Sleeping for People Powered Health

My take home message from the Future of People Powered Health conference was that the balance of power and responsibility for health is undergoing a seismic shift.

When I applied to medical school, I wanted to make a difference. My ambition was to become one of the elite hospital specialists who could use the secret ‘black box’ of medicine to help people who were unable to help themselves (that, and to join George Clooney on ER).

A few decades later, and my perception of high impact healthcare has turned on its head. Chronic diseases cannot be solved by a quick trip to the doctor. Improving health at scale means getting better at prevention.

Proactive versus reactive health

To sustain a publicly-funded healthcare system we need a step-change in disease prevention. Most of us need to adopt healthier lifestyles, but few people have the capability to transform both their environment and the habits of a lifetime on their own.

Policymakers have the responsibility to help create the conditions that make being active, eating healthily, and living smoke-free the easy choices. But when demand for acute medical care is already stretching the NHS, who can provide the daily, moment-to- moment support which most of us need to maintain difficult changes in health behaviours?

We saw great examples at Nesta’s conference which showed that individuals, families and their communities can help themselves, and each other. The question is how to scale up these great examples.

How do you put the ‘power’ in People Powered Health?

I’d argue that technology and a good night’s sleep give us some very valuable tools - I work for Big Health, the company behind Sleepio, an evidence-based digital sleep improvement programme.

If you’ve ever had a bad night’s sleep (and you’d be very unusual if you hadn’t), you’ll be familiar with resulting lack of energy, irritability and poor concentration.

Many of us catch up on our ‘sleep debt’ at weekends, but more than one in ten adults suffer from chronic insomnia, debilitating sleep problems which persist for months, and often years.

When we can’t sleep our emotions go haywire. Small problems seem insurmountable, we have less self-control and we find it harder to look after ourselves. Insomnia is linked to increased risks of high blood pressure, weight gain, diabetes, weaker immune defences, cognitive decline, and depression. Insomnia sufferers typically have healthcare costs 60-75 per cent higher than good sleepers.

A digital solution to scaling effective therapy

Prescriptions for sleeping pills have soared 126 per cent in the last ten years, despite the fact that pills are not a cure, and harmful side effects are common.

Cognitive Behavioural Therapy for Insomnia, or CBT-I, is a toolkit of techniques which tackle both the negative thought patterns and unhelpful behaviours that make insomnia persist. Regrettably, hardly anyone in the NHS is trained - or has time - to deliver it.

Big Health’s co-founder, Peter Hames, came up with the idea for Sleepio after developing insomnia. He discovered a CBT-I self-help book written by Prof Colin Espie, a sleep expert now based at the University of Oxford. The CBT-I techniques were so effective that Peter was cured within six weeks.

In his newly energised state, Peter convinced Colin to transform CBT-I into a more accessible, digital version. They created Sleepio to empower poor sleepers to learn CBT-I techniques at a time and place that suits them.

Sleeping with The Prof

The star of Sleepio is The Prof, your virtual sleep expert, and his narcoleptic dog, Pavlov. The Prof teaches you to use a range of interactive tools and techniques, such as the sleep diary. If you have a wearable device like a Fitbit, Sleepio automatically imports the data to make it even easier to track your progress.

The mobile platform means that The Prof can be there at whatever time of day or night you want help. He enables poor sleepers to build a personalised 24-hour schedule that helps them plan what to do, when, and sends text reminders and notifications to help them stay on track.

In a placebo randomised controlled trial, we showed that Sleepio was as effective as face-toface therapy for addressing insomnia.(1) We’ve since demonstrated benefits for mental health and productivity at work.(2)(3)

Digitally enabled health improvement

Technology gives us the capacity to deliver help at times that you feel most vulnerable, with a flexibility that would be impossible for a medical professional.

But digital solutions don’t need to compete with professionals – one can enhance the other. In Manchester, Self Help Services have been providing Sleepio to patients with anxiety and depression. Sleepio plus a brief supportive phonecall from a wellbeing practitioner each week resulted in over 65 per cent of patients moving to recovery, versus a national average for psychological therapy providers of 45 per cent.(4) Digital self-help can be used to free up professionals’ time to focus on individuals who are less able to self-manage.

Sleepio is one of a growing number of ‘digital medicines’ which mimic the best qualities of drugs: accessible, scalable, affordable, evidence-based and yet with greater personalisation and without harmful side effects.

In the future, advances in machine learning promise an almost infinite ability to apply individual habits and preferences to deliver an experience optimised for the individual.

Sleepio is an example of patient experience leading to an inexpensive solution to a common health problem, powered by technology and clinical expertise.

Is the NHS ready for us? We’ve been awarded an NHS Innovation Accelerator Fellowship which we hope will help us demonstrate that digital medicine can not only improve patient outcomes, but reduce costs and improve efficiencies within the NHS.

REFERENCES

1. Espie, C.A. et al. (2012) A randomized, placebo-controlled, trial of online Cognitive Behavioral Therapy for chronic Insomnia Disorder delivered via an automated media-rich web application. ‘SLEEP.’ 35, 769-781.

2. Pillai, V. et al. (2015) The Anxiolytic effects of cognitive behavior therapy for insomnia: preliminary results from a web-delivered protocol. ‘Journal of Sleep Medicine Disorders.’ 2(2): 1017.

3. Bostock, S. et al. (2016) Sleep and productivity benefits of digital Cognitive Behavioral Therapy for Insomnia: a randomized controlled trial conducted in the workplace environment. ‘Journal of Occupational and Environmental Medicine.’ (published online 3 June).

4. Luik, et al. (2016) Treating depression and anxiety with digital Cognitive Behavioural Therapy for insomnia: a real world NHS evaluation using standardised outcome measures. ‘Behavioural and Cognitive Psychotherapy.’ (accepted for publication).

Author

Dr. Sophie Bostock

Dr. Sophie Bostock, Sleep Evangelist, Big Health (Sleepio).