The ViewWinter 2014

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Loughborough sleep expert Kevin Morgan has turned to the internet in a bid to help the UK's 6.4m insomniacs access CBT-I, a talking therapy developed by the University’s Clinical Sleep Research Unit.

It shows them that something they do can have an effect on their sleep and it makes them feel very powerful

We’ve all been there, tossing and turning in bed, constantly looking at the clock, cursing our inability to get to sleep and feeling like death in the morning.

Multiply that feeling several fold and you may get some idea how someone with chronic insomnia feels.

It is a distressing condition that affects 10% of the UK population. That’s a staggering 6.4 million people, whose lives – social and work – and relationships can be affected so badly there is an increased risk of depression.

So what do we do? We take sleeping tablets. Doctors hand out 12 million prescriptions a year. We swallow between 120 and 168 million tablets annually. The cost? £25m.

But, sleeping tablets are not a cure, merely a quick fix. Worse still, they can lead to more problems – addiction, withdrawal problems and daytime drowsiness. Think of that the next time you are driving first thing in the morning.

There is, however, an alternative. It’s a ‘talking therapy’ called Cognitive Behavioural Therapy for Insomnia (CBT-I).

Effective programmes of CBT-I have been developed by Professor Kevin Morgan, Director of the Clinical Sleep Research Unit (CSRU) at Loughborough University's School of Sport Exercise and Health Sciences, in collaboration with the Nottinghamshire Healthcare Trust (NHT) over the last 10 years.

These programmes, delivered by NHS therapists or available as ‘self-help’ packages, work on up to 80% of treated patients. But, getting the treatment programmes to the patients has proved a major challenge.

Professor Kevin Morgan Professor Kevin Morgan

Why? Because the demand for treatment easily outstrips the supply of NHS therapists. So why not offer the self-help version to patients on the web? This, remember, is the online era, where social network sites like Facebook are de rigeur.

Which is why Professor Morgan got together with Professor Shaun Lawson, a social computing expert from the University of Lincoln, and others, and came up with Sleepful.

Sleepful is the result of a £463,840 three year project funded by the Engineering and Physical Sciences Research Council (EPSRC) called ENACT: Exploiting Social Networks to Augment Cognitive Behavioural Therapy.

It is a referral only online therapeutic social network platform for the delivery of self-help CBT-I to NHS patients.

The website contains a structured eight-step treatment programme of CBT for insomnia, a mobile phone ‘app’ which records sleep patterns, a section on frequently asked questions (FAQs) and, crucially, an online social network where people with insomnia can talk to fellow sufferers.

The app, which is downloaded to a mobile phone, is clever. The phone emits a low register tone every 15 minutes. If awake, the patient taps the screen, which tells the computer programme and builds up a graph of that person’s sleeping patterns.

If CBT-I is working the patient’s ‘sleep efficiency’ – the percentage of time in bed spent asleep – will increase.

Sleepful supported my therapy and explained what i needed to do

That, says Professor Morgan, is a boost in itself. “It’s incredibly encouraging when you look at your original sleep efficiency of, say, 60% and you see it creep up towards 100.

“It shows them that something they do can have an effect on their sleep and it makes them feel very powerful.”

Professor Morgan believes Sleepful is the answer to getting insomniacs to try CBT-I and ditch the sleeping tablets.

He said: “What do we know about social networks? Well, if you are a parent you know you can’t get children off them.

“They are what computer experts call ‘Sticky’. They engage you, pull you in.

“So here we have a therapy (CBT) which, in many conventional computerised forms, people disengage from way too quickly.

“On the other hand we have a technology (social networks) that we know is like flypaper.

“So why don’t we put the two together. That’s what Sleepful is all about

“We thought, ‘let’s see if we can mount an effective CBT-I programme on a social network platform’.

“We knew we had an effective self-help product because we had trialled it. So we took a CBT-I programme and dropped it into a sexy network to see whether we could make it work in a way that allows people to communicate with other people.

“Now you can do computerised CBT for insomnia but you have all the benefits of a social network. You can have FAQ, you can talk to people, upload photos etc.

“The bullet is the therapy, Sleepful is the gun. It’s a delivery mechanism. We are making it easy to access and use in a way that everyone expects stuff to be done today.”

Professor Morgan says some of the country’s leading sleep technicians were delighted with Sleepful. “They all said ‘this is good, give it to us.’”

So were people involved in a trial. “These were savvy young people with sleep problems,” he said.

Professor Morgan and his partners are now working on getting Sleepful into GP practices for the benefit of the nation’s insomniacs.

Last year, Loughborough's CSRU and the NHT started a one year programme aimed at designing an optimal ‘care pathway’ for NHS patients with insomnia.

The aim will be to position treatments like Sleepful at an ideal point in the patient’s excursion through NHS care.

Professor Morgan said: “We developed this with an NHS Trust, Notts Healthcare, so they must have first pick.

“We have a product we know works. We know the therapy works. What we want to do now is get it distributed. We are also going to offer it to a commercial software partner.”

The process of making Sleepful more accessible should be helped by the presence of IAPT (Improving Access to Psychological Therapies), an initiative introduced by the last Labour Government.

Trained IAPT practitioners are now in primary care, and are capable of prescribing Sleepful, and monitoring patients on the self-help programme.

 “We are working to make Sleepful available throughout the NHS,” said Professor Morgan.

“The Sleepful team feel it’s ready to go. We are applying for additional NHS funding to support further development. Like all software solutions, Sleepful will remain a work in progress.

“We designed it with public money. It exists as a product, it is driven by good science and we know it works. It’s a product in waiting, we just need to get it out there.

“You can have one therapist who looks after many patients. They can steer them towards Sleepful.

“That hugely amplifies the capacity of the therapist, but it also allows them to monitor the effective use of the self-help resources, which is quite different from telling someone to go away, read a booklet and listen to a CD.”

While Professor Morgan is not anti-sleeping tablets he insists they are not a long term answer to insomnia.

“Insomnia doesn’t just affect your sleep, it affects your life,” he said.  “CBT-I and Sleepful offer treatments which are lastingly effective.

“Talk to senior sleep physicians and they want their insomnia patients to get CBT-I.

“CBT-I is recommended by the NHS as the first-line treatment for insomnia – but it remains inaccessible for most patients.

“Sleeping tablets are effective, they do what is written on the tin. For a maximum of 21 days!

“But show me the insomnia that lasts for only 21 days. Insomnia is a chronic problem. Sleeping tablets are a short term fix.”

Sleepful, says Professor Morgan, will be hugely important to insomniacs.

+ Other members of the Sleepful Development team: Dr Maureen Tomeny (Nottinghamshire Healthcare (NHS) Trust and Loughborough University Clinical Research Unit); Professor Niroshan Siriwardena (University of Lincoln Community and Health Research Group). Andrew Garbett (University of Newcastle), Dr Erica Kucharczyk (De Montfort University), Dr Sue Jamison-Powell ( University of Leicester), Dr Conor Linehan ( University of Lincoln ), Dr Kate Cavanagh (University of Sussex).

What is CBT-I

Cognitive Behavioural Therapy for Insomnia (CBT-I) is based on evidence that falling asleep is strongly influenced by two psychological processes - learning and thinking.

Good sleepers learn to feel sleepier as a result of going to bed, and find little difficulty in ‘winding down’ their thoughts before going to sleep. People with insomnia, on the other hand, learn to feel more alert in bed, and often describe their minds as ‘racing’.

CBT-I is a ‘talking therapy’ which offers a range of effective strategies to increase sleepiness in bed, control pre-sleep thoughts and worries, deal practically with periods of night-time wakefulness, and appropriately manage fatigue during the day. 

Treatments involve adjusting sleep habits, learning techniques to reduce worries and increase relaxation at night, general education about ‘sleep hygiene’, and self-monitoring using daily sleep diaries.

Unlike drugs, CBT-I addresses the root causes of insomnia – safely and lastingly.