Usage and user experience

Current usage and reach

Sleepio is currently available to improving access to psychological therapies (IAPT) patients from 10 clinical commissioning groups in England and to NHS staff in 3 NHS trusts.

The developer manages the Sleepio website and app. Sleepio has been designed as a scalable population health intervention, so the developer expects to manage any increase in users from the NHS.

Table 3 Evidence of usage and reach

Evidence

Source

19% of 17,500 employees at a company using Sleepio engaged with the personalised light sleep help and 8% with the full Sleepio programme. 79% of people using the full programme were actively using the programme for more than 12 weeks. On average each person had completed 53 sleep diaries.

The developer

82% of Sleepio users completed all their online therapy sessions compared with 79% in the control group. In the study with community-based patients with self-reported insomnia, 93% of people who activated the online intervention completed just 1 Sleepio session and 50% completed all 6 sessions.

Espie et al. 2012; McGrath et al. 2016

Progress through the programme was similar between people in the treatment group and waiting list group, with 54% and 52% respectively completing all 6 sessions. The response rate for the final survey was 45%.

Barnes et al. 2016

In a study analysing data from a single IAPT service, 74% of patients completed all 6 Sleepio sessions. This was higher than the current IAPT services average completion rate of 48%, which demonstrates the feasibility of a digital self-help programme in IAPT services.

Luik et al. 2017

In a large randomised controlled trial, 50% of patients assigned to use Sleepio dropped out. This rate was higher than the control group (25% at 3 weeks). By week 10 and 22 the dropout rate was 61% and 68% respectively.

Treatment uptake was relatively low. There was a progressive decline in the number of patients engaging with the programme. From 69% of the patients who logged on for at least 1 treatment session, only 18% accessed all 6 sessions.

Freeman et al. 2017

Reported user experience

Source

Self Help has made Sleepio available to 505 users since 2015. It reported that using Sleepio helped users to cope with their sleep problems better, had a positive impact on overall wellbeing, confidence and their ability to cope with stressful situations. Users did not experience any technical difficulties with the programme.

Self Help

A patient who had previously not used any other systems or drugs for insomnia found Sleepio very simple and easy to use, and described a benefit in falling asleep as well as learning relaxation techniques. As with face-to-face CBT‑I, some people who try Sleepio do not like it and some actively disliked it. However, most users find it very helpful and the feedback is generally positive. Some users like the fact that they can buy ongoing subscriptions and can therefore have booster sessions when they need them.

Specialist commentators

This study reported an online survey exploring the reasons for deciding to engage with the online community feature of Sleepio. People related their community experiences to engagement with the Sleepio program, with many stating it had supported their efforts to improve their sleep, as well as helping with adherence and commitment to the program. Despite some concerns, members regarded the Sleepio community as a valuable resource.

Coulson et al. 2016

According to unpublished developer data, 88% of Sleepio users would recommend Sleepio to a friend or colleague with sleep troubles. Based on user feedback, Sleepio helped improve sleep, reduced use of over-the-counter sleep aids and provided support in the form of resources and techniques.

Unpublished data from the developer

Abbreviations: CBT‑I, cognitive behavioural therapy for insomnia; IAPT, improving access to psychological therapies.

Case study: Self Help

Self Help is a registered mental health charity that is commissioned by the NHS to provide a range of primary care mental health services, including eTherapy services.

Self Help delivers Sleepio as part of the 'step 2' IAPT services that is included in its eTherapy programme. It has prescribed Sleepio to 505 users since 2015. These were people who identified poor sleep as their main problem at the first appointment. In addition to using it from home, users can access Sleepio at any of Self Help's community venues where eTherapy is available. Self Help provides Sleepio instead of face-to-face support with a psychological wellbeing practitioner, but users have weekly face-to-face or over-the-phone support from an eTherapy coordinator while using Sleepio.

Self Help found that Sleepio can improve psychological and physical health, reduce alcohol and drug use to aid sleep, and lead to lifestyle improvements, including increased activity levels, improvements in diet and weight loss. In addition, it may lead to fewer GP visits for medication prescriptions and subsequently reduce patient spending on prescriptions. It can potentially reduce work absence caused by fatigue, illness, and physical or mental health problems. Self Help also claims that using Sleepio can lead to improved academic achievement through improvements in cognitive functioning.

Overall assessment of user benefits

  • According to published evidence, there is mixed usage and engagement with Sleepio. In some studies the number of patients engaging with the programme progressively declines throughout treatment.

  • Many people do not have access to CBT‑I. Sleepio could reach large numbers of people who would otherwise have no access to this kind of therapy. However, practical matters such as access to mobile devices and the internet, and costs, may limit the range of patients who will benefit.

Most users have found Sleepio very helpful and provided generally positive feedback.