Sleepio to treat insomnia and insomnia symptoms

Overview

Insomnia disorder is among the top 10 reasons for consulting a GP (Wändell et al. 2025). But, it remains one of the most under-recognised, underserved and overlooked public health complaints in primary care. Sleep loss costs the UK an estimated £34 billion annually (Hafner et al. 2023), the equivalent of 1.86% of the UK's GDP. Improving how someone sleeps has wide-ranging health benefits that go far beyond just feeling less tired. Despite this, the tools available in primary care are largely limited to sleep hygiene advice, nonbenzodiazepines ('Z-drugs'), benzodiazepines and sedating antidepressants. These either do not work, only work short-term, or come with the added problem of dependence, tolerance and addiction.

NICE has recognised the problems associated with dependency-causing medicines in NICE's guideline on medicines associated with dependence or withdrawal symptoms. It sets out that people should be made aware of these risks before a treatment is prescribed. As 1 of only 7 Sleep Centres in the UK managing insomnia in secondary care, people are frequently referred to us who have been on Z-drugs for years. This is despite NICE's technology appraisal guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia, which recommends they are used for short-term relief. Many people also arrive having adopted habits they believe are helping their sleep, but which are in fact making things worse. This is not their fault; there is simply very little public awareness of what governs sleep, what undermines it, and how to address it.

Chronic insomnia disorder is complex, with psychological, behavioural and physiological factors all in play, shaped by everything from environment and lifestyle to comorbidities and medicines. Knowing this, we built therapist-led Cognitive Behavioural Therapy for Insomnia (CBT-I) into our service in 2018, well before NICE recommended Sleepio as a self-directed digital option in 2022 (see NICE's HealthTech guidance on Sleepio to treat insomnia and insomnia symptoms). Due to inconsistent commissioning of digital CBT-I tools such as Sleepio and Sleepstation across the UK, we have relied on our own therapist-led provision. Demand has grown year on year, and that waiting list now sits at 12 to 15 months, which for someone in the grip of chronic insomnia is simply too long.

The science of sleep medicine has been slow to reach clinical practice, but the approval of daridorexant in 2024 (see NICE's technology appraisal guidance on daridorexant for treating long-term insomnia) marks a genuine turning point. It is the first medicine of its kind licensed in the UK specifically for chronic insomnia disorder; a dual orexin receptor antagonist that reduces the brain's wake signal rather than broadly sedating it. The development of novel and targeted drugs means we can move away from the addictive, dependency-causing blunt pharmacology drugs of the 1960s. Instead, we can use targeted, science-driven medicines with much better safety profiles and no evidence of addiction.

Often, when people come to us, they are desperate and need help and guidance, having tried multiple strategies. That means not just better access to CBT-I, but flexible ways of delivering it, because insomnia can affect anyone at any age, and a single delivery model will not reach everyone.

There are also people who are not ready for the full CBT-I programme. For example, people who are acutely anxious, but who can still benefit enormously from selected components. These might include stimulus control therapy, sleep restriction, relaxation techniques and education on the physiology of sleep. We began incorporating these principles directly into clinic consultations, using them to support people through the process of coming off Z-drugs and benzodiazepines. We realised that not every person needs to undertake the full program of CBT-I to benefit. Parts of the program are also a lot more relevant to some people than others. By careful detailed clinical assessment we used the principles of CBT-I to help address the sleep challenges people face.

What became clear over time is that not every person needs the full programme. Some components are far more relevant to certain people than others, and a thorough clinical assessment allows you to identify which ones will make the biggest difference for that individual. That targeted approach, grounded in CBT-I principles but tailored to the person in front of you, is now central to how we work.

The majority of our referrals come from GPs, and it became clear that there was limited understanding in primary care of how to manage chronic insomnia disorder well. We responded by running teaching sessions across the local area, not just to improve referral quality, but to give GPs better tools to help the people who never make it onto a waiting list.