App could replace sleeping pills in NHS treatment of insomnia

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

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

The National Institute for Health and Care Excellence (Nice) said it would save the NHS money and reduce prescriptions for drugs such as zolpidem and zopiclone, which can create a addiction.

Their economic analysis found that healthcare costs were lower after one year of Sleepio use, primarily due to fewer GP appointments and prescribed sleeping pills.

The app offers a six-week digital self-help program that includes a sleep test, weekly interactive CBT-I sessions, and keeping a diary of their sleep habits.

The Sleepio app uses a daily sleep diary to help users track their progress

Sessions focus on identifying thoughts, feelings, and behaviors that contribute to symptoms of insomnia. Cognitive interventions aim to improve how a person thinks about sleep and behavioral interventions aim to promote a healthy sleep routine.

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

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

This allows people to complete sessions at their own pace and review sessions. Participants can also access e-library articles, online tools, and join the online Sleepio user community for support.

A daily sleep diary helps users track their progress, and the program tailors advice to individuals. Users can fill in the log manually or the data can be downloaded automatically from a compatible wearable tracking device, such as an Apple Watch or Fitbit.

Clinical evidence presented to the Nice Medical Technology Advisory Committee from 12 randomized controlled trials showed that Sleepio is more effective in reducing insomnia than sleep hygiene and sleeping pills.

sleep survey
Nice predicts that up to 800,000 people could benefit from using Sleepio in England (Dominic Lipinksi/PA)

Jeanette Kusel, Acting Director of MedTech and Digital in Nice, said: “So far, people suffering from insomnia have been offered sleeping pills and have been informed about sleep hygiene, so the recommendation of Sleepio by our committee offers GPs and their patients a new treatment option.

“Our rigorous, transparent and evidence-based analysis found that Sleepio saves the NHS compared to standard primary care treatments. It will also reduce the reliance of people with insomnia on addictive drugs such as zolpidem and zopiclone.

“This is a good example of how digital health technology can help the NHS. Evidence has shown that using Sleepio reduces the number of GP appointments for people with insomnia and will also reduce the number of prescriptions for sleeping pills dispensed by pharmacists.

The cost of Sleepio is £45 (excluding VAT) per person, but Nice says Sleepio is cost-effective compared to usual primary care treatment. This is based on an analysis of primary care resource utilization data before and after the introduction of Sleepio in nine GP practices.

The independent Nice committee recommended that a medical evaluation be carried out before referring to Sleepio during pregnancy and in people with comorbidities. Pregnant women should be evaluated as insomnia can mimic other conditions like restless legs, or it could be a consequence of undiagnosed sleep apnea.

They also recommended more research or data collection to show the effectiveness of Sleepio compared to face-to-face CBT-I.

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