The Sleepio app uses an artificial intelligence algorithm to provide people with tailored digital cognitive behavioural therapy for insomnia (CBT-I).
NICE has recommended Sleepio as an alternative to sleeping pills, which it says would save the NHS money as well as reducing prescriptions of medicines such as zolpidem and zopiclone that carry the risk of drug dependence.
Clinical evidence from 12 randomised controlled trials showed that Sleepio is more effective at reducing insomnia than sleep hygiene and sleeping pills. An analysis of primary care resource use data before and after Sleepio was introduced in nine GP practices found that Sleepio is cost saving after one year compared with usual treatment in primary care, mostly because of fewer GP appointments and sleeping pills prescribed.
The cost of Sleepio is £45 (excluding VAT) per person who starts session 1 of the Sleepio programme. NICE estimates that up to 800,000 people could benefit from using the app in England.
Sleepio provides a digital six-week self-help programme involving a sleep test, weekly interactive CBT-I sessions and a daily sleep diary.
The CBT sessions focus on identifying thoughts, feelings and behaviours that contribute to the symptoms of insomnia. Cognitive interventions aim to improve the way a person thinks about sleep and the behavioural interventions aim to promote a healthy sleep routine.
Although the programme is designed to be completed in six weeks, users have full access to the programme for 12 months from registration. This allows people to complete the sessions at their own pace and revisit sessions if they wish. Participants can also access electronic library articles, online tools and join the online Sleepio user community for support.
The sleep diary helps users track their progress and the programme tailors advice to individuals. Users can fill in the diary manually or the data can be automatically uploaded from a compatible wearable tracking device, like an Apple watch or Fitbit.
Digital health technology
Jeanette Kusel, acting director for medtech and digital at NICE, said: '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.
'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 evidence has shown using Sleepio reduces the number of GP appointments people with insomnia need and will also cut the number of prescriptions for sleeping pills delivered by pharmacists.'
Professor Nicole Tang, director of the Warwick Sleep and Pain Lab, said: 'This is of course exciting news. CBT-I has been recognised as first-line treatment for insomnia for some time, and yet we lack a health infrastructure to disseminate this non-drug treatment option widely. Sleepio is a digital avenue to help us achieve that.'
NICE recommends pregnant women and people with comorbidities are medically assessed before referral to Sleepio, because insomnia can mimic other conditions like restless legs or it could be a consequence of undiagnosed sleep apnoea.
There is limited evidence of Sleepio's effectiveness compared with face-to-face CBT-I, so NICE has recommended further research in this context.