A 2022 Survey of Commercially Available Smartphone Apps for Sleep

•Most sleep apps available to consumers are designed enhance by reducing latency with auditory stimuli.•While most do not have peer-reviewed evidence supporting the specific app, use types of enhancement that backed scientific evidence.•Sleep widely available, low no cost, and mostly focus on helping consumer fall faster using sounds.•Sleep could be considered a possible strategy for patients improve their sleep, although more validation these is recommended. While sufficient quality critical health,1Ramar K. Malhotra R.K. Carden K.A. et al.Sleep essential health: an American Academy Sleep Medicine position statement.J Clin Med. 2021; 17: 2115-2119Crossref PubMed Scopus (59) Google Scholar chronic loss strikingly pervasive within global population.2Chattu V.K. Manzar M.D. Kumary S. al.The problem insufficient its Serious public health Implications.Healthcare (Basel). 2018; 7https://doi.org/10.3390/healthcare7010001Crossref Scholar,3Stranges Tigbe W. Gomez-Olive F.X. problems: emerging epidemic? Findings from INDEPTH WHO-SAGE study among than 40,000 older adults 8 countries across Africa Asia.Sleep. 2012; 35: 1173-1181Crossref (328) In addition negative impact individual, also costly society. U.S. alone it estimated $411 billion lost every year due sleep.4Hafner M. Stepanek Taylor J. al.Why Matters-The Economic Costs Insufficient Sleep: A Cross-Country Comparative Analysis.Rand Health Q. 2017; 6: 11PubMed Also U.S., individuals seeking treatment disorders.5Acquavella Mehra R. Bron al.Prevalence narcolepsy other disorders frequency diagnostic tests 2013-2016 in insured actively care.J 2020; 16: 1255-1263Google Moreover, globally insomnia appears grown during COVID-19 pandemic.6Cenat J.M. Blais-Rochette C. Kokou-Kpolou C.K. symptoms depression, anxiety, insomnia, posttraumatic stress disorder, psychological distress populations affected pandemic: systematic review meta-analysis.Psychiatry Res. 295: 113599Crossref (0) Scholar,7Jahrami H.A. Alhaj O.A. Humood A.M. disturbances review, meta-analysis, meta-regression.Sleep Med Rev. 2022; 62: 101591Crossref (64) As epidemic continues increase, concerns about dangers grow, demand specialty care has risen. The pandemic only worsened concerns, as health-related fears even greater limitations access outpatient were amplified. virus itself been linked rise insomnia.8Marelli Castelnuovo A. Somma al.Impact lockdown university students administration staff.J Neurol. 268: 8-15Crossref (353) Scholar,9Neculicioiu V.S. Colosi I.A. Costache al.Time sleep?-A mental health.Int J Environ Res Public Health. : 19https://doi.org/10.3390/ijerph19063497Crossref Unfortunately, there widespread shortage providers. Some estimates hold one physician empaneled over per provider.10Watson N.F. Rosen I.M. Chervin R.D. Past Prologue: future medicine.J 13: 127-135Crossref limitless potential online environment given boom telehealth.11Shamim-Uzzaman Q.A. Bae C.J. Ehsan Z. telemedicine diagnosis disorders: update.J 1103-1107Crossref (29) Previously domain behavioral numerous specialties come realize benefits safety social distancing, need brick-and-mortar facilities, foot traffic parking demands, increasing efficiency. convenient patients, still requires same amount provider’s time, ability bill services limited. Digital prescription therapy addiction emerged, yet may difficult access. virtual demonstrate agility respect demands unheralded smartphone known mobile (mHealth) apps. 2021 report IQVIA Institute Human Data Science noted 90,000 new introduced 2020 leading 350,000 end 2020.12Aitken Report: Trends 2021, July 22 2021. https://www.iqvia.com/insights/the-iqvia-institute/reports/digital-health-trends-2021.Google mHealth consumer, smartphones. Pew Research Center February 85% owned smartphone, up 35% May 2011.13Mobile Fact Sheet. Center, 2022. https://www.pewresearch.org/internet/fact-sheet/mobile/. Accessed October 01, 2022.Google growing sector focused - example Consumer Technology (CST) defined (AASM).14Khosla Deak M.C. Gault D. al.Consumer technology: medicine 14: 877-880Crossref (113) AASM’s 2018 statement CSTs, recognized “Most CSTs FDA cleared or validated clinical devices/applications, but accessibility (and patients) augment patient engagement.” notes advantages such popularity cost. number users does appear recent complete sleep-related consumers. Largely, previous reviews measure sleep.15Ong A.A. Gillespie M.B. Overview applications analysis.World Otorhinolaryngol Head Neck Surg. 2016; 2: 45-49Crossref Scholar, 16Lorenz C.P. Williams A.J. apps: what role they play medicine?.Curr Opin Pulm 23: 512-516Google 17Mansukhani M.P. Kolla B.P. Apps fitness trackers sleep: useful?.Cleve 84: 451-456Google 18Guillodo E. Lemey Simonnet al.Clinical wearable-based monitoring: review.JMIR Mhealth Uhealth. 8: e10733Google 19Ananth current challenges.Sleep Sci. 83-86Google 20Choi Y.K. Demiris G. Lin S.Y. al.Smartphone support self-management: evaluation.J 1783-1790Crossref (88) measurement broader context technology include wearable scoping review.21Baron K.G. Duffecy Berendsen M.A. al.Feeling yet? consumer-targeted sleep.Sleep 40: 151-159Crossref (97) Additional included related problems broadly22Lee-Tobin P.A. Ogeil R.P. Savic al.Rate my examining information, function, Basis Empirical devices.J 1349-1354Google specifically, obstructive apnea.23Baptista P.M. Martin F. Ross H. al.A devices apnea.Braz Otorhinolaryngol. https://doi.org/10.1016/j.bjorl.2022.01.004Crossref Additionally, little literature centered aim sleep. fact, specifically removed market. For example, excluded 642 “environmental sound/meditation/relaxation” self-management, this category accounted fourth all found initial review.20Choi With increase market, can healthcare providers understand scope utility available. Previous app surveys almost exclusively measurement. However, our knowledge, efforts made systematically identify existing main characteristics (ie, when how used). We sought provide comprehensive apps, look into (if any) developers offered supports claims. Both Android Play Store Apple iOS App searched 26SEP2022 Maryland, restrict store browsing compatible download proprietary applications, so instead searching websites search engine Chrome, alternative platforms used conduct search. Chromebook was two third-party (https://theappstore.org/and https://fnd.io/), iPhone 12. searches conducted entering keyword “sleep” bars each platform. Results exported PDFs. 12 check confirm website inclusive Store. function operating system platform, referred throughout rest article. Two reviewers independently assessed identified any application processes, initiation maintenance, hygiene, behavior, wake after non-sleep-related which hashtag word description gain hits did features Examples games, voice changers, Christmas countdown timer One reviewer extracted data results results. checked both stores accuracy following extraction. extraction fields determined through iterative process. Following inclusion exclusion determination, screenshots provided seller. Basic information collected first included: name application; seller app; (Apple Android) where identified; whether platforms. addition, another column added note if had survey,24Stekl Klosterman Simonelli al.0095 2021: Updated survey apps.Sleep. 45: A43Google June similar described above. Next, relevant data. Starting type, sorted 6 types: enhancement, measurement, snore detection, manual trackers, basic alarms. alarms standard alarm clocks; those required logging bed times; detection phone microphone record snoring talking accelerometry, microphones, paired directly stages, heart rate, physiological measures attempt reduce latency, smart inertia upon awakening, hygiene programs coaches personalized improvement insights. further regarding methods latency. These categorized either visual stimuli target latency; broken down to: Verbal (bedtime stories; guided meditations; lyrical music) Nonverbal (nature sounds; artificial sounds including white noise binaural beats; instrumental music). cost information: free version available; subscription one-time payment option amount. Lastly, determined; claims making. Descriptive statistics performed SPSS Version 25. Frequencies categories then utilizing Enhancement (eg, labeled “Enhancement Only” “Both” Type category) Measurement “Measurement category). assess frequencies Reduced Latency “Reduced Latency, Hygiene Tips”, Smart Alarm”, Tips Alarm” Furthermore, while descriptive whole, split compared Of 512 appeared Stores “sleep,” 461 deemed truly sleep-related. Table 1 Fig. outline 270 (58.6%) method 192 (41.6%) stores. large majority (N = 422, 95.9%) ranged $0.00 $119.99, average being $9.77± $17.31 (standard deviation). offer at least trial version, 120 (26%) remained options. Over half 242, 52.5%) 21.5% purchase 99).Table 1All commercially android apple storesAll AppsBoth StoresN 461AndroidN 233 (50.5% total)AppleN 228 (49.5.% total)In Survey270 (58.6%)101 (43.3%)169 (74.1%)In Stores192 (41.6%)73 (31.3%)119 (52.2%)Free Available442 (95.9%)229 (98.3%)213 (93.4%)Cost Range$0.00–119.99$0.00–119.99$0.00–119.99Average Cost (±sd)$9.77 ± $17.31$6.18 $14.27$13.48 $19.30Payment OptionFree – No Payment Options120 (26.0%)91 (39.1%)29 (12.7%)Onetime99 (21.5%)47 (20.2%)52 (22.8%)Subscription242 (52.5%)95 (40.8%)147 (64.5%)When Used?Sleep47 (10.2%)18 (7.7%)29 (12.7%)Wake354 (76.8%)188 (80.7%)166 (72.8%)Both60 (13.0%)27 (11.6%)33 (14.5%)Peer-Reviewed Evidence Specific Exists18 (3.9%)7 (3.0%)11 (4.8%)Type AppEnhancement Only338 (73.3%)183 (78.5%)155 (68.0%)Measurement Only22 (4.8%)3 (1.3%)19 (8.3%)Both Enhancement57 (12.4%)24 (10.3%)33 (14.5%)Manual Tracker29 (6.3%)16 (6.9%)13 (5.7%)Snore Detection8 (1.7%)5 (2.1%)3 (1.3%)Basic Alarm7 (1.5%)2 (0.9%)5 (2.2%) Open table tab 354, 76.8%), 13.0% 60) wake, 10.2% 47) alone. Only 18 (3.9%) app. discussed detail later discussion. Most 338, 73.3%), (4.8%), 57 (12.4%). Less 10% fell final three categories: Manual Tracker 29, 6.3%), Snore Detection 8, 1.7%), Alarm 7, 1.5%). 2 account 395, 85.7% apps) like overall 1. utilized reduced 370, 93.7%). 25 utilize some form Program 20, 5.1%) Alarms 5, 1.3%). examined type (Fig. 2). 311, 78.7%). When parsed out, non-verbal 176, 48.4%) concert verbal 151, 41.5%). tended variety stimuli, often single therefore, reported here overlapping categories. relied heavily Guided Meditation 142, 75.5%), Stories 101, 53.7%) Lyrical Music 44, 23.4%). Nature Sounds 286, 87.5%) Instrumental 239, 73.1%) frequently Artificial Sounds, beats, less 70, 21.4%).Table 2All enhancementEnhancement StoresAndroidAppleTotal395207 (52.4%)188 (47.6%)In Survey232 (58.7%)91 (44.0%)141 (75%)In Stores165 (41.8%)68 (32.9%)97 (51.6%)Free Available381 (96.5%)203 (98.1%)178 (94.7%)Cost Range$0.00–119.99$0.00–119.99$0.00–99.99When Used?Sleep13 (3.3%)9 (4.3%)4 (2.1%)Wake325 (82.3%)173 (83.6%)152 (80.9%)Both57 (14.4%)25 (12.1%)32 (17.0%)Peer-Reviewed Exists14 (3.5%)5 (2.4%)9 (4.8%)Enhancement MethodReduced Latency325 (82.3%)168 (81.2%)157 (83.5%)Sleep Tips/Program20 (5.1%)16 (7.7%)4 (2.1%)Smart Alarm5 (1.3%)2 (1.0%)3 (1.6%)Reduced Tips/Program9 (2.3%)5 (2.4%)4 (2.1%)Reduced Alarm23 (5.8%)10 (4.8%)13 (6.9%)Reduced Tips, Alarm13 (3.3%)6 (2.9%)7 (3.7%)Type EnhancementAuditory311 (78.7%)166 (80.2%)145 (77.1%)Visual6 (1.5%)5 (2.4%)1 (0.5%)Both53 (13.4%)18 (8.7%)35 (18.6%)None (does Latency)25 (6.3%)18 (8.7%)7 (3.7%) It worth noting four 14, 3.5% Apps). several studies evaluating Calm (eg,25Huberty Puzia M.E. Larkey L. al.Can meditation help sleep? cross-sectional users.PLoS One. e0257518Google 26Huberty al.Use consumer-based disturbances: study.JMIR Form 4: e19508Crossref (6) 27Huberty Green Glissmann al.Efficacy mindfulness "Calm" College students: randomized controlled trial.JMIR 2019; 7: e14273Crossref (160) Scholar) Headspace (eg,28Bostock Crosswell A.D. Prather al.Mindfulness on-the-go: effects work well-being.J Occup Psychol. 24: 127-138Google 29Zollars I. Poirier T.I. Pailden Effects mindfulness, well-being, perceived stress.Curr Pharm Teach Learn. 11: 1022-1028Crossref (40) 30Rung A.L. Oral Berghammer al.Feasibility Acceptability intervention Women: e15943Crossref (12) Scholar). investigating concluded trials associated promising.31O'Daffer Colt S.F. Wasil A.R. conflicts interest Ment 9: e40924Google aimed stimulation applied before 20% 79, 17.1% apps; 3). contrast Apps, primarily 36.7%) Wake 50, 63.3% many Forty percent device 32), 31.6% 25), 6.3% accelerometry (6.3%). combined 12, 15.2%), few others 6.3%).Table 3All measurementMeasurement StoresAndroidAppleTotal7927 (34.2%)52 (65.8%)In Survey48 (60.8%)11 (40.7%)37 (71.2%)In Stores39 (49.4%)11 (40.7%)28 (53.8%)Free Available73 (92.4%)27 (100%)46 (88.5%)Cost Range$0.00–119.99$0.00–119.99$0.00–119.99When Used?Sleep29 (36.7%)7 (25.9%)22 (42.3%)Wake000Both50 (63.3%)20 (74.1%)30 (57.7%)Peer-Reviewed Exists8 (10.1%)1 (3.7%)7 (13.5%)Measurement MethodMicrophone25 (31.6%)11 (40.7%)14 (26.9%)Paired Device32 (40.5%)6 (22.2%)26 (50.0%)Accelerometry5 (6.3%)3 (11.1%)2 (3.8%)Accelerometry Microphone12 (15.2%)5 (18.5%)7 (13.5%)Accelerometry, Microphone, Paired Device5 (6.3%)2 (7.4%)3 (5.8%) Eight research Seven device: Fitbit,32Chinoy E.D. Cuellar J.A. 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Marsiliani DeMasi al.Researcher Choices infant assessment: Parent report, actigraphy, Novel Video system.J Genet Jul-Aug 182: 218-235Google Cycle AB published use.40Patel Kim J.Y. Brooks L.J. Accuracy children.Sleep Breath. 505-511Crossref (33) between exceptions. First, turnover 74.1% survey, 43.3% were. Second, versions (Android 229, 98.4% vs 213, 93.4%) $6.18 $14.27, $13.48 $19.30). Third, offers Subscription options completely without necessary (Subscription: 95, 147; Totally Free: 91, 29). 27, 52) eight Apple. high means potentially wide technology. we 400 Notably, sounds. interesting This sheds light important area review. rather On surface, seem paradoxical shorten time asleep, waking period Those Also, test out having itself. evenly roughly 40% Compared 58% represent rapid mean newer content lose particularly valuable use. wa