Transcranial Direct Current Stimulation (tDCS) as a Therapeutic Tool for Chronic Insomnia
,
Abstract
Background and Objective: Insomnia is the most common sleep problem which is associated with cortical over-excitation. Transcranial direct-current stimulation (tDCS) potentially modifies insomnia-related cortical state. There-fore, we tested the hypothesis that insomnia severity can be modulated by tDCS.
Materials and Methods: The current study was conducted with a pretest-posttest design and a control group. A total of 32 women with insomnia were randomly categorized into an intervention group (active stimulation) and a control group (sham stimulation). In the intervention group, tDCS was used with an intensity of 2mA for 20 to 30 minutes during 12 sessions (3 times a week). Anodal stimulation was performed on the left primary motor cortex (M1) and cathodal stimulation was performed on the right dorsal lateral prefrontal cortex (DLPFC). The control group received sham stim-ulation for 20 to 30 minutes during 12 sessions (3 times a week). All participants were evaluated before and after the intervention using the Insomnia Severity Index (ISI) and Positive Affect and Negative Affect Schedule (PANAS).
Results: The results of univariate analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) showed a significant difference between the tDCS group and the sham group in terms of reduction in the severity of insomnia. We also observed that positive affect increased and negative affect decreased following insomnia treatment (P ≤ 0.005).
Conclusion: The results of our study indicated that performing our designed tDCS protocol for treating insomnia can be effective in treating insomnia and improving positive and negative affect.
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J Sleep Sci, Vol. 7, No. 3-4, 2022
http://jss.tums.ac.ir
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3. American Academy of Sleep Medicine. International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL: American Academy of Sleep Medicine; 2014.
4. Zeng LN, Zong QQ, Yang Y, et al. Gender difference in the prevalence of insomnia: A meta-analysis of obser-vational studies. Front Psychiatry 2020; 11: 577429.
5. Zhang B, Wing YK. Sex differences in insomnia: A meta-analysis. Sleep 2006; 29: 85-93.
6. van der Werf YD, Altena E, van Dijk KD, et al. Is disturbed intracortical excitability a stable trait of chronic insomnia? A study using transcranial magnetic stimulation before and after multimodal sleep therapy. Biol Psychiatry 2010; 68: 950-5.
7. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev 2010; 14: 9-15.
8. Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev 2010; 14: 19-31.
9. Fernandez-Mendoza J, Li Y, Vgontzas AN, et al. Insomnia is associated with cortical hyperarousal as early as adolescence. Sleep 2016; 39: 1029-36.
10. Huang Z, Zhan S, Li N, et al. Abnormal recovery function of somatosensory evoked potentials in patients with primary insomnia. Psychiatry Res 2012; 198: 463-7.
11. Corsi-Cabrera M, Figueredo-Rodriguez P, del Rio-Portilla Y, et al. Enhanced frontoparietal synchronized activation during the wake-sleep transition in patients with primary insomnia. Sleep 2012; 35: 501-11.
12. Perrier J, Clochon P, Bertran F, et al. Specific EEG sleep pattern in the prefrontal cortex in primary insomnia. PLoS One 2015; 10: e0116864.
13. Schwabedal JT, Riedl M, Penzel T, et al. Alpha-wave frequency characteristics in health and insomnia during sleep. J Sleep Res 2016; 25: 278-86.
14. Riedner BA, Goldstein MR, Plante DT, et al. Re-gional patterns of elevated alpha and high-frequency electroencephalographic activity during nonrapid eye movement sleep in chronic insomnia: A pilot study. Sleep 2016; 39: 801-12.
15. Taylor DJ, Mallory LJ, Lichstein KL, et al. Comorbidity of chronic insomnia with medical problems. Sleep 2007; 30: 213-8.
16. Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep dis-turbances, anxiety, and depression. Sleep 2013; 36: 1059-68.
17. Bouwmans MEJ, Bos EH, Hoenders HJR, et al. Sleep quality predicts positive and negative affect but not vice versa. An electronic diary study in depressed and healthy individuals. J Affect Disord 2017; 207: 260-7.
18. O'Leary K, Small BJ, Panaite V, et al. Sleep quality in healthy and mood-disordered persons predicts daily life emotional reactivity. Cogn Emot 2017; 31: 435-43.
19. Mason EC, Harvey AG. Insomnia before and after treatment for anxiety and depression. J Affect Disord 2014; 168: 415-21.
20. Oyane NM, Pallesen S, Moen BE, et al. Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses. PLoS One 2013; 8: e70228.
21. Terauchi M, Hiramitsu S, Akiyoshi M, et al. Associations between anxiety, depression and insomnia in peri- and post-menopausal women. Maturitas 2012; 72: 61-5.
22. Herrero Babiloni A, De Koninck BP, Beetz G, et al. Sleep and pain: Recent insights, mechanisms, and future directions in the investigation of this relationship. J Neural Transm (Vienna) 2020; 127: 647-60.
23. Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35: 33-50.
24. Fang H, Tu S, Sheng J, et al. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med 2019; 23: 2324-32.
25. Latif I, Hughes ATL, Bendall RCA. Positive and negative affect mediate the influences of a maladaptive emotion regulation strategy on sleep quality. Front Psychiatry 2019; 10: 628.
26. Dirksen SR, Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs 2008; 61: 664-75.
27. Matthews EE, Arnedt JT, McCarthy MS, et al. Adherence to cognitive behavioral therapy for insomnia: A systematic review. Sleep Med Rev 2013; 17: 453-64.
28. Morin CM, Drake CL, Harvey AG, et al. Insomnia disorder. Nat Rev Dis Primers 2015; 1: 15026.
29. Herrero Babiloni A, Bellemare A, Beetz G, et al. The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuro-psychiatric conditions: A systematic review. Sleep Med Rev 2021; 55: 101381.
30. Ding F, O'Donnell J, Xu Q, et al. Changes in the composition of brain interstitial ions control the sleep-wake cycle. Science 2016; 352: 550-5.
31. Riemann D, Nissen C, Palagini L, et al. The neuro-biology, investigation, and treatment of chronic insomnia. Lancet Neurol 2015; 14: 547-58.
32. Polania R, Nitsche MA, Paulus W. Modulating functional connectivity patterns and topological functional organization of the human brain with transcrani-al direct current stimulation. Hum Brain Mapp 2011; 32: 1236-49.
33. Nitsche MA, Cohen LG, Wassermann EM, et al. Transcranial direct current stimulation: State of the art 2008. Brain Stimul 2008; 1: 206-23.
34. Nitsche MA, Paulus W. Transcranial direct current stimulation-update 2011. Restor Neurol Neurosci 2011; 29: 463-92.
35. Rivera-Urbina N, Nitsche M, Molero-Chamizo As. Transcranial direct current stimulation (tDCS) in the context of sleep and insomnia. J Sleep Med Disord 2016; 3: 1060.
36. Jiang CG, Zhang T, Yue FG, et al. Efficacy of repetitive transcranial magnetic stimulation in the treatment of patients with chronic primary insomnia. Cell Biochem Biophys 2013; 67: 169-73.
J Sleep Sci, Vol. 7, No. 3-4, 2022
http://jss.tums.ac.ir
21. Terauchi M, Hiramitsu S, Akiyoshi M, et al. Associ-ations between anxiety, depression and insomnia in peri- and post-menopausal women. Maturitas 2012; 72: 61-5.
22. Herrero Babiloni A, De Koninck BP, Beetz G, et al. Sleep and pain: Recent insights, mechanisms, and future directions in the investigation of this relation-ship. J Neural Transm (Vienna) 2020; 127: 647-60.
23. Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35: 33-50.
24. Fang H, Tu S, Sheng J, et al. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med 2019; 23: 2324-32.
25. Latif I, Hughes ATL, Bendall RCA. Positive and negative affect mediate the influences of a maladaptive emotion regulation strategy on sleep quality. Front Psychiatry 2019; 10: 628.
26. Dirksen SR, Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs 2008; 61: 664-75.
27. Matthews EE, Arnedt JT, McCarthy MS, et al. Adherence to cognitive behavioral therapy for insomnia: A systematic review. Sleep Med Rev 2013; 17: 453-64.
28. Morin CM, Drake CL, Harvey AG, et al. Insomnia disorder. Nat Rev Dis Primers 2015; 1: 15026.
29. Herrero Babiloni A, Bellemare A, Beetz G, et al. The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuro-psychiatric conditions: A systematic review. Sleep Med Rev 2021; 55: 101381.
30. Ding F, O'Donnell J, Xu Q, et al. Changes in the composition of brain interstitial ions control the sleep-wake cycle. Science 2016; 352: 550-5.
31. Riemann D, Nissen C, Palagini L, et al. The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol 2015; 14: 547-58.
32. Polania R, Nitsche MA, Paulus W. Modulating functional connectivity patterns and topological func-tional organization of the human brain with transcrani-al direct current stimulation. Hum Brain Mapp 2011; 32: 1236-49.
33. Nitsche MA, Cohen LG, Wassermann EM, et al. Transcranial direct current stimulation: State of the art 2008. Brain Stimul 2008; 1: 206-23.
34. Nitsche MA, Paulus W. Transcranial direct current stimulation-update 2011. Restor Neurol Neurosci 2011; 29: 463-92.
35. Rivera-Urbina N, Nitsche M, Molero-Chamizo As. Transcranial direct current stimulation (tDCS) in the context of sleep and insomnia. J Sleep Med Disord 2016; 3: 1060.
36. Jiang CG, Zhang T, Yue FG, et al. Efficacy of repetitive transcranial magnetic stimulation in the treatment of patients with chronic primary insomnia. Cell Biochem Biophys 2013; 67: 169-73.
37. Feng J, Zhang Q, Zhang C, et al. The Effect of sequential bilateral low-frequency rTMS over dorsolat-eral prefrontal cortex on serum level of BDNF and GABA in patients with primary insomnia. Brain Behav 2019; 9: e01206.
38. Zhang YP, Liao WJ, Xia WG. Effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation on chronic insomnia: A randomized clinical trial. Curr Med Sci 2018; 38: 491-8.
39. Etoom M, Alwardat M, Alghwiri A, et al. Effects of transcranial direct current stimulation on sleep in athletes: A protocol of a randomized controlled trial. J Clin Med 2022; 11.
40. Lanza G, Cantone M, Arico D, et al. Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory-motor network in patients with restless legs syndrome. Ther Adv Neurol Disord 2018; 11: 1756286418759973.
41. Lanza G, Lanuzza B, Arico D, et al. Impaired short-term plasticity in restless legs syndrome: A pilot rTMS study. Sleep Med 2018; 46: 1-4.
42. Frase L, Piosczyk H, Zittel S, et al. Modulation of total sleep time by transcranial direct current stimulation (tDCS). Neuropsychopharmacology 2016; 41: 2577-86.
43. Eggert T, Dorn H, Sauter C, et al. No effects of slow oscillatory transcranial direct current stimulation (tDCS) on sleep-dependent memory consolidation in healthy elderly subjects. Brain Stimul 2013; 6: 938-45.
44. Passmann S, Kulzow N, Ladenbauer J, et al. Boosting slow oscillatory activity using tdcs during early nocturnal slow wave sleep does not improve memory consolidation in healthy older adults. Brain Stimul 2016; 9: 730-9.
45. Roizenblatt S, Fregni F, Gimenez R, et al. Site-specific effects of transcranial direct current stimula-tion on sleep and pain in fibromyalgia: A randomized, sham-controlled study. Pain Pract 2007; 7: 297-306.
46. Sherwood MS, Madaris AT, Mullenger CR, et al. Repetitive transcranial electrical stimulation induces quantified changes in resting cerebral perfusion measured from arterial spin labeling. Neural Plast 2018; 2018: 5769861.
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| Files | ||
| Issue | Vol 7 No 3-4 (2022): Summer-Autumn | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jss.v7i(3-4).15250 | |
| Keywords | ||
| Transcranial direct current stimulation; Insomnia; Motor cortex; Dorsolateral prefrontal cortex | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Motevalizadeh T, Rezaei F, Sadeghniiat Haghighi K, Sepahvand MA. Transcranial Direct Current Stimulation (tDCS) as a Therapeutic Tool for Chronic Insomnia. J Sleep Sci. 2024;7(3-4):80-89.
