Supporting Sleep Health and Chronic Care Management Information for Patient Self-Care

Sleep health is a multidimensional concept affected by multiple cognitive, environmental, and physiological factors, including the circadian rhythm. Poor sleep health causes short-term impairment to cognition, emotional regulation and mood, and functional performance. Poor sleep health is also implicated in long-term adverse health outcomes such as mental health conditions, diabetes, cardiovascular diseases, and cancer. Circadian rhythms that are desynchronized with desired sleep-wake schedules are both causes and outcomes of chronic conditions affecting cognitive and physical functioning and interactions. Conditions like fibromyalgia, mood disorders, type I diabetes, and post-concussive syndrome disproportionately affect women. Unfortunately, current physiological monitoring technologies do not support real-time assessment of the circadian rhythm, especially in everyday contexts (i.e., outside a sleep lab). This gap complicates circadian misalignment detection and severely limits timeliness and effectiveness of interventions and patient self-care efforts. This paper explores the system dynamics associated with a continuous physiological monitoring system that tracks the circadian rhythm via melatonin levels. Melatonin fluctuations and subsequent circadian phase shifts due to environmental time-cues, as well as interactions between circadian misalignment and other chronic conditions, represent feedback control and homeostasis loops affecting the patient. A continuous melatonin monitor and patient-facing display would support patient self-care through enhanced health literacy and situation awareness regarding their current and projected future states. These capabilities will enable timely, effective interventions and patient-led supervisory control actions to improve sleep health and thus ultimately enhance overall patient condition.