What makes Small Hours different, and why it works best alongside your clinician

Small Hours is a self-guided six-week CBT-I program in an app. You can use it on your own, and it is designed to work best alongside a clinician such as a doctor, psychologist or counsellor. Working best alongside a clinician is a design intent, not a proven result: Small Hours has no published trial of its own. What the research does show is that in trials of CBT-I programs, more personal support often goes with better outcomes, though not in every analysis. ^[1][2][3]

CBT-I means cognitive behavioural therapy for insomnia. It is the treatment guidelines name first for chronic insomnia. ^[6] If you want the basics first, start with what CBT-I is.

What the research says

Four reviews point mostly one way, with one twist. In 11 trials of internet-delivered CBT-I, more personal clinical support went with larger effects, and more dropout in the program group with smaller ones. ^[1] A network analysis of 54 trials and 11,815 people ranked web-based CBT-I with a therapist highest. ^[2] Among 20 trials of self-help CBT-I, subgroup analyses supported an added benefit from telephone consultation. ^[3] The twist comes from a 2023 comparison of the settings CBT-I is delivered in, across 52 trials and corrected in 2025 after a scoring error: in the corrected figures every setting beat a waiting list, with large effects for in-person one-to-one, group, video-call, guided-book, smartphone-app and unguided-internet delivery and medium effects for guided internet programs and unguided books, and no setting was superior to another. The authors say self-help settings may be a viable alternative when live CBT-I is not available. ^[4][5] In plain terms, a program alone can work, and a person alongside it often adds something, though not in every analysis.

The studies behind this

• Support and outcomes (Zachariae, 2016). In 11 trials of internet-delivered CBT-I, a higher degree of personal clinical support went with larger effects. Larger dropout in the program group went with smaller effects. ^[1]
• Therapist input (Hasan, 2022). In a network analysis of 54 trials and 11,815 people, web-based CBT-I with a therapist ranked highest. ^[2]
• Phone contact (Ho, 2015). In 20 trials of self-help CBT-I, the subgroup analyses supported an added benefit from telephone consultation. ^[3]
• Settings compared (Simon, 2023, corrected 2025). A network analysis of 52 trials compared the settings CBT-I is delivered in. A 2025 correction fixed a scoring error, and in the corrected figures every setting examined reduced insomnia severity more than a waiting list: in-person one to one, group, video call, guided books, smartphone apps and unguided internet programs all showed large effects, and guided internet programs and unguided books medium effects. No setting was superior to another. The authors say self-help settings may be a viable alternative when live CBT-I, in person, in a group or by video call, is not available. ^[4][5]

Two plain readings of this. A program on its own can help, and a human involved often helps more, though the Simon review's corrected figures found unguided internet programs did at least as well as guided ones. Neither tells you how Small Hours itself performs, which nobody has measured yet.

How Small Hours is different

Everything in this list describes what the app does today. Whether it matters to you is your call.

• It starts free and stays free where it counts. The sleep diary, your sleep-efficiency numbers, the weekly time-in-bed recommendation and the lessons for weeks 1 to 3 have no time limit. The rest costs money. See the pricing page.
• Billed in Canadian dollars. The pricing page and terms say so. Some programs with US-based teams list prices without naming a currency, so it is worth checking before you pay. ^[10]
• A diary first, and decisions from the weekly average. Each morning is a two-minute check-in answered from memory. The app works out how much of your time in bed was spent asleep, each night and as a weekly average. The weekly recommendation is based on the past seven nights, not one bad night. The number you see is sleep efficiency, the share of your time in bed that was sleep, which is the measure clinicians use in CBT-I. Anyone can try the arithmetic on the free sleep efficiency calculator first. Sleep efficiency is not a wearable's proprietary sleep score, and no wearable is needed.
• The weekly change comes from a fixed table, not from AI. The program recommends a change to your time in bed once a week. You can accept it, change it or decline it, and you choose which end of the night to move. No model computes the number.
• Screening before it asks you to spend less time in bed. Before the first sleep schedule it asks about bipolar disorder, seizure history, chronic migraine, pregnancy and other major conditions. If you flag one, it offers a version without time-in-bed restriction. Signs of sleep apnea prompt you to raise it with your doctor. This matters because the American Academy of Sleep Medicine guideline notes that restricting time in bed may be contraindicated for people predisposed to mania or hypomania, people with poorly controlled seizure disorders, and people in high-risk occupations such as drivers or heavy machinery operators. ^[6] The app does not ask about your job, so if you are a driver, a heavy machinery operator or in another high-risk occupation, talk to your doctor before starting.
• An AI coach for the hard hours, with a separate safety check. The coach is part of the subscription: you can ask it questions at any hour. Its answers draw on CBT-I science and the program's own material. A separate safety check reads each message before the coach replies. Messages that suggest crisis get crisis resources (call or text 9-8-8 in Canada), and questions about changing a medication are sent back to the person who prescribes it, or a pharmacist.
• A progress report you can hand to your clinician. From your own diary the app builds a short PDF with charts, a summary and your window changes. You email, print or bring it yourself. The app never contacts your clinician. The progress report is part of the subscription, and free during the trial.
• Canadian and clear about privacy. Small Hours is built in British Columbia and handles personal information under BC's Personal Information Protection Act. Nothing is bought from or sold to advertisers.
• Honest about what it is. It is not a medical service, does not diagnose, and does not replace your doctor. It does not ask you to change any medication.

How it compares with other options

We do not claim Small Hours is better than anything on this list. The honest picture is that each option wins on something.

• A therapist-led program such as HALEO gives you a person every week. HALEO's FAQ says its programs run about 5 to 6 weeks with a weekly online session. ^[8] Small Hours has no therapist. If you want one, use one, and use Small Hours alongside.
• Sleepio is a six-session program led by a virtual sleep expert rather than a person. ^[9] It has been tested in randomized trials, and the authors of one declare ties to its developer. ^[7] Small Hours cannot cite its own trial.
• The free diary-first start is the thing we think is distinctive: you can learn what your own numbers look like before deciding whether to pay.

For a fuller side-by-side, see CBT-I in Canada: your options compared.

Why alongside a clinician is the ideal, and not a requirement

• Someone knows your whole picture. A doctor knows your medications, your other conditions and your history. An app does not. If you take a sleep medication, any change is a decision for you and the person who prescribed it.
• Someone can check the plan with you. A clinician can look at the progress report, ask how the early weeks went and adjust. In trials, personal support often went with larger effects. ^[1][3]
• Someone can spot another problem. If your sleep may be affected by sleep apnea, depression or pain, that needs a clinician, not an app.
• Not required. Many people can follow a structured program on their own, and self-help CBT-I has shown clear gains in trials. ^[3] Can you do CBT-I on your own? weighs this up. If you do it solo, the app tells you plainly when to talk to a doctor.

If you are a clinician, there is a page for you, and the evidence for digital CBT-I is summarised for you with the guideline positions. Patients sign up themselves, and you do not need to set anything up.

Where the evidence is thin

• Small Hours has no published trial of its own. Everything above about outcomes is about CBT-I and digital CBT-I as categories.
• The trials of support and outcomes compare different programs, so they cannot say how much extra benefit any particular clinician adds to any particular app.
• The Simon review's results changed in its 2025 correction. Older summaries of it, including ones that said smartphone-delivered CBT-I did no better than a waiting list, are out of date. The corrected analysis still rests on the trials available at the time, and may not reflect newer apps. ^[4][5]
• Some of the trial evidence for products like Sleepio comes from teams with ties to the developer, which is common but worth knowing. ^[7]

If you would like to try it, you can start the free diary at trysmallhours.com.

General education, not medical advice.