Automatically Capturing Sleep and Social Factorsto Understand Ramadan in the Real World

Abdulfatai Popoola, Maryam Butt, Taha B.M.J. Ouarda, Inas Khayal, IEEE Member

Abstract— We live in a fast-paced busy world where one ofthe key biomedical factors we compensate with is sleep. Sleepimpacts many facets of our lives from chronic disorders toworkplace productivity, happiness and many other dimensionsthat we are continually discovering. Advances in technologyand health informatics have made it possible to measureand understand sleep and related social factors in the realworld. We are specifically interested in understanding sleepbefore and during the month of Ramadan – a time whenpeople fast from sunrise to sunset. This fast is observed bymore than a billion humans yearly and consequently thereare some impacts to the society. In this paper we introducethe development of a health information system capable ofacquiring, managing and visualizing health data for 1. Sleepsignals were acquired by utilizing wireless sensing technology tomeasure sleep in a naturalistic setting rather than asking usersto sleep in a sleep laboratory and 2. Social factors capturedfrom surveys through a web platform rather than utilizingpaper surveys. The system was developed to be easy-to-use byusers and study administrators. We introduce to our knowledgethe first research study, Fasting In Ramadan Research sTudy(FIRST@Masdar), capturing sleep and social factors beforeand during Ramadan from a total of 40 participants over twoconsecutive fasting years of 2012 and 2013.

I. INTRODUCTION AND MOTIVATION

One of the monumental health challenges of today is theneed to assess health outside clinical environments, despitethe fact that most common health problems have their rootsin lifestyle, social and environmental factors. To understandthe real world mechanisms of how social and behavioralfactors affect our health, it is important to measure thesefrom the wild (not under controlled conditions) rather thanthe confines of laboratory experiments.

Sleep is needed to maintain optimal well-being and has aconsiderable health impact when disturbed. The deficiency ofsleep degrades immune, metabolic and cardiovascular func-tion [1], [2], [3] and causes adverse health effects rangingfrom depression to obesity and diabetes [4], [5], [6]; lowsleep quality has also been linked to increased mortality ratesworldwide [1]. Secondary effects of sleep deficiency include

Research was partially sponsored by Masdar Institute Fellowship and theMIT/Masdar Collaborative Research Grant.

A. Popoola is a research assistant in the Sustainable Health Lab at theMasdar Institute of Science and Technology, Abu Dhabi, UAE (e-mail:apopoola@masdar.ac.ae).

M. Butt is a masters student at the Masdar Institute of Science andTechnology, Abu Dhabi, UAE (e-mail: mbutt@masdar-alumni.ac.ae).

T. B.M.J. Ouarda is a Full Professor at the Masdar Institute of Science andTechnology, Masdar City, Abu Dhabi, UAE (e-mail: touarda@masdar.ac.ae).

I. Khayal is an Assistant Professor at the Masdar Institute of Science andTechnology, Masdar City, Abu Dhabi, UAE (e-mail: ikhayal@masdar.ac.ae).She is also a research affiliate at The Media Lab, Massachusetts Instituteof Technology, Cambridge, MA 02124 USA (e-mail: ikhayal@mit.edu).

sleepiness, impaired cognitive and emotional function, lowjob performance and vehicle accidents which result in healthand financial losses [1], [7], [8], [9], [10], [11].

People fasting in the month of Ramadan abstain fromeating and drinking between dawn and sunset. Studies tryingto understand the impact on Ramadan on self-reported sleepinformation and sleepiness have shown conflicting results:some studies reported a decrease in sleep duration whileothers reported no differences [12], [13], [14], [15], [16]. Oneof the few studies which looked at impact of Ramadan onsleep architecture [12] demonstrated a significant reductionin REM sleep in Ramadan. However, this study regulatedits subjects’s food intake and included only two nocturnalsleep lab recordings in Ramadan and one before and afterRamadan. Such controlled experiments may not reflect prac-tices in the real-world.

Ramadan in the U.A.E. and many other countries bringsabout shifts in meal schedules, work routines and socialgatherings. These activities which typically include shopping,festivals and late-night outdoor events typically results indisruption of the circadian pattern of sleep. Therefore, itbecomes important to capture these modifications in socialand behavioral factors to understand the real world dynamicsof Ramadan.

One of the key challenges in understanding the relation-ship between Ramadan, sleep, social and behavioral factors isthe long term monitoring and acquisition of data, especiallydetailed sleep patterns, from the subject’s natural sleep set-ting. Data acquisition through the most commonly practisedmethod of sleep pattern capture, laboratory polysomnography(LPSG) can disturb and change an individuals usual sleepquality and quantity from that under habitual conditions [17],[18]. Whereas in-home studies either rely on self-reportedsleep information or use methods such as actigraphy whichare unable to capture detailed sleep patterns and are proneto inaccuracies [19], [20].

The emergence of portable and accurate in-home sleepmeasuring devices allow automated long-term acquisition ofdetailed sleep data from the wild. In addition, the use ofonline surveys that can be completed via smart-phones and/orcomputers make it easy to acquire and manage data aboutsocial and behavioural factors. By levaraging both platforms- the sleep measuring devices and online surveys; it becomespossible to run robust studies that help us to understand thereal world dynamics of these behavioral factors and sleep.

In this paper, we describe a first-of-its-kind experimentwhich aims to study the relationship between Ramadan,sleep architecture and socio-behavioral factors. We capture

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quantified sleep in a real-home environment using wirelessmobile technology and leverage web-based surveys to mon-itor social and behavioral changes. We also present a webplatform that can be used in remote health studies to collectparticipants’ information, provide subjects with an overviewof their performance and channels for help and guidance.

II. STUDY METHODOLOGY

The Fasting in Ramadan Sleep sTudy at Masdar(FIRST@Masdar) is a non-invasive health data acquisitionexperiment run in the ‘wild’, capturing sleep and sociabilitydata from individuals in a real-home environment. This studyutilized a portable state-of-the-art sleep device, Zeo Inc., tocapture detailed sleep information of the participants in theirnatural sleep environment. We also captured social factorssuch as participants‘ daily mood, diet and social interactionswith family and friends using online surveys accessible viamobile phones and computers. The data was automaticallyuploaded and saved to our in-house database system. Thefollowing sections will detail A. The study protocol andparticipants and B. The latest system architecture and webplatform.

A. Study Protocol and Subjects

The study was approved by the Institutional Review Board(IRB) at Masdar Institute of Science and Technology calledthe Human Subjects Research Ethics Committee (HSREC)for both Ramadan2012 and Ramadan2013 and conductedunder strict protocol guidelines. The study was initiatedduring Ramadan 2012 and repeated in 2013. The protocolrequested participants join the study in the pre-Ramadanphase: a maximum of two weeks immediately preceding thestart of Ramadan and during Ramadan: minimum of twoweeks into Ramadan. Eligible participants were expectedto fast during Ramadan, be part of the Masdar researchcommunity and live in the United Arab Emirates for theduration of the study. A total of 40 participants enrolledbetween the past two Ramadan months.

1) Sleep Device: All participants were provided with Zeodevices for use whenever they went to bed. The devicemeasures the electrical signals of the brain which is analysedand converted into meaningful metrics such as the onsetand duration of the various sleep phases, this informationis then stored on the device. Zeo sleep measurements havebeen suggested to be nearly as accurate as highly-specializedonsite sleep measuring equipment [29] and provide sleepinformation that off-site accelerometers simply can not.

Participants wear a sensor headband which wirelesslytransmits measurements of electrical activity from the brainto a bedside unit for storage and data analysis. The bed-side component of the Zeo ran data mining algorithms toprocess the electrical signals; it also served as a feedbackunit, providing participants with a summary of their sleepperformance over the past few days.

2) Surveys: The Sustainable Health Lab (SHL) designedsurveys to capture information about subjects’ mood, diet,

social behavior and pre-sleep activities both before and dur-ing Ramadan. The web-based surveys were easily accessibleacross a wide variety of devices and subjects had to completethese surveys daily. To minimize the submission of staleor made-up data, participants had a short one-day windowto complete the survey. Three surveys were created - Pre-ramadan, ramadan and exit; to ensure a commitment tosurvey filling, users received compensation commensuratewith their survey completion rate.

3) Compensation: Participants were provided a monetarycompensation amount for each day they provided both sleepand sociability information. This daily compensation amountwas doubled after 20 days of continued participation - an in-centive designed to encourage prolonged study participation.Earnings were shown (described in the System Architecturesection) to boost and encourage further participation in thestudy.

III. SYSTEM ARCHITECTURE ANDWEB PLATFORM

Figure 1 shows the System Architecture of the study.A custom web platform was developed to help with datacollection, study administration and subjects’ participationtracking. Subjects had personalized accounts on the platformand this enabled them to track their progress, upload dailyinformation and view their progress over time.

Study Subject  

Study Admin

 Web  Interface   SHL  Hosted  

Database  

SurveyGizmo  Web  Service  

Fill  Online  Surveys  

Data Uploads

Survey Data Retrieval

Aggregated Study Data

Personalized Composite Data View    

Personal  Records  

View  Aggregated  Records  

Use  In-­‐home    Sleep  Monitoring  

Fig. 1. System Architecture for FIRST@Masdar

The web platform is a modular system consisting ofvarious components. The Web interfaces were written asindependent entities in JavaScript, while the hosted databaselayer was written in PHP. Each of the components exposestandardized interfaces that allow for communication and theexchange of information.

A. Technology

The technology used to achieve this modular systeminclude section describes the various software libraries usedin the development of the web platform.

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Fig. 2. Study Subject Personalized Composite Data Dashboard Visualization

• RaphealJS (http://raphaeljs.com/) This was used to cre-ate summaries of study status widgets for the dashboard.

• Twitter Bootstrap (http://getbootstrap.com/) This wasused to create the pages, layouts and user interfaceelements of the platform.

• JQuery DataTables (http://datatables.net/) This was usedto create tables of data with searching, sorting and re-ordering capabilities.

• JQplot (http://www.jqplot.com/) This was used to creategraphs of subject data entries over time.

• JQuery (http://jquery.com/) This was used for web doc-ument traversals, event handling and inter-componentcommunications.

B. Architectural Components

1) Web (User) Interface: The Web Interface is the primaryinteraction point for users of the platform. Users can fillsurveys, view participation records and track the state ofthe study. There are also a couple of widgets that providesummaries of earnings, number of submitted entries and theexpected number of entries.

Users can choose to view their record history and thisis displayed as a graph of entries over the duration of thestudy. Information about subjects’ moods, sleep quality, foodquality, stress, productivity levels as well as sleepiness, seeFigure 2.

Subjects can also view their earnings as well as search fortheir earnings for specific days, see Figure 3.

Fig. 3. Study Subject Earnings Report

The platform is configured based on the various stagesof the study (e.g. pre-ramadan and ramadan) by settingthe start dates of each epoch. Based on these settings, theappropriate surveys are displayed to users once they access

the dashboard. These settings are also used to drive thesummarized information available through the widgets. Somefeatures (e.g. exit survey support) are also activated as certainthresholds are reached.

The frequently-asked question section made it easy forsubjects to find answers to potential issues, guidelines onthe usage of the sleep devices and contact information. Thismade it easy for the subjects to monitor their participationin the study and also minimized the need for making trips tothe laboratory. It also enhanced subject privacy as individualshad personalized and private profiles.

2) SurveyGizmo Web Service: SurveyGizmo(www.surveygizmo.com) is a commercial platform offeringtools for creating, running and administering data gatheringstudies. The easy-to-use and tools makes it easy to createtailored surveys and/or questionnaires for data intensivestudies.

Surveygizmo also provides an application programminginterface (API) that enables customers to send data to theirservice, retrieve data chunks as well as filter using certaincriteria (e.g. date).

Three surveys targeting the various stages of the FIRSTwere created on SurveyGizmo and then embedded in the webinterface described above. Subjects could seamlessly com-plete these surveys without leaving the SHL web platform.

The default SurveyGizmo data export feature providedaccess to all uploaded data however this was not flexibleand difficult to integrate into the web platform for real timeupdates. Thus, a data retrieval module was created - themodule accessed the SurveyGizmo data store after passingthrough an authentication layer. This enabled the retrieval,filtering and transfer of data to our hosted database, whichwas a second data store.

Two datastores were used throughout the entire survey,information (including extraneous information like locationand IP addresses) was available on the SurveyGizmo plat-form while data for driving the web and administrativeinterfaces was regularly transferred to our hosted database.

The surveys also gave subjects a personalized feedbackchannel which provided an opportunity to listen to user issuesand complaints in real-time.

3) SHL Hosted Database: Automated PHP scripts on theSHL domain were used to retrieve, filter out extraneous

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fields and store information in the database. The retrieval ofdata occurred on a hourly basis, this was frequent enoughto keep the data relatively fresh and infrequent enoughto prevent the script from being barred due to incessantrequests. The scripts also update old data entries whenevernewer information is available.

To ensure subjects’ privacy and data integrity, privateinformation were encrypted by using hashing algorithms; thisincreased the security of the system and protected againstleaks and breaches.

4) Web (Admin) Interface: Given that each day of Ra-madan or pre-Ramadan would not be repeated for anotheryear, the study required an easy everyday view of partic-ipation to maximize the collected information. The datareporting and analysis tools offered by SurveyGizmo didnot meet our needs since it was difficult to track the statusof the study and data uploads at a glance, moreover thedata classification needed for study administration were notavailable in the generic offerings.

The administrative interface allows administrators to tracksubjects, their performance, most recent submissions andexpected number of submissions. This makes it easy toidentify participants who have missing entries and helpedwith the early discovery and resolution of issues during thestudy. This information gathering approach maximizes theamount of useful information captured.

IV. CONCLUSIONSIn conclusion, this paper described the development of

a health information system capable of collecting, manag-ing and visualizing health and health-related data from thefasting in Ramadan study. A web platform was detailed toimprove the experience of the users and enhance the overallview of all the available information to administrators of thestudy.

The system can be improved to provide more information(such as sleep data and sleep patterns) and suggestionsfor improvement to participants. Future iterations of theplatform may have a custom data acquisition module that willremove the dependence on the external Surveygizmo plat-form. Finally, the administrative interface can be extendedto include more specific features to handle secure privatecommunication channels, issue reporting and content editing.

ACKNOWLEDGMENT

We would like to thank Khasaiba Al Dalel and RahmanOloritun for their contributions towards the experimentaldesign and deployment. We would also like to thank theparticipants of the Ramadan Sleep Studies.

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