Should the Sleepio programme be available free of charge across the whole of the UK?

Dear Editor,

In a piece of medical technologies guidance published in May 2022, the UK National Institute for Health and Care Excellence (NICE) recommends the Sleepio programme as a cost saving option for treating insomnia and its symptoms in primary care for patients who would otherwise receive sleep hygiene advice or sleeping pills [1].

It has been argued in a report by Oxford University and the Royal Society of Public Health that getting enough sleep should be a key priority for public health [2]. The second most common health issue after pain is insufficient sleep, which affects four in ten people. Having trouble falling asleep, staying asleep, waking up early, or having non-restorative sleep, despite adequate opportunity for sleep, are all features of insomnia [3]. All this makes it hard to concentrate, affects an individual's mood, and makes them tired during the day. In Western nations, it is thought that between six and ten percent of adults meet the criteria for insomnia disorder. Almost twice as many females suffer from insomnia as males do and the condition is most likely to occur in older people. In addition, people who have psychiatric conditions like depression and anxiety, as well as comorbid conditions like heart failure, are more likely to experience insomnia.

Numerous effects of insomnia are possible [3]. These may include cognitive issues like trouble remembering, paying attention, and staying focused. It can also result in a decline in functioning and quality of life, lower work performance, a rise in motor vehicle accidents, and an increased risk of falling in older people. There are a number of mental health issues that can arise from insomnia, and there may be associations between chronic insomnia and increased risk of cardiovascular disease and type II diabetes, and a possible rise in all-cause mortality.

The British Association for Psychopharmacology recommends that those who suffer from insomnia first receive guidance regarding proper sleep hygiene [1]. In the event that this isn't successful and they are seriously impacted during the day, then a three to seven day course of a non-benzodiazepine hypnotic medication should be considered if symptoms are likely to settle rapidly. Face-to-face or digital Cognitive Behavioural Therapy for Insomnia (CBT-I) should be offered to the individual if symptoms are unlikely to improve soon. However, the majority of those who suffer from insomnia do not typically have access to face-to-face CBT-I on the UK National Health Service (NHS). If a person suffers from comorbid conditions, they should be referred to a sleep clinic or neurology [3].

Big Health's Sleepio is a self-help programme for improving sleep that can be accessed through a website or an app for iOS and Android devices [1]. Sleepio provides individuals with customized digital CBT-I through the use of an artificial intelligence (AI) algorithm. A sleep test, weekly interactive CBT-I sessions, and regular entries into a sleep diary make up the programme's structure. The sessions focus on identifying the thoughts, emotions, and actions that cause insomnia symptoms. The behavioural interventions are intended to encourage a healthy sleeping pattern, while the cognitive interventions aim to improve a person's perspective on sleep. The Sleepio programme is designed to be completed in six weeks, but once registered, participants have access to it for a year. An individual's progress can be tracked using a daily sleep diary, and the package provides individualized guidance.

NICE does say that before referring someone to Sleepio, a medical evaluation should be done for people who may be more likely to have other sleep disorder conditions [1]. Furthermore, NICE recommends that more research is required for people who are eligible for face-to-face CBT-I in primary care due to there being currently insufficient evidence to demonstrate that Sleepio is more effective than this treatment.

NICE hired an external assessment centre (EAC) to evaluate Big Health's evidence regarding cost savings [1]. According to the base case, Sleepio saves £4.52 per person over standard treatment after one year. The cost savings per person are £90.08 if the results of resource savings at one year are extrapolated to three years.

Big Health and NHS Scotland have collaborated to make Sleepio accessible to all residents of Scotland at zero cost to them [4]. However, Sleepio is currently not free in any of the other UK home nations except through Macmillan Cancer Support for those living with or beyond cancer. Given the significance of treating insomnia, and the NICE recommendation, I believe that Sleepio should be rolled out free of charge across the whole of the UK to address this inequity, as well as potentially wider afield.

Conflicts of interest

None.