Insomniacs in England to be offered app treatment instead of sleeping pills

Hundreds of thousands of people struggling to sleep are to be offered treatment via an app instead of sleeping pills in the biggest shake-up of guidelines for insomnia in decades.

Until now, people with insomnia have typically been given advice about sleep hygiene or prescribed sleeping pills. Now they could be offered a £45 app-based treatment programme on the NHS instead of pills, under new guidelines from the National Institute for Health and Care Excellence (Nice).

Nice is recommending Sleepio as an effective alternative for the first time, saving the NHS cash and reducing prescriptions of drugs which can be addictive. An analysis found healthcare costs were lower when using Sleepio, mostly because of fewer GP appointments and sleeping pills prescribed, Nice said.

The app uses an artificial intelligence algorithm to provide people with tailored digital cognitive behavioural therapy for insomnia (CBT-I). As many as 800,000 people could benefit from the new guidelines in England.

“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, the 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 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.”

The app offers 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 how a patient thinks about sleep, and behavioural interventions aim to promote a healthy sleep routine.

The programme is designed to be completed in six weeks, but under the new guidelines people will have full access to it for 12 months from registration. This will allow NHS patients to complete the sessions at their own pace and revisit sessions, Nice said. Participants can also access electronic library articles, online tools and join the online Sleepio user community for support.

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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 per person and will also save the NHS money, Nice said. This is based on an analysis of primary care resource use data before and after Sleepio was introduced in nine GP practices.