BIG READ: Commercial sleep aids have sceptical experts on the alert

Insomnia is a global plague. It is keeping the Sandman wide awake and busy at night.  

The science behind insomnia is growing. A Chinese study in Health Data Science in July is one of the most comprehensive sleep-health analyses yet. It links insufficient restful sleep with more than 172 health problems, many of them life-threatening. They include heart disease, type 2 diabetes, depression, dementia and weight gain.

The tech world has responded with a dazzling array of gadgets, gizmos and wearable wizardry designed to monitor, manipulate and mend harmful sleep patterns.

Do they work or are they marketing hype designed to separate you from your hard-earned cash?

Expert opinion is, at best, divided. And concerned. Overreliance on sleep tech may contribute to orthosomnia, a pop-psychology term for anxiety triggered by obsessing over sleep data.

Orthosomnia creates missed opportunity for correct diagnosis and endless opportunity for mismanagement of undiagnosed or misdiagnosed underlying disorders.

Despite concerns, health-sector innovation continues.  

Smart beds now rest securely on sleep technology’s top tier. These are fully integrated base-and-mattress systems and priced on steep gradients.

At the high end, they offer split bases with dual controls, allowing sleepers to adjust head, feet and firmness independently. Think of them as diplomatic solutions for couples. One person can sleep in zero gravity while the other binge-watches true crime at a 45º angle with posture, peace and personal space preserved.

Top-end smart mattresses form the plush layer on top. Features include embedded sensors, AI-driven algorithms, app-based analytics for sleep tracking, snore detection, climate control and alarms to wake you gently from your lightest sleep stage.

No SA brands offer fully integrated sets. The best workaround is to mix-and-match bases from one brand with mattresses from another.

Adjustable bed bases available locally cost R17,999-R60,000. They’re mechanically smart — remote-controlled, motorised and posture-friendly — but lack biometric or digital intelligence. Smart mattresses sold locally are also not smart. They focus on comfort, not diagnostics, with prices in the R5,799-R32,200 range.

A fully integrated, biometric-enabled smart bed imported from the US, such as market leaders Eight Sleep Pod or GhostBed 3D Matrix, could set you back R190,000. That’s after factoring in international shipping, VAT, duties and potential tariffs linked to politics and recent US-SA trade tension and tiffs.

Clinical evidence for smart beds and mattresses remains limited. They are more “tech-enhanced naps” than miracle aids.

The same applies to smart pillows, close companions of smart beds. At the high end, these feature ergonomic design and advanced functions, such as sleep tracking, snore detection, temperature regulation, sound therapy and AI-driven personalisation. 

A US leader is the Tesla Smart Pillow. It’s unrelated to Elon Musk’s Tesla Inc and is part of a consumer electronics brand named after Nikola Tesla, the Serbian-American inventor, electrical engineer and futurist. It claims to enhance sleep via built-in monitoring, far-infrared heating for cervical spine comfort, and speakers playing music or white noise, all controlled via Bluetooth and a companion app.

It is a hi-tech cuddle buddy with delusions of grandeur and no solid research backing it up.

Most smart pillows available locally cost R300-R1,800, and are also not clinically or technologically smart. They offer ergonomic shaping, cooling gel layers, latex foam cores and premium fabrics for comfort, not diagnostics.

A spin-off of smart-beds is a resurgence in the popularity of weighted blankets, costing R650-R2,000. These are covers made from breathable fabrics, such as microfibre, fleece and cotton (Egyptian cotton in premium versions), filled with evenly distributed glass beads, plastic pellets or ceramic weights.

The goal is gentle, evenly distributed pressure across the body. This mimics touch therapy that calms the nervous system by activating pressure receptors in the skin. Known as tactile or deep pressure stimulation, it promotes relaxation and sleep by lowering cortisol and boosting serotonin and melatonin.

A 2024 randomised controlled trial in BMC Psychiatry found significant improvements in sleep and anxiety among adults with insomnia using weighted blankets over four weeks. A 2024 review in Frontiers in Psychiatry supported their use across diverse populations.

Other innovations include: 

• The Oura Ring, dubbed the “tiny oracle of sleep” — a sleek ring worn on the index finger of the nondominant hand for optimal accuracy, it tracks heart rate variability (HRV), body temperature, blood oxygen levels and movement. Research confirms HRV and temperature fluctuations as reliable sleep-quality indicators. A 2025 review in Current Sleep Medicine Reports found AI-powered wearables increasingly accurate in classifying sleep stages and predicting recovery needs. Each morning, the ring delivers a “Readiness Score” — your body’s way of saying, “You’re good to go” or “Bad day beckons”. It is locally available, costing R5,500-R7,000 depending on finish and exchange rate.

• Sleep masks — hi-tech versions do more than block light. They include Bluetooth speakers, vibration alarms and light or warming therapy. Some use EEG sensors to monitor brain activity and adjust stimuli. Light exposure is shown to aid circadian rhythm regulation. Blocking blue light and introducing red or amber tones signals the body to wind down. In SA, prices are R149-R1,289 for basic blackout to Bluetooth-enabled models. Models offering heat, massage or sleep tracking cost R2,000-R4,500.

• Apps that whisper you to sleep — these offer guided meditation, sleep stories, smart alarms and snore tracking. Research shows that relaxation techniques reduce sleep latency (the time it takes to fall asleep) and improve sleep quality. A randomised trial in PLOS One journal found that the Calm app significantly reduced presleep arousal and improved sleep among adults with insomnia. Popular apps, such as Sleep Cycle, Calm and BetterSleep, are free with the usual optional “freemium” upgrades. Costs are R90-R280 monthly, R950-R1,300 annually and R2,000-R5,000 one-off for lifetime use of advanced features.  

SA physician pulmonologist Luke Krige has a jaundiced view of these products. 

His vantage point is 40 years’ experience, a master’s degree in sleep medicine from Oxford University and head of a team of sleep doctors, technologists and assistants at the SA Sleep Lab, with branches in Johannesburg, Cape Town, Gqeberha and East London. He is also a member of the medical steering committee of the SA Society for Sleep and Health. 

“Most sleep aids on the market are useless fads,” Krige says. “As their usage decreases, they soon disappear off the market.” 

Sleep pillows and MADs (maxillary advancement device — two fitted gum guards that pull the lower jaw forward) may have a benefit, he says. However, efficacy is “poor and compliance is even worse”.

Insomnia is a complex, common condition and the most well-studied disorder under the medical profession’s vast umbrella of sleep disorders, Krige says.

It affects 40%-50% of adults at some point, with 15%-22% meeting clinical criteria for a chronic insomnia disorder. It affects women more than men (60%:40%). Children are not immune, as parents attest. A third of children may experience insomnia symptoms at some time.

Krige defines insomnia as the inability to achieve refreshing sleep despite adequate opportunity and with no other factors preventing adequate sleep. Typical symptoms include difficulty falling asleep, staying asleep, waking too early, poor sleep quality and daytime impairment, such as fatigue and reduced cognitive function and concentration.

Insomnia causes are varied and include genetics, familial (often from the maternal line), excess caffeine intake and other environmental factors, he says. In the digital age, these include staring at screens late at night.

For doctors to diagnose insomnia, symptoms should present at least three times a week for three months, he says. Recent opinion downgraded that to one month. A medical diagnosis is vital, as is patients’ understanding just what insomnia is and is not.

The many myths swirling around insomnia don’t help. 

“One or two nights of disturbed sleep does not constitute insomnia,” Krige says.

Naps during the day longer than 20 minutes will worsen insomnia symptoms at night by decreasing adenosine build-up, which drives the body’s ability to fall asleep at night, he says.

Alcohol is addictive. Initially, it has a depressant effect, which may assist sleep. Thereafter, it has a stimulating effect that negatively affects quality and duration of sleep.

Cannabis use depends on how much CBD (cannabidiol) or THC (tetrahydrocannabinol, the psychoactive compound) it contains. THC is not considered to have a sleep-inducing effect. CBD may have a mild anxiolytic effect that can benefit sleep.

A note of caution from Krige: “Most cannabis products available in SA are not medically trialled and THC and CBD content has not been confirmed clinically.  

“Cannabis carries risks and should not be recommended for insomnia. There are better alternatives.”

Sleeping tablets are likewise a mixed bag.

The benzodiazepines and “Z-drugs” — a class of sedative-hypnotic medications used to treat insomnia that include zolpidem (Ambien) and zaleplon (Sonata) — are addictive if used for long periods, Krige says. Z-drugs are often referred to as “nonbenzodiazepines” because they act similarly to benzodiazepines but with a different chemical structure 

“DORAs” (dual orexin receptor antagonists) are new sedatives with no addictive properties. Melatonin, a naturally occurring hormone, is also not addictive. It enjoys a reputation in some circles as “the most powerful natural sleep aid out there”.  

Krige advises melatonin use only under medical supervision and correct circumstances.

“Magnesium and zinc supplements may have some benefit,” he says. “Valerian is shown to have serious side-effects and shouldn’t be used. Chamomile tea is shown to be ineffective in clinical trials.”

Perhaps the biggest obstacle for purveyors of sleep aids, says Krige, is that insomnia can be as much a sign as a symptom of a serious underlying disorder. A common, serious example is obstructive sleep apnoea (OSA), which has symptoms overlapping with insomnia.

“OSA happens when the upper airways collapse due to muscle relaxation, which results in no air being inspired, causing frequent waking,” says Krige. “It is a form of suffocation.”

Estimates of OSA prevalence in SA adults are that 20% have it seriously enough to warrant treatment. OSA is less common in children, though not rare. Global estimates suggest paediatric OSA prevalence at 1%-5%; some studies suggest up to 13%, depending on diagnostic criteria and population.

“The best treatment protocol for insomnia is CBTi [cognitive behavioural therapy for insomnia],” says Krige. “It can be done online.”

Sleep hygiene (the medical term for habits, behaviours and environmental factors that regulate circadian rhythms and improve overall sleep quality) is also important. It includes sleeping and waking at regular hours, including weekends, and using the bedroom only for sleeping and intimacy.

“Frontline treatment for OSA remains the CPAP [continuous positive airway pressure] mask,” Krige says.

It delivers a steady stream of air to keep the airway open during sleep. CPAP technology has evolved significantly to improve comfort, usability and effectiveness.

Anton Fourie, a clinical technologist with a special interest in sleep medicine, is relatively sanguine about commercial sleep aids. 

Fourie is clinical operations manager of the Fourie & Associates Clinical Technology Group with branches in Cape Town, Pretoria and Johannesburg. The practice has conducted diagnostic procedures in sleep, pulmonary function, critical care and neurophysiology for more than 25 years, and established SA’s first private sleep laboratory in Milnerton, Cape Town, in 1994.

“Commercial aids can complement good sleep habits, such as consistent schedules and a dark, quiet, cool bedroom,” he says.

“Their usefulness depends on specific sleep issues and individual response to interventions.”

The best approach, says Fourie, is to identify the primary challenge — whether discomfort, racing thoughts or poor sleep environment — and then to choose an aid that directly addresses it.

For persistent sleep problems, he recommends consulting a doctor or sleep specialist.

Fourie endorses CBTi and sleep hygiene as frontline treatments for insomnia, and CPAP as the gold standard for OSA.

When all else fails, remember that sleep is not a shutdown. It’s a system reboot. Understand it, make friends with it and you will optimise waking life after it. 

As 17th century English playwright Thomas Dekker said: “Sleep is the golden chain that ties health and our bodies together.”