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Volume 15 No. 11
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Accepted Papers

Emerging Technologies

Sleep/Wake Detection by Behavioral Response to Haptic Stimuli

Katherine E. Miller, PhD1,2; Linda Bäbler, MSc3; Thomas Maillart, PhD4; Afik Faerman, MS1,5; Steven H. Woodward, PhD1
1National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California; 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; 3Zühlke Engineering AG, Bogenschützenstrasse 9A, Bern, Switzerland; 4University of Geneva, Geneva School of Economics and Management and Citizen Cyber Lab, Campus Biotech, Geneva, Switzerland; 5Department of Psychology, Palo Alto University, Palo Alto, California

Study Objectives:

Actigraphy, the tool of choice for assessment of sleep phase disorders, is insensitive to movement-free waking. This study aimed to determine whether the detection of waking could be performed by recording instrumental responses to haptic stimuli delivered by a low-cost device.


Twenty adults underwent 2 nights of laboratory polysomnography (PSG) while wearing a fingerless glove under which a stimulating actigraph (“Wakemeter”) was apposed to the palm. The Wakemeter, controlled by a tablet computer, delivered gentle, haptic stimuli every 10 minutes during the sleep period. If a stimulus was detected, the participant squeezed the Wakemeter. Stimulus times, response times and movements were streamed to the tablet. Concurrent PSG data were scored blind to stimuli and responses. Self-reported sleep quality ratings were collected each morning.


The Wakemeter was acceptable to 19 of 20 participants, and effects on self-reported and objective sleep were small. The probability of a response to the stimulus during a wake epoch was high regardless of movement. In contrast, actigraphy magnitude distributions were indistinguishable across epochs scored wake without movement versus sleep, confirming a known limitation of actigraphy. A simple method for calculating sleep efficiency from responses to the stimuli yielded estimates that were highly correlated with PSG-derived estimates (rho = .69, P < .001).


Behavioral responses to haptic stimuli detected epochs of movement-free wake during the sleep period and may augment actigraphy in the low-burden estimation of sleep efficiency. Acceptability of the method over longer recording periods remains to be established.


Miller KE, Bäbler L, Maillart T, Faerman A, Woodward SH. Sleep/wake detection by behavioral response to haptic stimuli. J Clin Sleep Med. 2019;15(11):1675–1681.

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