Non-Intrusive Sleep Analyzer for Real Time
Detection of Sleep Anomalies
Krasimir Tonchev1, Pavlina Koleva2, Agata Manolova3, Georgi Tsenov4, and Vladimir Poulkov5
Faculty of Telecommunications and Faculty of Automatics
Technical University of Sofia
Sofia, Bulgaria
Email: {k_tonchev, p_koleva, amanolova, gogotzenov, vkp,}@tu-sofia.bg
Abstract—Solutions for caring for the elderly both efficacious
and cost-effective are given by Ambient Assisted Living (AAL)
systems that combine the research fields of intelligent systems
and communication technologies. These systems are promising
for the improvement of the quality of life of elderly and disabled
people. One important characteristic of health and well-being is
sleep. While sleep quantity is directly measurable, its quality has
traditionally been assessed with subjective methods such as
questionnaires. In this paper, we propose a non-intrusive sleep
analyzer for real time detection of sleep anomalies, part of an
effective AAL system. The proposed solution is based on
combination of non-invasive sensors and an algorithm for sleep
analysis with two stages – low and high level reasoning. It also
offers the opportunity to include third party devices. Using the
analyzer we can monitor basic sleep behavior and to detect sleep
anomalies, which can serve as an important indicator for both
mental and physical health.
Keywords—Sleep Monitoring, Context Awareness, Sleep
Anomaly Detection, REM, NREM, HMM
I. INTRODUCTION
Sleep is an important part of health and well-being. The
importance of sleep quality often manifests itself when there is
a disturbance: the lack of quality sleep has immediate
consequences in the form of reduced daytime functionality, and
long-term consequences affecting both mental and physical
health. The study of sleep disorders has for a long time been
confined to clinical environments, and patients have had to
endure cumbersome procedures involving multiple electrodes
placed on the body. Recent developments in sensor technology
as well as data analysis methods have enabled continuous,
unobtrusive sleep data recording in the home environment.
This has opened new possibilities for studying various sleep
parameters and their effect on the quality of sleep [1].
Although the human sleep still remains a largely unknown
area, it is proven that this process is not homogeneous. It
consists of two broad types: rapid eye movement sleep (REM)
and non-rapid eye movement sleep (NREM) [2]. The sleep
quality is considered to be mainly a subjective phenomenon
[3], however the total sleep duration and the amount of time
spent in each mentioned stage are important for diagnosis of
most of the sleep disorders. The stages in sleep can be inferred
from some well-known physiological signals: the
This work was supported in part by the Grant Agreement No: 610658,
eWALL: eWall for Active Long Living” of the EU Seventh Framework
Programme. The authors wish to thank the invaluable help received from all
the consortium members.
978-1-5090-1288-6/16/$31.00 ©2016 IEEE
electroencephalogram (EEG), the electrooculogram (EOG), the
electromyogram (EMG), respiration data, etc. The system
proposed by Rechtschaffen and Kales (R&K) [4] is accepted as
standard for visual scoring of human sleep. The amount of
time an adult needs to sleep each night varies from person to
person, and probably has to do with genetics. But the National
Institutes of Health suggests that adults get between 7 and 8
hours of sleep each night. To keep with current health demand
from people with different needs, a number of smartphone
apps, wearable tech and different home sensors on the market
claim to track sleep patterns that aim to help users understand
what might lead to a bad night's rest, so the triggers for bad
sleep can be avoided.
Generally, there are three types of sleep gadgets on the
market. The first are the fitness trackers that have sleep-
tracking capabilities. Most of these gadgets involve a wearable
wristband or sensor that tracks the user’s body movements as
he or she sleeps. Some research is done over the capabilities of
such sensors and the modalities they measure to estimate
accurately sleep quality [5, 6]. The authors prove that wrist
devices yield accurate and valid data for sleep estimation. The
second category is smartphone apps, which use the
accelerometer that is built into the user’s phone to capture his
movements. One research [7] uses the Best Effort Sleep (BES)
model to develop a smartphone sleep monitoring system. This
model estimates only sleep duration via phone activity. Even
though according to the authors the model proves to be
accurate enough, sleep data collected by on-body sensors is
more reliable. The third category is different types of bed
sensors that offer sleep measurement in an unobtrusive way. A
lot of products are currently present on the market and a lot of
research is done on the data that can be gathered by these
sensors [8, 9].
The main contribution of this paper is to present a non-
intrusive sleep analyzer by monitoring in real time several
events for detecting sleep anomalies, using a combination of
sensors as bed pressure sensor, microphone and accelerometer.
This sleep analyzer can also incorporate third party devices that
can offer additional measurements not only for sleep pattern
analysis but for other everyday health monitoring.
The rest of the paper is organized as follows: the next
section describes the overview of the system including the
algorithm for the sleep analyzer incorporated in the EU project
400 TSP 2016
“eWALL” (http://ewallproject.eu). Section III introduces the
implementation details and illustrates the experimental results.
The final section draws the conclusion and suggests the scope
of future work.
II. SLEEP ANALYZER DESCRIPTION
A. Non-invasive sensors
AAL applications have special architectural requirements,
including low power consumption, low intrusiveness and low
computing power [10]. Based on these requirements we have
selected the three main hardware components of the sleep
analyzer’s current implementation: bed pressure sensor,
microphone, and accelerometer.
One of the important modalities delivering important
information about user’s activity and movements in bed during
sleep is the accelerometer. Our system monitors how many
times a person tosses and turns during the course of the night
and how many times the person leaves the bed. In this way, the
frequency of movements can help in determining whether a
person is asleep or not. Frequency of movements is also
different for different sleep stages and thus can be related to the
sleep stage a person is currently in. Transitions between
different sleep stages also correspond to change in frequency of
body movements. The sleep events that are measured by this
sensor in the system are: body movement shorter than 15 sec.
or longer than 15 sec.
The bed pressure sensor delivers a Boolean type of
information, whether or not the user is on or off bed. Although
in some sense this information overlaps with the one from the
accelerometer, fusing both modalities can improve the
inference and reduce errors. The sleep events that are measured
by this sensor in the system are: in and out of bed, morning exit
and out of bed during the night.
Another modality, which is utilized to evaluate the user’s
sleep, is audio. The sound waves produced on account of
inhalation and exhalation are used to monitor the respiration
rate. We use a microphone sensor to capture the breath sounds.
The sounds produced during inhalation and exhalation is given
as input, the voltage variations produced by it are amplified and
integrated to obtain a consolidated pattern. The microphone is
used to measure snoring. Snoring is usually the major signal
indicating obstructive sleep apnea (OSA), which is
characterized by repetitive upper airway obstruction during
sleep, causing total or partial cessation of airflow (apneas and
hypopneas) [11]. The recorded signal shows a voltage signal
close to zero for a long period due to absence of respiration,
after which there is increase in amplitude due to deep
inspiration after apnea. The interval gives the apnea duration,
time interval and nature of apnea. The sleep events that are
measured by this sensor in the system are: snoring, breathing
levels – fast, slow and normal.
Using the described modalities the system can extract
important information about the user’s sleep states. An expert
work group within the eWALL consortium decided upon the
most relevant information using the sensors described above.
Based on their analysis, the measurements selected for
implementation are given in Table 1.
401
TABLE I. NECESSARY MEASUREMENTS FOR SLEEP ANALYSIS
Measurement Description
Time in bed
This is the total time user was in bed.
(TB) in hours
Total Sleep time The total sleep time is calculated by accumulating
(TST) in hours the time user is asleep for particular night.
Sleep efficiency This is the ratio of the total time user was asleep
(SE) over the total time in bed.
Sleep latency
The time needed for the user to fall asleep.
(IM)
Snoring time
(SNR)
The total time user spent snoring.
This is the Pittsburgh Sleep Quality Index (PSQI),
PSQI
standard for measuring sleep quality [12].
O2 statistics
Min, Max and average value of the O2 saturation
measurements conducted while user was asleep.
Number of times the user woke up during the
Woke-ups count
night.
B. Algorithm description
In Fig. 1 is illustrated the algorithm, implemented in two
stages. The first one performs low level reasoning and extracts
the sleep events described in the previous subsection. The
second stage performs high level reasoning described in Table
1 and delivers the information to the users or the caregivers.
Fig. 1. Sleep Analyzer reasoning stages
The reason for this two stage implementation is primary for
implementation and optimization. Performing the low level
reasoning requires the component to be positioned “close” to
the database where high level rates of data are required. Also,
the algorithm runs constantly, inferring the different sleep
states the user is in. On the other hand, the high level reasoning
requires the data of the previous night to be already collected,
i.e. the low level reasoning to be finished for the night. The
synchronization between the two stages is simple. The high
level reasoning starts after receiving the woke-up event.
Additional reason for such division is the integration with Fitbit
(https://www.fitbit.com). As can be seen from the Fig.1, Fitbit
is a third party component, which delivers partially low level,
partially high level reasoning. This information has to be
further processed before consumed by the applications and this
is done by the high level reasoning stage.
The low level reasoning consumes the data delivered by the
sensors which were introduced in the previous sub-section.
Based on this data an estimate of user’s sleep activity is
performed. The used set of events is: the person is out of bed
and thus does not sleep; the person is in bed, but does not
sleep; the person is in bed and sleeps; the person starts snoring;
the person stops snoring. This set of events, excluding the
snoring event, requires dynamical analysis over time of the
input sensory information. Analyzing the information in static
manner i.e. on a sample basis can provide erroneous results.
Since the sleep events follow a natural pattern, a better
approach would be to perform time dependent analysis. ' - ( P )q ( 1* $
1 1

Avoiding additional complications the best solution is the first % - ( P )q ( 2 * " (3)
order Hidden Markov Model (HMM). In the model prior !(% 2
" 1

% "
probabilities which reflect the common belief of the sleep % "
pattern could also be included. This is rather useful in cases &- ( PN
)q ( N *# 1 N !1

where there is no, or very small amount of data. Block diagram

of the low level reasoning of the Sleep analyzer is depicted in The sequence of observation is represented as a matrix
Fig. 2 a). As input, the low level reasoning receives Moving O=(o1,o2,…,oT), arranged from feature vectors
Average indicators (IMA) values, which are accumulated o t ( .o1t , o2t ,..., oDt / ,1 + t + T , where T is the number of
T
absolute values of accelerometer data per 10 seconds and bed
pressure sensor data. The HMM is split in two: probabilities observations and D is the feature vector dimensionality. The
buildup and Viterbi decoder. statistical dependence between o and a state q = j = 1, 2, … N
is given by a set of characteristics B ( 0b j )o *1N which are
j (1

Gaussian Probability Density Functions (PDF) with mean

vectors "j and covariance matrices #j. Each bj(o) is calculated
according to:

1 ,
1
)o ," j *T # j )o ," j *
,1
(4)
b j )o * ( e 2

)2- *
D
) *
det # j

The Prior probability depicted on the figure is also Gaussian

with high variance and it represents our belief on when the
user is most probably to be sleeping. The full HMM
description is denoted with ! = (A, B, !). The generative
a) b)
nature of the HMM is illustrated on Fig. 3: the model starts
with selecting an initial state j from the vector of the initial
Fig. 2. a) Block diagram of Sleep analyzer’s low level reasoning and b) High state distribution !, an observation is generated from the state j
level reasoning of Sleep analyzer by the distribution bj(ot), the new state is generated from the
transition probability matrix, move to the next state t = t + 1
The HMM itself is a probabilistic model used to describe the and so on.
statistical dependency between “hidden” sequence of states q
and the dependency between a given state qt and the directly
observable feature vector ot (an observation) as well (t
denotes the time step). The HMM can be regarded as
description of a double stochastic process. The statistical
dependency between states is given by the transition
probability matrix A:

'a 11
a 12
! a1N $
%a a ! a " (1)
A(% 21 22 2N
" ,
% " " # " "
% "
&a N1
a N2
! aNN # N !N

where N denotes the number of states. Each element in A: Fig. 3. The generative nature of a HMM with two states

a ( P)q ( j | q ( i *,1 + i, j + N (2) The “optimal” states sequence q* is the most probable one
ij t t ,1
given the observations and model parameters:
is the probability the model is being in state j given the
previous state i. In the given context the transitions from q * ( arg max 0P )q | O, 2 *1 (
q
nonconsecutive states are impossible, so a13 = 0 and a31 = 0 (5)
(see Fig.3). The information about the state in the first time 8 p )q, O | 2 * 5
( arg max 7 4(
step t = 1 is given by the vector of the initial state distribution q 6 p )O | 2 * 3
!: ( arg max 0P )q, O | 2 *1
q

A computational efficient solution for (5) is the Viterbi

402
algorithm. It exploits the likelihood "t(i) of the most probable
state sequence for the first t observations and the sequence
finishes with state i at time t. The Viterbi algorithm consists of
the following steps:
1. Initialization of the first phase. Set t = 2; calculate
"1(i)=#1bi(o1) and set $1(i) = 0;
2. Induction. Calculate 9 t )i * ( max09 t ,1 ) j *a ji 1bi )o t * and the
1+ j + N
state that maximizes "t(i) i.e. : t )i * ( arg max 09 t ,1 ) j *a ji 1 ;
1+ j + N
3. Move to next time step. Set t = t + 1. If t + T , go to step
2, otherwise go to step 4;
4. End of the first phase and initialization of the second
phase. Calculate qT* ( arg max 09 T )i *1 and set t = T - 1;
1+i + N
5. Decode the current state. Calculate
) *
qt ( : t ;1 qt ;1 ,1 + t + T , 1 ;
* *
6. Move to the previous time step. Set t = t - 1. If t < 1 , go
to step 5, otherwise terminate the procedure.
The output of the algorithm is the inferred sleep event
which is exposed to the rest of the system via REST endpoint.
Once the sleep events are available and collected during
the night a high level reasoning is performed. The high level
reasoning is depicted on Fig 2 b). After the sleep
measurements are calculated, they are stored in the database
and are further exposed by REST endpoint. The high level
reasoning can take two inputs. One from Fitbit, while the other
from the low level reasoning. When the input is from Fitbit,
simple data re-formatting and re-calculation is performed in
order to meet eWALL requirements. When using sleep events,
the sleep measurements from Table 1 are easy to calculate.
III. IMPLEMENTATION TECHNIQUE
The sleep analyzer module is done in a way to reflect the
two stages of reasoning. The low level reasoning is
implemented as a part of the Physical Activity Service brick,
part of the eWall architecture, while the high level reasoning is
done as an Intelligent Decision Support System (IDSS)
reasoner. The IDSS module leverages instantaneous situational
information to make inference on the current status of an end
user and to provide motivational messages and suggestions to
take actions. In this respect, it is used to anticipate immediate
or long term action, proactively offer situation-aware and
usable content. The reason for including the low level
reasoning as part of a service brick is the need for quick access
to the IMA values. Since the service brick is already reading
this data, and to avoid double reading, the low level reasoning
is re-using it. Both, the low level reasoning and the high level
reasoning expose endpoints. In Table II the response
parameters from the sleepData endpoint are described.
TABLE II. DESCRIPTION OF THE „SLEEPDATA“ ENDPOINT PARAMETERS
sleepData
Parameters Description
Username The name of the user issuing the call
Timestamp The timestamp of the recorded measurements
totalSleepTime The total amount of hours the user slept in hours
sleepEfficiency The total amount of sleep over the total amount of
403
time in the bed. This value is in %
sleepLatency The time in minutes it takes for the user to fall asleep.
frequencyWakingUp How many times the user woke up
snoringTime The total time in minutes the user was snoring
timeInBed The total time in minutes the user spent in the bed
remTime The time in minutes, user was in REM state
Psqi The PSQI index
O2 The average value of the O2 saturation measurements
measured during the course of sleep
bedOnTime Timestamp in milliseconds the user went on bed
bedOffTime Timestamp in milliseconds the user went out of bed
IV. CONCLUSION
In this paper we present a non-intrusive sleep analyzer for real
time detection of sleep anomalies based on HMM and Viterbi
algorithm. The Sleep Analyzer component is implemented as
an IDSS reasoner and is fully functional. The design and
architectural definition of this hardware and software
component, together with its deployment model is operational
and ready for end-user testing. To date the analyzer is installed
as part of the eWall smart home monitoring system in target
patients’ homes and measurements of its performance will be
obtained in real life conditions. Using the analyzer we can
monitor basic sleep behavior and how to detect sleep
anomalies, which can serve as an important indicator for both
mental and physical health of patients with COPD and MCI.
The utilization of PSQI index will be described in future work.
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