by Isabel Leming, TMS Technician
In her latest expert blog post, Isabel Leming explores how rTMS could help sufferers of chronic primary insomnia, a condition which frustrates and exhausts those who experience it.
“In recent times more and more people are complaining of sleep disturbances and are experiencing sleep deprivation as a result of the changes in our daily lives. It is estimated that as many as two-thirds of adults around the world aren’t getting enough sleep. In the modern world there are a range of things that are leading us to sleep less and less.
What is impacting our sleep?
“Caffeine and alcohol are just two of these things keeping us awake and fragmenting our sleep. These substances, among others, have been shown to affect both the quantity and quality of sleep.
“The increased use of technology has also had an impact on this. Our mobile phones, tablets and computers emit LED light’s, breaking our natural melanin cycle. This melanin cycle is responsible for alerting us of when it is time to sleep. Living in a world now surrounded by social media, means that this cycle is being broken more and more as many of us can find ourselves scrolling through our long in to the early hours of the morning, leaving us less than restored for a hard day at work.
“However, for some adults, this sleep deprivation is a result of Insomnia, a sleep disorder that affects people from all populations. Insomnia is characterized by a difficulty falling asleep or staying asleep.
“Whilst insomnia is often secondary to another underlying illness e.g. depression, anxiety or pain but in some instances, people can experience primary insomnia. Research by WHO suggests that primary insomnia is present in roughly 10% of the population. Primary insomnia is when there are no other underlying medical issues.
Symptoms of insomnia include:
- Difficulty falling asleep at night.
- Waking up during the night.
- Waking up too early.
- Not feeling well-rested after a night’s sleep.
- Daytime tiredness or sleepiness.
- Irritability, depression or anxiety.
- Difficulty paying attention, focusing on tasks or remembering.
- Increased errors or accidents.
“Neurologically, Insomnia has recently been linked to neuronal hyper-excitability as well as an increase in both beta and gamma wave activity during sleep onset and light sleep (Van der Werf, 2010). Research by Sales et al. also showed that a particular area of the brain, the motor cortex has more neuroplasticity in patients with chronic insomnia than in people who sleep well.
Treatment”For those struggling with chronic insomnia there are both medical and non-medical treatments available.
Non-medical/behavioural treatments include:
- Relaxation training: breathing exercises, mindfulness, medication techniques, guided imagery.
- Sleep hygiene – building an association between the bedroom and sleep. E.g. going to bed only when you are sleepy, and getting out of bed if you’ve been awake for 20 minutes or more.
- Cognitive Behavioural Therapy (CBT) – This focuses on both thinking positively about sleep and bedtime routine and changing behaviours related to bedtime routine e.g. only going to bed when you are tired.
Medical Treatments include:
- Medication – most commonly, antidepressant drugs or sedatives are prescribed to treat primary insomnia. However, the evidence supporting the efficacy of these is lacking. Whilst the may provide symptomatic relief, when treatment is terminated patients commonly show a full return to insomnia.
- rTMS – Research has begun to investigate the use of rTMS as a treatment for insomnia.
“Research by jiang in 2013 compared rTMS, CBT and antidepressants on a range of sleep parameters. The results showed that rTMS significantly increased both slow wave sleep and REM sleep when compared to CBT and medicine and patients treated with rTMS also showed the lowest levels of relapse. TMS increased total sleep time by about 25% and stress levels were also restored towards normal levels and no side effects were reported.
“Further research (Sanchez-Escandon et al, 2014) studied patients with insomnia who were shown to have EEG abnormalities. Ten patients were treated with daily TMS for 15 minutes over ten days. Significant improvements were seen in sleep efficiency and total time spent awake.
“rTMS is currently recommended under the NICE guidelines as a treatment for depression and is often preferred to other treatment forms, such as antidepressants due to the lack of side-effects.”
rTMS for Chronic Primary Insomnia
Isabel Leming, TMS Technician
Isabel is a member of the Smart TMS team of technicians. Her qualifications and experience prior to working at Smart TMS include:
- Behaviour Support Worker, North Bristol NHS Trust, working on a neurology/stroke ward
- Role Play Therapist, behavioural outreach service and learning support within education
- Researcher at The University of Glasgow
- Research masters in Brain Sciences, 2015, The University of Glasgow
- Bachelor of Science (BS) in Psychology and Sport, 2014, The University of Stirling
She is based at our Bristol TMS Clinic.
Smart TMS
Smart TMS was established in 2015, dedicated to providing TMS treatment in London at their South Kensington/Brompton Cross centre. The company opened a second clinic in Birmingham in September 2017 and also has a base in Northampton. The first Irish clinic was opened in Dublin in October 2017. Smart TMS is planning further locations for Manchester and Bristol in 2018.
CONTACT US
For any queries or for patients wishing to book an appointment at one of our UK clinics, please contact us:
Tel: 0345 222 5678
Email: info@smarttms.co.uk
Irish patients may contact Our Dublin Clinic direct on:
Email: info@smarttms.ie
Tel: 353 (01) 254 2514
Website: www.smarttms.ie