The Dilemma of Digital Sleep Solutions

Digital aids are sweeping through a sleepless world.
| Photo Credit: Getty Images/iStockphoto

A wooden bowl, filled with water and bobbing wooden orbs, is sloshed around with a spatula. A soft brush caresses the face. A pen scribbles on paper. These ASMR (autonomous sensory meridian response) videos on YouTube “obsess” Shilpi (name changed), a 19-year-old barista in Mumbai. Shilpi, who has battled chronic insomnia for years, watches them on a loop at night. The auditory and visual stimuli in these videos “feel like someone’s massaging my brain”, she says. “They put me to sleep within minutes.”

Shilpi is not alone. ASMR videos—not a new phenomenon, but one that continues to capture millions of viewers—are just one segment of an array of digital aids sweeping through a sleepless world.

In William Shakespeare’s 17th century tragedy, a guilt-ridden Macbeth talks about his agonisingly elusive sleep ‘…innocent sleep, Sleep that knits up the ravell’d sleeve of care, The death of each day’s life, sore labor’s bath, Balm of hurt minds, great nature’s second course, Chief nourisher in life’s feast…’ There is much contemporary literature on the regenerative power of sleep, and on the impact of insomnia that affects one in 10 people around the world. Chronic lack of sleep can increase the risk of depression and anxiety, high blood pressure, and obstructive sleep apnea.

While cognitive behavioural therapy (CBT), medication, and lifestyle changes have been the traditionally prescribed remedies for the disorder, there has been a steady digital take-over of sleep.

In 2022, the UK’s National Institute for Health and Care Excellence (NICE), which serves the English and Welsh NHS (National Health Service), recommended offering an app-based treatment, Sleepio, for people with insomnia instead of sleeping pills that can be habit-forming. Sleepio is a six-week clinically proven programme used to treat insomnia, available free on the NHS. The app uses artificial intelligence to help people with “tailored digital cognitive behavioural therapy” for insomnia. The sessions identify thoughts and behaviours that can trigger insomnia. The app is available for free for patients on the NHS in England and Scotland.

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“This is a good example of where a digital health technology can help the NHS,” said Jeanette Kusel, acting director for MedTech and digital at NICE, in a statement. “The evidence has shown using Sleepio reduces the number of GP appointments people with insomnia need and will also cut the number of prescriptions for sleeping pills delivered by pharmacists.”

Peak pandemic

Sleep disorders peaked during the COVID-19 pandemic, which circumscribed life as we knew it: a startling 40 per cent of people experienced sleep disorders after the pandemic (among individuals affected by the disease), according to a 2023 research paper published in the journal Sleep Medicine. And this is when digital interventions such as the Internet-based “Brief Therapies for Insomnia” became a fallback for many. The paper goes on to recommend the designing of “More structured and personalised digital sleep interventions… and other diverse digital technologies” to help manage sleep disorders. Today, even the iPhone has built-in white sound to help you sleep: you can choose between “ocean”, “rain” “stream” and other audio. 

Shilpi believes she struggles to sleep because of her lifestyle. “Everything messes with my circadian rhythm: I’m on my computer all day; I drink a lot of coffee, and I scroll through my phone well into the night.” The “circadian rhyth”, driven by our internal biological clock, which responds to day and night, influences sleep.

American geneticist Michael Rosbash, 80, who has spent decades researching the molecular mechanisms underlying circadian clocks, won the Nobel Prize in Physiology or Medicine in 2017 for a breakthrough: he, and Jeffrey C. Hall and Michael W. Young, who he shared the award with, used fruit flies as a model organism, and isolated a gene that controls this biological rhythm, which functions by the same principle in other multicellular organisms, including humans.

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So how clinically sound are these digital aids in managing sleep disorders? Nitin Chouhan, a neurobiologist who studies sleep functions using neurogenetic tools, and a reader at the department of biological sciences at TIFR, Mumbai, has a mixed response. “CBT has been shown to help with long-term sleep problems and has been suggested as an alternative to sleep medicines,” he says. However, “I am a bit sceptical that an app could provide precise feedback and suggest behavioural interventions,” he says adding that “it is definitely a step in the right direction to improve sleep across populations.” And while COVID was a stressful period that may have affected sleep disproportionately, “we need more control studies to test the efficacy of these digital interventions on sleep.” As for ASMR, says Chouhan, “There is not enough scientific data to support the claim that it helps get better sleep.”

The Shakespearean “Balm of hurt minds” indeed appears to remain elusive.