Ever since he was a child, Dan Roberts had rarely been able to get a good night’s sleep. He was born with cerebral palsy that left his entire left arm and leg tight and painful, forcing him to walk with a pronounced limp. He was often in severe pain and there were many nights where he didn’t sleep at all. “It was very difficult for my parents,” he remembers today.
Compounding things, Robert was bullied at school, and rarely felt like he fit in anywhere. Over time, he began to suffer from depression and anxiety. For the last 11 years Roberts worked as a physical therapist assistant at Boston Medical Centre, helping rehabilitate people who had suffered from strokes and the same types of physical ailments that he'd experienced.
Now aged 36, things were starting to look up. New neuro-pathways in Roberts’ brain had developed, lessening his pain and allowing him to walk with only a slight limp. But insomnia continued to be an issue.
Up until late last year Roberts, 36, was still lying awake in bed for hours on end, his mind racing. The next day he would feel like a zombie, sometimes only able to see just over half a dozen patients before crashing that night.
Roberts started looking into the possibility of getting a prescription to sleeping pills and paying for a professional sleep study when, in October 2015, he got a weekly newsletter from his bosses inviting him to take an introductory sleep quiz.
This new health perk from his employer, Boston Medical Centre (BMC), was an app called Sleepio, that used cognitive behavioural therapy to tackle insomnia. For consumers, the app costs $300 a year to use. For BMC employees it was free for the first six months.
Roberts decided to give it a shot and downloaded the app to his phone and computer at home.
When he took the sleep quiz, Roberts scored zero out of 10. “I was really, really bad,” he says.
Then he listened to a some of the “lectures” in the app about once a week, sometimes making notes, and following some of its suggested changes, such as doing relaxing activities before bed, or making sure the bedroom was dark and noise-free. He’d monitor his sleep each night with a separate app, Sleep Cycle, then enter those results into Sleepio.
Sleepio eventually made its big ask. “I was spending 8-9 hours in the bed trying to force myself to sleep,” Roberts says. But the app said he should only go to bed at the times he would fall asleep anyway: 1.30am till 6.30am.
“That lasted for about five weeks,” he says. “It was tough to get used to that.” After five weeks, he could extend the time he was in bed by 15 minutes, and extend it again over time. It took several months, but today, and for the first time in years, Roberts is going to bed at 12.30am and getting up at 7am. For most of those hours he is fast asleep.
“Everything has improved,” he says. “My outlook, my energy levels, how I interact with my patients and co-workers. I’m more positive overall.”
Roberts not only feels better, he’s doing more work, and able to see 10 to 15 patients a day instead, of just over half-a-dozen.
Though Roberts’s experience of insomnia was severe, his employer hopes that other colleagues who work in the high-stress environment of the hospital will find that Sleepio helps in a similar way. While the app presents itself as therapy for sleep, it’s tackling depression and anxiety too, two conditions that studies show are closely correlated with insomnia.
Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults over the age of 18, or 18% of the population, according to The National Institute of Mental Health.
The app is effectively a Trojan Horse, says its creator, Peter Hames, who runs the startup Big Health.
“Sleep is very destigmatized,” he says, whereas anxiety and depression still have huge stigmas attached to them. If Roberts had received an email suggesting he take a quiz on depression, he might not have felt so comfortable to take part, but in the process of fixing his sleep problem, that area of his mental health has improved too.
Hames has been running Big Health since 2010, after he cured his own insomnia by reading a self-help book. Hames contacted the author of the book, Professor Colin Espie at Oxford University, and used his methods to build automated therapy (software) to target insomnia. Espie joined the board, became a co-founder and now provides the voice of The Prof, the animated therapist in the Sleepio app.
Today Big Health makes money by selling corporate subscriptions to Sleepio to employers like Boston Medical Centre, as well as
On Wednesday the startup announced it had raised $12 million in new funding from Octopus Ventures,
Till then, Hames plans to grow his company by signing up more self-insured employers like Boston Medical Centre, pitching his app as a salvo to rising health care costs. “People with insomnia cost employers 75% more on average,” Hames says. “That’s $3,500 a year above normal.”
Around half of all employers in the U.S. are self-insured, meaning the boss is paying for all your health care costs plus the administration costs - not just a premium to insurance companies. These are bigger companies with large cash reserves, who have the time and ability to do the same kind of risk assessments that an insurance company would do.
Self-insured employers typically need to budget around $8-10,000 per employee annually, just for health care costs. For 100 workers, that's as much as $1 million dollars a year. Many of these employers are now looking to software and gadgets like the Fitbit as potential solutions to the rising health care costs they’re experiencing, particularly related to diseases like diabetes or stress that can be lowered by encouraging employees to change their habits.
“Every program we put in place, we’re looking at the data first,” says Lisa Kelly-Croswell, chief human resources officer for Boston Medical Center. In the case of Sleepio there were 14 published papers and three, randomised clinical studies showing that the app could lower levels of insomnia, depression and anxiety. Big Health claims it has collected the most evidence of any software company targeting mental health.
So far, the app appears to be working beyond single cases like Dan Roberts. Kelly-Croswell says that nine months in, Sleepio has had a marked impact on other employees at BMC since it was introduced last October: employees who use it are getting three more hours of sleep per week, and reporting a 50% reduction in absenteeism. Around 20% of BMC’s staff, or 1,200 people, have tried using Sleepio, she says.
“I’ve been doing this job for 25 years and '20% of people' actually using it is very high,” Kelly-Croswell says, adding that programs like smoking cessation or fitness tracking tend to get around 5-10% uptake from staff. She’ll be looking out for a drop in health care claims related to stress (things like migraines, or trips to the psychiatrist) in December 2016 to see if Sleepio really has lowered Boston Medical Center’s health care costs.
Hames, 36, has grand visions for what Sleepio heralds for the future. “We’re on the cusp of the creation of a completely new industry, rooted in health but using technology as a vehicle,” he says. He calls the method of giving CBT (cognitive behavioural therapy) face-to-face, “medieval.”
“We can automate it and deliver it on a huge scale, like a drug,” he says. “For the first time ever we can create scaleable, non-drug healthcare… The level of data we already have is way, way beyond what you’d look at, for the vast majority of medical spend, in terms of effectiveness.”
Researchers at Goldman Sachs said in a report last year that the digital healthcare market could reap $32.4 billion in near-term revenues.
"What has surprised us through conversations with physicians, major hospital networks, payors, and the start-up community, has been the general willingness to explore digital health as a viable component in daily healthcare practice," its analysts said in their report. They pointed out that the FDA has cleared more than 100 mobile health apps for medical use.
The starting point is self-insured employers, which are in themselves, “a huge market opportunity,” says Hames. “In the traditional model, people are incentivized to give you as much treatment as possible," he adds. "We want to get the individual as healthy as possible, as quickly as possible.”
Listen to the full interview with Roberts here:
