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

Frase, L.; Selhausen, P.; Krone, L.; Tsodor, S.; Jahn, F.; Feige, B.; Maier, Jonathan Gabriel; Mainberger, F.; Piosczyk, H.; Kuhn, M.; Klöppel, Stefan; Sterr, A.; Baglioni, C.; Spiegelhalder, K.; Riemann, D.; Nitsche, M. A.; Nissen, Christoph (2019). Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls. Brain stimulation, 12(3), pp. 674-683. Elsevier 10.1016/j.brs.2019.01.001

[img] Text
1-s2.0-S1935861X19300014-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy > Translational Research Center
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Geriatric Psychiatry and Psychotherapy

UniBE Contributor:

Maier, Jonathan Gabriel; Klöppel, Stefan and Nissen, Christoph


600 Technology > 610 Medicine & health








Panagiota Milona

Date Deposited:

20 Feb 2019 09:28

Last Modified:

18 Dec 2019 14:26

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Brain stimulation Eeg Electrosleep Hyperarousal Non-invasive





Actions (login required)

Edit item Edit item
Provide Feedback