App could replace sleeping pills in NHS insomnia treatment

It would save the NHS money and reduce prescriptions of medicine that can be addictive

The proposed Sleepio app uses an artificial intelligence algorithm to provide people with tailored therapy for insomnia. iStockphoto.com

A sleep app that offers a digital six-week treatment programme could be used to replace sleeping pills for people suffering insomnia.

The proposed Sleepio app uses an artificial intelligence algorithm to provide individuals with tailored cognitive behavioural therapy for insomnia (CBT-I).

The National Institute for Health and Care Excellence, or Nice, said it would save the National Health Service money and reduce prescriptions of medicines such as zolpidem and zopiclone, which can be addictive.

Their economic analysis found that healthcare costs were lower after one year of using Sleepio, mostly because of fewer GP appointments and sleeping pills prescribed.

The app provides a six-week self-help programme involving a sleep test, weekly interactive CBT-I sessions and keeping a diary about their sleeping patterns.

The sessions focus on identifying thoughts, feelings and behaviour that contribute to the symptoms of insomnia.

Cognitive intervention aims to improve the way a person thinks about sleep and the behavioural intervention aims to promote a healthy sleep routine.

Nice predicts that up to 800,000 people could benefit from using Sleepio in England.

The programme is designed to be completed in six weeks but people have full access to it for 12 months from registration.

This allows people to complete the sessions at their own pace and revisit sessions. Participants also have access to electronic library articles, online tools and the online Sleepio user community for support.

A daily sleep diary helps users to track their progress and the programme tailors individual advice.

Users can fill in the diary manually or the data can be automatically uploaded from a compatible wearable tracking device, such as an Apple Watch or Fitbit.

Clinical evidence presented to Nice’s medical technologies advisory committee from 12 randomised controlled trials showed that Sleepio is more effective at reducing insomnia than sleep hygiene and pills.

“Until now people with insomnia have been offered sleeping pills and taught about sleep hygiene, so our committee’s recommendation of Sleepio provides GPs and their patients with a new treatment option," said Jeanette Kusel, acting director for MedTech and digital at Nice.

“Our rigorous, transparent and evidence-based analysis has found that Sleepio is cost-saving for the NHS compared with usual treatments in primary care.

"It will also reduce people with insomnia’s reliance on dependence-forming drugs such as zolpidem and zopiclone.

“This is a good example of where a digital health technology can help the NHS."

The cost of Sleepio is £45 ($56), excluding VAT. But Nice says it is cost-saving compared with usual treatment in primary care.

This is based on an analysis of primary care resource use data before and after Sleepio was introduced in nine GP practices.

The independent Nice committee has recommended a medical assessment should be done before referral to Sleepio during pregnancy and in people with co-morbidities.

Pregnant women should undergo an assessment because insomnia can mimic other conditions, like restless legs, or it could be a consequence of undiagnosed sleep apnoea.

The committee has also recommended more research or data collection to show how effective Sleepio is compared with face-to-face CBT-I.