Digital therapy for insomnia could save NHS millions and improve anxiety and depression symptoms

• Users report dramatic reductions in insomnia, anxiety and depression rates and marked decrease in use of prescription medication

• GPs can offer ‘simple digital prescription’ and close the ‘treatment gap’ for insomnia

Online therapy for insomnia can deliver high recovery rates, significantly improve mental health outcomes and save the NHS millions, according to a new report.

Widespread use of cognitive behavioural therapy (CBT) for insomnia could save the NHS as much as £56 million over three years, say researchers.

Patients living with the condition who used Sleepio – a digital sleep improvement programme featuring CBT techniques – had a recovery rate of 56 percent.

Sleepio also made a significant positive impact on mental health, with users experiencing a 70 percent reduction in symptoms of anxiety and a 72 percent reduction in symptoms of depression.

The findings highlight a significant reduction (56 percent) in the usage of prescription medication and over-the-counter sleep aids amongst Sleepio patients, and users were 21 percent less likely to be absent from work due to poor sleep.

The research reveals how digital therapies can be used to help the health service deal with the anticipated surge in patients needing mental health treatment in light of the pandemic, and offers GPs an alternative to routinely prescribing sleeping pills.

The report, Scaling digital CBT for insomnia via the NHS, authored by digital therapeutics company Big Health and the Oxford Academic Health Science Network, details the first and largest real-world implementation of a digital therapeutic in partnership with the NHS. The study analysed the results of over 16,000 people who accessed the Sleepio programme and more than 7,000 who received CBT treatment across the Thames Valley from 2018.

The report also highlights the findings of an independent study conducted by the Office of Health Economics across nine GP practices in the Thames Valley, which found that Sleepio resulted in a projected saving of £106 per patient over three years. If Sleepio were made available across all clinical commissioning groups (CCGs) in England, this could represent savings for the NHS of as much as £56 million over three years.

NICE clinical guidelines recommend CBT as the first-line treatment for chronic insomnia. However, millions of people are unable to access the treatment they need – resulting in a ‘treatment gap’ for insomnia – with harmful consequences for patients and the NHS.

Current poor CBT provision is largely due to a shortfall of adequately trained staff. The NHS has one CBT therapist for every 1,000 people with insomnia – with most therapists not specifically trained in the condition. Where services are available, waiting times for group CBT can exceed a year.

Commenting on the findings, Big Health co-founder and Professor of Sleep Medicine at the University of Oxford, Professor Colin Espie, said:

“This study demonstrates how digital therapeutics can help the NHS grapple with long-standing challenges that leave millions every year without access to appropriate treatment. We’ve shown that the ‘treatment gap’ for insomnia can be bridged by providing access to digital CBT, which is safe, effective, standardised and scalable.

“Interventions like Sleepio can ease the burden on existing services by delivering clinically proven therapy at the click of a button, eliminating waiting times and avoiding unnecessary in-person contact. This is of particular benefit in the midst of the COVID-19 pandemic when the need for remote access to treatment is greater than ever, but in the long-run, access to digital CBT for insomnia as an early intervention will help to prevent people’s health needs becoming more complex and difficult to treat down the line.”

Director of Clinical Innovation Adoption at Oxford Academic Health Science Network, Tracey Marriott, said:

“These results highlight the system-wide impact that is made possible through collaborative partnerships. Scaling up digital therapeutics like Sleepio in this way offers an exciting opportunity to provide both economic benefit and improve patient outcomes. Moving forward, we want to ensure that the environment is ripe for these types of partnerships to continue, and that these services reach as many people as possible.”

Lead researcher and Principal Economist at the Office of Health Economics, Dr Chris Sampson, said that access to Sleepio had eased pressure on GP practices and resulted in less money being spent by the NHS on prescriptions.

“We rarely find scalable treatments that improve people’s health and reduce NHS service use. We found increased savings for people with depression or anxiety, highlighting the potential for future research to demonstrate even greater value in specific patient groups.”

Buckinghamshire GP Dr. Ian Wood added:

“Many GPs are finding they have very few options other than to prescribe hypnotics for insomnia. Availability and access to CBT for insomnia is too often poor across the country and that’s not going to change soon. I am delighted to be able to offer Sleepio for free to my patients – an effective digital tool with a robust clinical evidence base behind it. It’s a simple digital prescription, and it means that patients can access CBT in their own time and at their own pace.”

The project was funded by Innovate UK, whose Innovation Lead for Health & Care, Chris Sawyer, said:

“UK Research and Innovation, through the Digital Health Technology Catalyst, has invested £35 million in projects that will improve patient outcomes, access to healthcare and treatments by harnessing the power of digital innovation. Products like Sleepio demonstrate the very clear value of such investments – improving people’s mental and physical health and quality of life.”

Insomnia is the UK’s most common mental health complaint, with 8-12 percent of adults suffering from chronic insomnia and 30-50 percent experiencing insomnia symptoms. A recent study by King’s College London and Ipsos MORI revealed that COVID-19 is having a significant negative impact on sleep, with nearly two-thirds (63 percent) of respondents reporting that their sleep had been worse since the lockdown was announced.  

Left untreated, insomnia is associated with increased risk of mental health disorders such as anxiety and depression, and chronic conditions including diabetes, obesity, and cardiovascular disease.