Interpreting Smartwatch Sleep Metrics in Menopausal Patients, With Fiona Baker, PhD

Smartwatch-derived sleep data should be used as a complement to patient-reported sleep outcomes rather than a substitute, and primary care physicians should prioritize asking menopausal patients directly about sleep disturbance regardless of whether wearable data is available, according to Fiona Baker, PhD, of SRI International, speaking at SLEEP 2026.¹

Check out part 1 of the interview with Baker here.

Baker emphasized the clinical conversation itself is the essential starting point. Wearable data can serve as an entry point for discussing sleep in menopausal patients, but self-report remains the primary measure because the ultimate clinical goal is improving how a woman feels about her sleep, not optimizing a device metric.

Sleep disturbance affects more than half of women during and after the menopausal transition and carries measurable impact on next-day functioning and quality of life. Despite its prevalence, sleep is frequently underaddressed in primary care visits focused on other menopausal symptoms.

Wearable Data as a Clinical Conversation Tool in Menopausal Sleep Disturbance

Baker noted sleep disturbance in the context of menopause is often accompanied by nocturnal vasomotor symptoms, and ESTeeM data confirmed the pattern: women who reported more severe insomnia symptoms also showed greater objectively measured sleep disturbance on their smartwatch, even within the study's small sample.¹ The directional alignment between subjective severity and objective measurement, while modest, supports the utility of wearable data as a supplementary signal.

For primary care physicians, Baker framed wearable data as one tool among several rather than a standalone diagnostic instrument. Not every menopausal patient will have a wearable, and among those who do, the data should inform rather than override clinical judgment.

"You don't want to only rely on the wearable," Baker said. "It's most important to focus on how a woman is feeling about her sleep and her sleep disturbance in the context of menopause."

When a patient does bring smartwatch data to a visit, Baker described it as an opportunity rather than a complexity to manage. Patients sharing their own wearable data can be empowered to lead the conversation, and the data itself provides a concrete anchor for discussing specific sleep parameters such as wake time, fragmentation, and night-to-night consistency. The combination of self-report and objective tracking offers a more complete picture than either source alone.

Gaps in Menopausal Sleep Research and the Path Toward Treatment

Baker identified the current evidence base as foundational but incomplete, with meaningful gaps remaining in understanding the specific contributions of nocturnal hot flashes and night sweats to sleep disturbance versus other mechanisms operating independently of vasomotor symptoms.¹ ESTeeM was designed to address part of this gap by pairing continuous wearable tracking with daily diary data, providing a more granular view of sleep variability than episodic laboratory assessments allow.

"There's been a lot of gaps about understanding sleep disturbance specifically in the context of menopause," Baker said. "As we begin to understand more, we're getting closer towards also considering what we can do about it."

The longer-term goal, Baker noted, is establishing sleep as a modifiable target in menopausal care and expanding the range of treatment options available to women experiencing sleep disturbance. Better measurement, whether through validated self-report tools or wearable devices, is a prerequisite for designing and evaluating interventions. Multiple treatment approaches remain under investigation, and Baker positioned improved sleep measurement as foundational to determining which strategies are most effective for whom.²

Editors’ note: Baker reports relevant disclosures with Bayer.

References

1. Baker F. Night-to-night sleep variability in menopausal women: smartwatch-derived sleep metrics in comparison with patient-reported outcomes from the ESTeeM study. Presented at: SLEEP 2026; June 2026.

2. Kravitz HM, Joffe H. Sleep during the perimenopause: a SWAN story. Obstet Gynecol Clin North Am. 2011;38(3):567-586. doi:10.1016/j.ogc.2011.06.002