Journal of sleep researchDec 15, 2023

Using wearable headbands to measure brain and body arousal in people with stress-related mental health conditions

Updated Mar 4, 2026

Abstract

Analysis of 371 nights of sleep data from 83 participants indicates that wearable devices can effectively assess sleep in psychiatric patients.

Wearable devices recorded both brain activity and heart rate during sleep, demonstrating good acceptance and data quality among participants.
Trends for significance were observed in sleep continuity, but not in sleep depth between groups.
No significant differences were found in spectral analyses between healthy participants and those with stress-related mental disorders.
A notable interaction was observed where the normal age-related decline in low versus high frequency power ratio was less pronounced in the patient group.
Patients exhibited a higher mean heart rate before sleep compared to healthy participants, which decreased during sleep and returned to baseline at wakefulness.

Simplified

Several stress-related mental disorders are characterised by disturbed sleep, but objective sleep biomarkers are not routinely examined in psychiatric patients. We examined the use of wearable-based sleep biomarkers in a psychiatric sample with headband electroencephalography (EEG) including pulse photoplethysmography (PPG), with an additional focus on microstructural elements as especially the shift from low to high frequencies appears relevant for several stress-related mental disorders. We analysed 371 nights of sufficient quality from 83 healthy participants and those with a confirmed stress-related mental disorder (anxiety-affective spectrum). The median value of macrostructural, microstructural (spectral slope fitting), and heart rate variables was calculated across nights and analysed at the individual level (N = 83). The headbands were accepted well by patients and the data quality was sufficient for most nights. The macrostructural analyses revealed trends for significance regarding sleep continuity but not sleep depth variables. The spectral analyses yielded no between-group differences except for a group × age interaction, with the normal age-related decline in the low versus high frequency power ratio flattening in the patient group. The PPG analyses showed that the mean heart rate was higher in the patient group in pre-sleep epochs, a difference that reduced during sleep and dissipated at wakefulness. Wearable devices that record EEG and/or PPG could be used over multiple nights to assess sleep fragmentation, spectral balance, and sympathetic drive throughout the sleep-wake cycle in patients with stress-related mental disorders and healthy controls, although macrostructural and spectral markers did not differ between the two groups.

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