Is rTMS an Effective Treatment for Insomnia?

Is rTMS effective for treating insomnia?

Due to autonomic nervous system dysfunction, I was prescribed Lorazepam 0.5 mg by my doctor.
After taking it for over three months, I stopped the medication and experienced insomnia, which I never had before.
I deeply suspect that it is a side effect of the medication.
After switching doctors, my current physician has tried over a dozen different medications (excluding controlled substances).
When I asked if I should go back to taking Lorazepam, the doctor advised against it, suggesting that I gradually switch medications, assuring me that there would eventually be a suitable option.
However, after a year and a half, I am still experiencing the same insomnia.
Falling asleep is somewhat manageable, but I can only sleep for 1-3 hours before waking up, and sometimes I wake up in less than an hour.
Although I can fall back asleep, I often wake up repeatedly, resulting in very poor sleep quality.
I have been suffering from insomnia for a year and a half, which is extremely distressing.
I have also consulted other doctors, but they prescribed multiple controlled substances at once, which I am hesitant to take.
After initially stopping one medication, I cannot accept the idea of taking many.
My original doctor explained that prescribing many short-acting medications is only a temporary solution and does not address the root cause.
I do not want to take Lorazepam anymore; when I see children, I feel no joy and my mind is very calm, yet my stomach pain persists, which is not what I want.
Would rTMS be effective for me? Is there a doctor who can answer my question? I would be very grateful.

Ning Ning, 40~49 year old female. Ask Date: 2022/12/16

Dr. Qiu Junda reply Psychiatry

Hello.
I don't have experience in this area and cannot share with you.
However, rTMS (repetitive Transcranial Magnetic Stimulation) is primarily used to treat patients with treatment-resistant depression (currently out-of-pocket as it is not covered by insurance).
It is rarely used for insomnia treatment.
I suggest you call facilities that offer this treatment option to understand the relevant details (indications, pricing, etc.) before considering its feasibility.

Reply Date: 2022/12/16

More Info

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive procedure that has gained attention for its potential in treating various mental health conditions, particularly major depressive disorder. However, its application for insomnia is less common and still under investigation.

Effectiveness of rTMS for Insomnia
Research on the effectiveness of rTMS specifically for insomnia is limited, but some studies suggest that it may help improve sleep quality, particularly in individuals with co-occurring depression or anxiety disorders. The mechanism behind rTMS involves the use of magnetic fields to stimulate nerve cells in the brain, which can influence mood and potentially improve sleep patterns. For individuals who have experienced insomnia as a result of anxiety or depression, rTMS may provide a dual benefit by addressing both mood and sleep issues.

In your case, it seems that the insomnia developed after discontinuing Lorazepam, a benzodiazepine that can lead to dependence and withdrawal symptoms, including sleep disturbances. The transition from benzodiazepines to other medications can be challenging, and it’s not uncommon for patients to experience prolonged insomnia during this period. rTMS could be a viable option to explore, especially if traditional pharmacological treatments have not yielded satisfactory results.

Risks and Considerations
While rTMS is generally considered safe, it does come with some risks. The most common side effects include headaches, scalp discomfort, and, in rare cases, seizures. It is crucial to have a thorough evaluation by a qualified healthcare provider to determine if rTMS is appropriate for your specific situation. Additionally, the treatment is typically not covered by insurance, which can be a significant consideration for many patients.

Alternative Approaches
Given your experience with various medications and the distress caused by insomnia, it may also be beneficial to consider non-pharmacological approaches alongside or instead of rTMS. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-established treatment that focuses on changing sleep habits and misconceptions about sleep. It has been shown to be effective for many individuals with chronic insomnia.

Incorporating lifestyle changes such as maintaining a regular sleep schedule, creating a calming bedtime routine, and avoiding stimulants like caffeine and nicotine can also significantly impact sleep quality. Mindfulness practices, relaxation techniques, and even gentle exercise can help reduce anxiety and improve overall well-being.

Conclusion
In summary, rTMS may offer a potential treatment avenue for insomnia, particularly if it is linked to underlying mood disorders. However, it is essential to weigh the benefits against the risks and consider other therapeutic options, including CBT-I and lifestyle modifications. Consulting with a healthcare professional who specializes in sleep disorders can provide you with tailored advice and help you navigate your treatment options effectively. Your journey towards better sleep may require a multifaceted approach, and finding the right combination of therapies is key to achieving lasting relief.

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