Dreem team: insomnia therapy goes hi-tech

Chloe Kent 10 September 2019 (Last Updated September 10th, 2019 14:50)

Insomnia is estimated to affect a quarter of the population every year, so it’s no surprise the wearable market is crawling with sleep trackers. Dreem CEO Hugo Mercier discusses the company’s CBT-influenced wearable, and how it can enhance the quality of sleep.

Dreem team: insomnia therapy goes hi-tech
The device runs using real-world feedback collection from the device’s beta version, with more than 800,000 nights of sleep recorded. Credit: Dreem

The Dreem 2 headband is an FDA-registered medical device equipped with five electroencephalogram (EEG) sensors, a pulse oximeter and an accelerometer, which all work together to measure sleep activity. The device delivers sound vibrations through bone conduction to soothe patients to sleep, while its companion app corroborates a user’s measurements into a personalised cognitive behavioural therapy for insomnia (CBTi) program.

The device runs using real-world feedback collection from the its beta version, with more than 800,000 nights of sleep recorded. Thus far, evidence indicates that the technology tracks and records sleep as accurately as a polysomnography and treats insomnia better than an in-person CBTi therapist.

Dreem CEO Hugo Mercier talks us through the tech and what it could mean for the future of insomnia study and treatment.

Chloe Kent: How does Dreem approach the science of sleep?

Hugo Mercier: We started approaching sleep problems with a very scientific approach. I understood very rapidly that if we really want to solve sleep problems, we need to first understand sleep accurately. The very first step was to make a product that can measure sleep with a similar accuracy to EEG equipment. But it wasn’t enough for me to make something to help people sleep better, because tracking is not enough.

We started with the first application, which was deep stimulation, using sounds to simulate the brain in order to enhance the quality of deep sleep. We saw that it was pretty good on average to increase the quality of users’ sleep. But when we looked at the insomniac population, their biggest problem wasn’t the restorative aspect of sleep but their difficulties initiating it in the first place. So, we started to develop a library of neurofeedback and biofeedback techniques like breathing exercises, meditation, cognitive exercises. These worked fine, but in the worst cases of chronic insomnia the patients have mental barriers – it’s not only about relaxing and falling asleep but, it’s really a psychological battle, and so we discovered CBTi.

In CBTi you meet with a therapist one a week for eight weeks and restructure the steps you take to fall asleep so you don’t wake up at night. We’ve developed a CBTi program which is inside the product, and for the first time it’s a CBTi program which is based on objective measurement of sleep rather than patient self-reports. Some people also need a human expert they can talk to, so it’s included in the price of Dreem that users can have two 30 minute calls with a CBTi expert who can give specific advice to the person.

CK: What is the patient experience of using the Dreem 2 headband?

HM: It’s a pretty simple user experience. You need to plug your headband to your Wi-Fi because it’s going to send all the raw data to the servers and with Bluetooth to your phone. The very first period of seven nights is an onboarding period and at the end you get an insightful and detailed report on how you sleep and where your problem is coming from.

Based on that, we’re going to recommend you a CBTi programme. The programme is six to eight weeks, depending on the user’s profile and their receptiveness to the to the to the therapy. Every day you get expert advice, things that you need to do, things that you need to learn. It’s done in a really user-friendly way so people are really engaged with the content and the advice, and most importantly it’s personalised.

CK: How does Dreem 2 apply the principles of CBTi?

HM: So first of all, Dreem has a big educational button where you learn how sleep works. It explains the differences between the perception of your sleep and your subjective measuring of the data.

Then you have multiple modules of CBTi – for example, one of them is sleep restriction. One of the key problems of people living with insomnia is that they have conditioned their brain with the fact that even when they are lying in bed they are not sleeping. To break that pattern we limit the amount of time a person is actually allowed to lie in bed, and we do that for multiple days and modulate it based on the data in the user’s profile. It’s like experimenting with your sleep calendar.

CK: What is Dreem’s clinical trial history?

HM: The very first clinical trial was about what Dreem measures, mimicking an EEG and analysing sleep correctly. We have done a second trial of this of this kind at the Stanford Sleep Medicine Center, showing that Dreem now is as accurate as an EEG and as accurate as a sleep doctor to do analysis at night. We could use Dreem to do large-scale remote clinical studies as it’s close to the gold standard.

The data published in our white paper is field data generated by Dreem from hundreds of users during multiple months, and we have an 85% retention rate. If you do online therapy, it’s between a 20 to 35% retention rate, and if you do it with a real therapist the retention rate will be 70%. Plus, Dreem’s efficacy is 80%, so 80% of these people are not considered insomniac any more. We’re hoping to replicate these results in a large-scale clinical trial for FDA approval and CE marking.

CK: How do patients access Dreem?

HM: You can go on the Dreem website and buy it. But we understand that business will probably come from more than the direct-to-consumer aspect, so that’s why we’ve started to work on healthcare channels – providers, payers, companies. We know that if we want to go full-scale and treat the hundreds of millions of people not sleeping well we’ll need a dual approach.

We’ve discussed it with healthcare practitioners and primary care physicians in the US, and Dreem is fulfilling a big need for them because they don’t want to prescribe sleeping pills any more. It’s bad for your health, and it’s not solving the problem. It’s just dulling the symptoms.

CK: What are the causes of insomnia in the modern world?

HM: There has been a kind of cultural progression towards the cult of anti-sleep, that sleeping less will help you to accomplish more. We have built this idea that presidents, entrepreneurs and inventors are great, brilliant, talented guys who are not sleeping, they don’t need sleep, sleeping is boring. Then you have the increase of stress, anxiety, mental disorders, the overload of the information era. It’s hard to switch off.