Transcranial Magnetic Stimulation (TMS) is an innovative therapy that can help relieve symptoms of chronic insomnia without medication. This treatment uses magnetic pulses to stimulate specific regions of the brain involved in regulating sleep and mental health, helping address both poor sleep patterns as well as mental well-being.
If you suffer from insomnia and related mood disorders, TMS may be the treatment you’re looking for. In this blog, we discuss what you need to know about TMS treatment for primary chronic insomnia, including how the treatment works, research into its effectiveness, and how TMS targets both sleep and mental health at the same time.
What is insomnia?
Insomnia is a sleep disorder that manifests as difficulty falling asleep, staying asleep, or getting enough sleep. While it’s normal for anyone to experience occasional sleeplessness, insomnia is characterized by persistent difficulties that disrupt daily life. It can be short-term, often triggered by stress or life changes, or long-term, lasting for months or even years.
In the long-term, insomnia can impact a person’s energy levels, mood, and concentration, leading to increased risk of other medical or mental health issues, such as depression, generalized anxiety disorder, or even cardiovascular diseases.
Types of insomnia
There are two main forms of insomnia:
- Primary insomnia: This form of insomnia is not directly linked to other health conditions or issues.
- Secondary insomnia: This form of insomnia is linked to other health conditions, such as chronic pain, medication, depression, or substance abuse.
Most cases of insomnia are linked to underlying conditions like depression or anxiety, however primary chronic insomnia isn’t connected to mental health disorders, medication, or substance use. It is recognized as a separate, independent condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Primary chronic insomnia is also unrelated to other sleep disorders, such as narcolepsy, parasomnia (sleepwalking), or circadian rhythm disorders (struggling to stick to a normal day/night schedule).
Symptoms of insomnia
Insomnia symptoms can vary with each person, however they include:
- Difficulty falling asleep: Spending long periods tossing and turning before eventually falling asleep.
- Difficulty maintaining sleep: Waking up frequently during the night and struggling to fall back asleep.
- Waking up too early: Waking up earlier than desired and being unable to return to sleep.
- Resistance going to bed: Being unable to go to sleep at a reasonable hour.
The American Academy of Sleep Medicine (AASM) defines chronic insomnia as when a person experiences symptoms at least three times per week for at least three months. Additionally, a person must experience one or more of the following daytime symptoms:
- Fatigue or malaise: Feeling excessively tired or drowsy during the day despite spending enough time in bed.
- Irritability or mood changes: Increased anxiety, frustration, or depressive symptoms due to lack of proper sleep.
- Reduced concentration, attention or memory issues: Struggling to focus, retain information, or complete tasks effectively.
- Physical symptoms: Headaches, tension, or restlessness due to inadequate sleep.
- Negative impact on performance: Including social, family, work, or school performance.
- Behavioral issues: Including hyperactivity, aggression, or impulsive behavior.
Treatments for insomnia
Insomnia is often treated with psychotherapy or medication. Cognitive behavioral therapy (CBT) can help address and improve poor sleeping habits, while medication such as sedatives or antidepressants can offer symptomatic relief. Newer, more innovative insomnia treatments include Transcranial Magnetic Stimulation (TMS) therapy.
Because insomnia is often linked to stress, lifestyle factors, or co-occurring medical or psychiatric conditions, it’s important that treatment addresses both the underlying causes as well as the symptoms.
Cognitive behavioral therapy (CBT)
CBT is often considered the first-line treatment for insomnia, combining cognitive and behavioral approaches to help people control or reduce negative thoughts and actions that interfere with sleep.
The cognitive component of CBT helps people recognize and change negative beliefs and worries that keep them awake. For example, CBT for insomnia could help someone reframe fears about sleeplessness to reduce anxiety related to falling asleep.
The behavioral component of CBT focuses on teaching better sleep habits and stopping behaviors that interfere with proper sleep. This type of therapy is especially useful for those who struggle to fall asleep (as opposed to maintaining sleep or waking early).
Behavioral therapies for insomnia include:
- Stimulus control therapy: This focuses on training your mind and body to sleep better. For example, it might involve setting regular sleep/wake times or using the bed only for sleeping or intimacy.
- Sleep restriction: This focuses on reducing time spent in bed so a person gets less sleep, making them more tired the following night.
- Relaxation techniques: This focuses on reducing bedtime anxiety and promoting relaxation through techniques like progressive muscle relaxation, biofeedback, and breathing exercises.
- Paradoxical intention: This focuses on reducing the stress and pressure of falling asleep by encouraging people to actively stay awake instead of trying to sleep.
- Light therapy: This focuses on adjusting the internal sleep/wake cycle by using light exposure at specific times.
Prescription medicines
Prescription medications are also used to help manage insomnia. These are usually recommended for short-term use as they can lead to dependency or side effects. For many people with insomnia, medication is a last resort after CBT and other relaxation techniques have not been effective.
Medications used to treat insomnia include:
- Benziodiazepines (BZD): These are a class of psychoactive drugs that can help with sleep. Although five types of BZDs have been FDA-approved for treating insomnia, they’re not normally recommended due to their potential for abuse, tolerance, and dependency.
- Non-benzodiazepine sedatives (Z): These include medications like zolpidem (Ambien), which offer similar benefits to benzodiazepines with fewer side effects and abuse potential.
- Melatonin agonists: Melatonin is a hormone released by the pineal gland at night to induce feelings of sleepiness and relaxation. The medication ramelteon mimics the effects of melatonin, which can help people fall asleep easier. While ramelteon has less severe effects than BZDs and Z drugs, it can create dizziness, nausea, and fatigue in some people.
- Orexin receptor antagonists: Orexins are neurotransmitters that regulate sleepiness and wakefulness in the body. The medication suvorexant acts as an orexin receptor antagonist, making it useful in falling asleep or maintaining sleep.
- Other medications: Other medications that can treat insomnia include antidepressants and antipsychotic medications, as well as over-the-counter treatments such as antihistamines and melatonin supplements.
See: Do Antidepressants Work and How Effective Are They?
Transcranial Magnetic Stimulation (TMS)
TMS therapy is an emerging treatment for insomnia. This non-drug therapy uses magnetic pulses to stimulate specific regions of the brain involved in mood and sleep regulation. TMS can help relieve insomnia by addressing imbalances in brain activity that can cause sleep disturbances. It is also effective in reducing anxiety, which can often worsen insomnia.
Given as daily treatments over several weeks, TMS offers a non-invasive, non-systemic alternative to medication with minimal side effects.
What is TMS?
TMS is an innovative therapy that uses magnetic fields to stimulate specific areas of the brain. The treatment was first FDA-approved for treating major depressive disorder, and it has since shown promise in relieving a range of other neurological and mental health conditions, including anxiety disorders, post-traumatic stress disorder (PTSD), and even insomnia.
During a TMS session, a stimulator (or electric pulse generator) is connected to a magnetic coil placed on the individual’s scalp. This coil creates a magnetic field which induces an electric current that reaches specific regions of the brain and stimulates nerve cells.
TMS is a quick, non-invasive, drug-free treatment that offers a safe alternative for those who want to minimize or avoid taking medications. Each session lasts around 20 to 40 minutes and patients remain awake and alert throughout the procedure. After the session is over, they’re free to resume their regular activities as normal.
How does TMS for insomnia work?
TMS therapy for insomnia focuses on addressing abnormal brain activity associated with poor sleep. The treatment works by stimulating specific regions of the brain responsible for initiating and maintaining sleep, like the right dorsolateral prefrontal cortex (DLPC) or posterior parietal cortex. Stimulating these regions can help regulate brain activity and improve sleep quality for patients with primary chronic insomnia.
A low-frequency form of TMS, known as repetitive transcranial magnetic stimulation (rTMS) is particularly known to positively achieve better sleep cycles, especially Stage III and REM sleep. Numerous studies have explored the efficacy of rTMS treatment in improving sleep for patients with primary insomnia – we’ll look at these next.
Keep Reading: Who Qualifies for TMS Therapy? (TMS Requirements)
Can TMS help with insomnia?
Studies exploring TMS for insomnia have found it effective in improving sleep quality, duration, and overall restfulness. Below, we look into what research has shown into the effectiveness of TMS for insomnia.
TMS for insomnia study: More effective than medication and CBT
In 2013, a pivotal study examined 120 patients with primary chronic insomnia. They were divided into three treatment groups:
- Group one received low-frequency TMS for two weeks
- Group two were given a benzodiazepine medication for two weeks
- Group three received cognitive behavioral therapy for two weeks.
The study found that TMS increased the total average sleep time by 25%, outperforming both medication and psychotherapy. The treatment significantly improved REM sleep, and unlike medication and CBT, helped patients maintain sleep improvements over time. TMS was also found to lower stress levels, and none of the participants reported adverse effects – a key advantage over medication-based treatments.
TMS for insomnia: Systematic review and meta-analysis
A 2021 systematic review and meta-analysis published in Sleep Medicine further highlights the efficacy of rTMS for insomnia. Here, the researchers analyzed 36 trials from 28 studies, involving a total of 2,357 adults with an average age of 48.8 years. The findings concluded that rTMS is both safe and effective, whether used as a standalone treatment or in combination with other therapies.
The review also found that rTMS improved critical sleep stages, especially deep sleep (Stage III) and REM sleep, both of which are crucial for restorative rest and mental health.
Continue Reading: Short-Term and Long-Term Efficacy of Accelerated Transcranial Magnetic Stimulation for Depression
Link between sleep & mental health
Sleep and mental health are deeply intertwined. If you’ve ever had jet lag or a bad night’s sleep, you’ll have probably noticed the impact of poor sleep on your mood, memory, and focus the next day. Sleep is important for helping us regulate our emotions, consolidate memories, and maintain cognitive functioning. If our sleep is disrupted in any way, these processes suffer and can result in mood swings, irritability, and reduced problem-solving abilities.
For people with existing mental health conditions, chronic insomnia can worsen symptoms of:
- Depression by lowering serotonin levels and increasing feelings of hopelessness
- Anxiety by heightening stress responses and over-activating the brain’s fear centers
- PTSD by impairing the brain’s ability to process traumatic memories.
The relationship between sleep and mental health goes both ways. While poor sleep can worsen mental health, untreated mental health conditions can also affect sleep and lead to insomnia. For example, anxiety can make it difficult to fall asleep while depression can disrupt sleep cycles, causing someone to wake up early or sleep excessively without feeling rested.
This connection between sleep and mental health means restoring healthy sleep patterns can improve mental health and vice versa. What makes TMS unique is that it addresses both sleep and mental health simultaneously. Research shows that TMS not only improves sleep quality but also reduces symptoms of depression, anxiety, PTSD, and other mental health conditions.
Learn More: How Diet and Exercise Affect Your Mental Health
Benefits of TMS for insomnia
The benefits of TMS therapy for insomnia include:
- Improved sleep quality: Regular TMS sessions have been shown to improve both duration and quality of sleep.
- Better sleep cycles: TMS can normalize brain activity, helping patients achieve more restorative sleep cycles.
- Targeted treatments: TMS is a precise and personalized treatment. Technicians can target the specific regions of the brain most affected by insomnia, helping increase success rates while minimizing side effects.
- Addresses mental health conditions: TMS doesn’t just improve sleep, it can also help address underlying mental health conditions like comorbid major depressive disorder to improve overall well-being.
TMS for primary chronic insomnia
If traditional therapies like CBT or medications haven’t worked for your insomnia, TMS therapy could be the solution you’ve been looking for. This revolutionary treatment addresses the root causes of sleep and mental health at the same time, helping break the cycle and support long-term well-being.
At BestMind Behavioral Health, we’re dedicated to helping you improve your mental health with personalized care tailored to your unique needs. If chronic insomnia has been affecting your quality of life, contact our team today to explore how TMS can help restore your sleep and transform your mental health.
