Study: Self-guided sleep app Sleepio, combined with standard care for depression and anxiety, delivers better outcomes than standard care alone

Study backs ben­e­fit of insom­nia DTx Sleepio on men­tal health (pharmapho­rum):

The study – pub­lished in the jour­nal Behav­iour Research and Ther­a­py – test­ed the Sleepio app devel­oped by dig­i­tal health spe­cial­ist Big Health as an add-on to stan­dard NHS care for anx­i­ety and depres­sion under the improv­ing access to psy­cho­log­i­cal ther­a­pies (IAPT) policy.

Patients who signed up to use Sleepio – a six-week dig­i­tal cog­ni­tive behav­iour­al ther­a­py (CBT) course – achieved sig­nif­i­cant­ly bet­ter improve­ment in symp­toms com­pared to con­trols, with an IAPT recov­ery rate of near­ly 65% ver­sus 58% in the con­trol group.

Users of Sleepio also reduced their use of high-inten­si­ty IAPT treat­ment, includ­ing per­son­alised ther­a­py deliv­ered by men­tal health pro­fes­sion­als, accord­ing to the researchers from Big Health and Oxford Health NHS Foun­da­tion Trust. Around a mil­lion peo­ple are assessed by the IAPT pro­gramme in Eng­land every year.

“This eval­u­a­tion revealed sig­nif­i­cant val­ue in intro­duc­ing an evi­dence-based dig­i­tal sleep inter­ven­tion at scale with­in a clin­i­cal men­tal health ser­vice,” they con­clude … Big Health points out that treat­ment guide­lines, includ­ing guid­ance from the Nation­al Insti­tute for Health and Care Excel­lence (NICE), rec­om­mend CBT as the first line treat­ment for insom­nia. How­ev­er, most patients are either giv­en med­ica­tions or placed on a long wait­ing list for therapy.

The Study:

Does adjunc­tive dig­i­tal CBT for insom­nia improve clin­i­cal out­comes in an improv­ing access to psy­cho­log­i­cal ther­a­pies ser­vice? (Behav­iour Research and Ther­a­py). From the Abstract:

• Back­ground: Insom­nia has a bidi­rec­tion­al rela­tion­ship with broad­er men­tal health func­tion­ing, includ­ing anx­i­ety and depres­sion. Yet, poor sleep has his­tor­i­cal­ly been neglect­ed as a spe­cif­ic treat­ment tar­get in men­tal health programmes.
• Method: All patients over a 12-month peri­od enter­ing the Improv­ing Access to Psy­cho­log­i­cal Ther­a­pies (IAPT) ser­vice endors­ing a ‘poor sleep’ ques­tion­naire item at assess­ment, were offered a self-guid­ed dig­i­tal sleep inter­ven­tion, Sleepio, in addi­tion to rou­tine care. Sleepio is based on the prin­ci­ples of Cog­ni­tive Behav­iour­al Ther­a­py for Insom­nia (CBT‑I). Propen­si­ty score match­ing estab­lished a non-Sleepio con­trol group matched on demo­graph­ic and base­line clin­i­cal measures.
• Results: Patients who signed up to Sleepio (n = 510) achieved sig­nif­i­cant­ly bet­ter out­comes on core clin­i­cal met­rics (PHQ‑9, GAD‑7, WSAS) than con­trols. IAPT recov­ery rates (on PHQ‑9 and GAD‑7) were 64.7%, ver­sus 58% in the con­trol group. Dura­tion of clin­i­cal con­tact time was mar­gin­al­ly ele­vat­ed over­all in the Sleepio group but by less than 1 h.
• Con­clu­sions: Sig­nif­i­cant clin­i­cal ben­e­fit was asso­ci­at­ed with the intro­duc­tion of an evi­dence-based dig­i­tal sleep inter­ven­tion along­side oth­er men­tal health inter­ven­tions for depres­sion and anx­i­ety. Wide­spread deploy­ment was achieved with imme­di­ate avail­abil­i­ty, min­i­mal addi­tion­al clin­i­cal time or staff train­ing. This approach pro­vides a fea­si­ble and high­ly scal­able mod­el for improv­ing men­tal health out­comes in clin­i­cal services.

The Study in Context:

• The FDA clears Som­ryst, Pear’s dig­i­tal ther­a­peu­tic to treat chron­ic insomnia
• CVS Health: Cog­ni­tive behav­ioral ther­a­py (CBT) apps may help you more than sleep­ing pills
• A call to action: We need the right incen­tives to guide eth­i­cal inno­va­tion in neu­rotech and healthcare
• New report: Empow­er­ing 8 Bil­lion Minds via Eth­i­cal Devel­op­ment and Adop­tion of Neurotechnologies