It has been less than a year since Medgadget tried out SleepScore Lab’s SleepScore Max, the company’s second generation of sleep monitoring devices, following the S+ system. Today, we’re onto their third offering: the SleepScore App. While both S+ and SleepScore Max systems paired hardware and software in a combined offering, the latest release from SleepScore Labs is an app-only product that does not require the use of any hardware peripherals to monitor a user’s sleep.
Previously, the company’s hardware scanned the user while sleeping. Now, this functionality comes directly from smartphone speakers which send silent sound waves towards the user that are reflected back into the smartphone’s microphone. The returned signal is analyzed to identify breathing rate and body movement, the combination of which are used to determine various stages of sleep throughout the night. As we’ve heard previously from ResMed (a key partner in the SleepScore Labs joint venture) CEO Colin Lawlor, SleepScore Labs’ technology is validated against polysomnography (PSG) and actigraphy, two clinically accepted standards of measuring sleep. In addition to the existing feedback engine, SleepScore’s App now also allows a user to select a sleep goal, triggering targeted advice and challenges to help the user achieve their goals. A SleepShop also enhances SleepScore’s offering by providing curated products evaluated by SleepScore Labs that can help address many of the typical sleep challenges users face, such as falling asleep easily and snoring.
While the SleepScore App is free to download that tracks up to seven nights of sleep, premium features such as unlimited sleep logging, feedback, and access to the SleepShop are available with a monthly ($5.99) or annual ($49.99, on sale for $29.99 as of this article) fee. SleepScore Max users are automatically able to access the SleepScore App’s premium features.
Medgadget had another chance to hear from ResMed CEO Colin Lawlor about SleepScore Lab’s latest offering, and to try out the standalone SleepScore App. Check out both the interview and product review below.
Medgadget, Michael Batista: Within the last year and a half, we’ve reviewed two SleepScore systems and are now checking out your third. What led to this third iteration in ResMed’s product offering and a departure from the use of a bedside sleep monitor? Was there a change in smartphone technology that wasn’t possible before that facilitated this evolution?
Colin Lawlor: Starting with the last question – smartphones have improved both in terms of processing capability and speaker and microphone quality. When combining this with a revolutionary.and patented, new approach to sonar, we found a way to enable a pretty clear picture of the respiratory pattern and gross body motion which enabled us to leverage our years of work developing algorithms for the hardware platform. This was a breakthrough, originally developed and patented at the University of Washington, then substantially added to by the expertise of ResMed Sensor Technologies in Dublin. All of this made it possible for the first time to convert most smartphones into a highly reliable physiological sensor from which we can derive an accurate SleepScore.
On the first question – our mission is to improve sleep health for everyone. Simply speaking, requiring people to purchase hardware as the first step was substantially limiting the potential to make a difference. Now, people with a smartphone, so far we support all Apple devices from iPhone 6 up plus many Samsung devices – that equates to about 1.2b smart phones, can get their SleepScore tonight – for free. That totally changes the way in which we can scale and make a much bigger difference to sleep health globally. We have not departed from bedside monitoring and will continue to sell these devices to those interested in long term monitoring of their sleep health.
Medgadget: While the source of the data has changed, has there been any change or improvement to the underlying algorithms analyzing sleep data?
Lawlor: We have largely built on all of the work we have been doing for more than 13 years – so while the sensor is different, the core algorithms operate similarly. That said, we have implemented some improvements to those algorithms based on the 6 million nights of data collected. Keep an eye out as we share some riveting new insights through scientific papers and publications in this space.
Medgadget: Are there any new or improved features you’d like to highlight in the SleepScore system?
Lawlor: We have made several significant improvements to the advice engine which are now also available to SleepScore Max customers. We have added an unparalleled level of advice personalization. In addition, we have added our Sleep Shop – a location where more than 70 curated sleep improvement products and services can be found. The Sleep Shop features products which have undergone our 9-step assessment and includes products and services on which we have completed an extensive validation study. The high barrier we set means that less than 40% of all sleep products make the grade to be in our Sleep Shop. This provides a trusted source for consumers who are trying to figure out what works for them.
Medgadget: What has been the response to SleepScore’s latest offering from users?
Lawlor: Extremely strong – although we are at the early stages, we have had a tremendous response globally. The app is already in use in more than 100 countries. It has been amazing. That said, we also learned that we have a lot of things to improve and make better. Since launch, we have updated our app more than eight times – we take customer feedback extremely seriously and respond very quickly.
Medgadget: We previously spoke about the fact that while the SleepScore system is not a medical device, it has been validated against clinical-grade standards. Is SleepScore evaluating any other markets or use cases apart from selling to consumers for individual use?
Lawlor: Yes – the app is also validated against clinical standards – it performs extremely well and we have published the details on our website. You should also expect a series of published papers over the coming months on various aspects of our work – we have a truly world-class science and research team here and they have been making tremendous progress. As to new applications – we remain focused on sleep improvement but welcome opportunities to collaborate in adjacent areas.
Medgadget: Is SleepScore still supporting the SleepScore Max device and software? Are there any use cases where someone would want to use both systems or are they redundant to each other?
Lawlor: Absolutely we continue to support SleepScore Max. We see many users who prefer to use SleepScore Max day to day because of ease of use. Because of the dedicated hardware, once you set it up, you don’t have to position it every night. It also has more details, such as bedroom light and temperature and we give you personalized feedback based on this information. We believe SleepScore Max users will benefit from use the SleepScore app when travelling and being able to get their SleepScore no matter what. SleepScore Max users automatically get access to the premium subscription in the SleepScore app.
What’s in the Box?
Nothing! But seriously, as Colin mentioned in the interview above, the biggest difference in this new product offering, compared to previous SleepScore systems and other sleep monitoring products Medgadget has tried, is the complete lack of hardware required for use. Almost any individual can download and begin using the standalone SleepScore app immediately. I downloaded the SleepScore app for iOS to my iPhone 8, though a version is also available for Android.
Before beginning, I deleted my SleepScore Max app to avoid any confusion, but logged into the new SleepScore app using my SleepScore Max login credentials. Conveniently, my account information was already populated by the new SleepScore app, though there were a few new fields that I could complete in the Profile section. While full completion of the Profile is not required to record data and generate feedback, I did so to maximize the potential for personalized feedback generated by SleepScore’s algorithms.
To capture data during a sleep session, the smartphone needs to be plugged in and positioned next to the bed with speakers pointed towards the upper body from about an arm’s length away. The smartphone needs to lay flat and level with the body with nothing placed between the smartphone and the sleeping individual. An animated video on How To Setup Your Phone, located on the Settings screen, provided much needed help in making sure my smartphone positioning and setup was correct. Importantly, ensuring that the speakers are not obstructed requires that some smartphone cases be removed and the speakers cleaned if they are clogged with dirt or dust. For users like me, who can’t trust their smartphone to stay intact without a protective case, taking the smartphone case off each night and replacing it each morning is a little inconvenient.
Achieving the correct setup was, for me, the most challenging part of my SleepScore experience. Instead of a nightstand or anything positioned next to my bed, I have a headboard with a flat top that functions as a shelf and storage space. While an outlet behind the bed lets me plug my phone in and place it on the headboard, this position is well above my sleeping position. This meant that I had to both fashion a bedside table using stacked boxes and use an extension cord to keep the smartphone charging throughout the night. The SleepScore app does not allow the user to begin a sleep session unless the device is plugged in. These steps were required largely due to the setup of my bedroom, though others without night stands or conveniently located outlets may need to find their own workarounds to allow the SleepScore app to capture sleep data. Note that I have previously used SleepScore Labs’ S+ device successfully without any modifications to my bedroom setup.
Before beginning a sleep session, the home screen can prompt the user to respond to a series of “What Did You Do Today” questions similar to previous SleepScore systems and other sleep monitoring technologies. In this latest version of the SleepScore app, this data capture step is simplified to five easy questions about activities such as caffeine and alcohol intake, as well as exercise.
To begin a sleep session, the user taps on the “+” icon on the home screen and, once the phone is plugged in and in the proper setup, described above, all that’s left is to tap the screen once more and go to sleep. As promised, the use of a non-contact sleep monitor, once begun, is straightforward and requires no interaction until morning. A Smart Alarm option is available to help with waking up. Despite my overall positive experience with the app user interface, the Smart Alarm screen was confusing and challenging to set precisely. On the dynamic 24 hour central image, the user can modulate both the sleep and wake up time dials. It is unclear to me what changing the sleep time does for the alarm functionality apart from informing the user how long they will be sleeping. Additionally, while both sleep and wake up time dials can be moved, they scan all possible times and not, for example, 5 minute increments. This means that setting the wake up time to a precise number like 6:4 5am takes a few tries unless the user is fine being plus or minus a couple minutes from the target time.
My last comment on usage pertains to the data collection itself. I had mixed results with the SleepScore app successfully capturing a full night’s worth of sleep data without issue. Some nights, the report noted that “Due to sonar interference detected, your SleepScore may have been affected” and marked the score on the overview screens with an asterisk (*) to denote the potentially inaccurate data. Other nights, I would wake up to a message that significant interference resulted in unreliable sleep data and no score generated. These results occurred both when sleeping alone and with a partner. One guess as to the source behind these mixed results is that a body pillow I often sleep with ended up between me and my smartphone during the night. The smartphone itself was undisturbed on all occasions when the data capture ran into some issues.
Feedback and Reports
Feedback from the SleepScore app actually takes some days worth of data to generate. When provided, this content is available on the main Sleep Guide screen or home screen. This is an improvement from other systems, including SleepScore’s earlier offerings, which provided immediate feedback even after the first night of use. With historical context, the feedback ends up more contextually relevant and personalized. I also liked how feedback defined actionable next steps that both I and the system would take together. For example, after a particularly bad night of sleep where I woke up often, my morning feedback commented on this issue while noting that it would specifically create a challenge for me related to staying asleep throughout the night, if it documented multiple awakenings for the next couple nights. While there is still room for improvement, the feedback produced by the SleepScore app is one of, if not the most useful and relevant I have received from a sleep monitoring system. I understand that the mobile apps for SleepScore’s previous offerings are also getting the benefit of improved user feedback algorithms.
Unlike feedback, reports are available every morning immediately following a sleep session and through the History screen from the home page. The History screen provides easy navigation between monthly, weekly, and nightly summaries with individual reports accessible from the nightly historical view. Within an individual report, there are two main views: Score and Sleep Graph. The Score screen provides a quantitative SleepScore and a visual Aura that reflects the users’ score for each of the six variables on which the SleepScore is based. As described in the app, “These six variables are measured against known sleep averages for over two million nights of sleep. From there, we determine your specific nightly SleepScore from 0-100.” The six variables and their weighting on the SleepScore are as follows:
- Sleep Duration: 40
- REM Sleep: 20
- Light Sleep: 5
- Wake Time: 10
- Deep Sleep 20
- Time to Fall Asleep: 5
While the duration of each measured variable in hours and minutes is documented on the Score screen, tapping on the SleepScore, or any of the individual variables, provides a more detailed explanation of the SleepScore or variable, shows the specific score the user received for a specific variable, and highlights the relevant Aura segment associated with a specific variable. In addition to the SleepScore and Aura visualization, the Score screen also presents a Mind Score, Body Score, and Respiratory Rate. The Mind Score is based on the user’s REM sleep while the Body Score is based on the user’s deep sleep. These are separate scores from the REM and deep sleep variables despite. The Respiratory Rate is the average number of breaths per minute and typically falls between 12-20.
Complementing the Score screen is the Sleep Graph screen where a user can engage in an interactive visualization of their sleep session. By moving a horizontal slider, a user can scan through the sleep session and see specifically when and how long different phases of sleep were experienced. The slider is paired with a secondary interactive visualization that the user can also move in a circle to scan through their sleep session.
Overall, the SleepScore provides one of the most appealing, intuitive, and interactive sleep reports available in sleep monitoring apps today. A clear effort has been made to robustly document each sleep session while explaining how various scores are calculated and why they are important. Two areas for improvement are the Mind and Body scores. It is unclear what the maximum possible score is or what a good score would be for the Mind and Body measures. I was also unclear how these scores differentiate from the REM and deep sleep variables. Note that this was a similar observation made in Medgadget’s review of the SleepScore Max. Besides this, the combination of quantitative and visual information, along with additional explanations available by tapping on different measures, was incredibly informative and appreciated. Each time I wanted to interact with a visual element in the report, I was able to do so in exactly the way I expected. In the interview, Colin mentioned how the SleepScore team is both responsive to user feedback and iterates often to improve their product. It shows.
- Free download with no hardware peripherals
- Gorgeous, intuitive user interfaces on most screens
- Works with existing SleepScore accounts to allow use of SleepScore peripherals at home and SleepScore app on-the-go
- Contextual, personalized feedback
- Informative, interactive reports
- Requires some positioning effort depending on bedroom configuration
- Does not work with some smartphone covers
- Some measures (Mind and Body Scores) could use further clarification
- Challenges with consistent data collection
Link: SleepScore app…
Flashbacks: SleepScore Max by SleepScore Labs: CEO Interview & Product Review; S+, Setting a New Standard in Consumer and Clinical Sleep Technology: Interview with Colin Lawlor, CEO of SleepScore Labs