Brain Stimulation Therapy – a Novel Treatment for Insomnia?
Dr. Lukas Krone
Somnologist and Sleep Neuroscientist. Originally a medical doctor from Germany, he now works between the Universities of Oxford, United Kingdom, University of Bern, Switzerland, and University of Madison-Wisconsin, United States of America, as a Sir Henry Wellcome Fellow.
Dr. Lukas Krone, a medical graduate from the University of Freiburg, Germany, embarked on his sleep research journey during an MD project on non-invasive brain stimulation’s effects on sleep in healthy volunteers and insomnia patients. With a Wellcome Trust Doctoral Studentship, he pursued an MSc and DPhil in Neuroscience at the University of Oxford, investigating sleep regulatory mechanisms in fruit flies and mice. During his DPhil, conducted in the lab of Prof Vladyslav Vyazovskiy unveiled the crucial role of the cerebral cortex in sleep regulation. Dr. Krone, a Junior Research Fellow at Merton College Oxford, expanded his work on cellular mechanisms and neuronal circuits of cortical sleep regulation through a Sir Henry Wellcome Postdoctoral Fellowship. His research, supported by various scholarships, earned him early investigator awards from the German, European, and World Sleep Society, highlighting his significant contributions to sleep science.
Brain stimulation techniques as novel treatment options for insomnia: A systematic review
For this Sleep Science Friday, we invited Dr. Krone to highlight for us his recent research published in the paper “Brain stimulation techniques as novel treatment options for insomnia: A systematic review” (vide Krone et al., 2023).
Study Overview
Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with chronic insomnia do not sufficiently respond to available treatments. Novel therapeutic options are urgently needed. Brain stimulation methods allow the modulation of brain activity and have proven therapeutic benefits for several neurological and psychiatric conditions. In recent years, the use of non-invasive brain stimulation techniques in both clinical trials and medical practice has in particular grown rapidly. Since the 2017 European guideline for the diagnosis and treatment of insomnia, more than 100 papers have been published on the use of brain stimulation approaches in the treatment of insomnia. This novel approach created a need to assess the state of science in this field to feed into the updated 2023 European insomnia guideline. Two recent meta-analyses on this topic were largely based on articles not written in English, limiting their accessibility and interpretability for the international community. The aim of our work was to provide a systematic review guided by the Cochrane Collaboration handbook and reported according to PRISMA 2020 guidelines, including a standardised risk of bias assessment to meet international standards.
The Findings
While nearly all publications reported positive results, most studies only analysed pre-post treatment effects and did not meet the inclusion criteria for this systematic review. Double-blind, randomised trials comparing active stimulation to reliable sham conditions were sparse. We identified only two studies with a low risk of bias, one testing transcutaneous auricular vagus nerve stimulation and one a forehead cooling device. Both studies found no effect in the primary endpoints. Our systematic review leads to the conclusion that currently no brain-stimulation protocol can claim relevant therapeutic benefit for insomnia. We provide concrete action points, such as the implementation of double-blinding and credible device controls, the use of predefined and standardised outcome parameters, and the choice of stimulation targets that have a known function in sleep regulation, with the aim to facilitate future research and pave the way for non-invasive brain stimulation approaches to become viable treatment options for insomnia.
For the full results and discussion of findings, you can read the full paper here.
Infographic Fact Sheet "Brain Stimulation as Novel Treatment for Insomnia"
Download the “Brain Stimulation as Novel Treatment for Insomnia” infographic fact sheet in PDF format:
Article and infographic fact sheet based on:
Krone et al. 2023. Brain stimulation techniques as novel treatment options for insomnia: A systematic review. J Sleep Res.
Infographic designed by:
Dr. Maria Hrozanova
Postdoctoral fellow at the Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Norway, and a member of the ESRS Digital and Communication Committee.
Recent publications from ESRS members
- Sochal et al. (2023). Correlations between the symptoms of insomnia, depression, sleep quality, antitumor necrosis factor therapy, and disrupted circadian clock gene expression in inflammatory bowel disease. PolArch Intern Med.
- Burtscher et al. (2023). Mechanisms underlying the health benefits of intermittent hypoxia conditioning. J Physiol.
- Simoncini et al. (2023). Exploring the emotional and behavioural profile in paediatric narcolepsy type 1: A case-control study. J Sleep Res.
- De Soomer et al. (2023). Effects of Weight Change and Weight Cycling on Lung Function in Overweight and Obese Adults. Ann Am Thorac Soc.
- Cajochen et al. (2023). Ultradian sleep cycles: Frequency, duration, and associations with individual and environmental factors-A retrospective study. Sleep Health.
- De Pieri et al. (2023). Clinical and instrumental features in 82 patients with insufficient sleep syndrome. J Sleep Res.
- Voci et al. (2023). Restless sleep disorder in a sample of children and adolescents with autism spectrum disorder: preliminary results from a case series. J Clin Sleep Med.