# Sleep, Health Care–Seeking Behaviors, and Perceptions Associated With the Use of Sleep Wearables in Canada: Results From a Nationally Representative Survey

## TL;DR

This study explores how sleep-tracking wearables are used in Canada and their effects on sleep and anxiety.

## Contribution

The study provides new insights into sociodemographic predictors and behavioral impacts of sleep wearable use in a nationally representative Canadian sample.

## Key findings

- 19.3% of Canadians reported using sleep wearables, with users being younger, higher income earners, and more likely to have sleep or mental disorders.
- Wearable users reported shorter sleep duration and more severe insomnia symptoms compared to nonusers.
- Wearable use intensified the negative impact of anxiety on sleep duration.

## Abstract

The popularity of sleep-tracking wearables has surged worldwide. Yet, there are significant gaps in understanding the real-life implications of this phenomenon. While wearables may offer insights about sleep and promote sleep health awareness, evidence remains mixed on whether they lead to improved sleep outcomes or fuel sleep anxiety.

This study aims to (1) determine the prevalence and sociodemographic predictors of using sleep wearables in Canada, (2) evaluate the perceived effects of wearable use on sleep and stress, (3) compare sleep and health care–seeking behaviors in users and nonusers, and (4) investigate the moderating effects of wearable use on the association between sleep and anxiety.

An online survey investigating sleep and mental health was distributed to a representative sample of 1200 Canadians. The survey included questions on demographics, wearables use, sleep patterns, health care–seeking behaviors, insomnia (ISI-3 [Insomnia Severity Index-3]), and anxiety (GAD-7 [Generalized Anxiety Disorder-7]) symptoms. Analyses relied on descriptive statistics and logistic regression (aims 1 and 2), multivariate analyses of covariance and chi-squared analyses (aim 3), and multiple regression (aim 4).

Among the 1200 respondents (n=636, 53% female; aged 16 to 88 years), 19.3% (n=231) reported using a wearable device to monitor sleep. Several sociodemographic variables were associated with an increased likelihood of using wearables including: youth, being retired, being part of a racialized minority group, earning a higher income, having greater health care coverage, having a sleep disorder, and having a mental disorder (χ214=110.2, P<.001). Of all wearable users, nearly 45% felt that using sleep wearables had a positive effect on their sleep (n=102) and stress levels (n=97), while 4.5% (n=10) noted a negative effect. Compared to nonusers, wearable users reported 13 minutes longer sleep onset latency (F1,1151=5.21, P=.02, ƞp2=0.005), slept about 1 hour less (F1,1143=31.60, P<.001, ƞp2=0.027), and endorsed more severe insomnia symptoms (F1,1119=4.04, P<.05, ƞp2=0.004). After adjusting for the presence of sleep disorders, only the differences in sleep duration remained. The proportion of wearable users was almost twice as high in those having informed a health care provider about sleep difficulties (χ22=35.4, P<.001) and in those having used sleep medications (χ23=38.7, P<.001). Wearable use was identified as a moderator of the effect of anxiety symptoms on sleep duration, with wearable users showing a steeper decline in total sleep time as anxiety increased compared to nonusers (F1,1165=17.5, P<.001).

One in 5 Canadians acknowledged having used sleep wearables. Predictors include younger age, higher income, and having a sleep or mental disorder. Although many individuals reported positive effects of sleep wearables, wearables use strengthened the link between short sleep and anxiety. Expanding our understanding of the factors associated with beneficial versus detrimental use of sleep wearables may help support more informed applications.