-I is a kind of talk therapy that focuses on changing behaviors and thought patterns that can contribute to poor sleep. But although it’s proved in numerous solid studies to be effective as a long-term solution, it’s not widely available.

Even if you’re willing to seek out a sleep expert who is qualified to offer CBT-I, you may not find one near you; there are only a few hundred experts who practice CBT-I in the whole country. That’s why the CBT-I app comes in especially handy.

“I do not think many doctors know about CBT-I,” says Rachel Manber, a professor of psychiatry and behavorial sciences at Stanford University Medical Center. “Some provide sleep-hygiene recommendations. However, like dental hygiene, sleep hygiene is best thought of as preventive rather than treatment.” Such recommendations include sleeping in a dark room, sticking to regular bedtimes, and avoiding caffeine and exercise before bed.

CBT-I, meanwhile, has been proven to undo sleep problems, even when they’ve existed for a very long time. Most CBT-I treatments take four to six weeks to be fully effective, which explains why this method pales in comparison with the immediate, if not long-lasting, benefit of sleeping pills. But now Israeli scientists have come up with a way to potentially streamline the therapy for some, by bypassing a sleep lab and delivering the treatment via smartphone.

SleepRate was developed by Uli Gal-Oz and physician Anda Baharav, who has a background in sleep medicine and research at Tel Aviv University, and it’s designed to help people who can’t or don’t want to go to a sleep clinic.

Baharav, SleepRate’s founder, says the app can detect sleep disturbances by mathematically defining the connection between sleep, heart rate and respiration. The Israeli researchers have combined their diagnostic method with a smartphone adaptation of a Stanford University proprietary CBT-I treatment to bring the therapy to more people with sleep disorders.

Anyone with an iPhone or Android phone can download the app kit, which comes with the sleep plan and a heart-rate monitor worn across the chest. It costs about $100, plus shipping.

Here’s how it works: While you’re sleeping, the app collects audio through your phone—are you snoring? is your partner moving around a lot? is there a TV on in the other room?—and data from the heart-rate monitor to get a snapshot of what’s going on in and around you when you’re resting.

In the morning, the app sends all that information to the cloud for analysis based on algorithms from the Stanford Center for Sleep Sciences and Medicine. You do this for five nights in your own bed. You also record how you feel about your sleep and alertness before you start the program and then again every evening and morning for the five days of the assessment.

The app keeps track of all the information in a sleep diary and provides the results from the previous night’s sleep in an easy-to-read graphic that you will have a hard time not obsessing over. It will tell you how long it takes you to reach stable sleep, how many times you wake during the night, the sequence of your sleep stages throughout the night and how much quality sleep you get.

The audio provides clues to sleep problems, too. “If you’re used to living in New York City, for example,” Baharav says, “the traffic and sirens may not wake you, but your fridge banging on at 4 a.m. might.” So your sleep plan might include a service call from your appliance company—or a new fridge.

After the five-night assessment, you get a personalized sleep plan based on your particular sleep issues. The plan tells you when to go to bed and when to wake up, recommends exercises to help you unwind and forget about the day’s worries, and even offers ideas for how to spend the one to two hours before bed to make sure you have a winding-down routine that sets you up for rest.

BY THE NUMBERS The SleepRate app comes with a heart sensor that tracks your sleep depth and interruptions and your responses to noise and light.

Based on the information you entered, for instance, your smartphone screen will alert you when it’s time to start your buffer-time activity with something like a cartoon of someone sitting quietly on a sofa.

The suggestions are offered sequentially over four to six weeks to give you time to learn the new behaviors—much like how cognitive behavioral therapy works, where new habits and patterns are strengthened through repetition. And when it comes to sleep targets, if you don’t reach a goal, you try again. When you do hit your target, such as getting out of bed at the same time for several days in a row, the program adjusts and provides a new one for you. You can pull up your sleep data at any time to examine your own patterns and trends and, lest you lose your resolve over some of your goals, the app is there to remind you what not to do as well: “No! Don’t take a nap now.”

There are other user-friendly CBT-I kits available, including CBT-I Coach, which doesn’t have the same technological components of SleepRate but supports the work you may be doing with a therapist. SleepRate has lots of fans among experts, though. Shelby Harris, director of the Behavioral Sleep Medicine Program at the Sleep-Wake Disorders Center of Montefiore Medical Center in New York, says SleepRate is “more comprehensive, since it also takes into account medical causes for insomnia.”

Because there is a shortage of qualified CBT-I practitioners, Harris sees such apps as viable and welcome first-line efforts for people with insomnia. If the programs don’t work, she says, then patients can see a sleep specialist about their other options.

And what about people who don’t have a diagnosable sleep disorder but are simply sleep-deprived? Could such a program help parents of babies and young children, for instance, find more good-quality sleep? Baharav says that’s coming soon. Stay tuned.