“My GP Was Useless”
Is it your GP’s fault you can’t access the treatment you need?
The First Point Of Contact Is Who Many Blame
When I appear on the radio and TV and do phone ins, this is the message we hear again and again from poor sleepers. It usually comes after people have already tried a lot of things, apps, supplements, routines, before turning to the healthcare system for help.
But it is not your GP’s fault.
With a lack of options to treat you, a lack of budget to offer more personalised support, and very little training in sleep during medical degrees, GPs are being overwhelmed by people with sleep issues, often treating anything but sleep. To be frank, it really is not their fault.
Before we get into that, let’s look at what I have been reading in sleep this week.
🛌 Sleep This Week
🛠️Low-Cost Sleep Apnoea Device Targets Global Access Gap
Researchers in India have developed a low-cost, home-based diagnostic device for sleep apnoea using AI and sensor data.
Sleep tech isn’t just getting smarter, it’s getting cheaper, and that may matter more when it comes to real-world access.
🧠 New Neurostimulation Therapy Approved for Sleep Apnoea
LivaNova’s aura6000 system has received FDA approval, using hypoglossal nerve stimulation to keep the airway open during sleep.
It’s another sign that sleep apnoea treatment is moving beyond CPAP toward implantable, personalised interventions.
⏰ Has Medicine Forgotten Time?
A thoughtful Substack piece argues that modern medicine often ignores timing, despite biology being fundamentally rhythmic.
For sleep, it’s a reminder that when something happens can matter just as much as what happens.
🧠 The Brain’s ‘Night Shift’ Cleaning System
New coverage highlights the glymphatic system, the brain’s waste-clearance process that becomes most active during deep sleep.
Sleep isn’t passive downtime, it’s when the brain quite literally cleans itself.
👁️Sleep and Visual Impairment: Lived Experience Matters
A VICTA podcast brings together practitioners, parents and young people to explore how visual impairment shapes sleep.
A powerful reminder that sleep advice needs to reflect lived experience, not just generic guidelines.
The long read
I was doing a phone in on a mid morning TV programme. Not on air, but in the background between segments, the researcher came up to me and said, “Every single person we have spoken to today has said their GP was useless.”
It stuck, because it is something I hear all the time. It is easy to assume that if the GP cannot solve your sleep, then they are the problem. But when you look at what they actually have to work with, it starts to make more sense.
What GPs actually have
If you go to your GP with a sleep problem, there are three broad options. Medication, referral into secondary care, or digital support.
Medication is quick and accessible. Referral is limited and often slow. Digital support, particularly CBTi based programmes, has become the scalable middle ground.
That is the reality of the toolbox.
Insomnia, CBTi, and digital programmes
For insomnia, digital CBTi has become the default scalable solution. Sleepio is the most widely used, a six week programme with a tariff of around £45 per person, although it is paid on who starts rather than who finishes or improves sleep.
Sleepstation operates on a more local commissioning basis, with costs likely sitting somewhere between £80 and £200 per person depending on the level of support included.
From the system’s point of view, this makes sense. You are replacing a very blunt tool with something grounded in behavioural science. It is slightly more effective, significantly lower cost per patient than specialist care, and scalable.
From the patient point of view, particularly for those with complex or chronic insomnia, the experience is more mixed.
Digital CBTi works for some people. It often works well in the early stages. Then, for many, the effect reduces.
Part of the issue is how it is framed. When we present these programmes as a fix or a cure, we miss the reality of insomnia. It is something you understand and manage. It improves, it settles, and it can come back, particularly during periods of stress.
I think there is another Substack article in that alone.
Sleeping pills
Before comparing costs, it is worth being clear about what sleeping pills actually do.
Most of the sleeping pills available through GPs do not give you natural sleep, they sedate. They suppress wakefulness and knock you out. They can be useful in the short term, but they do not address what is driving insomnia.
There are newer drugs, particularly those targeting orexin systems, which work differently and are more effective than traditional sedatives. These can cost around ten times more per dose than older sleeping pills, but even then, the overall cost per patient typically ends up somewhere between £200 and £500.
So while pills are cheap per dosage, the overall cost per patient is not insignificant, especially when used over time.
Putting it together
When you look at the options side by side, the system decision becomes clear. You replace a really ineffective solution, most sleeping pills do not give you sleep, they knock you out, with something slightly more effective, lower cost per patient, and scalable across large populations.
Winner winner chicken dinner.
What the research says, and what people say
Sleepio is well researched. It has been compared not just to medication, but also to therapist delivered CBTi, and wider meta analyses suggest strong effectiveness of digital CBTi generally.
Sleepstation has less direct comparative research, particularly against in person CBTi practitioners.
Across the research base, digital CBTi performs well.
But the stories I hear do not always match that.
Most of the research focuses on shorter timeframes, often up to six months. Many people I speak to feel that these programmes work during that initial period, but once the programme finishes, and particularly after a 12 month subscription ends, the impact reduces.
For people with more complex insomnia, the pattern is clearer. The more human interaction they have, the better their long term outcome tends to be.
That is not always captured in the data.
Where are the actual services
There are insomnia clinics within the NHS, with trained practitioners delivering care.
They are nearly as rare as hen’s teeth.
Most are concentrated in London and a small number of surrounding areas. Outside of that, access is limited, unclear, and often not visible. So while digital services expand access on paper, access to specialist care remains extremely limited in practice.
Where physical clinics do exist, and where CBTi is delivered by a trained practitioner either in person or remotely, costs are hard to come by. We can presume they are more expensive per patient, and in some cases significantly so, but based on outcomes, they may not be. This is some of the problem. Sleepio wins because it has a clear tariff, that looks good value. Sleepstation may undercut Sleepio on a local level when spread across the whole population, and existing internal services, which have often being created by entrepreneurial NHS staff, with sticking tape and plasters, are not scaled because we don’t know how much they cost, or how effective they are. So we put public money into VC backed private enterprises that could potentially be more focused on shareholder return, than patient outcome.
Sleep apnoea, a different picture
Sleep apnoea has a clearer pathway. There are more clinics, greater awareness, and more defined routes to diagnosis.
But there are still major gaps.
There are millions of people with undiagnosed sleep apnoea. Even when people are diagnosed, there is often a significant gap between diagnosis and treatment.
Sometimes this is due to waiting lists before treatment begins. Sometimes it is because people struggle to stick to the treatment prescribed, most commonly CPAP.
So while the pathway exists, access to effective treatment is still inconsistent.
Other sleep disorders
It is with other sleep disorders that the system struggles most.
Conditions like restless legs syndrome, periodic limb movement disorder, narcolepsy, and circadian rhythm disorders are harder to diagnose and harder to treat.
Access to treatment is inconsistent and diagnosis can take years. Narcolepsy is a clear example, with average diagnosis times often quoted at around 8 to 11 years.
GPs may realise that symptoms are serious, but the pathways are not clear, and patients can spend years moving through the system without resolution.
And GPs
It is not the GP’s fault.
But there are things that should be said.
Some GPs offer private services and position themselves as sleep doctors or sleep experts, but you do not publicly see these services being offered in the surgeries they own or run that deliver NHS care.
It would be a positive step if that expertise was used more directly in the communities they are already paid to serve.
What actually needs to change
The issue is not choosing between digital tools, medication, or specialist care. The issue is how they work together as a system.
We need better triage at the start, so people are directed to the right support earlier. We need better education across the NHS, so that staff can deliver clear, practical advice where it is needed. We also need better education outside the NHS, in sleep retail, the third sector, in education, sports clubs and the workplace, because many people seek help elsewhere before they ever speak to a GP.
Support should be delivered as a mix of digital and in person, depending on need.
We need more trained CBTi practitioners within the NHS, so that people with complex insomnia, co occurring mental health conditions, or additional needs, including visual impairment, can access appropriate specialist care.
Because a one size fits all digital solution is not enough.
If we get this right, fewer people reach crisis point, fewer people are referred into the wrong services, and more people get the right help earlier.
Where this leaves us
People are frustrated, and understandably so. They go to their GP after trying many things and leave without a clear answer or a clear path forward.
But this is not a GP problem.
It is a system problem.
Until we build a system that educates earlier, triages better, and connects the different parts of sleep care properly, people will continue to fall through the gaps.
And we will keep hearing the same thing.
“My GP was useless.”
Even when, in most cases, they were not.
What I have been up to this week
Really looking forward to working with Bensons for Beds, the UK’s leading sleep specialist, working together to help the nation sleep better through practical, effective sleep advice.
Want To Find Out More About My Work?
Take a look at what I do as The Sleep Geek, and Sleepunity, where we specialise in supporting Employers, Sports, Education, Healthcare, Retail, Hospitality Third Sector and the Public;of Sector supporting the sleep of their people and providing training to help their customers and patients get better sleep for all. Everything I do sits under Frankly, which is a for profit Social enterprise, where we commit 50% of our profits to helping the country sleep better. This year we are supporting schools and colleges, so get in touch if you would like some free support.