Sleep therapy may soon be as close as your keyboard. Sleep apps for sleep therapy are becoming more common and effective and your employer may even pay for it. 

That’s the latest plan from pharmacy giant CVS Health anyway. They’re encouraging businesses to cover the cost of Sleepio, an app designed to treat insomnia without medication, for their employees. The therapy app plays like a video game where the player is on a quest to improve their sleep and features an animated sleep expert with a Scottish accent who offers weekly therapy sessions and guidance. It’s an attempt at storytelling and making this a fun process.

It sounds somewhat silly at first blush, but the science behind it is solid. Apps like Sleepio and SHUTi are based on cognitive behavioral therapy for insomnia (CBTi) and tested like a pharmaceutical with clinical trials for effectiveness. However, be aware there are many apps out there that make claims and are not based on science.  

While these apps can’t replace actual therapy, they do provide methods similar to those used by therapists. Users learn to develop a consistent sleep routine and good sleep habits like cutting out caffeine 8 hours before bedtime, getting fifteen minutes of sun in the morning, exercising regularly, etc. So it’s all right if you’re getting your advice from a fictional, animated sleep expert because the science behind it is good. 

Sleepio has put their app through numerous randomized clinical trials with positive results. The app users generally had an easier time falling asleep than non-users. However, the biggest drawback so far has been that most people stop using the app before completing their treatment plan.

In one study, only 18% of 3,700 participants finished their insomnia treatments. In another trial, only half of the 1,400 participants bothered to use the app at all. A Sleepio developer suggested that many who used the app solved their sleep issues and no longer needed it. Others worried that the cartoon-character/video-game interface may be off-putting to some, but the co-author of the latter study said that most people just prefer person-to-person therapy.

It’s unlikely that an app can deal with (and it definitely couldn’t understand) underlying emotional problems the way that a person can, so you’ll never be able to replace a well-trained human therapist. If you prefer to see a person, the good news is that in-person cognitive behavior therapy is fairly inexpensive and the treatment time is generally short. Unfortunately, finding a CBT therapist, that uses this therapy for sleep-related issues can be a bit tough. 

CBTi provides help for those who want to ease their anxiety, reduce their stress and sleep well, and it is backed up by a great deal of scientific data which shows that it works as well or better than prescription sleep medications for insomnia. CBTi is an excellent way to fix a sleep problem without resorting to prescription medicine. To be clear, I know that there are many situations where sleeping pills are necessary, but I’ll always be an advocate for the most natural method,(like NAD+ which I told you about last week, for example)of solving a sleep issue, first. 

So “Digital Therapy” is actually more like a do-it-yourself online course, which is specialized for sleep or sleep improvement, but generally not as comprehensive. Good News, if you want to improve your sleep you are welcome to check out one of my online courses if you want!

I am excited to see what happens with CVS and their new initiative. The more education about treatment options we can get out to the public, the better. I applaud CVS for making this landmark decision!

(On a side note, even if you’re using a CBTi app, it’s a good idea to keep electronics out of your bedroom at night because the blue light can wreak havoc on your sleep.) 

Back to School Backlash

The Wall Street Journal featured a story about school start times this week. While some school districts have allowed teenagers to start later, they’ve forced younger kids to start school even earlier mostly due to logistical issues surrounding bussing. Although the teenagers are generally happier with their extra sleep, parents and middle-school kids are not. 

The staggered school start times are creating a lot of issues with exhausted parents who have to fight with their kids to get out of bed before taking their unhappy and tired middle-schoolers to the bus stop by 6 a.m. Some schools even hand out reflective materials, so that motorists can see them during the pre-dawn.  

Although there is some research that indicates that middle schoolers may learn math and English better in the mornings, the officials in some counties have admitted that these earlier middle-school start times might be a mistake. 

And I would generally agree with that assessment. The early school start times are poorly aligned with the biological clocks of middle schoolers. It’s wonderful that some districts have taken teenage biology into account, but they are still failing to allow adequate rest for middle schoolers, many of whom need just as much sleep as their high-school counterparts. 

Just because we want high schoolers to start later does NOT mean middle schoolers need to start EARLY! This is going to be a struggle, but hopefully we will get there!

How Sleep Varies by Age, Gender and Around the World 

Last week, we talked about how teens are biologically driven to be most active in the evenings and how they like to sleep in. We are all Wolves as teenagers, but by the time we hit our mid to late twenties, we develop our life-long chronotypes. (Learn more about chronotypes). This week, a giant, new study was published that suggests it’s not unusual for people to maintain that stay-up-late and sleep-in biology well into their twenties, much longer than previously thought. 

This new study was HUGE! Over a quarter million nights of sleep were recorded during this worldwide study which examined sleep variations between geographical locations, gender and age. Here are what studies on sleep patterns around the world show::

  • Women go to bed earlier, sleeping about thirty minutes longer than men. 
  • North Americans and Europeans slept the longest, getting a bit over seven hours . 
  • Asians slept the shortest, getting about six and a half hours on average.
  • Middle Easterners went to bed the latest, sleeping about 6 hours and forty minutes in total.
  • The citizens of Australia and the South Pacific islands started their days the earliest, but still slept about seven hours. 

What’s interesting is that the small differences are mostly cultural. Each culture designates specific hours for sleep, and this is what accounts for the slight differences in sleep across the world.  

I hope no matter where you live, you’re getting a good night’s rest. 

Sweet Dreams,
Dr. Michael Breus 

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