The Big Bucks Behind Sleep (Or Lack Thereof)

The benefits of a good night’s sleep can’t be overstated – nor the negative consequences of not getting one. The average human being needs seven to nine hours per night of sleep, and while there is no medical benefit to sleeping more than that average, there are all kinds of risks associated with getting less.

The first one is weight gain (and all its associated health risks like diabetes, heart disease and cancer), because lack of sleep stimulates the production of hormones that increase appetite and limits the production of the hormones that make a person feel full. Which leads to the second (unsurprising) consequence: Given that lack of sleep makes one insatiably hungry, being tired also makes people cranky and depressed.

Yes, science has discovered that waking up on the wrong side of the bed is actually a medical diagnosis almost always brought on by the same root cause: lack of sleep.

The third problem is still under investigation, but is quite concerning. According to NIH studies, those who report poor sleep in middle age often experience symptoms of dementia or Alzheimer’s later in life. Sleep, it seems, plays a critical role in clearing the toxins associated with declines in brain function.

So in short, sleep could make you thin, make you pleasant to be around and, in the long run, possibly protect your brain from degrading. Sounds like it should sell itself – particularly considering that sleep is one of life’s few pleasures that is absolutely free and can be done without a partner or any special training.

But somehow, we are a nation of chronically under-rested people. According to the most recent available research on sleep, about one-third of Americans report routinely getting less than the recommended seven to nine hours a night, while another third report they “sometimes” don’t get enough sleep.

But luckily, where there is a problem, there is typically an innovative entrepreneur selling a solution – and in the case of sleep, there are a lot of solutions out there. According to McKinsey, if you take the approximate value of all the sleep swag on the market as of 2018 –think luxury pajamas, high-end bed linens, cuddling robots, DTC mattresses and odd gadgets – it generates somewhere between $30 billion and $45 billion annually in revenue worldwide. The mattress market alone is worth a whopping $15 billion. Throw in the amount spent on pharmaceutical sleep aids worldwide each year, and “big nap” as an industry will be worth at least $76.7 billion globally by 2020.

Consumers are clearly willing to invest in getting some much-needed rest – and if some of the firms we’ve covered in the last few years are any indication, they are willing to experiment with some out-of-the-box ideas. There’s the Ostrich Pillow, which allows the sleeper to tuck his head into a soft, pillowy box to make it easier to sleep on a desk or other surface. Or there’s the Bearaby, which could be mistaken for a blanket knitted by a grandmother but for the fact that it weighs 20 pounds and costs $250-$280.

If that is more than you want to spend on a pressurized blanket experience, there is the Hatch Sleep Pod, which costs only $100. It works on the same principle as a weighted blanket – applying uniform pressure across the body to reduce stress – but instead of using weights to create the effect, the pod wraps the sleeper tightly in what can only be described as a swaddle.

“It’s designed to feel like a hug,” Founder Matt Mundt explained to PYMNTS.

There is also the slightly different variation of the Sleep Pod – a much more literal one, offered by HOHM. The startup offers napping spaces on-demand in the form of a 43.5-square-foot portable pod that comes equipped with a twin bed and charging station. The pods set up shop in places where the nap-needing tend to gather – university campuses and office spaces being their two main sweet spots – and offer the chance to book a 20-minute to two-hour nap online or on mobile with a few clicks or taps. Once a pod is paid for, the customer checks in with the pod’s attendant, who unlocks it and lets the customer in for their nap.

“I think there’s definitely a demand and interest for a product like this,” the firm’s Founder and CEO Nikolas Woods told PYMNTS. “Wherever people need sleep, we want to be there.”

In the future, he noted, they will be looking to expand their services to airports and music festivals.

As it turns out, apps aren’t only useful for ordering up weighted blankets or time in a sleep pod. The team at Sleepio believes their anti-insomnia app – which comes with a built-in cartoon therapist – is just the tool Americans need to get to bed on time and sleep the right number of hours.

This week, the app got a major upvote of confidence. According to reports from The New York Times, CVS Health is encouraging employers to cover the costs for their workers to use the app. CVS recently included Sleepio, along with about a dozen or so other healthcare apps, as benefits whose downloads employers can cover as part of their insurance policies as easily as they can cover prescription drugs.

In general, CVS is part of a nascent push to bring digital therapeutics and telemedicine more into the mainstream.

“We are at this pivotal moment,” Lee Ritterband, a psychiatry professor at the University of Virginia School of Medicine, noted on the emergence of various digital therapy apps. “For years, these have been bubbling under the surface.”

So far, only a few employers have started offering Sleepio, though CVS expects more to sign on this fall. It was chosen, according to Dr. Troyen A. Brennan, CVS Health’s chief medical officer, because it came backed by rigorous published studies.

“It’s important for us as a pharmacy benefit management company, as a big retail pharmacy, to endorse digital therapeutics when they work as good as or better than medications one can take by mouth,” Dr. Brennan said. “We can give the stamp of approval from having looked at the scientific information.”

The app functions by turning sleep into something of a gamified experience – the person seeking sleep works with a cartoon therapist/chatbot with a Scottish accent and an affable but firm demeanor. The user and the advanced bot work through a series of six weekly online sessions aimed at healing “broken sleep,” according to Sleepio.

“It feels a lot more like play than work,” Lisa Kelly-Croswell, the chief human resources officer at Boston Medical Center, noted of the program. Boston Med has offered Sleepio since 2016.

But does it really work? The science is a bit more mixed than Dr. Brennan let on. In several randomized studies that assigned some volunteers to use Sleepio and others to use a different treatment, the Sleepio users generally performed better in terms of how long it took them to fall asleep and how long they stayed asleep throughout the night. But in terms of net time spent asleep, the two groups didn’t have very different outcomes.

Plus, the program seems to have some issues with keeping customers engaged. Boston Medical, for example, has had about 3,000 people start the program since it became available in 2016, but have only had about 350 finish it. And that 89 percent attrition rate doesn’t seem to be a problem that is wholly unique to medical workers in Boston drinking too much Dunkin’ coffee. One large randomized trial showed that only 18 percent of Sleepio users completed the insomnia treatment. Another showed that more than half of people who downloaded the app failed to engage with it at all.

In some sense, Sleepio has the same problem as every other solution: It can only work if one uses it. The weighted blanket won’t help if you kick it off, and the luxury pajamas won’t work if they never come out of their box.

But lying under a weighted blanket is not a lot of work (unless one tries to move), nor is slipping on a set of luxury pajamas or checking into a campus sleep pod. Sleepio’s user retention issues might indicate that its course of study can succeed, but that it might be a little too much work for someone who is already tired.

Plus, given the sheer volume of experts who point out that smartphones are one of the main factors contributing to Americans not getting enough sleep, one has to wonder if a phone app is really the right approach when it comes to an insomnia cure.

And honestly, we can’t help but wonder how many of the workers who downloaded Sleepio tried to use the app, opened up their phone to start their session with the cartoon sleep therapist and then got distracted by shopping on Amazon, checking in with social media, binge-watching something on Netflix or talking to a co-worker on Slack. For some consumers, a sleep app is clearly an effective solution – but for others, we imagine, it is sort of like hosting a Weight Watchers meeting in a bakery, in that it’s just not the right venue to encourage willpower or discipline.

For those customers, it might be better to offer lower-tech solutions.

Like a doll bed for their phone – which, of course, they keep in a room other than the one their actual bed is in.