Orthosomnia: when sleep tracking keeps you awake

What is orthosomnia?

The word comes from a short case report in the Journal of Clinical Sleep Medicine in 2017, by Kelly Glazer Baron and colleagues at Rush and Northwestern universities in Chicago. It described three patients who sought treatment for sleep problems they had diagnosed themselves from their tracker data — too little sleep, or too much of it light or restless. The link the patients drew between those numbers and their tiredness, the authors wrote, could become “a perfectionistic quest for the ideal sleep”, and the tracker often felt truer to them than the validated tests a sleep clinic uses (Baron and colleagues, 2017; Guldbrandsen and colleagues, 2025).

In everyday words, it is sleep-tracker anxiety: being so caught up in your sleep score that the checking and the worrying become part of the problem. The name echoes orthorexia, an obsession with eating healthily: ortho for correct, somnia for sleep. It is a description, not a diagnosis. An editorial in Nature and Science of Sleep put the difference simply in 2023: insomnia is a diagnosable sleep disorder, orthosomnia “a societal phenomenon” (Jahrami and colleagues). Researchers are still working out how to measure it. A scale built specifically for it, the Bergen Orthosomnia Scale, was only published in 2025, and in its development higher scores went with more effort to sleep, more unhelpful beliefs about sleep, perfectionism, obsessive-compulsive symptoms and health anxiety (Guldbrandsen and colleagues).

Can a sleep score change how you feel?

Yes — and that is the best-tested part of the story. In a 2018 experiment at the University of Oxford, 63 adults with insomnia disorder wore a watch that recorded their sleep and, the next morning, told them how efficiently they had slept. The verdict was assigned at random, not read from the night: half were told they had slept well, half that they had slept badly.

By the evening, those given the bad news felt less alert and more sleepy and fatigued than those given the good news, whose mood and alertness had also risen more through the morning. On objective tests — reaction time, and a computer test of attention to sleep-related cues — the two groups did not differ (Gavriloff and colleagues, 2018). The verdict changed how the day felt, not how people did on the tests, and the authors drew the lesson for wearables that claim to measure “objective” sleep but may get it wrong.

And they do get it wrong, most of all on the nights that worry people. In a 2021 laboratory test of seven consumer devices, accuracy tended to fall on nights of poorer, disrupted sleep, and most devices missed between a third and a half of deep and of REM sleep (Chinoy and colleagues). Are sleep trackers accurate? goes through the evidence device by device.

Why does watching your sleep make it worse?

Because sleep is one of the few things that effort undoes. Colin Espie’s account of how insomnia takes hold, the attention–intention–effort pathway, starts from the observation that normal sleep is automatic, and argues that it is inhibited by focused attention and by direct attempts to control it (Espie and colleagues, 2006). Why trying to sleep keeps you awake explains it in plain terms.

A tracker feeds every step of that pathway. It makes attention to sleep a daily habit; it gives intention a target, a score to beat; and it suggests the effort — an earlier night, a longer lie-in, another gadget.

The cost of watching is not hypothetical, either. In the first of two experiments, people asked to keep an eye on a clock while trying to fall asleep worried more and took longer to drop off than people who were not, good and poor sleepers alike. In the second, among 38 people with insomnia, those given a clock to watch rather than a meaningless digit display worried more, reported taking longer to fall asleep than on a normal night, and overestimated the wait by a wider margin (Tang, Schmidt and Harvey, 2007). A tracker checked at 3 a.m. is that clock, with a verdict attached.

Is my sleep tracker making my sleep worse?

For most people who use one, probably not — but for some it does, and the signs are recognisable. In a 2025 survey of 1,200 Canadians, 231 had used a wearable to track their sleep: 102 said it had a positive effect on their sleep, and 10 reported a negative effect. Among users, though, sleep fell more steeply as anxiety rose than it did among non-users — and a survey cannot say whether the device or the trouble came first (Dion and colleagues).

Signs that it has started to work against you:

• You check the score before deciding how you feel.
• A bad number changes your day — you cancel things, or brace for a tiredness you had not noticed.
• You go to bed thinking about tonight’s score.
• You go to bed earlier, or lie in longer, to push the numbers up.
• You check it during the night.

The data themselves are not the enemy. In a 2023 trial, 113 adults with insomnia symptoms were given either five weeks of feedback from a Fitbit and an EEG headband, with guidance on how to read it, or sleep education and sleep hygiene advice. The feedback group ended with less severe insomnia and less disturbed sleep than the education group (Spina and colleagues). What seems to matter is how the numbers are read, and what they are allowed to decide.

What should you do about it?

• Put it away for a fortnight. Take it off, or at least stop opening the app, and notice how you feel without a number to tell you. We could not find a trial of a tracker break (we searched Europe PMC in October 2026), so the two weeks is a practical choice, not a studied one: long enough for an ordinary bad night to come and go without a verdict.
• When you go back, look at weeks, not nights. A weekly average is steadier than any single night, and deep and REM sleep, which devices estimate least well, deserve the least attention.
• Never check it in the night. If you wake, the number will not help you back to sleep, and looking is the clock-watching the experiments above found makes the wait longer. What to do when you can’t sleep covers the rest of the night.
• Don’t stay in bed to improve the score. Spending unusually long in bed to coax better data is one of the habits the 2023 editorial described, and lying awake in bed is what teaches the bed to mean wakefulness — the bed is a cue.
• Judge a slow night by what is normal, not by the app. If it says you took half an hour to fall asleep, read how long it should take to fall asleep before deciding anything is wrong.
• Switch off what you can. If your app lets you hide the score or silence its morning summary, try it: a device that only records, and is looked at once a week, is a different object from one that grades you every morning.

When is it insomnia?

When the trouble is there with or without the tracker. If falling or staying asleep is hard on most nights, has gone on for months and is affecting your days, see a doctor. The first treatment the American Academy of Sleep Medicine recommends for chronic insomnia is cognitive behavioural therapy for insomnia, CBT-I (Edinger and colleagues, 2021) — and Baron and her colleagues argued for building tracker data into it, which makes a few weeks of it a reasonable thing to take to the appointment.

Loud snoring, or breathing that someone has seen stop and start in the night, is a different conversation with a doctor, and not one for a sleep score: when to see a doctor rather than a dashboard has the signs.