![]() ![]() ![]() Some studies of TMS have reported significant improvements in sleep quality, suggesting it may also be an option in the future. Previous work has shown that TMS is safe and effective. 15 Currently, TMS is primarily used to alleviate symptoms of depression, anxiety, and migraine. 14 Transcranial magnetic stimulation (TMS) has been used to understand the neurobiology of insomnia and proposed as a potential therapeutic tool. Alpha stimulation is a type of CES that is an FDA-approved, handheld, prescription medical device. Cranial electrical stimulation (CES) is increasingly being considered, but more research is needed to assess its clinical benefits. 13 Sleep-Promoting Devices and ToolsĪ number of devices hold promise for insomnia resolution. 12 Hypnotherapy may have benefit, but there are some precautions to consider (eg, headache, drowsiness, creation of false memories, or strong emotions due to stressful events from earlier memories). 11 Although acupuncture may be effective, larger trials are still needed to assess the long-term effects. Acupuncture combined with estazolam (a sedative/hypnotic benzodiazepine) led to higher rates of improving sleep initiation, duration, and efficiency compared with estazolam alone. 9,10 Acupuncture, either alone or in combination with other treatments is an option. A randomized controlled trial is currently being performed to seek more evidence for efficacy of mindfulness meditation. A study showed that sleep efficacy improved from 30.87% to 69.87% following mindfulness meditation alone however, this study was limited by lack of a control group. Mindfulness meditation can help patients adopt new ways to manage symptoms through meditation exercises, discussions, and daily monitoring of sleep-wake activities. Other adjunctive techniques may also help treat insomnia. ![]() If patients can not access in-person CBT-I, it can be offered online or via video conference. 4-7 Because of the limited number of fellowship-trained sleep psychologists, alternative options (eg, supervised behavioral sleep-trained nurses, individuals with a master’s degree in psychology, or wellness coaches) are being explored. 3 Strategies for CBT-I management options are listed in the Table. The American Academy of Sleep Medicine and the American College of Physicians recommend CBT-I as first-line treatment for chronic insomnia. In CBT-I, patients are guided through a structured and personalized program, typically by a sleep behavior psychologist, to modify their cognitive processes and sleep behaviors in an effort to improve their sleep. The accepted standard treatment for chronic insomnia is cognitive-behavioral therapy for insomnia (CBT-I). Clinicians, however, now have Food and Drug Administration (FDA)-approved home monitoring devices to help evaluate insomnia, which can provide high-value care for patients and more individualized understanding of a particular patient’s sleep patterns. Insomnia remains a clinical diagnosis based on these symptoms and does not require polysomnography. 2 Patients often experience daytime sleepiness and/or reduced cognitive function that negatively interferes with daily life, affecting productivity and mood. InsomniaĬhronic insomnia is generally categorized as difficulty falling asleep or maintaining a regular sleep schedule for at least 3 months. Screenshots from MySleepApp show how digital screening can help identify and advise patients about potential sleep disorders. ![]()
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