SleepLM: Natural-Language Intelligence for Human Sleep

Polysomnography (PSG) provides the gold standard for sleep assessment but suffers from substantial heterogeneity across recording devices and cohorts. There have been growing efforts to build general-purpose foundation models (FMs) for sleep physiology, but lack an in-depth understanding of the pre-training process and scaling patterns that lead to more generalizable sleep FMs. To fill this gap, we curate a massive corpus of 166,500 hours of sleep recordings from nine public sources and establish SleepBench, a comprehensive, fully open-source benchmark. Leveraging SleepBench, we systematically evaluate four families of self-supervised pre-training objectives and uncover three critical findings: (1) existing FMs fail to generalize to missing channels at inference; (2) channel-invariant feature learning is essential for pre-training; and (3) scaling sample size, model capacity, and multi-source data mixture consistently improves downstream performance.With an enhanced pre-training and scaling recipe, we introduce OSF, a family of sleep FMs that achieves state-of-the-art performance across nine datasets on diverse sleep and disease prediction tasks. Further analysis of OSF also reveals intriguing properties in sample efficiency, hierarchical aggregation, and cross-dataset scaling.

Foundation models offer a promising route to compress multi-modal physiological signals into compact representations of human health, with broad applications across sleep medicine, cardiology, neurology and other healthcare domains. Existing models have typically been trained with masked-reconstruction or contrastive objectives. However, masked reconstruction may be poorly suited to the stochastic nature of these signals, while contrastive approaches rely on positive-pair definitions despite the semantic invariances of physiological signals being poorly understood. In this work, we show that next-token prediction is a simple and scalable alternative. We develop Hypnos, a multi-modal sleep foundation model trained using eight different sensing modalities (e.g. EEG, ECG, respiratory signals) drawn from over 20,000 overnight polysomnography recordings. We tokenize each modality into streams of discrete tokens using residual vector quantization, then train a large auto-regressive RQ-Transformer to jointly predict the next token across all modalities in parallel. After training, Hypnos can be applied to continuous streams of sensor data from any subset of supported modalities, generating embeddings for downstream tasks. Across a range of benchmarks, Hypnos significantly outperforms existing foundation models. In sleep stage classification, we match the performance of strong supervised baselines on held-out test sets whilst using $100\times$ less labelled data. Hypnos even generalises to daytime physiology, surpassing a dedicated ECG foundation model at detecting atrial fibrillation. Our results demonstrate that next-token prediction is a strong self-supervised objective for representation learning from multi-modal physiological signals.

Sleep physiology arises from the coordinated dynamics of the central nervous system (CNS) and autonomic nervous system (ANS), as reflected by multimodal polysomnography signals including EEG, EOG, EMG, ECG, and respiration. However, existing sleep foundation models often fuse heterogeneous biosignals in a topology-agnostic manner, overlooking their physiological organization. We introduce Omni-Sleep, a sleep foundation model that uses the CNS/ANS partition as a physiological prior for topology-constrained representation learning. Omni-Sleep learns structured representations through three objectives: intra-system consistency, which captures shared subsystem-level factors within neural and cardio-respiratory signals; inter-system synchronization, which aligns subsystem trajectories to model brain--body dynamics; and latent-space masked temporal modeling, which captures long-horizon sleep dynamics. Pre-trained on over 100,000 hours of multi-center multimodal PSG data, Omni-Sleep is evaluated on sleep staging and multi-disease classification. Across datasets and modality-ablation settings, Omni-Sleep outperforms strong foundation-model baselines, showing improved label efficiency, cross-dataset generalization, and robustness to missing modalities. These results highlight the value of physiological hierarchy for generalizable sleep representation learning. Code is available at https://github.com/AutoBrain-sleep/OmniSleep.