The Oura ring is a novel, multisensory device that claims to be able to distinguish sleep stages, including REM sleep,. I purchased one recently and after several months of evaluation and an extensive look at the data supporting it I have to say I am much more impressed with OURA’s hype, marketing and style than any useful or actionable information about sleep that comes from it.
The Oura website is full of pictures of cool people doing cool things wearing their Oura rings-like this guy
It’s also chock full of marketing blather which implies that somehow the ring will dramatically improve your sleep and your waking life.
We see every individual as unique: your state of health and wellness today, tomorrow, and days to follow. Getting enough restorative sleep has a profound impact on mental and physical health and performance. Your daily choices and rhythms define how well you sleep. With Oura, you learn your optimal times to move, eat and take a break to get that restorative sleep.
Giving you actionable steps to improve your life opens a totally new universe of possibilities – be it for mental, cognitive or physical performance, or for beauty, health, and longevity.
A quick look at the OURA web site certainly conveys the sense that this is the slickest, most cutting edge personal wearable sleep and activity tracker one could purchase.
However, despite Oura’s tantalizing claims there is only one legitimate scientific comparison of the ring to the gold-standard of sleep evaluation, polysmnography (PSG). This was published in 2017 in Behavior Sleep Medicine and its full contents can be read here.
In addition, there is no published evidence whatsoever that changing one’s behaviour based on the various parameters that the ring produces will have any favorable effect on your sleep quality or health in general.
I’ll be quoting from that 2017 published paper which I think is a good, unbiased analysis and I’ll throw in some of my own observations throughout this piece.
How The Ring Works And What It Claims To Do
A good night’s sleep, everyone should know by now is incredibly important to optimal performance the next day. In addition poor sleep quality is linked to a whole host of pathologies (with causality yet to be proven for most.) Thus, I quickly purchased an OURAring after hearing Peter Attia rave about his ring.
OURA likes to promote the idea that it has some sort of special way of measuring sleep based on a combination of sensors.
The Oura ring and its proprietary algorithms are a combination of extensive scientific understanding, years of careful research and development work, and top-notch engineering. All insights and guidance you get are based on proven algorithms and verified knowledge. For example, Oura’s sleep staging algorithms were the first in the market that have been independently validated. The validation study was made by SRI International.
The OURA website notes that the ring is fitted with the following sensors to collect physiologic signals from your body.
NTC BODY TEMPERATURE SENSOR
The Oura ring registers your body temperature reading every minute while you sleep. By comparing that value to values from earlier nights, it indicates your body temperature baseline and any variations from it.
Measuring blood volume pulse directly from the palmar arteries of the finger.
3D ACCELEROMETER AND GYROSCOPE
Detects the amplitude and intensity of your body movement, automatically recognizes that you’re active and tracks the time you were inactive during the day.
Ōuraring (Oulu, Finland) claims to use these physiological signals (a combination of motion, heart rate, heart rate variability, and pulse wave variability amplitude) in combination with sophisticated machine learning based methods to calculate deep (PSG N3), light (PSG N1+N2) and rapid-eye-movement (REM) sleep in addition to sleep/wake states.
After obtaining a sizing kit from OURA I selected my ring and within a few weeks it was delivered. I downloaded the free OURA iPhone app, charged the ring with the supplied USB charger, slipped it on my left ring finger and eagerly awaited my first night’s analysis.
Upon arising in the morning I opened the OURA app and visualized an entrancing display like the one below.
It’s a nice graphic summary of the night’s sleep with my minutes of REM, light, and deep sleep nicely quantified.
More graphs and more data are available by connecting to Oura’s online application which automatically syncs to your smartphone app.
Unfortunately, the app was telling me that I was awake for 109 minutes of the time I was in bed. Which was not correct. I was truly awake only for 10 minutes around 130 AM. This overestimation of my awake time has been a consistent error of the ring for my recordings. If the app can’t accurately track awake time all of its metrics are going to be inaccurate.
In fact, over several months of using the ring/app I have found little relationship between how I feel after sleeping versus how Oura has rated my sleep. There is even less correlation between the “readiness” score that Oura produces and how I feel during the day. Overall, I have found absolutely no actionable information from my months of using the ring.
One morning Oura gave me a “readiness” score of 68 and told me:
“Don’t push it. Your resting heart rate was above average, so you might not be fully recovered”
I felt great throughout the day. These recommendations in my experience are almost unversally inaccurate and useless.
Oura also makes recommendations on when it thinks you should go to bed. One time it told me I should go to bed at 7 PM. I have been ignoring its advice in this area.
Now I am just one individual and it is entirely possible there is something unique about my sleep that invalidates the ring’s accuracy. The ex-eternal fiancee’ tells me I’m a restless sleeper.
In fact, devices that rely on actigraphy tend to be fairly accurate at identifying when you are sleeping but not when you are awake which is the opposite of what OURA is doing in my case.
The SRI paper puts it this way
Compared to PSG, actigraphy has high sensitivity (ability to detect sleep) although specificity (ability to detect wakefulness) is lower(Marino et al., 2013; Sadeh, 2011), with a wide range of accuracy,depending on the amount of night-time wakefulness(Paquet, Kawinska, & Carrier, 2007),the algorithms used and the particular population studied(Van de Water, Holmes, & Hurley, 2011). Most importantly, actigraphy relies on a single sensor, an accelerometer, and thus it provides a measure of motion from which it predicts sleep and wake states. However, information about sleep stage composition, fundamental in studying sleep and sleep disorders,is not provided.
The Science Behind Oura’s Sleep Analytics: Detecting Sleep Stages
So what does the SRI paper OURA likes to quote as proving its accuracy say.
The paper is entitled “The Sleep of the Ring: Comparison of the ŌURASleep TrackerAgainst Polysomnography” and it was written by researchers at SRI international, a research consortium in Menlo Park, California with no ties to OURA.
Another paper which used to be touted on the Oura Ring website (but is no longer referenced on the site) utilized home PSG recordings and was done by an in-house OURA employee.
The SRI researchers studied 41 healthy adolescents and young adults with an average of 17 years and sleep data were recorded using the ŌURA ring and standard PSG on a single laboratory overnight. Metrics were compared using Bland-Altman plots and epoch-by-epoch (EBE) analysis.
EBE analysis showed that ŌURA accurately detected “light” and “deep” sleep in 65% and 51% of the epochs, respectively. It also accurately detected REM sleep epochs 61% of the time, with an overall overestimationof PSG REM sleep (by about 17 min). When the ŌURA ring misclassified PSG REM sleep, the algorithm classified the epoch as “light sleep” (76%) for the majority of the time.
These data suggest that the Oura Ring is virtually useless in telling you if you are in REM sleep versus deep or light sleep.
As the authors noted
Distinguishing sleep stages such as REM and N3 with non-EEG based systems has been challenging and is a goal of several commercial sleep-trackers, with mixed success.
Clearly, further work is needed to determine what combination of sensors might be used to optimally develop an algorithm that differentiates sleep stages sufficiently well to detect real differences or changes in healthy and clinical populations.
A look at the Bland-Altman plots really tells you how much variation there was in the PSG estimates of various parameters versus the OURA
The Bland-Altman plots show us how much the PSG time in REM differed from the Oura REM time for each individual subject. You can see that some individuals had considerable over-estimation of REM time whereas other had considerable overestimation of REM time.
Although OURA REM time was on average only 17 minutes higher than the PSG REM time this was because the marked overestimation of REM time in some (7 subjects over 30 minutes) was balanced by marked underestimation in others (9 subjects with over 40 minutes and one with 160 minutes).
Given that the average REM time was 92 minutes for most subjects there was a significant discrepancy between PSG. and OURA assessments.
OURA: Coin Flip For Detecting Awake
Oura ring was also pretty useless at identifying when you are awake
Overall, ŌURA had 96% sensitivity (ability to detect sleep), 48% specificity (ability to detect wake), 65% agreementin detecting “light sleep”, 51% agreementin detecting “deep sleep”, and 61% agreementin detecting REM sleep, relative to PSG
Like other sleep sensors utilizing actigraphy, Oura in most individuals can’t accurately differentiate between times when you are lying still but awake and when you are lying still and asleep.
The limitations of wrist actigraphy (see here) for differentiating sleep from wake are worse in those with insomnia:
With actigraphy, because sleep is inferred from lack of movement, subjects who are awake but lie motionless can be classified incorrectly as being asleep, and thus the technique is biased toward overestimating time to sleep, which may lead to incorrectly minimizing the severity of sleep disturbances. This may present a specific challenge for patients with insomnia, and may partially explain the limited validity of wrist actigraphy for estimating sleep onset latency..
There are multiple other issues and questions with the usefulness of the data that Oura provides that need clarifying before the ring can be considered useful.
For example the SRI paper found significant differences in results depending on which finger the ring was placed on.
Interestingly, we found that PSG-ŌURA discrepancies for “light sleep” and REM were greater on the ring finger compared to the other fingers, a result that was independent from the amount of PSG sleep fragmentation.Assuming that the main parameters that ŌURA uses to determine sleep stages are motion and optical sensor outputs, it is possible that the different blood supply among fingers maypartially explain these results. For example, it has been shown that SpO2 values differ between fingers as well as hands suggesting a finger-dependent difference in accuracy of the pulse oximetry signal (Basaranoglu et al., 2015).Further studies should confirm and better characterize the dependency of the PSG-ŌURA discrepancies on the ring position by having the same participants simultaneously wear different rings on different fingers.
The in-house Oura study also noted that results were more accurate on the non-dominant hand finger compared to the dominant hand but the Oura website makes no recommendation on which finger to use.
The other data that Oura compiles (heart rate, heart rate variability, temperature change, respirations) are clearly related to sleep cycles but Oura provides no evidence that these data or their proprietary algorithms to give you “readiness” or sleep quality scores are accurate or of any value.
Shold You Buy An Oura Ring?
If you are hoping to get improved analysis of your sleep quality I don’t think Oura adds anything to what is elsewhere available using cheaper wrist actigraphy devices.
The ring is expensive at 299$ and cannot accurately detect sleep stages.
Although most reviews you will encounter on the internet are wildly enthusiastic about Oura, they are likely biased and they provide no evidence that the unique aspects of the ring sensors provide useful information.
Would I buy it again?
I’ve misplaced my ring several times and I have to say that this distressed me immensely. Given that I think the sleep analysis is worthless this is hard to explain.
I think my attachment to the ring is due to a number of factors
- It’s stylish and it mimics a wedding ring (which I otherwise would not have.)
- I’m intrigued by some of the cardiovascular data it produces (night time heart rate and heart rate variability). Although currently I don’t think the data can guide me to healthier behavior, it’s possible that there is useful information in there somewhere. I hope to write a post on heart rate variability down the line. I’ve done research in this area and have some strong opinions on its value.
- I’m curious to see if the respiratory rate data and the temperature data is of any value whatsoever.
So, the ring is best I would say for well-heeled,, self-hacking and self-experimenting techno geeks.
33 thoughts on “The Oura Ring For Personal Sleep Analysis: Lots of Hype and Data, Little Science, Utility or Accuracy”
Hello, are you aware of a wearable device that accurately determines heart rhythm? I have a tachyarrhythmia that may be A-fib or SVT. I wore a bulky Holter monitor for a month and recorded a single episode that my cardiologist couldn’t define. I occasionally feel palpitations at home that I presume are PVCs but having a peek at my rhythm would be amazing. I’m imagining something similar to the heart rate strap that I wear when I run with a third lead that could transmit a simple rhythm interpretation to a watch or phone. Heard of such a device?
I have been a fitful, poor sleeper since menopause began 15 years ago – still having hot flashes waking me as well as aches and pains of being a sculptor. Then last year I was rated at 87% on a sleep study and am now contending with a CPAP machine — which keeps me awake blasting cold air in my poor abused nostrils — as much as the hot flashes do. I’m working with a sleep disorder expert to improve my sleep and say goodbye to the CPAP. I bought my OURA in December. Bedtime always begins with a hot bath. I listen to an Audible book and usually have a wonderful sleep in the tub that relaxes me before facing the CPAP machine. With the pandemic, I now wake at 4 am and have such a hard time getting back to sleep, I take another bath — a godsend, because again it calms me down and I sleep for at least another hour in the tub. The OURA always recognizes the time in the tub as Awake. And it is usually my most relaxing sleep. Very discouraging getting the results in the morning — 3 hours or more awake in bed each night, very little REM…
This week I joined the USF COVID study. I am wondering, given the accuracy issues, do you feel the OURA, Fitbits, etc can be helpful to track COVID as the digital thermometer companies are in tracking fever spikes across the country?
You might consider trying a Valerian tea made from steeping the actual root (not pills). The studies have a lot of variability but a big suspicion is that it’s caused by poor quality of the various pills. Making a tea from the root eliminates that factor. It’s the one things I’ve found that helps me stay asleep longer.
Martha, my Gynecologist prescribed Effexor XR 37.5 mg for hot flashes. Within a few weeks, I started sleeping much better. I also added Magnesium Citrate just before bed. I’m sleeping the best I have in years.
I actually picked up the Oura Ring to monitor my night time temp. As I’m in the transition phase towards menopause, I experience some hot flashes at night even with the Rx. I came down with a cold – not Covid by PCR – and have found the temp data interesting and overnight resting heart rate handy. The heart rate correlates to my polar ignite wrist unit.
The sleep stuff just is silly on either device. I just pay attention to how I feel. My polar ignite is more for working out.
Regarding HRV, Marco Altinu from HRV4 Training has written about using HRV to ensure one isn’t working out too hard. IDK if it’s all BS or not.
Thanks for these posts. It’s more grist for the mill.
Agree with you on the fact that the most important thing with sleep is how you feel the next day. analysis of sleep cycles from wearable sleep devices like Oura don’t add anything except dollars to the makers and people selling advertisements.
I think HRV (in terms of using it as actionable information from wearables) is total BS. My colleagues who have studied HRV for decades agree with me.
Thanks, Dr. P. I’m a chemist and reading through the scores of papers is more than I want to deal with. Relying upon professionals is a must. Trying to figure out which professionals to trust though is the hardest part.
I’ll wear my silly ring til it dies or I get sick of it. I admit that my lowest heart rate at night is interesting. I’ve recently suffered with an upper respiratory infection (not Covid by pcr test). I’ve noticed my lowest heart rate higher by 7-10 bpm.
The temperature info is sort of odd. It being relative makes sense, I guess. I tend to have colder hands. When I get a hot flash, even my hands feel warm. Whether it’s a measurable difference or not, who knows.
Thanks for responding. Definitely interesting. If I were to do it again, I’d not get the ring. So far it’s meh.
Try using a snore app that records all sounds during the night and comparing the time stamped noises picked up against Oura’s sleep stage time stamps.
Thank you for your article Dr. AP. I was seriously considering purchasing the o ring. My main goal was so it could motivate me to work out more. I thought that by collecting HRV data I could see over time if my heart was getting stronger or more “fit.” I also wanted to see how it measures my heart rate during exercise versus when I’m sleeping. However I noticed on their website that they state, “Oura doesn’t track heart rate during exercise or other activities. The ring tracks your resting heart rate while you sleep, and during restful moments during the day.” Well how can this be? If my ultimate goal is fitness, how can it accurately detect my movement and activities and therefore calories burned? This product caters to sleep behavior only and by the looks of the scatterplot chart, it is not very accurate. It seems to me that the technology still has a long way to go. This I feel is the case with most fitness/health trackers. It always leaves me wanting more.
Whenever you go from analogue to digital (ie, finger to ring), you are never going to get accurate information. There will always be some sort of inaccurate representation of things.
All I want is the best way to monitor HRV awake and asleep. Is it a ring, a wristband, a chest strap? whats the difference between ECG and PPG?
ECG will always be more accurate than ECG.
However, the big question is why do you want HRV data on yourself. There is little evidence to suggest that HRV provides important information on an individual basis.
Dr. P you mentioned that you might write an article about the utility of HRV. Looking forward to that or any links you might find valuable.
Could it be that you actually are awake during the times your Oura ring indicates, you just don’t remember it? A New Yorker article on sleep quotes Meir Kryger and says ““healthy sleepers” typically experience about five awakenings an hour, although they do not remember them.”
I’ve been monitoring the HRV field and have yet to see anything that suggests individuals benefit from monitoring their HRV. If any readers are aware of such data let me know. I’m preparing a post on the QardioCore wearable which monitors HRV and will probably at least briefly talk about HRV in that.
You are not the first to suggest that I was actually awake and didn’t know it. I spend some time researching that possibility and dismissed it. The “awakenings” that we are not aware of appear to be very brief whereas the OURA ring was telling me I was awake for an hour at a time during a time I thought I was asleep. Beyond accurate measurmeent of actual sleep which i think with actigraphy is questionable, devices without EEG monitoring can’t tell you about deep sleep quality or duration or REM sleep quality/duration. To me, it is marketing hype without substance.
I have actually found my Oura to be considerably more accurate in terms of knowing when I’ve gone to bed, when I’ve fallen asleep and when I’ve awaken vs gotten out of bed than any of the wrist-based wearables I’ve used (and I’ve used far more than I care to admit). I am not in a good position to know how well it measures the sleep stages but I do know that on days when it records my REM sleep as low, there is a corresponding foggy headiness that usually goes along with it. I think that like so many of these wearables the degree of accuracy/utility varies among individuals. For example, MIO used to have a whitepaper on their site which stated that wrist-based HR accuracy decreases with lower BMI (yes, the paper said “BMI” not body fat).
Put that ring on your other hand, buy a wedding band and wear it, Consult SWMBO with regard to your sleeping performance. Cheaper and far more accurate & useful data.
Hi Doctor – I’ve been enjoying your blog and Twitter for some time now – thank you for the great info! This post prompted me to pass along info about a device I started using in December – The Viatom Lookee Sleep Ring (https://www.amazon.com/dp/B07F68DY22/ref=cm_sw_em_r_mt_dp_U_IF1xCb4ZRABYM). I was diagnosed with paroxysmal atrial fibrillation just over 10 years ago and my episodes only start at night. I’ve never been clinically diagnosed, but I’m pretty sure I also have central sleep apnea as my ex wife and my now girlfriend have both commented there are times when they can’t hear me breathing when asleep. After my last episode of afib, I researched something like this and decided to try this device out and I can honestly say it seems to work. I put it on at night before going to sleep and it constantly monitors O2 level and HR throughout the night and more importantly, it vibrates when O2 drops below 90%. It also has a corresponding app that you can use to download and see your nightly readings. I find that it vibrates and wakes me up 2-3 times a week and I usually just roll over and go back to sleep. Since starting to use it in mid-December, I have not had another episode of afib! The product clearly states it’s not a medical device and I’m not implying it is either, but in my personal experience it has been effective at waking me up when my O2 levels drop below 90% and perhaps indirectly, preventing further episodes of afib. I’ve only used a couple months now and fingers crossed it continues to work! Thanks again and looking forward to learning more from your blog!
Thanks for the kind words on the blog. The Viatom Lookee Sleep Ring is intriguing. Hopefully all those wake-up vibrations you are getting are doing some good. Personally, my sleep would be horribly disrupted by them. Keep me updated on whether it has some influence over your AF episodes.
Any thoughts on Welltory?
None. Have you used it?
Going cold turkey off Tramdol for chronic pain was surprisingly easy – perhaps not so surprising, as there was no euphoria, only pain relief.
Dietary changes based on microbiome analysis gave almost total relief from severe chronic eye pain over a few months, so no need for Tramadol.
Severe insomnia was only problem with stopping Tramadol, and SR melatonin gave excellent sleep. Recent world travel avoided the usual jet lag with the melatonin.
I have a Misfit bracelet that gives excellent sleep analysis and reporting, but can only report after syncing with iPhone.
Now looking for sleep monitoring app for new AW4, where I find the AW4 EKG mostly agreeing with the old AW3 with the Kardia band.
The main points of difference between Kardia and Apple are :
1. Ability to send off EKC to a cardiologist via email with Kardia to get very quick expert report, while Apple lacks this feature.
2. Kardia Smart Rhythm app takes over entire watch, so activity and workout tracking is erroneous. The equivalent Cardiogram app on AW4 still has neural net monitoring but does not affect activity and workout.
In summary, both excellent.
Thanks for the review anthony, you have well summed up several issues. The wearables are great for promoting health awareness and interest but using them in a specific way for sleep quality is elusive. Some folks may become over focused on the night to night variablity(at times in contrast to how they are feeling clinically as you rightly point out).
Thanks for the feedback. Coming from a prominent sleep expert it is greatly appreciated! I’m curious if there are any wearables you either recommend to your patients or use personally.
My ring sometimes thinks I am sleeping during times I am merely trying to sleep, but it does not inaccurately label sleep as wakefulness like yours is. Maybe yours is wrongly thinking you are awake, but might it still be useful to know that you are active during the night? Have you noticed a lot of household chores are mysteriously completed when you get up in the morning?
Haha! Interesting hypothesis. Perhaps I need to make video recordings at night to understand why OURA thinks I’m awake when I think I’m asleep.
That _would_ be interesting. I should do that too.
My Oura ring I’ve found has been incredibly accurate with my wakeful/sleeping times, but I naturally move around and fidget alot when I’m awake and when I sleep I’m very docile. That said, this was an excellent article for my awareness of the accuracy of the ring. I’ve been wondering whether the sleep stages were accurate or not.. ?
The current FitBit watches gather sleep data and provide guidelines at to normality. Have you looked at them?
I haven’t looked at them. I’ve been looking at Apple Watch based sleep apps (and am not impressed). They have virtually no correspondence to the sleep analysis that OURA provides.
Doc, I’m curious if you can comment on the Oura ring’s heart rate accuracy? As a type B dissection patient I want to adhere to my doctor’s counsel to keep my HR below a specific upper limit, but find my Fitbit is not as accurate when my HR goes above 110 bpm. This is problematic as I try to regain some level of fitness. As a cardiologist, did you look at their HR and HRV accuracy?
I am a psychiatrist and have been looking everywhere for something like what this ring promises. However, when just looking at one website picture for ‘sleep’ it shows over a 3.5 hour period without a REM cycle which I do not believe is possible. I would expect one every 1.5 hours or so if you are going through your normal sleep cycles. That alone had me doubting which led me to your website. I would like to say well done and I agree with everything you have written. The article notes below just hammered it home. I will not be trying one out to see if it works for my patients as you have done the work for me. Thanks again, Dr. M, Diplomate ABPN
From EBE analysis, ŌURA ring had a 96% sensitivity to detect sleep, and agreement of 65%, 51%, and 61%, in detecting “light sleep” (N1), “deep sleep” (N2 + N3), and REM sleep, respectively. Specificity in detecting wake was 48%.
Indeed. Promises, promises from the OURA marketing behemoth but nothing of substance for health.
I haven’t evaluated FitBit but looking at the FitBit website they are trying to use the same technology that OURA uses:
“Fitbit estimates your sleep stages using a combination of your movement and heart-rate patterns. When you haven’t moved for about an hour, your tracker or watch assumes that you’re asleep. Additional data—such as the length of time your movements are indicative of sleep behavior (such as rolling over, etc.)—help confirm that you’re asleep. While you’re sleeping, your device tracks the beat-to-beat changes in your heart rate, known as heart rate variability (HRV), which fluctuate as you transition between light sleep, deep sleep, and REM sleep stages. When you sync your device in the morning, we use your movement and heart rate patterns to estimate your sleep cycles from the previous night. ”
Despite claiming the ability to “estimate your sleep cycles” they provide zero evidence that they have any proven ability to do this accurately.
I believe the recent changes to the app (Fall 2020) have improved the awake detection and they have added the ability to adjust start/end of sleep times. Yes, there are limitations to the technology but I do believe that for many people, it can help them place a healthy emphasis on prioritizing sleep. When I first got my ring in 2018, it was a shiny new toy and as the novelty wore off, I wore it but didn’t really pay much attention to it. A year later I started paying attention to it again and got more serious about improving my sleep (esp. doing better at reinforcing my circadian rhythm). I am now in a much better place sleep-wise.
Whatever you think about HRV and Oura, it will prove to you how bad excessive alcohol is to your sleep and your readiness. It also helped me understand the impact of playing competitive sport too late in the evening was impacting me, and that I was in fact over-trained and not recovering well at all. I now use other apps like EliteHRV and Morpheus to help me dial in my training better. The bottom line is that I believe that health tech, even imperfect health tech, can be applied by many people to start a journey to better health if they have the right mindset.