Insomnia is a common sleep disorder affecting about a third of the worldwide population. It can manifest in different ways; some people struggle with sleep onset, not able to fall asleep. Others have issues with sleep maintenance; waking up frequently during the night and not able to easily fall back asleep. A study done by the University of Pennsylvania this year states a quarter of the population experiences acute insomnia annually and 6% find that the condition becomes chronic over the course of a year.
The causes of insomnia are many; whether due to people working too much and having less downtime, having a family history, or from experiencing depression. This clearly impacts an individual in multiple areas of life, and is also a significant cost to the government in terms of healthcare costs and to the workforce with reduced productivity. Unfortunately, there is not a one size fits all treatment path for helping someone work through insomnia, but there is certainly a big market for it.
The US Insomnia Market alone is expected to be worth $4.24 billion by the year 2021, an increase from $3.38 billion in 2016. Much of this will be from release of new drugs in the market, although there will be competition among brands as more generics are available. The cost of non-pharmaceutical treatments are factored into this overall number. The need for insomnia treatment is expected to increase in years ahead among younger member of the population who have higher stress levels along with a growth in the number of people who have chronic illnesses requiring sedation.
But there are challenges ahead. GlobalData identified several unmet needs in the market, include accessibility to non-pharmaceutical treatment for insomnia such as cognitive behavioural therapy for insomnia (CBTI), education for primary doctors, and products that improve the overall quality of sleep, not just the sleep onset. There are already a number of drugs that provide short-term relief but do not improve the quality, and result in problematic side effects. Doctors are concerned about the potential for abuse and patients report feeling hungover the next morning with many of these drugs.
Although CBTi is a promising long-term solution because patients can practice the skills on their own, there is a limit to the number of professionals that are certified to deliver CBT specifically for insomnia. Startups addressing mental health have the potential to help people who struggle with insomnia and seek an alternative to a drug only treatment. For example, SHUTi describes itself as “an industry-leading online CBTi program with unsurpassed, proven results”.
Research on SHUTi was done at the University of Virginia and published in the journal JAMA Psychiatry. In this study, half the participants received general education on insomnia and the other half were provided online therapy with SHUTi. The researchers found that those who received the internet therapy improved compared to those who did not.
Frances Thorndike, one of the original developers of SHUTi and the Chief Science Officer of BeHealth Solutions stated they "are continuing to evaluate SHUTi in different populations to determine who is well served by this digital approach. Right now, the Center for Behavioral Health and Technology at the University of Virginia is evaluating a tailored version of SHUTi for adults 55 and older." Thorndike noted there were also a few clinical trials evaluating SHUTi within the Veterans Health Administration.
CBTi has proven itself to improve sleep and overall health, which saves on healthcare costs and keeps employees in the workplace. As a scalable solution, it can be made available to the masses for little cost, and without the unpleasant side effects. However, it is not an overnight solution and requires compliance from patients who are willing to stick with treatment rather than taking only medication.
The American Academy of Sleep Medicine support CBT an effective and recommended therapy for clients who have chronic insomnia. However, they are cautious to recommend one single therapy over others. They also do not suggest that a single therapy, compared to combining different interventions both behavioral and psychological, are the right solution.
But insomnia is a problem that needs to be treated as more and more people are impacted by it, which includes those who do not experience it personally. People with insomnia impact others with lack of alertness while driving and an increased stress level for other family members. Whether medication, therapy, technology or a combination of the three will be the best course of action remains to be seen.