Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls

Lukas Frase; Peter Selhausen; Lukas Krone; Sulamith Tsodor; Friederike Jahn; Bernd Feige; Jonathan G Maier; Florian Mainberger; Hannah Piosczyk; Marion Kuhn; Stefan Klöppel; Annette Sterr; Chiara Baglioni; Kai Spiegelhalder; Dieter Riemann; Michael A Nitsche; Christoph Nissen

doi:10.1016/j.brs.2019.01.001

Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls

Brain Stimul. 2019 May-Jun;12(3):674-683. doi: 10.1016/j.brs.2019.01.001. Epub 2019 Jan 4.

Authors

Lukas Frase¹, Peter Selhausen², Lukas Krone², Sulamith Tsodor², Friederike Jahn², Bernd Feige², Jonathan G Maier², Florian Mainberger², Hannah Piosczyk², Marion Kuhn², Stefan Klöppel³, Annette Sterr⁴, Chiara Baglioni², Kai Spiegelhalder², Dieter Riemann², Michael A Nitsche⁵, Christoph Nissen⁶

Affiliations

¹ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Center for NeuroModulation, Faculty of Medciine, University of Freiburg, Germany.
² Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
³ University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland.
⁴ Department of Psychology, University of Surrey, UK.
⁵ Department of Clinical Neurophysiology, University Medical Center Göttingen, Germany; Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
⁶ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland. Electronic address: christoph.nissen@upd.ch.

PMID: 30639236
DOI: 10.1016/j.brs.2019.01.001

Abstract

Background: Arousal and sleep represent basic domains of behavior, and alterations are of high clinical importance.

Objective/hypothesis: The aim of this study was to further elucidate the neurobiology of insomnia disorder (ID) and the potential for new treatment developments, based on the modulation of cortical activity through the non-invasive brain stimulation technique transcranial direct current stimulation (tDCS). Specifically, we tested the hypotheses that bi-frontal anodal tDCS shortens and cathodal tDCS prolongs total sleep time in patients with ID, compared to sham stimulation. Furthermore, we tested for differences in indices of arousal between ID patients and healthy controls and explored their potential impact on tDCS effects.

Methods: Nineteen ID patients underwent a within-subject repeated-measures sleep laboratory study with adaptation, baseline and three experimental nights. Bifrontal anodal, cathodal and sham tDCS was delivered in a counterbalanced order immediately prior to sleep. Wake EEG was recorded prior to and after tDCS as well as on the following morning. Subsequently, we compared patients with ID to a healthy control group from an earlier dataset.

Results: Against our hypothesis, we did not observe any tDCS effects on sleep continuity or sleep architecture in patients with ID. Further analyses of nights without stimulation demonstrated significantly increased levels of arousal in ID patients compared to healthy controls, as indexed by subjective reports, reduced total sleep time, increased wake after sleep onset and increased high frequency EEG power during wakefulness and NREM sleep. Of note, indices of increased arousal predicted the lack of effect of tDCS in ID patients.

Conclusions: Our study characterizes for the first time differential effects of tDCS on sleep in patients with ID and healthy controls, presumably related to persistent hyperarousal in ID. These findings suggest that adapted tDCS protocols need to be developed to modulate arousal and sleep dependent on baseline arousal levels.

Keywords: Brain stimulation; EEG; Electrosleep; Hyperarousal; Non-invasive.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Arousal*
Case-Control Studies
Female
Humans
Male
Middle Aged
Sleep Initiation and Maintenance Disorders / physiopathology*
Sleep Initiation and Maintenance Disorders / therapy
Sleep*
Transcranial Direct Current Stimulation / methods*
Wakefulness