Specialist commentators comments

Comments on this technology were invited from specialist commentators working in the relevant fields and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three out of 5 specialist commentators were familiar with or had used Sleepio in practice.

Level of innovation

The commentators noted that although cognitive behavioural therapy for insomnia (CBT‑I) is not innovative, Sleepio is innovative as a means of delivering CBT‑I. They felt that any method of making this content more easily available to people is worth considering. One commentator noted that the other innovative aspect of Sleepio is that it can integrate patient data directly from a wearable device, personalising and automating the data collection.

Two commentators noted evidence (from 1 randomised controlled trial and 2 meta-analyses), which shows that computerised CBT‑I is no better than other forms of CBT‑I.

Potential patient impact

The commentators noted that Sleepio could help improve not only sleep quality but also quality of life, anxiety and depression. Self-disciplined, motivated people without complex comorbidities may benefit most. Face-to-face CBT‑I has a high dropout rate so user adherence is crucial for it to be effective.

Most commentators stated that Sleepio may lead to fewer hospital visits, but 1 noted that it has not been possible to demonstrate a clear benefit in long-term health with Sleepio, and there is no evidence that CBT‑I reduces hospital visits. The same commentator noted that there is a need to educate patients and GPs about CBT‑I in order to fully benefit.

According to 1 commentator, insomnia is highly prevalent, has an enormous negative effect on patients' quality of life, and it is rarely adequately treated.

The specialist commentators report no safety issues with Sleepio. One commentator noted that all CBT‑I treatments that involve sleep-restriction (including Sleepio) increase daytime sleepiness and so can affect driving safety and lower seizure threshold.

Three commentators considered that users will need some guidance on how to use Sleepio because CBT‑I is not suitable for everyone with insomnia, such as some people with complex comorbidities.

Potential system impact

Three specialist commentators noted that Sleepio could be cost saving for the NHS without needing any changes in infrastructure or other facilities. They noted that face-to-face CBT‑I can cost up to £750 for 5 sessions.

One commentator stated that GP clinical systems may need upgrading to encourage the prescription of apps such as Sleepio and the collection of related data. Training in sleep disorders exists within the improving access to psychological therapies (IAPT) programme but not necessarily in other health disciplines, so staff may have limited knowledge of sleep disorders and insomnia. This would mean extra training.

One commentator noted that there is a cost for training psychological wellbeing practitioners to use Sleepio and to screen the right patients.

One commentator felt that the direct cost of hypnotic drugs is unlikely to be reduced by using Sleepio. However, indirect costs may be reduced in terms of patient distress and time off work. Costs may also be lower than the comparator cost of face-to-face CBT‑I. Sleepio may help to reduce waiting times for some patients with insomnia.

One commentator noted that despite the clear health benefits treating insomnia with CBT‑I, and the potential side effects of hypnotic drugs, there is insufficient evidence to demonstrate cost savings in the UK.

General comments

One commentator noted that sleep management would typically be used as part of a CBT‑I package for a wide range of illnesses, diseases and problems. Another noted that wider public adoption of smartphones and access to the internet would be needed for Sleepio to be used.