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Hundreds of thousands of people suffering from insomnia who would usually be prescribed sleeping pills could be offered an app-based treatment programme instead, NICE has said.

Man asleep wearing sleep tracker on his wrist © Andrey_Popov/ Shutterstock

The National Institute for Health and Care Excellence (NICE) has recommended Sleepio as an effective alternative to sleeping pills, which would save the NHS money as well we reducing prescriptions of medicines such as zolpidem and zopiclone that can be dependency forming. Economic analysis found that healthcare costs were lower at one year when using Sleepio, mostly because of fewer GP appointments and sleeping pills prescribed.

Sleepio was developed by Professor Colin Espie, who, along with his role as co-founder of Big Health, the parent company of Sleepio, is also the Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford. Sleepio has been evaluated by several Oxford studies to investigate the relationship between sleep and mental health.

The Sleepio app uses an artificial intelligence (AI) algorithm to provide people with tailored digital cognitive behavioural therapy for insomnia (CBT-I). Up to 800,000 people could benefit from using Sleepio in England. The app provides a digital 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 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.

The programme is designed to be completed in six weeks, but people 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. A daily 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.

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 sleeping pills.

The cost of Sleepio is £45 (excluding VAT) per person who starts session 1 of the Sleepio programme. Sleepio 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. Healthcare costs were lower at 1 year, mostly because of fewer GP appointments and sleeping pills prescribed.

The independent NICE committee has recommended a medical assessment should be done before referral to Sleepio during pregnancy and in people with comorbidities. 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.
They have also recommended more research or data collection to show how effective Sleepio is compared with face-to-face CBT-I.

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