By Sree Roy

Via the video monitor during in-lab sleep studies, sleep tech Tracy Kopp, RPSGT, CCSH, has witnessed firsthand why some patients who experience repeated arousals are not ultimately diagnosed with a sleep disorder. Though apneas, seizures, or other physiological disruptions were suspected during the initial office visit, the real culprit for their excessive daytime sleepiness (EDS) is far more prosaic: These patients are interacting with their smartphones during their sleep time.

“We have seen patients routinely wake up countless times throughout the night to check their smartphones out of habit, stating that they do not remember it the next day or realize how it is creating the EDS they are experiencing,” says Kopp, a clinical sleep educator at Froedtert South, Kenosha (Wis) Medical Center Campus, via email. “Having that video to show the patient can really be an eye-opener for them.”

In 2017, mobile analytics company Flurry found that the time US consumers spend on mobile devices continues to increase. In the fourth quarter of 2016, the average time spent had reached 300 minutes—or 5 hours—per day.1 In the same year, Pew Research Center reported that 77% of Americans own smartphones.2

This means that sleep disorders centers are increasingly encountering patients who won’t power down their smartphones. The challenge is how to address mobile device use with patients, particularly in cases where ill-timed alerts will sabotage the integrity of a sleep study, such as by increasing latency to sleep or not allowing the patient to achieve REM. Just like you likely caution patients against drinking alcohol the night of their study, sleep clinicians must now become proactive in addressing mobile device use with patients and sleep center directors must have conversations with team members about how to handle patient smartphone encounters.

At Kenosha Medical Center Campus, patient phones must be completely powered down during the nap portions of multiple sleep latency tests. Since the nap portions are short and the sleep staging so critical, “of course we wouldn’t want the actual nap interrupted,” Kopp explains.

For overnight PSGs, the center trusts techs to use their skills to know what’s best for specific patients. “Some patients are single parents with teenage children at home, so turning off their phone may cause them undue stress that can affect the sleep latency and efficiency,” Kopp says. “Now if we have a severe OSA patient who is getting interrupted and not achieving REM or having time to titrate, they would be asked to turn the phone off.”

Centers that have guidelines for in-lab studies may not have solutions for patients who undergo home sleep studies. In these cases, consider having patients download an app that tracks when they unlock their smartphone and/or their device usage by time of day. (Options include Moment, Checky, and Menthal.) So if the patient denies smartphone use in the middle of the night, objective evidence exists that may be time-matched to study data to determine whether device use plays a role in the patient’s EDS. Better still, use your clinical judgement to advise appropriate patients to do this tracking on their own before a sleep study is ordered, thereby not using resources to “diagnose” patients with “smartphone disorder.”

Sree Roy is editor of Sleep Review.

References

1. Khalaf S, Kesiraju L. U.S. consumers time-spent on mobile crosses 5 hours a day. Flurry Analytics Blog. Available at flurrymobile.tumblr.com/post/157921590345/us-consumers-time-spent-on-mobile-crosses-5.

2. Smith A. Record shares of Americans now own smartphones, have home broadband. Pew Research Center FacTank. Available at www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology.