A study found that combining transcranial direct current stimulation (tDCS) with repetitive transcranial magnetic stimulation (rTMS) is a safe, effective and noninvasive treatment for chronic insomnia.
By
Lana Pine
| Published on November 27, 2024
5 min read
Credit: Adobe Stock/sornram
Combining two noninvasive brain stimulation therapies, transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), can significantly improve insomnia symptoms. After just two weeks of treatment, patients experienced notable relief that persisted during follow-up, showing the long-term benefits of this combined approach.
This therapy offers a safe, effective option for adults with chronic insomnia, providing rapid results and sustained improvements in sleep quality.
Insomnia affects approximately 10% to 20% of the population and can significantly impact a person’s physical and mental health, reduce work efficiency and alertness, and can sometimes lead to accidents.
Both pharmacological and nonpharmacological treatments are commonly prescribed to treat the condition, among them being sedative-hypnotic drugs. While this treatment can be effective, it is also associated with a number of adverse reactions that can include withdrawal syndrome. Therefore, research is increasingly focusing on finding effective and safe nonpharmacological treatment options, such as neurotherapy.
“Specifically, techniques such as tDCS and rTMS are widely used in clinical practice, both domestically and internationally, because of their noninvasive, penetrating and easy-to-operate characteristics,” wrote a group of investigators from the Department of Psychiatry at Ningbo Kangning Hospital in Zhejiang, China.
rTMS works by using time-varied magnetic signals to pass through the skull to generate currents in particular parts of the brain, which can lead to electrophysiological and functional changes. These effects are long-lasting and have been shown to increase slow-wave sleep and rapid eye movement sleep phases, which in turn improves sleep quality. tDCS treatment regulates cortical activity by applying a low-intensity current to the scalp, which can lead to ion activity, brain oscillatory activity and neurotransmitter release.
In this double-blind, parallel-controlled trial, investigators evaluated the safety and efficacy of combination therapy with tDCS and rTMS among adults with chronic insomnia enrolled in the Sleep Clinic Center at Ningbo Kangning Hospital. A sample of 157 participants were randomly assigned into three groups: one that received both therapies together (tDCS + rTMS), another that received rTMS with a fake tDCS treatment (sham tDCS + rTMS), and the third that received tDCS with a fake rTMS treatment (tDCS + sham rTMS). Each group completed 20 sessions over a four-week period.
No significant differences in demographics and clinical information were observed between the three cohorts, and the retention rate at the end of the study period was 95.7%.
Results demonstrated that the tDCS + rTMS group had the best improvements in sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), with benefits lasting for three months after treatment. This group also exhibited the greatest reductions in anxiety and depression symptoms, measured by the Hamilton Depression (HAMD) and Anxiety (HAMA) Scales.
For male participants, the group receiving both tDCS + rTMS had the best sleep improvement (lowest PSQI scores) compared with the other groups at 2 weeks, 4 weeks and 3 months after treatment. Significant differences were also observed when comparing this combination therapy to either single-therapy group (tDCS + sham rTMS or sham tDCS + rTMS), showing clear advantages. Among women, tDCS + rTMS treatment also showed the best results at 2 weeks and 3 months after treatment. However, at 4 weeks, there were no significant differences between the groups, suggesting some fluctuation in treatment response for women.
Importantly, no serious side effects occurred during the study, suggesting this combined approach is both effective and safe for managing chronic insomnia. The most frequently cited side effects were transient headache (three patients), mild skin redness (two patients) and mild pruritus (two patients).
“Further research is encouraged to explore how tDCS and rTMS improve sleep quality using objective tools to definitely evaluate their efficacy,” investigators concluded. “Additionally, investigating the underlying mechanism through neuroelectrophysiological methods could provide valuable insights into how this treatment works for insomnia.”
