Want Better Sleep? There May Soon Be an App for That

It can be difficult to get a good night’s rest; sometimes, counting sheep just doesn’t cut it. And without a sleep tracking device like the Apple Watch or Fitbit, it’s even harder to accurately gauge whether you had restful Zzzz or a restless night.

CVS Health recently launched a medical application, called Sleepio, to help Americans sleep better at night. The app uses a cartoon therapist that offers advice and lessons on modifying your behavior before, during, and after sleep.

Right now, the program is primarily offered through employers for their employees in the U.S. and U.K., but it is possible to sign up without an employer sponsor and enroll in sleep studies.

More Than Just Zzzz

Experts hope that this app is a step in the right direction for apps that serve as digital therapeutics to help treat conditions like multiple sclerosis and schizophrenia. This type of technology make therapy much more accessible and can drive down the costs of in-person therapy with a mental health professional.

CVS Health is giving companies a variety of digital therapeutic apps for employees to select from. And the organization covers downloads like they do prescription drugs.

Big Health is the start-up that developed Sleepio. But it’s certainly not alone in the digital health space; more than a dozen companies are digitizing health treatment like cognitive behavioral therapy. They’re also coming up with novel and innovative ways to deliver therapy, for example, to children with attention deficit hyperactivity disorder getting therapy through video games.

Scaling & Concerns

Sleepio hasn’t taken off yet, and there’s a good reason for that: not many companies have signed up to start offering it. But CVS Health says more companies are expected to join the program this fall. Eventually, the insomnia app could reach tens of millions of people across the nation. One of the best parts about this offering is that it doesn’t require a prescription.

Some experts aren’t convinced, however, citing that the masses may not be ready to adopt online therapies. In a recent Nature-published research study, researchers cautioned that most digital treatment apps lack evidence of health improvement or benefits. The Food and Drug Administration (FDA) has to approve any app that claims to treat disease, so many apps make vague claims, like “better sleep”, rather than “insomnia solved”, to overcome this regulatory hurdle.

CVS Health says that, in the case of Sleepio, the app was selected because it was backed by rigorous published studies, according to CVS Health’s chief medical officer Dr. Troyen A. Brennan.

App-Based vs Pill-Based

Dr. Brennan says, for CVS, it’s important “to endorse digital therapeutics when they work as good as or better than medications one can take by mouth.”

In randomized studies, those who used Sleepio showed milder insomnia than patients who used online sleep education or a placebo treatment app. But we’re still not sure about the app’s efficacy against in-person behavioral therapy or sleeping pills, which are the primary ways most insomnia patients are dealing with their issues.

U.S. retail pharmacies dispensed over 29 million prescriptions for sleeping pills in 2018, and the FDA warned that taking certain sleeping pills causes “sleep driving” and endangering sleepwalking. For patients with chronic insomnia, the American College of Physicians recommends cognitive behavioral therapy.

The Quest to Defeat Poor Sleep

Chief executive of Big Health, Peter Hames, says his own insomnia caused him to come up with a digital method to improve his sleeping habits. He began by reading self-help books on cognitive behavioral therapy by professor Colin A. Espie, who teaches sleep medicine at Oxford University. The two teamed up to launch Big Health and digitize the therapy for others to help themselves.

Sleepio’s animated sleep expert, named “the Prof”, sends you on a quest for better sleep. The Prof is a bot who offers therapy over the course of six weekly online sessions. In the first session, the Prof assures you that, “if we work closely together on this, we have an excellent chance of defeating your poor sleep.”

Trial Results

Boston Medical Center and Delta Airlines are two companies that are working directly with Big Health in testing Sleepio on employees. They’ve stated that their employees report better sleep.

In several randomized studies that measured the effects that Sleepio have on sleep, some volunteers were given a different treatment, like online sleep education. Ultimately, the studies concluded, the Sleepio users had a bigger reduction in time-to-fall-asleep and time spent awake at night than their counterparts. However, there was not much difference in overall total sleep time between those who did and didn’t use Sleepio.

What’s truly concerning is that in one large randomized clinical trial (involving over 3,700 participants), only 18% of Sleepio users completed their treatment. In a separate study that involved almost 1,400 participants, more than 50% of the Sleepio users didn’t even engage with the app in a meaningful way.

According to Christopher L. Drake, who leads sleep research at Henry Ford Health System in Detroit, many people just prefer in-person therapy instead. In the future, he says, we’ll want to create a treatment that involves the accessibility of digital therapy apps with the personalization you’d get from a face-to-face consultation with a human therapist.

Bigger Benefits for Patients

Sleepio is the first major app that CVS Health is offering in an attempt to popularize online health treatment as an employee benefit. As more digital therapy apps are added, the challenge will be ensuring that all are high-quality, high-efficacy, and optimized for user experience.

What digital app would make life (or sleep) a lot easier for you? Let us know in the comments below!