How Big Health’s Digital Therapeutics are partnering with the Scottish Government to meet increased demand to improve insomnia and anxiety

By Teresa Murray, freelance writer for healthtech and writer for Giant Health.

Few among us will have escaped the curse of sleepless nights, when unless adrenaline courses through our veins, one is at best sluggish and somewhat out of sorts the next day.

It is estimated that over 30% of people in the UK and US suffer from sleep quality problems, a percentage that translates into millions of people. Poor sleep quality, according to some statistics and anecdotal evidence, has been further exacerbated by the pandemic. As poor sleepers know only too well, once you start to experience difficulties falling or staying asleep, a vicious cycle emerges that is hard to break.

Insomnia can wreak havoc in a person’s life because sleep is so vital to well-being and the ability to function well.

Dr. Charlotte Lee, UK Director for Big Health, talks about how Big Health is scaling a digital therapeutic solution in partnership with the Scottish Government to help many
more suffering from sleep problems and anxiety gain access to effective help. Dr. Lee gave a talk at this year’s Giant Health event on why evidence is so important when
scaling mental health digital therapeutics.

Big Health was founded by Peter Hames in 2010. Hames suffered from insomnia before managing to find respite and cure in the seminal work of Professor Colin Espie,
a sleep expert who is now at Oxford University and author of Overcoming Insomnia and Sleep Problems, the book that resolved Hames’ sleep issues for good. Everything
else he had tried had failed.

Inspired by Professor Espie’s methods and determined to get this knowledge out to as many people as possible, Hames, together with Espie, started Big Health.

Espie and Hames built Sleepio, a digital therapeutic delivered via app and web platform that digitalised proven behavioural interventions, including cognitive behavioural therapy (CBT), based on Espie’s decades of experience.

Digitalising the techniques was the best way to scale beyond the constraints of traditional care settings, which required a therapist to work with the patient and are
often prone to long waiting lists, even if the person meets the criteria for therapy.

Sleepio is a fully automated digital programme based on CBT. Over multiple weeks, a virtual teacher “the Prof” teaches behavioural and cognitive skills and techniques
geared to improving the underlying problems that cause poor sleep.

Dr. Lee explains that what makes this digitally delivered programme stand out from other digital mental health solutions is that it is rigorously tested and has been put through randomised controlled trials (RCT), one of which demonstrated that 76% of patients using Sleepio achieve clinical improvement in insomnia.

It is a similar story with Big Health’s Daylight app, which was designed specifically for anxiety and shown in an RCT showed to help people achieve a 71% clinical
improvement in anxiety.

In effect, the two programmes work hand in hand. Daylight supports management of worry and anxiety during the day, while Sleepio galvanises routines and mind-sets
optimised for good sleep hygiene so overall outcomes improve.

To date, Big Health has put its digital therapeutics through a total of 13 RCTS with over 28,000 study participants, the results of which have appeared in over 60 publications. Professor Espie wouldn’t have had it any other way. He wanted Sleepio to prove itself in RCTs and Big Health have walked the evidence-based talk since their beginnings.

In fact, this drive to provide evidence-based treatment and Big Health’s culture of scientific rigour is what has led to their being chosen to partner with the Scottish Government. Dr. Lee, a former GP herself, explains that the Scottish health authorities were already looking into Mental Health Digital Therapeutics long before the pandemic. This forward thinking and early adoption of a digital therapeutic solution like Sleepio and Daylight has put Scotland ahead of the game in its ability to scale solutions to needs, and solves several problems.

First and foremost, digital therapeutics expands Scotland’s reach exponentially in provision of support for insomnia and anxiety. Anyone can now access Sleepio and
Daylight through their NHS services. This is good for both doctors and patients.

Dr. Lee, drawing on her own experience, points out just how limited most GPs are when someone comes to them with sleep problems. There is currently no standardised treatment for insomnia. Options are limited to drug therapy, anxiety medication or
anti-depressants which can have side-effects and don’t necessarily resolve the problems underlying sleep disturbance. GPs can give the person advice on sleep
hygiene if they have the knowledge but can’t follow up on adherence, so most of the time GPS refer the person on to therapy or to some other alternative. Now GPs can
recommend Big Health’s apps.

For the Scottish Government seeking to resolve the problem of increased demand and insufficient capacity, Sleepio and Daylight are a way to increase prevention and
management of insomnia and anxiety.

In terms of access, Dr. Lee says that Sleepio provides a wrapper that everyone can engage with. It reduces stigma so proactive health-seeking behaviour increases
because using the apps is socially more acceptable than say needing therapy or taking medication to sleep. After all she says, talking about one’s sleep problems around the dinner table is much more common than talking about one’s anxiety. Sleepio and Daylight offer effective CBT-based programmes that are not dependent on
therapist availability, and partnering with the Scottish government ensures that everybody has access to these treatments to tackle their sleep issues.

For Dr. Charlotte Lee, this is a game changer, and she sees the rapid digitalisation of healthcare and adoption of digital therapeutics as “an exciting new treatment
paradigm”. She herself comes from a fascinating mix of the arts, medicine and innovation. When working in hospitals as a junior doctor, Charlotte saw so many
opportunities to automate and innovate in hospital functioning – “so much low hanging fruit” but alas not enough being done, so she hung up her white coat and
went into healthcare innovation.

It is critical for digital therapeutics in the healthcare sector to be rigorously evaluated in clinical trials, Dr. Lee says. Otherwise, health authorities, payers, GPs and other
professionals dealing with insomnia or anxiety will not have sufficient trust to recommend a particular digital solution.

It has been Big Health’s goal from the very beginning to be entrenched in national health systems as the best way to obtain maximum reach and impact. Big Health is
aptly named given the company’s big ambition to help millions of people improve their mental health. Dr. Lee concludes that “the future of digital medicine is changing and
Big Health are excited to bring digital therapeutics mainstream.”

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