Big Health Online Therapy Review

Americans’ anxiety is skyrocketing. In a 2022 survey by the American Psychological Association, 79% of psychologists reported an increase in anxiety disorders among their patients. Sleep disturbances are also on the rise: Since the start of the COVID pandemic, 60% of people reported an increase in insomnia. One study found that in 2022, there was a marked increase specifically in mild insomnia that did not meet a diagnosable threshold. And the two issues are related: as many as 36% of people with insomnia also have an anxiety disorder, and sleep disturbances are a diagnostic symptom for anxiety disorders. Yet, as the need for mental health services continues to increase, therapists cannot keep up with demand. 

Big Health has created two mental health apps, Daylight and Sleepio, to help fill this gap. Daylight is focused on helping people reduce their anxiety symptoms and is specifically geared toward those with generalized anxiety disorder. Sleepio is intended for those looking to address their insomnia. Big Health’s apps are almost exclusively accessed via employer-provided health insurance. After wages, employers, on average, spend more on health insurance than on any other benefit. Big Health’s second aim is to reduce employer healthcare costs by supporting employees in improving their mental health. 

In order to evaluate Big Health’s offerings, we surveyed 105 users of the company, spoke with a user of its apps, Sleepio and Daylight, directly, and asked a subject matter expert to comment on its services. Read on to learn more about Big Health and its apps, and how effective we feel they are at addressing some of the most common mental health issues impacting people today.

What Is Big Health?

In 2010, entrepreneur Peter Hames co-founded Big Health with neuroscientist Colin Espie, PhD. Hames was searching for an alternative to medication to help him sleep and found Dr. Espie’s books on overcoming sleep disorders using cognitive behavioral therapy (CBT). The company has been making waves in the tech and business spaces, including being named to Fast Company’s list of the top 10 most innovative health tech companies. 

Big Health investors include Kaiser Permanente, Samsung Next, and Glide Healthcare. January 2022 saw the company raise $75 million in its latest funding round; the company also has an advertised partnership with the University of Oxford. A January 2022 announcement said the company plans to launch six new applications within the next two years. What those apps are going to do is unclear. 

Big Health’s two phone-based applications, Sleepio and Daylight, use CBT strategies to decrease insomnia and anxiety, respectively. The company espouses a drug-free mental health intervention approach throughout its website; a featured blog post even discusses “Mental health medication side effects at work.” 

In the U.S., the applications are accessible through employer-sponsored health insurance providers, such as Evernorth (Cigna’s health services section) and CVS Caremark’s Point Solutions Management program, as part of a benefits package. Companies such as The Home Depot, AmeriGas, The Hartford, and Boston Medical Center currently offer access to the Big Health apps. (In the U.K., they’re accessible through the National Health Service [NHS]).

 What Services Does Big Health Offer?

Big Health has two self-guided online mental health programs, one for anxiety and one for insomnia. These programs are primarily meant to be used on an iPad or iPhone app, but can also be completed on a desktop computer via a user portal. There is no actual therapist to connect with in the program.

Daylight is a personalized self-help program that teaches CBT-informed techniques to manage anxiety. You fill out a questionnaire indicating your specific problematic thoughts, then a virtual anxiety expert teaches you a different CBT technique to help you change negative thought and behavior patterns. Your questionnaire responses inform the program the app creates for you to follow. Sessions are less than 30 minutes long, with many guided videos being only five minutes each. Big Health recommends using Daylight for a few minutes each day to maximize effectiveness. 

Sleepio also starts with a questionnaire, where you’ll outline your current sleep patterns and problems. Then, a virtual sleep expert teaches you about how certain lifestyle and environmental factors may be impacting your sleep, and how to use CBT techniques to help with your specific sleep issues. The app builds a program for you based on your questionnaire responses. You participate in sessions once a week for six weeks. You can track your progress using a sleep diary on the app. The Sleepio program also has a community section of chatrooms and a digital library of resources. Most of the features outside of the sessions are only available on a desktop computer, and the chatrooms are not behind a subscription paywall.

Who Is Big Health For?

The ideal users of Big Health’s applications, according to the company, are adults aged 18 years and older who want to improve their mental health and reduce their reliance on medications. The program is designed to help you do this by learning how to change your behavior in ways that may help reduce your need for pharmaceutical interventions (that is, via CBT). 

From a clinical perspective, it’s clear that an ideal user is also a person who responds well to cognitive behavioral therapy (CBT) and is more at home with an automated solution rather than the person-to-person interaction offered by other platforms. 

Big Health’s apps are intended for those who have access to its services through their employee health insurance and are not generally available to the public. When you try to log in without employee credentials, you are sent to a page where you can sign up for research studies. If you are selected for those research studies, you get to use the apps for free.

Sleepio specifically warns that those with conditions including bipolar disorder, schizophrenia, and epilepsy, and those who fall down easily, should consult their physician before using the programs. Big Health says these risks have to do with the use of a technique called sleep restriction, a behavioral insomnia treatment that aims to improve your sleep efficiency by limiting the amount of time you spend in bed.

Big Health says Daylight is for people with stable physical and mental health who are experiencing difficulties with worry and anxiety or generalized anxiety disorder symptoms. Daylight is not suitable for those with substance use issues, psychosis, mania, or dementia, or those who are in crisis or are experiencing symptoms such as the urge to self-harm, suicidal ideation, or violence toward others.

How Much Does Big Health Cost?

It’s unclear how much Big Health costs its user—or even the user’s employer—as this information is not publicly shared. The Daylight website says the application comes at “zero cost to you.”

Does Big Health Take Insurance?

Yes, you can only log in to the apps via a link sent by your employer or health insurance provider.

Does Big Health Offer Discounts?

While Big Health offered its products for free during the early stages of the COVID-19 pandemic, it no longer offers free services or discounts, except to those currently enrolled in research studies.

Navigating the Big Health Website 

Big Health’s website is a mix of marketing materials, research, disclaimers, and company announcements. Across the top of the website, there are menus for Products, For Organizations, Research, Resources, and Contact Us.

Under products, you’ll find a page for each app. “For Organizations” is essentially a pitch to company owners and benefits managers to adopt the products for their employees. Big Health’s research page provides an overview of its total number of publications, randomized controlled trials (RCTs), study participants, and clinical guideline citations. The page summarizes Big Health’s research conclusions about the effectiveness of its two apps and provides links to featured studies. 

Under resources are Blog, News, Webinars, Reports, and Tools. All of these free resources appear geared toward helping company benefits managers or other human resources professionals understand the importance of mental health benefits, with webinar titles like “Communicating the Impact of Mental Health Equity & ROI” and tools titled “Mental health FAQs & key terminology.”

The menu at the bottom of the Big Health website repeats most of the top menu items, with the addition of Company: About Us and Careers.

In addition to the page about each app on the main website, Daylight and Sleepio have their own separate web pages, which don’t appear to be linked from the Big Health page, but can be accessed via a web search. 

The Sleepio site has more in-depth information, including a multitude of sleep-focused guides that are available publicly. Its dark navy color scheme has a nighttime, sleep-inducing vibe. The site’s top menu includes How It Works, Evidence, Articles, Employers, Health Professionals, and Log In. Further down the page, after data that looks at the relative costs of the average worker’s mental healthcare, comes a simple video describing Sleepio’s benefits, which does not include captions or other accessibility features. 

The extensive menu along the bottom of the page includes The Sleepio Program, under which are links to The Science, User Reviews, FAQs, Is Sleepio for You?, and Further Resources. There's also an About Us tab with links to About Sleepio, Sleepio Experts, Blog, Contact Us, Jobs, Terms, Privacy, Accessibility, Posting Policy, and Site Map. Finally comes Connect With Us, with links to the app’s social media profiles. Most areas of the page include an action button to “get started” using the program.

Daylight’s site, meanwhile, uses an orange and green theme that evokes a natural morning wake-up call and proclaims it can help you “Outsmart your anxiety.” The initial webpage takes a similar approach, highlighting the app’s virtues—particularly its ease of use—before diving into a video interview of a satisfied Daylight user. Daylight’s separate page is largely focused on what the app is not promising—no “magic bullet” for anxiety here—rather than what it is. This site contains a menu across the top for How It Works, Evidence, FAQ, and Sign Up.” All of these links simply send you further down the main page. 

A chart on the page compares Daylight positively to meditation and wellness apps, in-person therapy, and prescription medication, asserting that, unlike those, the app is clinically recommended, has no side effects, offers long-lasting benefits, and is available 24/7 at no cost to you. There is no bottom menu, but the FAQs at the bottom of the page conclude with a customer contact email. This page also includes frequent action buttons encouraging you to “get started” using the program.

It’s a bit confusing that information about Big Health and its programs is found on so many different websites. I was also curious why the individual sites for Daylight and Sleepio didn’t match at all in the layout or information provided. In our survey, 70% of respondents found navigating Big Health’s websites to be either easy or very easy. These users could be referring to their interface with the online portals for the programs themselves once logged in, and not the introductory sites.

 Does Big Health Have an App?

Sleepio and Daylight are available on the Google Play and Apple app stores. Sleepio also has an online login. Both Sleepio and Daylight have instruction manuals for their use, which give you a good sense of how the program works and provide warnings, such as who the programs might not be a good fit for and how you can get the most out of the programs. 

The Sleepio program is conducted entirely online via a home computer, iPad, or iPhone app. Compared to similar services they’d tried in the past, 48% of our survey respondents said Big Health’s apps were easier to use.

How Do You Sign Up for Therapy at Big Health?

For most users of both Sleepio and Daylight, signing up occurs via a link sent by your healthcare provider or employer. From the apps’ websites, clicking on any of the “get started” buttons sends you to a page where you can see if you're eligible for the app by entering the name of your employer.

Daylight

First, you fill out a questionnaire, where you describe your specific negative or problematic thoughts and behaviors. The app tries to determine which type of anxiety you have within generalized anxiety disorder. Using that information, the app creates a personalized program to address your anxiety.

Sleepio

 Sleepio also starts with a questionnaire, where you describe your current sleep patterns and issues, and detail what you’d like help with (getting to sleep, staying asleep, etc.). The app then assigns you a unique “sleep score,” builds a program for you based on your questionnaire input, and assists you in crafting a 24-hour sleep/wake schedule. 

Once you’ve signed up, you can log in to program’s online portal or download the relevant app from the app store and begin using its services. In our survey, 69% of users said they found signing up for Big Health apps easy or very easy.

How Do Sessions Work at Big Health?

Daylight 

Daylight requires you to log in on the app once you’ve entered your initial information on the website. It uses what it calls a “virtual therapist” to guide you through a series of sessions where you’ll learn several different CBT techniques using visual prompts, such as animations. In each educational session, a virtual anxiety expert teaches you a different technique to help you change negative thought and behavior patterns. Sessions are less than 30 minutes long. You can decide which techniques work best for you. 

Big Health recommends that you use Daylight for a few minutes per day, and will also nudge you for weekly check-in sessions within the app. Daylight also offers smaller sessions to help you practice what the app calls “techniques.” Those strategies involve what independent researchers identified as “applied relaxation, stimulus control, cognitive restructuring, and imaginal exposure.”

The company’s research into Daylight’s effectiveness showed 71% of users moved from clinical to non-clinical anxiety levels after 10 weeks of regular app use, compared to 33% of those in the control group.

Sleepio

Sleepio’s in-app companion “The Prof” explains how lifestyle and environmental factors may be impacting your sleep, and teaches you CBT techniques to help with your specific sleep issues. Similar to the Daylight app, the CBT techniques Sleepio uses focus on helping you identify and change any negative thought patterns; in Sleepio’s case, thought patterns that may be interfering with your sleep. 

Key areas include goal setting, sleep optimization, clearing the mind before sleeping, expanding the number of techniques you use to sleep, and how to ask questions of experts. A five-question quiz accompanies each session to reinforce what you’ve learned and track your progress. Sleepio doles out its sessions once a week for six weeks. Once you complete a session, you get access to the next session. In order to progress, you must fill in the sleep diary regularly. 

Sleepio’s features can be accessed via a website portal as well as via iPad or iPhone app. It can also be integrated with devices that can track your sleep, like a smartwatch. The Sleepio program also has a community forum and a digital library of resources. Most of the features outside of the sessions themselves are only available on a desktop computer and are meant to provide additional assistance beyond the sessions themselves. 

The company’s research has shown that 76% of Sleepio users achieved clinical improvement in insomnia after six weeks of regular use.

Quality of Care and User Satisfaction

Hector Ruiz, who spoke to Verywell Mind about his experiences using both Sleepio and Daylight, says that while he found the tools useful—and would consider them in the future if his employees wanted access—the fact that they are so heavily marketed toward employers rather than users led him to pursue offerings by different companies. 

“I saw that the product was especially geared toward employers to make it part of the benefit packages,” he said. “Whereas the other apps that I ended up enjoying more, [had me] diving in more, were, in my opinion, geared more towards the user and allowing the user to build his or her own daily experience.” 

Both of Big Health’s apps are advertised as “personalized,” but there are limitations. The tools are linked to questionnaires that heavily influence the user’s experience, and while Daylight does allow you to go back and review lessons, its use of CBT techniques makes it more of a psychological tool than apps like Calm and Headspace, which guide the user through meditation, mindfulness, and sleep assistance.

In our survey, 90% of respondents rated the company positively, reporting its services to be good, very good, or excellent overall. Almost half of respondents said they turned to Big Health because of their anxiety level, and 35% said they were looking to find support for their depression. That connection makes sense as we’ve long known that depression and anxiety are deeply linked. “Anxiety and depression are often comorbid, meaning that people often experience both at once,” explains Hannah Owens, LMSW, a subject matter expert. “There are even many medications that treat both depression and anxiety and can be prescribed to treat one or both together.”

In total, 79% of survey respondents said that most or all of their needs were met by Big Health’s offerings, and 45% of those who stopped using the service said they had discontinued therapy altogether. What’s more 75% of survey respondents said that they were likely or very likely to recommend the service to a friend. Strangely, 90% of respondents rated therapist qualifications positively, even though the service doesn’t connect you to an actual therapist. Users may have been responding to the fact that the app’s CBT techniques are scientifically backed.

Privacy Policies at Big Health

Both Sleepio and Daylight have extensive privacy policies on their respective websites, which are very similar, and each was most recently updated in June 2022. Both apps provide ways to contact privacy compliance offices and staff in both the US and UK. The company is also clear on its HIPAA compliance and data privacy obligations. 

Sleepio makes note of the data with a high potential to become public, namely messages shared in its community tab. It recommends that users keep information that could compromise their privacy out of that forum. There is even a note that reminds users to create a username that wouldn’t inadvertently reveal their identity. Sleepio’s terms also allow for medical professionals who access Sleepio Clinic, a resource bank for medical professionals, to have your data shared with them, but only if you give express permission.

Big Health vs. Its Competitors

Big Health, unlike many other providers we evaluated, does not involve live consultation. Sleepio and Daylight are self-guided therapeutic tools and education rather than counseling or therapy services. While Sleepio does provide a small community support aspect, Big Health is much more in competition with applications like Headspace and Calm. 

Headspace and Calm both have 4.8 stars in the Apple App store and 4.4 stars in the Google Play store, based on several hundred thousand ratings. The Daylight app has 4.9 stars on Apple and 3.6 stars on Google Play, but based on only about two dozen ratings. Sleepio has 4.6 stars on the Apple App store based on 150 or so ratings, and four stars in the Google Play store based on 175 ratings. 

Big Health can also be compared to Talkspace, which offers its own self-guided therapy app. The biggest perk with Talkspace is that, if needed, you can easily connect with an actual therapist via the service and message a therapists anytime. Talkspace is open to anyone (not just via an employer or insurer) and accepts insurance.

In our survey, 90% of users rated their overall experience with Talkspace positively, 78% said their provider met all or most of their needs, 50% said they’d likely still be using the service six months from now, and 92% rated therapist qualifications positively. In those categories, Big Health’s scored similarly, earning 90%, 79%, 46%, and 90%, respectively. Clearly, our users appreciated the Big Health apps’ individualized and informative lessons, 24/7 availability, ability to self-pace, and use of proven CBT techniques to target two specific diagnoses.

Final Verdict

Big Health’s lack of public transparency when it comes to cost and the fact that most prospective clients can’t log in without work-based coverage put it at a disadvantage when compared to other providers we evaluated this year. Its medication-hesitant approach could also push some users away, although most respondents seemed to find the tools useful. 

Most often, mental health apps are best used alongside person-to-person therapy or to address mental health concerns that may not rise to the level of requiring therapeutic intervention. “With only an app, you are missing a therapist who can meet you where you are and respond to your specific thoughts and emotions as they are happening,” says Owens. “So if anything you say or feel has not been pre-programmed in the app as an issue it can address, you won’t get a personal response from a human who can address those issues directly.”

That said, the company does give ample warnings and advice about who may (or may not) be best served by the company’s cognitive behavioral approach. Daylight is not suitable for those with substance use issues, psychosis, mania, or dementia. Those with bipolar disorder, schizophrenia, and epilepsy should not use Sleepio. In addition, those who are in crisis, are feeling suicidal, or are experiencing the urge to harm themselves or others are not the intended audience for these apps and should seek in-person treatment elsewhere. 

While the field is relatively new, so far, independent research has shown that mental health apps have little effect. In the end, Daylight and Sleepio are well-crafted, research-rooted tools that won’t stand in for regular one-on-one or group mental health support, but could instead complement those services. With efficacy rates above 70% for both tools, according to the company’s research, using Daylight and Sleepio has the potential to add useful support to your mental health journey.

Methodology

To fairly and accurately review the best online therapy programs, we sent questionnaires to 55 companies and surveyed 105 current users of each. This allowed us to directly compare services offered by gathering qualitative and quantitative data about each company and its users’ experiences.

Specifically, we evaluated each company on the following factors: website usability, the sign-up and therapist matching processes, therapist qualifications, types of therapy offered, the service's quality of care, client-therapist communication options, session length, subscription offerings, client privacy protections, average cost and value for money, whether it accepts insurance, how easy it is to change therapists, overall user satisfaction, and the likelihood that clients would recommend them.