Insomnia app recommended by NICE unavailable in most of NHS

An app that can help people with insomnia is still unavailable to most patients in England, despite having been recommended by the National Institute for Health and Care Excellence (NICE).

Sleepio, an AI-driven app that delivers cognitive behavioural therapy for insomnia (CBTi), is still awaiting NHS England funding, having been approved by NICE back in May 2022 for adoption in the NHS.

NICE said that Sleepio had potential to increase access to CBTi, the first-line treatment for insomnia, which can be delivered either face-to-face by a qualified therapist or digitally. The guideline states: “Sleepio is recommended as a cost saving option for treating insomnia and insomnia symptoms in primary care for people who would otherwise be offered sleep hygiene or sleeping pills.”

The US version of the app has recently received clearance from the Food and Drug Administration (FDA) in the USA.

The app, which provides people with tailored therapy, was piloted in the south of England in 2018 and made available across London in 2019 after it was selected as a partner by the Good Thinking service. It has been accessible in Scotland since 2021.

Sleepio is structured around a sleep test, weekly interactive CBT‑I sessions and regular sleep diary entries. According to the NICE guideline: “Clinical evidence shows that Sleepio reduces insomnia symptoms compared with sleep hygiene and sleeping pills. There is no direct evidence of its effectiveness compared with face-to-face CBT‑I, so further research is recommended in this context.”

Will Goddard, UK managing director of Big Health, which created Sleepio, said: “The UK has ambitions to be a life sciences and medical technology powerhouse,  leveraging the single-payer NHS model to rapidly adopt proven innovations that deliver exceptional care to patients at exceptional value for taxpayers.

“However, despite Sleepio being recommended by NICE, proven within the NHS, and cost-saving in-year, patients in England still don’t have access.

“This begs the question: what’s the use in NICE guidelines that clinicians cannot follow, and that patients cannot benefit from? In contrast, FDA clearance in the US is a significant milestone and we are delighted that clinically effective digital CBTi will soon be available to patients.

“We just hope that, as is already the case in Scotland, patients in England will soon be able to access this guideline-recommended treatment, too.”

No requirement for NHS to fund NICE-recommended digital technologies

NICE’s guideline on Sleepio, published in May 2022, said that by funding the app nationally, the NHS could benefit from in-year cost savings by reducing GP appointments and prescription medication costs.

A spokesperson for NHS England told the publication Digital Health News that there was no requirement for the NHS in England to fund the commissioning of NICE-recommended digital technologies. They added that the NICE funding mandate applies only to pharmaceuticals recommended by the body, after it has carried out a technology appraisal and published positive guidance.

The spokesperson added that a number of local services already commission digital therapeutics for insomnia, including Sleepio and Sleepstation, and that integrated care systems are able to choose to directly fund and commission digital therapeutics for insomnia if they want.

In September 2024, NICE said that figures from its rapid assessments comparing digital technologies to face-to-face therapy show that the use of recommended digital therapies for mental health conditions could free up thousands of NHS therapists’ hours.