TMS Therapy for Insomnia and Sleep Disorders

Lack of sleep or low-quality sleep can test even the calmest, most tolerant personality. Chronic insomnia can trigger or worsen depressive symptoms and is also one classic symptom of both Major Depressive Disorder and Generalized Anxiety Disorder. Insomnia is also a common symptom in many other neuropsychiatric conditions. 

Read more: TMS for anxiety →

Current research estimates that 30% to 40% of adults may suffer from insomnia at any given time.¹ But there’s hope. Studies are showing promising results using TMS therapy for treating insomnia, as well as for depression and anxiety disorders, which TMS is best known for.

Read more: TMS for depression →

Postpartum Depression affects some 15% of New Mothers

Pregnancy and the postpartum period can play havoc with mental health. The pressure is on new mothers to be overjoyed to bring a new life into the world, while recovering from the exhausting and painful process of giving birth. Breastfeeding can be a challenge for many and sometimes not an option due to extenuating factors or a personal decision. Most newborns don’t sleep well and need to eat every few hours as is, leading to poor sleep. Add to this an extreme change in hormone levels and it can be easy to understand how this is a high-risk time frame for postpartum depression and anxiety.  Statistics point to some 15% or more of all new mothers experiencing postpartum depression each year. This approaches one million mothers per year in the US when including miscarriage and stillbirths.

Insomnia is typically characterized by unrelenting struggles to fall and remain asleep for an average of 6-8 hours. Inability to fall asleep in a timely fashion can be caused by, or result in, anxiety over the ability to fall asleep and a catch-22 situation occurs. When sleep does occur, it can be restless, broken, and of inadequate quality. Early wakening can occur as well and it can be impossible to get back to sleep. Daytime sleepiness, irritability, brain fog, and associated negative emotional states ensue and this significantly reduces the quality and function of daily life. 

Treatment will depend on various individual factors and examination of lifestyles and medications to identify root causes. Medication or sleep medicine is usually a last resort and initial remedies should include education about sleep hygiene, avoiding stimulants such as tea and coffee, avoiding alcohol, practicing physical exercise in the daytime, setting up a regular sleep routine, ensuring a relaxing sleep environment with a cool ambient temperature, providing adequate air circulation, removing mobile phones, laptops and TVs from the bedroom and stopping use of same at least an hour before sleep. Refer to our blog post on tips for insomnia relief here →

Repetitive Transcranial Magnetic Stimulation-rTMS for Insomnia

During one study from 2014, after 10 days of rTMS treatment, study participants saw an improvement in total sleep time, sleep efficiency, sleep onset latency, total wake time, and wake time after sleep onset.²

Another larger study from 2013, found that rTMS improved both Slow Wave Sleep and REM sleep in comparison with CBT and hypnotic medications such as Ambien. They reported that TMS had the lowest relapse rate for insomnia and was a better long term treatment option for insomnia than CBT or medications.³

Treating Insomnia caused by Depression or Anxiety

TMS is most commonly known to treat Major Depressive Disorder (FDA Approved) and Generalized Anxiety Disorder (off label, but gaining traction), and while treating these disorders, a secondary effect of improved sleep and relief from insomnia is often seen. In one study, right sided rTMS treatment, typically used to treat anxiety, showed the most improvement in sleep quality with an increase in average time of sleep, decreased number of times eyes opened during sleep, and improved sympathetic activity in sleep.⁴

Read more: How TMS therapy works →

In another, Huang et al. 2018 described right sided stimulation for generalized anxiety and insomnia using a low-frequency protocol for 10 days, showing improvement in the Hamilton Rating Scale for Anxiety as well as the Pittsburgh Sleep Quality Index in 36 patients.

Another study by Li et al. 2013 studied 30 patients with major depressive disorder and 30 patients with major depressive disorder associated with insomnia receiving TMS.  Both groups improved with respect to depression and the latter as well to insomnia.⁵

Another study in 2017, found TMS to the right dorsolateral prefrontal cortex improved insomnia in 20 out of 25 patients.⁶

Read more: TMS therapy for depression →

Several other studies targeting anxiety with the use of TMS likewise showed improvement in sleep parameters.⁷⁸ Other studies have similarly shown improvements in sleep parameters and quality of sleep with left sided treatment in the context of depression treatment. Measuring cortisol and melatonin levels, another case study revealed excitatory left sided treatment, which is typically used to treat depression symptoms, as effective in decreasing cortisol levels, the stress hormone, and increasing melatonin levels two days after treatment, thus resulting in improved sleep and relief from insomnia.⁹

Read more: TMS therapy for anxiety →

In a recent meta-analysis looking at multiple studies using TMS for various indications, TMS was superior to sham treatment in improving sleep efficiency, total sleep time, sleep onset latency, wake up after sleep onset, and number of awakenings.¹⁰

TMS for Insomnia caused by Restless Leg Syndrome (RLS)

Sleep disruption is a by-product of Restless Leg Syndrome preventing undisturbed sleep. Several studies have shown improvement in RLS and sleep with the use of TMS.¹¹¹²  Improvements occurred in total sleep hours, quality of sleep, and reduction in leg movements. And benefits were sustained for at least 2 months on repeat check-in.

TMS for Insomnia Associated with Other Conditions

Sleep improvement has been demonstrated in several studies evaluating insomnia associated with chronic back pain, Parkinson’s Disease, and in the context of Substance Use Disorder treatment.¹³¹⁴¹⁵¹⁶

Read more: TMS vs medication →

As with other areas of neuropsychiatric research, the full use of Transcranial Magnetic Stimulation continues to be explored and insomnia symptoms have occurred in many studies. Positive developments spur further research and studies leading to improved and enhanced solutions for the myriad of neuropsychiatric conditions. As a non-invasive, and potentially fast acting treatment, how much more sleep can you afford to lose?

TMS for Sleep Disorder at Inspire TMS Denver

The team at Inspire TMS Denver can offer individual consultations to explore if and how TMS could support you with depression, anxiety, and insomnia. Although TMS treatment specifically for insomnia remains off-label and not covered by insurance, we offer competitive sliding scale self-payment options and insomnia often coexists in Major Depressive Disorder - which is FDA approved and insurance covered. Every contraindication will be robustly examined and if treatment is supported, the team will compose a bespoke, personalized treatment schedule catering to you and your condition. Schedule a free consultation or call us today. →