In a Brazil where about a third of the population shows signs of insomnia or difficulty sleepinga new generation of cell phone treatment emerges as an alternative to help people who want to solve the problem, often without resorting to medication.
Recent studies carried out by the Instituto do Sono showed that 45% of the residents of the city of São Paulo report suffering from insomnia or difficulty sleeping. In addition, 15% have chronic insomnia.
According to Dalva Poyares, a professor of sleep medicine at Unifesp (Federal University of São Paulo) and a medical researcher at the São Paulo Sleep Institute, among the adult population, the insomnia is more common in women.
THE Insomnia is characterized by difficulty initiating and/or maintaining sleep during the night, as well as early awakening in the morning.. Symptoms must occur at least three times a week for at least three months to qualify as a chronic condition.
There are several consequences related to chronic insomnia, such as: increased risk of hypertension, metabolic and cognitive problems, for example, long-term memory and reasoning impairment, and symptoms of depression.
anxiety and depression
The teacher explains that insomnia is a disorder that causes prolonged stress in individuals and exhausts the body. During this period, it can contribute to the development of depression.
“A person who lives for a long time just experiencing stress, dealing with stress, who has a lot of problems for a long time, is more likely to develop depression,” he adds.
already the Anxiety disorder appears after the diagnosis of insomnia and can worsen symptoms of the disorder, especially when it is not adequately treated.
The relationship is called complementary disorders, which can arise due to the presence of the other. For example, it is common for an anxious person to have episodes of insomnia, in the same way that an insomniac can have feelings of anguish when they are unable to sleep and end up becoming anxious.
Insomnia can be related to any health problem, however people who take more medication and have poorer physical or mental health suffer more from the condition. This is not to say that healthy individuals cannot develop the disorder. The solution for both groups is to prioritize a quality night’s sleep.
The treatment of insomnia has two main pillars: the non-drug route and the one that uses drugs.
If it’s necessary, Medicines must be prescribed by a doctor, used in the lowest possible dose and for a period that I saw depending on the gravity of the case.
The alternative without the prescription of medicines that has more scientific evidence is the CBT-i (cognitive behavioral therapy for insomnia)which can be carried out virtually or face-to-face.
Applications that aim to improve users’ sleep quality make use of this therapy, which acts on sleep reeducation. Components of the procedure include instructions for better sleep, exclusion of unfavorable behaviors and cognitive restructuring, for example.
Platforms must be scientifically validated and offer therapy in a complete way, not just with relaxation techniques. The researcher shows that these points are essential not to intensify insomnia.
“The problem with treatments that are not validated is that they do not improve insomnia 100%, the person changes modality, and insomnia is perpetuated”, he reported.
Also according to the expert, CBT-i can help reduce the need for medications and, therefore, should be applied responsibly. Applications such as SleepUp and Sleep Vigilantes are increasingly present in this market and meeting this demand.
The SleepUp app is a digital therapy approved by the Anvisa (National Health Surveillance Agency), being considered a medical software. The platform accumulates 13,000 users and has the complete journey for the treatment of sleep disorders, especially insomnia, guided by an artificial intelligence, Dr. moon.
The user starts the process by answering seven clinical questionnaires, which deal with sleep quality, insomnia, drowsiness, depression, dysfunctional beliefs and chronotype (morning, afternoon or intermediate profile).
From them and from the sleep diary, in which he records all his behaviors, the patient understands whether the causes of the disorder are behavioral or cognitive and if there are indications that he has any psychiatric illness other than insomnia.
Based on the CBT-i techniques, the app divides the therapy into eight weeks – each one referring to the journey the user must complete. The modules are progressive and use methods that, for example, address sleep hygiene and modifying dysfunctional thoughts.
“We start to work on thinking to be able to modify other feelings completely, this is the essence of TCC-i”, informed Renata Redondo Bonaldi, co-founder and CEO of SleepUp.
The app also combines the treatment with MBCTi (mindfulness-based cognitive-behavioral therapy for insomnia), which is mindfulness-based cognitive therapy. The feature treats and calms the thoughts that get in the way of falling asleep.
SleepUp also makes use of telemedicine and provides sleep professionals to humanize and complement the therapy journey.
As more than half of users take sleeping pills, the platform has a medication diary to track their impact on sleep metrics.
“We did a study to understand how much our psychotherapy improves the effectiveness and safety of sleeping pills, and we found that we were able to significantly improve sleep efficiency, sleep hygiene and the insomnia rate – three very important metrics. important. We improved the insomnia index by 41%, the sleep hygiene index by 40% and the sleep efficiency by 13 percentage points”, reports the CEO.
In partnership with Samsung Health and Google Fit, the platform also captures biometric signals such as steps and heart rate, and together with clinical trials and the sleep diary, charts the most effective therapeutic journey for each user.
The app has three plans: one free and two paid.
Another app with similar features is Sleep Watchers. Its goal is to help people sleep better, fall asleep faster, wake up less during the night and feel more energetic the next day.
The platform also digitized the TCC-i, so that it could be done by anyone and at the right time for them. The program, in addition to having a sleep diary, is divided into 5 to 10 minute conversations, held five to six times a week with the artificial intelligence, Dr. Sonia.
“Sônia, our artificial intelligence, is super intelligent. Depending on what you answer, she will throw you into conversation paths that are more interesting for you, and she is very empathetic”, details Lucas Baraças Figueiredo, CEO and co-founder of Vigilantes do Sono.
All processes are based on scientific articles, available for reading throughout the treatment. Through integration with the Apple Health app, biometric data from Apple smartwatch users is also collected.
The individual can follow the evolution of his condition and evaluate the techniques that are really being effective for him through a sleep monitor. In addition, there is the possibility for specialized professionals to monitor cases on the platform.
The developer of Sleep Vigilantes claims that 50,000 people have already used the platform.
In addition to these relationships, the application combines objective data, such as the number of times the user woke up, and subjective data (willingness to wake up, for example) to measure the efficiency of its methods.
“People who do our program, in the first two weeks, can already reduce the time they are awake in bed by 27 minutes – that moment when you can’t sleep. Increases total sleep time by 17 minutes. People who continued on the program for up to seven weeks reduced, on average, 74 minutes in the total time they stayed in bed and increased the total time of sleep by 59 minutes”, reports Baraças.
The app is paid but has a free trial period
Even in the face of the potential benefits already offered by the applications, the innovations do not stop. The co-founder of SleepUp adds that the company is patenting the development of a wearable electroencephalogram band. The algorithm is ready and the hardware structuring is in the final stages.
The creation will allow the detection of brain signals and, therefore, the analysis of sleep stages. From this recognition, the application will be able, for example, to know if the medication used by the user is, in fact, collaborating with the sleep architecture.
A procedure that could only be found in sleep clinics, through a polysomnography, will be accessible for use at home.
“The proposal is to bring precisely this monitoring of brain signals integrated into digital therapy, with clinical validation”, adds Renata.
The co-founder of Vigilantes do Sono says that, soon, the app will be expanded to also address emotional health issues. In addition, in the future, the initiative will provide care with health professionals directly in the app.
Along with these novelties, the program received approval for a project worth more than one million reais from Fapesp (Fundação de Amparo à Pesquisa do Estado de São Paulo), through the Pipe program (Innovative Research in Small Businesses), to develop a technology that is able to capture sleep apnea – an underdiagnosed disease that requires invasive tests for detection – only with the mobile device.
Baraças estimates that, possibly, the tool will be available next year.
“This is an innovative project at a global level and it is still based on doctoral theses that predict that if you have some anthropometric measurement data [tamanho do seu pescoço, da língua ou distância entre os olhos]we were able to predict with greater assertiveness whether or not you have apnea”, he informed.
* Intern at R7 under the supervision of Fernando Mellis