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Astral Codex Ten Podcast

May 13, 2021


Trouble falling asleep? You could take sleeping pills, but they've got side effects. Guidelines recommend you try Cognitive Behavioral Therapy For Insomnia (CBT-i), a medication-free process where you train yourself to fall asleep by altering your schedule and sleep conditions.

The journals are full of articles begging doctors to use CBT-i instead of potentially-dangerous sleeping pills. Doctors rarely comply: getting patients CBT-i is hard. The usual sound bite is that “there are 60 million people with insomnia in the US but only 75 licensed CBT-i therapists.” What can you do? Not much.

Until now! Late last year, Pear Therapeutics released a CBT-i app (formerly “SHUT-i”, now “Somryst”) which holds the patient’s hand through the complicated CBT-i process. Studies show it works as well as a real therapist, which is very well indeed. There’s only one catch: you need a doctor’s prescription.

Wait, you can prescription-gate an app? Yes! Although you can download Somryst off your normal App Store, it won’t work until a doctor writes you a prescription to “activate” it. Until then, it just shows you ads for how great CBT-i would be if you could get it.

And it’s not just Somryst. I know of at least three other prescription apps. reSET and reSET-O are 12-week courses to help addiction and opioid addiction, respectively. EndeavourRx is a video game which is supposed to help manage ADHD in kids. I guarantee you there are a lot more of these in the pipeline.

In theory, an app is a great solution to accessibility issues. Some people can’t afford to see a professional. Or they have complicated schedules that make it hard to see a professional. Or they’ve been traumatized by the medical system and don’t want to see a professional. Or they have executive function problems and can’t schedule a appointment with a professional. Or they have bad insurance that doesn’t have many professionals in-network, and all of them have six month wait lists. Freddie de Boer, who has more resources and know-how than most people, describes his experience trying to get a therapist here: