Are You Tracking Yourself Into Worse Sleep?

In this episode we discuss:

• What sleep trackers get right—and where they go wrong
• The rise of orthosomnia and why it’s becoming more common
• How sleep anxiety triggers cortisol and disrupts rest
• The “hyperarousal” model of insomnia explained
• Why perfectionist beliefs about sleep can backfire
• When sleep tracking is useful—and when it becomes harmful
• Why CBT-I is the gold standard for insomnia treatment
• The importance of managing daytime stress for better sleep
• A new framework: sleep as a biological process, not a performance metric

Show notes:

• “Orthosomnia: Are some patients taking the quantified self too far?” by Baron, K.G., et al
• “HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies” by Dressle, R.J., et al.
• “Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity” by Faaland, P., et al.
• “Prevalence of orthosomnia in a general population sample: A cross-sectional study” by Jahrami, H., et al.
• “Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version” by Morin, C.M., Vallières, A., & Ivers, H.
• “Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: Clinical implications” by Vgontzas, A.N., et al.
• CBT-I (Cognitive Behavioral Therapy for Insomnia)
• Sleep Reset Program
• Learn more about the Adapt Naturals Steady Spirit or take our quiz to see which products best suit your needs
• If you’d like to ask a question for Chris to answer in a future episode, submit it here
• Follow Chris on Instagram or Facebook

Hey everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to talk about something that has become a massive part of the wellness conversation, sleep tracking. If you own an Oura ring, an Apple watch, a WHOOP strap, or any of the dozens of wearables on the market, you’ve probably found yourself checking your sleep score first thing in the morning. And if that score was low, you may have noticed it changed the way you felt about your day before the day even started.

I have a somewhat unique perspective on this, because, in my years of clinical practice, I treated thousands of patients with sleep issues. Many of them came in clutching their phone, showing me graphs and scores and percentages of deep sleep. Some of them even had spreadsheets and years of sleep history tracking. They were doing everything right, and yet they still felt terrible. Over time, I started to see a pattern. The more obsessively someone tracked their sleep, the worse their sleep tended to get. This isn’t just my clinical observation. Researchers have given this phenomenon a name: orthosomnia, similar to orthorexia, the unhealthy obsession with diet. A 2017 paper in the Journal of Clinical Sleep Medicine described a growing number of patients seeking treatment for self-diagnosed sleep problems based entirely on their tracker data. The term combines “ortho,” meaning correct, and “somnia,” meaning sleep, because the perfectionist pursuit of ideal sleep data mirrors what we see with orthorexia and food. This matters because we’re living in an era where “optimize everything” is the default mindset, and sleep has become the latest target. The global sleep tech market is enormous, and the messaging is clear: track your sleep, improve your score, and you’ll feel better. But what happens when that loop backfires? What happens when the tool designed to improve your sleep becomes the very thing keeping you awake?

By the end of this episode, you’ll understand what orthosomnia is and why it’s becoming more common, how anxiety about sleep can trigger a cortisol response that makes sleep worse, why the belief you need perfect sleep every night is itself harmful, and what the research says about the most effective way to improve your sleep without a gadget. Let’s dive in.

Let’s start with what this looks like in real life. In the original case series, one patient was a 27-year-old woman whose sleep tracker told her she wasn’t sleeping well. She came into the sleep lab, and polysomnography, which is the gold standard for measuring sleep, showed she was sleeping fine. Her sleep architecture was normal. But she wouldn’t believe the lab results because they contradicted her tracker. She trusted the algorithm more than the objective medical data. That’s not an isolated case. Another patient in the same series was spending excessive time in bed, trying to push his tracker’s reported sleep duration higher. The irony is that spending too much time in bed is one of the most common behaviors that worsens insomnia. He was doing the exact opposite of what would help him, and the tracker was reinforcing it. A more recent study in Brain Sciences in 2024 tried to estimate how common orthosomnia is in the general population. Among about 500 participants, about 36 percent regularly used sleep trackers. Using a multi-criteria screening algorithm that combined tracker use, insomnia symptoms, anxiety levels, and preoccupation with sleep, the researchers found that orthosomnia isn’t a fringe phenomenon. It’s showing up in a meaningful percentage of tracker users, particularly those who already have some anxiety about sleep.

I saw this pattern constantly in my practice. A patient would get a tracker, notice their deep sleep was low, often based on metrics that consumer devices measure with poor accuracy, and then start lying awake worrying about their deep sleep percentage. The worry created arousal, the arousal disrupted sleep, and the disrupted sleep produced a worse score the next morning, which created more worry. It’s a vicious cycle that feeds on itself.

The biology behind this is rooted in your stress response. Insomnia researchers have long recognized something called the hyperarousal model. The basic idea is that insomnia isn’t just a nighttime problem, it’s a 24-hour state of elevated physiological activation. A 2022 systematic review and meta-analysis in Sleep Medicine Reviews looked at 20 studies comparing cortisol levels in people with chronic insomnia versus good sleepers. People with insomnia had moderately elevated cortisol levels throughout the entire day and night. The effect was most pronounced when measured through blood samples, with an effect size of 0.67, which is considered moderate to large. So insomnia isn’t just about what happens in bed at night. It’s driven by a stress system, the HPA axis, that’s the hypothalamic-pituitary-adrenal axis, that never fully downshifts. Anything that increases your anxiety about sleep, anything that makes you worry more about whether you’re sleeping well enough, has the potential to activate your stress response system.

Think of it this way. Your cortisol system is like a smoke detector. It’s supposed to go off when there’s a real fire, a real threat. But if you’re lying in bed anxiously refreshing your sleep score in your head, wondering whether tonight is going to be a good night or a bad night, that smoke detector starts going off because of the worry itself. And once cortisol is elevated, your brain is in a state of alertness that is fundamentally incompatible with sleep. You cannot worry your way to better sleep. It just doesn’t work. When I was seeing patients, the people who struggled most with sleep were the ones running around like a chicken with their head cut off all day, dealing with stress constantly, not doing anything to manage it, and then expecting to magically fall asleep the moment their head hit the pillow. That’s not how the nervous system works. Sleep isn’t a switch you flip. It’s a gradual downregulation of arousal that begins hours before bedtime. If your cortisol has been spiking all day from work stress, relationship stress, and then sleep score stress on top of it, your body’s not going to cooperate at 10 pm.

The more you try to control and optimize sleep, the more elusive it can become. Better sleep starts with reducing anxiety, not increasing data. #ChrisKresser #sleep

Okay, let’s talk about the beliefs themselves. Sleep researchers have identified a set of what they call “dysfunctional beliefs and attitudes about sleep.” There’s a validated scale for measuring them, the DBAS-16, published in Sleep in 2007. The scale captures beliefs like “I need eight hours of sleep to function,” “If I don’t sleep well, I won’t be able to cope tomorrow,” and “Insomnia is essentially caused by a chemical imbalance.” These beliefs are strongly correlated with insomnia severity and anxiety. A 2023 study in Sleep looked at over 1000 participants in a randomized controlled trial of digital cognitive behavioral therapy for insomnia. Changes in dysfunctional sleep beliefs mediated 64 percent of the improvement in insomnia severity. More than half the benefit of the most effective insomnia treatment we have came from changing what people believe about sleep. It’s not primarily the sleep hygiene tips or the specific techniques, although those can be important. It’s the beliefs. And this is exactly where sleep trackers can do the most damage. They reinforce the belief that sleep is a performance metric, that every night needs to hit a target, that deviations from optimal are cause for concern. They turn a natural biological process into a scoreboard. And for a subset of people, that scoreboard becomes a source of anxiety that perpetuates the very problem they’re trying to solve. I don’t think it’s helpful for people to get the idea that they have to sleep eight hours every single night perfectly to be healthy and well. Humans are far more resilient than that. We’ve survived for hundreds of thousands of years without sleep scores. A bad night here and there is normal. Your body compensates. But if you’re carrying the belief that anything less than a perfect score means tomorrow will be a disaster, that belief itself generates the arousal that keeps you awake.

Now I want to be clear, sleep trackers aren’t useless. They can be helpful, especially in the early stages, for identifying things that interfere with sleep that you may not be aware of. For example, if you have a glass of red wine with dinner, and your tracker shows you slept terribly that night and you weren’t aware of the connection, that’s valuable information. If you notice your sleep improves dramatically on days you exercise and you weren’t aware of that, that’s useful too. The problem is that once you’ve identified the major factors, the value drops off sharply. The tracker’s done its job. You know that alcohol disrupts your sleep. You know that late caffeine is a problem. You know that exercise helps. At that point, continuing to obsessively monitor creates diminishing returns, and for many people, a net negative effect. The data stops being informative and starts being anxiety-producing. It’s a bit like stepping on a scale. If you haven’t weighed yourself in a year and you want a baseline, that’s reasonable. But weighing yourself every hour and adjusting your behavior based on each fluctuation? That’s a recipe for an unhealthy relationship with your body. Sleep tracking works in a similar way. There’s a window of utility, and beyond that window, it can become counterproductive.

So what does work? Well, as I’ve talked about many times on this podcast and written about in my books and on my website, proper sleep hygiene is critical. But if you already have that dialed in and you’re not sleeping well, what else should you be focused on? Well, the evidence is quite overwhelming here when you look at it, and it points in one direction: Cognitive Behavioral Therapy for Insomnia, or CBT-I. This is the gold standard recommended by the American Academy of Sleep Medicine as the first line treatment for chronic insomnia. It works better than sleep medications in the long run, without the side effects or dependency risk. CBT-I includes several components: sleep restriction, which sounds counterintuitive but is remarkably effective, stimulus control, cognitive restructuring, which directly addresses those dysfunctional beliefs we talked about, and sleep hygiene education. The key insight is that it works by changing your relationship with sleep, not by adding more gadgets or supplements to the equation. The research base here really is massive. Meta-analyses consistently show large effect sizes for insomnia severity and the benefits persist long after treatment ends, unlike medications where sleep often deteriorates again when you stop taking them. Digital versions of CBT-I have also been shown to be effective, which makes it more accessible than ever.

If you’re someone who’s been stuck in the tracker anxiety cycle, the single most important first step is releasing unhelpful beliefs about sleep. That’s where CBT-I shines. One program I recommend is the Sleep Reset Program at TheSleepReset.com. It’s a clinician backed, CBT-I based program that includes personalized coaching and has been really well received. It’s a great option if you don’t have access to a sleep therapist in your area, and it addresses exactly the kinds of beliefs and behaviors that keep the insomnia cycle going. Beyond that, managing your stress during the day is perhaps the most overlooked piece of the puzzle. The reason sleep medications are so popular is that most people don’t manage their daytime anxiety and stress, and so they need something that acts like a sledgehammer to force sleep at night. That’s a band-aid approach. The real work is creating conditions for sleep to happen naturally, and that starts with how you manage your nervous system during the 16 plus hours you’re awake. This was one of the reasons I developed Steady Spirit, which is a formula designed to support your body’s natural stress response throughout the day and into the evening. It includes adaptogens like ashwagandha, holy basil, and L-theanine, along with saffron extract and lemon balm. The idea behind the formulation was simple: if you can support a calmer baseline during the day, you give your nervous system a much better chance of transitioning smoothly into sleep at night. So it’s not just a sleep supplement, it’s a daytime stress support formula, and for many people, that distinction makes all the difference. You can find it at AdaptNaturals.com. 

Here’s the broader principle I keep coming back to. We live in a culture that tells us we can optimize our way to health, that the right data, the right protocol, the right stack of interventions will unlock some higher level of performance. And sometimes, for some things, that approach has tremendous merit. But sleep is fundamentally different. Sleep is an act of letting go. It requires the opposite of optimization. It requires trust in your body, tolerance for imperfection, and the willingness to stop trying so hard. Sometimes the most powerful thing you can do for your health is put down the tracker, turn off the score, and just go to bed.

Thanks for listening. You can find show notes and links to all the studies I mentioned at ChrisKresser.com. If you have questions about this episode or suggestions for future topics, head over to ChrisKresser.com/podcastquestion and leave me a message. I read all of them, and your questions help shape the content I create. Until next time, be well.