QuietOn Ear Buds for Sleep
QuietOn Ear Buds for Sleep
Report of the Evidence, An Independent Academic Viewpoint
By Dr David Broome
DREEM is a headband that monitors sleep by measuring brain activity, heart rate and movement. It plays sounds which aim to make falling asleep easier as well as improve time spent in deep sleep. High “sleep inertia” causes drowsiness and the transition from sleep to awake can last up to a few hours. A sudden wake-up during the deep-sleep phase generates much greater sleep inertia than when it occurs during light sleep. The DREEM also claims to allow you to wake up more gently.
The marketing material on the products website comments that sleeping pills, mattresses and sleep trackers are ineffective. The following is a review of the science that supports the claims, which has been informed by a personal examination of the DREEM.
The product was developed four years ago by graduates of Ecole Polytechnique, France who examined the effects of sound simulations on sleep. The product was beta tested in 2016 after a year of development and was sent to 500 shortlisted applicants from a long list of 7000. Further developments have culminated in the product currently commercially available from the website https://dreem.com/en
The headband uses polysomnography (PSG) sleep monitoring technology to measure sleep accurately. PSG is used in sleep research centres and laboratory’s around the world but has been brought to the home with the DREEM. It includes 4 EEG sensors to measure brain activity and has a pulse oximeter to measure heart rate. It also contains a bone conduction piece to transmit sound from the forehead to the inner ear which removes the requirement for earphones. Finally, an accelerometer measures movement during sleep and throughout the night, all this biological data is collected in real time minute by minute.
The products developers have been working with academic researchers and the science board consists of world leading sleep experts from the Universities of Oxford, Seattle and Stanford. To support the efficacy of the product, impressively there are numerous research studies with one clinical trial complete and a further two ongoing. In the first clinical trial, Debellemaniere et al (2018) assessed sleep after one and 10 nights in the home environment in 90 middle aged adults using the DREEM. Various sleep outcomes improved but the main aim of this study was to test how well the DREEM recorded the biological data compared to the expensive PSG equipment traditionally used in the lab. Testing took place with 24 participants recording the data with both methods and they were highly correlated with r values up to 0.9 for various measures including sensitivity. What this means is the DREEM is measuring the data similar to lab standard at less cost and is less invasive.
Two further clinical trials are ongoing. One is being undertaken by the University of Stamford to test the DREEM’s ability to measure the severity of sleep apnea in 70 patients. In the second trial taking place at the French Armed Forces Biomedical Research Institute, 25 healthy volunteers with mild sleep complaints are sleeping overnight wearing the DREEM and standard PSG lab equipment. The primary objective of this study is to validate the performance of DREEMS automatic sleep staging and sleep patterns detection algorithms compared to the consensus of blinded sleep experts’ scoring of simultaneous PSG records. The results of this studies are anticipated in the coming months.
To get started you download the DREEM coach app in the App store for iOS or google play for android devices. After creating an account, you sync the app to the headband by simply switching on the power button. You then follow the instructions on the app. Interestingly you can test if your brain activity is being picked up and it clearly changes when you move from closing your eyes to then reading for example. My resting heart rate recorded by the pulse oximeter is exactly the same as when I measured previously in our exercise physiology lab.
Stage 1 is an assessment of your sleep which lasts 7 nights. The app provides a video tutorial on how to effectively place the headband correctly. To test the set up, I tried to start my first nights sleep during the day but it discarded the data as the collection had not been for at least 15 minutes. You are also unable to use the other functions being ‘nap’ and ‘relax’ until you have completed the full 7-night sleep assessment cycle.
The DREEM is very easy to initiate by merely starting the app. You set an alarm to indicate when you would like to wake but it selects the point at which your sleep is lightest within a specific time frame. The headband was comfortable and did not agitate me at any point. Despite not needing earphones it does not disturb anyone in close proximity. When charged in the morning, the Bluetooth or WiFi connection sends the data collected overnight to the app which then displays your total sleep duration, how long it took you to fall to sleep and how many times you woke up in the night.
A hypnogram also provides your sleep stages, heart rate and movement for every minute of sleep and the larger the surface area the better your overall sleep. I personally found that my sleep onset is good i.e. it took me on average 9 minutes to get to sleep and I have few awakenings with a mode of 2. However, agitation, which is calculated through the number of movements I made in the night and fragmentation being the number of times I change from one sleep stage to another were high.
On completion of the 7-day assessment, it uses the neurofeedback and its algorithms to improve your sleep. Neurofeedback is a form of biofeedback which translates a biological signal such as the heartbeat or breathing rate into another signal more perceptible to the user such as sound. The sensors measure the shape of the brain waves and translate this into a sound signal.
The DREEM coach app suggests personalised relaxation techniques, breathing exercises and meditation depending on the findings and from responses to a series of questions about previous sleep patterns, work, lifestyle and stress. The practical tips and to-do lists seek are useful and I learnt about sleep consolidation which is a powerful technique that requires you to stick to a schedule to encourage sleep in one uninterrupted block with minimal movement.
I was fascinated by the ability to view minute by minute and was able to use the data to enable me to understand my sleep and consider my bad habits to improve my sleep hygiene. I don’t believe I have a sleep problem per se but the promotional material indicates that if you have chronic insomnia you are encouraged to use one of the different programmes such as cognitive behavioural therapy which is also embedded.
Difficulty falling asleep is a frequent complaint among the general population (Roth, 2007). The DREEM website quotes that 10% of the population suffers from chronic insomnia and 20% sleep apnea. This has numerous detrimental effects on health and productivity which the DREEM hopes to solve. It is expensive at approximately £399 but it is worthwhile considering you sleep and will therefore use DREEM everyday. To understand and become a master of your sleep I recommend you visit the product website which can be found at https://dreem.com/en.
For extensive information about the product, its development and the science supporting it I suggest requesting the DREEM whitepaper (DREEM, 2019) that was published in March.
Debellemaniere, E. et al (2018). Performance of an Ambulatory Dry-EEG Device for Auditory Closed-Loop Stimulation of Sleep Slow Oscillations in the Home Environment. Frontiers in Human Neuroscience. doi: https://doi.org/10.3389/fnhum.2018.00088
Dreem (2019). Whitepaper. Author
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 15(3), S7-10.
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Review completed and approved for use by Sheffield Hallam University
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