By Bertrand Beauté

Matteo Franceschetti, CEO of the New York-based startup Eight Sleep, which develops connected mattresses, told the US news site TechCrunch in an interview, "Our potential market is by definition much larger than that of connected fitness companies like Peloton. Everyone sleeps, right?" As such, he highlights the potential of the sleep business. Sleeping is not a leisure activity, but a need, and human beings spend an average of one-third of their lives asleep. So everyone needs some help for a good night’s rest. That’s 7.6 billion potential customers!

However, the sleep market has long been in a haze, amounting to a mattress change once every 10 to 15 years. Why? "In a world that worships performance and professional success, sleep has often been overlooked, thought of as a waste of time," says José Haba‑Rubio, licensed physician with the Center for Investigation and Research in Sleep (CIRS) at Lausanne University Hospital. The HypnoLaus study conducted in Lausanne estimated that people in French-speaking Switzerland sleep on average slightly less than seven hours per night, that is 1.5 hours less than 100 years ago.

"Most have a sleep debt and live feeling that they are constantly chasing after rest to try and catch up," says Raphaël Heinzer, director of the CIRS and co-author of the book Je rêve de dormir (I dream of sleeping). This sleep debt was long ignored and even given value. CEOs like Tim Cook, the boss of Apple, and Bob Iger, the head of Disney, would never miss the chance to vaunt their short nights as the reason for their success.

That was a mistake. "We sometimes get the impression that we save time and perform better by sleeping less, but it’s the opposite," Raphaël Heinzer adds. Lack of sleep increases the risk of disease: obesity, diabetes, and hypertension. Several scientific studies report that people who sleep less than five hours a night are twice as likely to develop cardiovascular diseases and increase their risk of being overweight by 50%. A study published in the journal Sleep in 2015 also showed that sleep-deprived people have four times the chances of catching a cold than others who enjoy adequate nights of rest.

Sleep quality is by no means irrelevant. It is a real public health issue. An Australian study, which caught a great deal of attention when it was published in 2018 in Sleep, showed that the global "sleep deprivation epidemic", as the authors’ put it, comes at an astronomical cost: $45.21 billion a year in Australia alone, due to illnesses, accidents, but also due to lower productivity and absenteeism at work. The authors assert that "these costs justify a substantial investment in preventive measures to address the problem through education and regulation."

Countless applications such as Sleep Cycle, Sleep Better, Réveil Bonjour, Calm or iRonfle

The message seems to be getting through. Some governments have launched awareness campaigns, while a number of organisations have instituted nap rooms. And the general public is hearing it too. "For years, sleep has been neglected, but today we are experiencing a para- digm shift," says Dr Maxime Elbaz, an expert in connected objects at the Sleep and Vigilance Centre, part of Hôtel‑Dieu Hospital (AP‑HP) in Paris. "People are increasingly aware that they don’t feel good if they don’t sleep well."

Dr Katerina Espa Cervena, director of the Cenas Sleep Centre in Geneva, agrees, "Before, patients would come to us to ask us how to reduce their sleep time. Now, we never get that type of request. Thanks to media coverage of the issue of sleep, much more value is attached to getting enough rest."

This realisation is even more striking in our hyper-connected Western countries, where people tend to sleep more and more poorly. The Swiss Health Survey 2017 published in ­February 2019 reported that nearly 30% of the Swiss suffered from sleep disorders in 2017, as opposed to 25% in 2015. After campaigns urging the population to eat better and move more, the time for sleeping well has come. According to consulting firm Frost & Sullivan’s study, the global sleep market, estimated at $432 billion in 2019, is expected to be $585 billion by 2024. In an article on the sleep market, US firm McKinsey gauged in 2017 that "there’s little doubt that the sleep-health economy will offer robust investment opportunities," as, "based on the growing awareness of the mental, physical, and economic costs of sleep insufficiency, consumers are increasingly seeking out new solutions."

What more is needed to attract the tech industry, which is always on the lookout for new high-potential markets? Launched in 2014, US firm Casper began by shaking up the entire bedding industry by infringing on the segment of mattress sale and delivery. Before then, customers would test and buy these products in stores. Now Casper has opened the floodgates of one-click online purchases with the option of returning the mattress free of charge within 100 days.

But the revolution has not stopped at the mere sales channel. Dozens of startups have cropped up, riding the promise of giving us a better night’s sleep with new technology. Countless applications, such as Sleep Cycle, Sleep Better, Réveil Bonjour, Calm or iRonfle, offer to analyse your sleep cycle, wake you up "at the right time", or reduce your snoring.

As far as hardware goes, the unlisted New York-based startup Eight Sleep, for example, sells connected mattresses that can monitor sleep and make recommendations via a special app. French startup Moona has created a pillow that adjusts its temperature, and sound giant Bose makes Sleepbuds to help you fall asleep faster. Not to mention, of course, dawn simulators, connected headbands and smartwatches, all of which now have a sleep tracking function. The list is long.

"Some connected objects for the consumer market are getting scientific validation"

Dr Maxime Elbaz, connected objects expert at the Sleep and Vigilance Centre at Hôtel‑Dieu Hospital in Paris.

This new "sleep tech" industry is booming. "Sleep has become a gold mine for startups, because people sleep badly and they want to sleep better," says Maxime Elbaz, developer of the Apple Watch app, iSommeil, which measures sleep time and snoring. A Global Market Insights report estimates that the global sleep tech market will reach $40.6 billion by 2027, up from $12.5 billion in 2020, coming out to an annual growth rate of 17.8%.

And tech giants do not intend to leave the pieces of that pie to ambitious startups. In the spring of 2021, Google launched its second-generation personal assistant Nest Hub. This new iteration by the giant from Mountain View can now track your sleep via radar. Every morning the device displays a summary of the user’s sleep and tips on how to improve it. Google has been looking into our sleep quality for several years. Back in 2019, the ubiquitous search engine bought Fitbit for $2.1 billion. Among other things, its connected bracelets can be used to track sleep. In this niche, Fitbit competes with the Apple Watch, which also has a sleep tracking feature, as do bracelets by Samsung, Huawei and even Garmin. In 2017, Apple bought the startup Bed-dit, which also sells a sleep monitor. "The sleep tech market is currently made up of lots of startups. But the market will self-regulate. Some will disappear and others will be bought out," says Maxime Elbaz. "In the end, only GAFAM will be left."

But do these connected gadgets really help people sleep better? "All technology that improves comfort, such as bedding that regulates temperature and mattresses that adjust position, are very good," José Haba‑Rubio says. "And if people feel that they sleep better with a dawn simulator, eye mask or ear plugs, they should do it! What people feel is very important in trying to get more sleep. If they feel better with whatever object, then that’s positive."

However, the utility of gadgets used to track sleep, such as connected watches, bedside radars, and mattresses or pillows with sensors, is less clear. The first generation of these devices emerged about 10 years ago and only tracked sleepers’ movements. "But movement is not a reliable indicator of how a person sleeps," Raphaël Heinzer says. "For example, insomniacs don’t move much."

But the latest models are proving much more efficient by integrating physiological measurements, including heart rate and oxygen saturation, along with artificial intelligence. The investment bank Bryan, Garnier & Co. states that "recent advancements in data acquisition opened the door to a big data revolution in sleep." This opinion is shared by Maxime Elbaz, an expert in connected objects with the Sleep and Vigilance Centre at Hôtel‑Dieu Hospital in Paris. "I strongly believe in self-measuring sleep over short periods to assess sleep quality. This helps people realise they have a health problem and can push them to see a doctor."

Philippe Koller, founder of the Swiss startup Netsensing, agrees. "There is a real need to provide more wide-spread screening for sleep disorders, because that’s where the challenge lies. It can take three to six months to get an appointment with a sleep centre in Switzerland and up to two years in the UK! So we need to find a quick and easy way to detect conditions like sleep apnoea." And there are two contrasting approaches to doing that. On one hand, startups like Netsensing in Switzerland and Dream in France are developing medically approved solutions. "We have compared our solution with devices used in hospitals," Koller says. "And the results show that our detectors perform just as well. We will therefore launch a clinical study in 2022 to get scientific validation." On the other hand are consumer trackers offering many promises but usually without proof. "Tech companies tend to sell B2C products, and then do the clini-cal trials afterwards," Maxime Elbaz says, amused. "Some connected objects for the consumer market are getting scientific validation. One is Fitbit, which has produced studies showing that its bracelets are effective, and Finnish company Oura, that markets a connected ring. Meanwhile, Apple does a lot of marketing but they haven’t published anything, nor has Samsung."

But as these technologies become mainstream, doctors’ offices are filling up with patients anxious about what their sleep apps are saying. "We’re getting more patients who come to see us because their smartwatch or app has reported that they’re sleeping poorly," says Dr Katerina Espa Cervena. The problem is that not all of these devices are reliable. Raphaël Heinzer therefore advises people who feel well not to use them. "What is the point of tracking people’s sleep if they get enough rest and don’t feel drowsy during the day?" asks the head of the CIRS at Lausanne University Hospital. "There is none. Using these devices could even be harmful if users on a quest for the perfect night’s sleep start to focus too much on it. To the point of disrupting it. This condition is called orthosomnia."

The name of this disorder was coined in 2017, just as smart sleep tracking devices poured onto the market. In a Journal of Clinical Sleep Medicine study, the researchers who came up with the term explained that they based the word "orthosomnia" on its similarity to orthorexia, the unhealthy obsession with healthy eating. Data recorded by sleep tracking devices causes orthosomniacs to become obsessed with sleep. They give it excessive importance and want to sleep well at all costs to optimise their days. The result? They don’t get any sleep! "New sleep measurement technologies can be interesting," says Dr Cervena. "But the important thing is not the device, but how you use it."

THE MAIN SLEEP DISORDERS

INSOMNIA
The most common sleep disorder, insomnia is defined as trouble falling asleep, waking up at night without falling back asleep and/or waking up too early in the morning. Studies estimate that it affects 15% to 20% of the population, and 9% suffer from severe insomnia. It is more common in women and increases with age.

OBSTRUCTIVE SLEEP APNOEA
Sleep apnoea involves recurrent episodes of obstructed breathing during the night. Sleep becomes fragmented because each apnoea causes a micro-arousal of which the patient is not necessarily aware. Fifty per cent of men and 25% of women over age 40 suffer from sleep apnoea.

RESTLESS LEGS SYNDROME
Restless legs syndrome (RLS) is a chronic disorder characterised by an uncontrollable urge to move the legs, combined with unpleasant sensations in the lower limbs. It occurs mainly at night.

HYPERSOMNIA
Even though they get a long, uninterrupted night’s sleep, people who suffer from hypersomnia are always tired and complain of feeling overly sleepy during the day. They often feel the need to take long naps and have trouble waking up.

PARASOMNIA
Known as sleepwalking, parasomnia is the act of walking, talking or engaging in any other form of complex activity while asleep. This disorder can cause significant problems for livein partners, especially when the patient unconsciously initiates sexual relations. A sleep debt, poor sleep habits and the consumption of stimulants (caffeine, alcohol) can bring on such episodes.