For as long as I can remember, I’ve had trouble falling asleep at night. Like many people, I struggle with intrusive thoughts and find it hard to switch off. Bedtime triggers conversation replays, worries about my kids, or my greatest-hits reel of social blunders and embarrassing gaffes. Early waking, hungry cats, tweeting birds, and an insistent bladder have all played a part in my insomnia. Whatever the cause, burning the candle at both ends has me feeling stressed, anxious, and desperate.
That’s how I arrived at Sleepio, a six-week digital course that employs cognitive behavioral therapy (CBT) to overcome sleep problems, developed by Colin Espie, professor of sleep medicine at the University of Oxford. Big Health cofounder Peter Hames battled chronic insomnia but found success with CBT techniques after reading one of Espie’s books. The two then partnered to develop Sleepio to bring evidence-based, cognitive-behavioral techniques to the sleep-deprived masses.
I'm happy to say it worked for me. For the first time in years, I’m regularly sleeping for seven-hour stretches.
Far too many people get less than the seven hours per night recommended for adults. Sleep disorders come in many forms, but more than a third of adults in the US suffer occasional insomnia symptoms, and one in 10 have a chronic condition, according to the American Academy of Sleep Medicine. Treatment generally falls into two camps; pharmacological or the aforementioned CBT.
“Some clinical trials have compared the two, and the results are really astonishing,” says Rebecca Robbins, a sleep scientist with the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital and Harvard Medical School. “We see that the behavioral component does as well if not better than the pharmacological treatment.”
Drugs come with side effects and often mask symptoms rather than tackling the root of the problem. Anecdotally, medication leaves me feeling unpleasantly groggy in the morning and does little for the quality of my writing. Both the National Institute for Health and Care Excellence and the American College of Physicians now prefer non-drug therapies, including behavioral therapies, as the first line of treatment for insomnia.
I've also tried several sleep gadgets and apps that promise a good night’s shut-eye without much success. Understanding what will work and how to choose with such a bewildering array of options is tough.
“The market can be kind of the Wild West, because not everything has been developed with an eye to the scientific literature,” Robbins says. “To sift through the noise as a consumer, look at products and see if they have either been tested in a clinical trial or if they've been developed in partnership with anyone who has a background in sleep science or sleep medicine.”
One of Espie’s conditions in agreeing to help develop Sleepio was a randomized placebo-controlled trial, like this one, to test the efficacy and safety of the software before release. In 12 trials, with over 9,000 participants, Sleepio was proven to help people fall asleep 54 percent faster, spend 62 percent less time awake at night, and have 45 percent better functioning the following day.
After following the six-week course, I'm finally getting seven hours of sleep if not more every night. It's wonderful. But I won’t lie to you—it has not been easy. The sessions are just 20 minutes, once a week, but you must keep a comprehensive sleep diary to get tailored advice and techniques to improve the quality of your slumber. It’s not a quick fix. Just as a fitness tracker alone can't help you lose weight, Sleepio demands commitment and determination.
You have to change your habits, and that's hard. No more doomscrolling or watching TV in bed. No nightcaps or late-night snacks, and no lying awake for longer than 15 minutes without getting up. Perhaps most challenging of all is the sleep compression, which restricts your sleep to set hours— between midnight and 6 am, for example—gradually increasing the window in 15-minute increments as your sleep efficiency improves.
Alongside a healthier bedtime routine and environment, Sleepio offered me a few techniques to deal with problematic thoughts. Mindfulness exercises helped reduce my stress; developing my imagery skills allowed me to relax; and either accepting or challenging worrisome thoughts enabled me to reduce their negative impact.
On occasion, I failed to abide by a few Sleepio rules, but I mostly followed the advice and parked my skepticism at the door. A few weeks in, the results spoke for themselves. I've gone from an average of five hours of sleep a night when I started three months ago to seven hours and five minutes in recent weeks.
I have tried many gadgets and tricks to tackle my insomnia over the years. Most failed, while some offered short-term success, but I now realize that I have consistently avoided changing my unhealthy behaviors in hopes of finding an easy fix.
“Non-evidence-based apps and devices are like vitamins,” Espie says. “Vitamins are helpful when you're healthy, but once you fall ill they cannot address the root of the issue.”
Unfortunately, access to Sleepio is limited if you're in the US. I live in Scotland, where Sleepio is available for free through the National Health Service. In the US, you can access the course only through large payers as a benefit to employees. Major employers such as Comcast, The Hartford, AmeriGas, and others offer Sleepio for employees. Big Health also has an agreement with CVS that allows clients using CVS Pharmacy Benefits Management Services to utilize Sleepio.
If your employer doesn't offer it, you can sign up for a chance to take part in Sleepio's research, and in turn you'll get free access to Sleepio. But there are alternatives. You can practice many CBT techniques yourself with a little research.
“One of the components of insomnia is stress associated with sleep,” Robbins says. “CBT tries to rewire that reaction, so the bedroom is a soothing place with positive associations.”
Your physical environment plays a big role, and it’s low-hanging fruit for people with problems sleeping. Your bedroom should be quiet, dark, and cool, Robbins says, and there are easy hacks to get there. Consider earplugs or sleep sounds to mask unwelcome noise. Find a charger that doesn’t have a bright LED, or use tape to cover it. Block light coming under your door with a towel, and use a clothespin to clamp your curtains shut. Open a window to keep the temperature down, try a lighter duvet or fewer blankets, and consider a fan or window AC that can double as soothing white noise.
“Temperature is of tremendous importance when it comes to sleep,” Robbins says. Research has found that we fall asleep faster when our core body temperature is cooler, while warmer environments lead to more fragmented sleep and an increased risk of nightmares.
Preparing for sleep should also be viewed as a process. Reserve your bed as a place for sleep; avoid other activities there. And give yourself time to unwind at the end of each day.
“We can't turn our brain off, like our smartphones,” Robbins says. “It takes time, so create a buffer of at least 20 to 30 minutes, and use that time to do things that are sleep-inducing to you.”
Everyone is different, so develop your wind-down routine. A mindfulness exercise or muscle relaxation visualization might be effective, but maybe sitting on the porch in quiet contemplation, listening to a podcast, or reading a book is more your speed. Just make sure you avoid stimulating or stressful activities like work or social media.
Sleep problems are common, so it can be tricky to recognize when insomnia is bad enough that you should seek help. If you have a sustained period where you consistently take longer than 30 minutes to fall asleep, or you wake in the middle of the night or too early in the morning and can’t get back to sleep—and this starts to impact your day—Robbins suggests a visit to a physician to diagnose the problem.
It’s important to remember that you aren’t alone. One of the aspects of the Sleepio course I appreciated most was the lively community where people share tips and experiences. Now that I'm finally getting seven hours of sleep on the regular, I have hope anyone can overcome their insomnia too. You just have to find what works best for you.
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