After several years of recognizing sleep’s role in productivity and controlling health-care costs, some employers are actively giving employees tools to do something about it, taking advantage of new hardware and apps to affect behavioral changes.
While experts applaud the attention being paid to workers’ sleep, some raise questions about privacy or how useful sleep data, if it’s provided without context, will be for many employees.
“These devices can be great measurement tools,” said Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona College of Medicine in Tucson, who has consulted for FitBit. “But then what do you do with that data?”
The shift is being fueled, at least in part, by a growing crop of hardware, more individually tailored software applications and a greater focus on behavioral change. Other services connect workers with behavioral sleep experts.
Employer interest has risen as sleep science has improved, the World Health Organization has recognized burnout as an “occupational phenomenon,” and companies have become more focused on mental health, said Arianna Huffington, founder of the wellness company Thrive Global. “Anyone data-driven can no longer buy into the cultural stereotype that ‘we’ll sleep when we’re dead,’ ” she said.
The app is the second sleep program New Balance has introduced to employees; the first was mostly “generic content about sleep that you could research yourself,” said Glenn Haskell, the company’s benefits manager. Almost nobody used it, Haskell said, while 12 percent of employees have already signed up for Dayzz. “The approach of using individual data to make specific recommendations ... it’s just more relevant," he said.
BlackRock, the giant asset management firm, started buying the Oura Ring, a sleep and activity tracker worn by tech CEOs like Twitter’s Jack Dorsey and Salesforce’s Marc Benioff, for select employees in a pilot program launched early last year. It now includes about 100 portfolio managers and other investment professionals.
“What we’ve been seeing so far ... is that the measurement makes them more aware,” said Emily Haisley, a managing director at BlackRock who specializes in behavioral science. “They can see the impact of exercise and earlier bedtimes. Some people have started meditating before bed or stopping screens before bed.”
Oura, which combines body temperature, resting heart rate and the previous night’s sleep into a “readiness score,” sends users a daily alert. It might tell them to “take it easy,” for instance, if the score is low after a late steak dinner with wine kept their heart rate high during the night.
The program at BlackRock is part of a behavioral finance initiative intended to make investors more aware of their own biases, as well as how stress and other issues factor into their decision-making and risk-taking. It is entirely voluntary, said Haisley, and employees own all their own data. Employees can also choose to share their individual data with Haisley and two other teammates for analysis, she said.
With growing employer interest, some tech companies are specifically targeting their products at them. Beddr, which makes a small wireless sensor users stick to their foreheads, announced in October that it was adding a sleep coaching program and network of sleep physicians.
Beddr CEO Mike Kisch said the company has just completed a pilot with a transportation company and expects to name tech and media clients this year. Dreem, which offers a sleep headband that tracks brain activity as well as heart rate, respiration and movement, said it was also shifting its focus to employers.
Meanwhile, CVS Health is making the widely used Sleepio app, which uses cognitive and behavioral techniques often used to treat insomnia, available to employers who use its pharmacy benefits manager. Sleepio was developed by the company Big Health.
Some employers in fields like transportation, where safety is critical, have been focused on sleep for years. John Pryor, a human resources executive at Southeastern Freight Lines, started working with Atlanta-based FusionHealth in 2011 to test its truck drivers for sleep apnea. The company began covering the full cost of an at-home test as well as a continuous positive airway pressure (CPAP) machine. FusionHealth can remotely detect whether drivers’ CPAP machines are leaking and report who is using the device at least 70 percent of the time.
While detailed medical information is not shared, Pryor said, Southeastern does know if individual drivers aren’t compliant. “The safety risk is the paramount thing,” he said, noting they’ve seen a 24 percent decrease in accidents by those treated for sleep apnea since starting the program. More recently, they expanded the benefit to anyone covered on its health plan, but monitoring is only for drivers.
FusionHealth, now known as Nox Health, has since moved into other sleep disorders, sending messages to employees with insomnia, for instance, if they fall off track with their cognitive behavioral therapy app.
“As we started expanding into bigger companies, the feedback we were getting is ‘I only have intermittent sleep problems — can I get content or education?’ ” said John Letter, the company’s president and chief operating officer, leading to more education tools, a personalized behavior change app and more access to behavioral health or medical experts.
Sleep, he said, has drawn the attention of employers because unlike mental health issues, “it’s not stigmatized. It’s an easier way to engage people about their overall health. Everyone wants to talk about sleep.”
Yet as the use of such tools or services grow, some employees may question their privacy.
Lee Tien, a senior staff attorney at the Electronic Frontier Foundation, said “many workplace wellness programs exist outside of any sort of HIPAA-regulated world,” referring to the privacy law for health data — it depends on how employers structure their plans. “It is slippery enough that it’s important for people to really get it straight,” he said. “What data is being collected? Who is it actually being shared with? Under what legal regimes are they being protected? If someone mishandles my information, what is my recourse?”
Experts warn that aggregate data may still be identifiable at companies with very few employees. Pam Dixon, executive director of the nonprofit World Privacy Forum, suggests employees ask whether their employers’ programs are specifically “covered by" HIPAA, and whether the data is being “de-identified” to HIPAA standards or could be resold for commercial purposes. “The laws and the rules around wellness plans are profoundly complex,” she said.
Dixon said that de-identifying data to HIPAA standards is a “baseline best practice." While it is unclear how many third-party providers meet that threshold, many providers, including Dayzz, Sleepio, Nox Health, Dreem and Beddr, said they only provide data “de-identified” to HIPAA standards to employers.
Many also said the only data they share with employers is aggregated, or high-level summaries of figures such as average sleep length across the workforce. A New Balance spokeswoman, Amy Dow, said the company is “confident” their wellness programs are HIPAA-compliant and they only get summary figures from Dayzz.
Meanwhile, research has shown that for some people, sleep trackers could lead to more anxiety about sleep. In 2017, researchers coined the phenomenon “orthosomnia” to refer to patients preoccupied with improving sleep data from wearables. With some people, said Kelly Baron, a clinical psychologist at the University of Utah, “it led them to engage in some behaviors that made their sleep worse.”
Sleep programs might also seem like a Band-Aid for those employees who question why managers aren’t just hiring more people to lessen heavy workloads or dumping toxic managers to help alleviate sleep disruptions. And if late-night emails or off-hours conference calls are part of workplace culture, guidance to power down phones early might ring hollow.
“One of the best things you could do is just have a culture where you don’t send emails at night,” said Baron, “or where you incentivize people [against] being glued to their laptops all the time.”
With Thrive Global’s wellness platform, Huffington said users get “microstep” nudges for whichever wellness area they want to work on, such as text reminders not to have caffeine after a set cutoff time.
“Our focus is on people beginning to feel differently with these ‘microsteps’ and seeing the impact when you’re fully recharged,” Huffington said. “In the end, the only way to change behavior is for people to see the benefits.”