Vestibular neuromodulation for chronic insomnia after traumatic brain injury: a case series

Sleep dysfunction is common after traumatic brain injury (TBI) and can be difficult to manage due to medication side effects and complex neuropsychiatric comorbidities. Noninvasive electrical vestibular system stimulation (VSS) is an emerging neuromodulation therapy that has demonstrated benefit for primary chronic insomnia in adults without known brain injury, but has not been described for chronic insomnia in individuals with TBI.

We present a retrospective case series of 5 adult veterans with chronic TBI and moderate-to-severe insomnia (Insomnia Severity Index [ISI] ≥15) who were treated with nightly home VSS. All patients reported subjective improvement in sleep at 3 to 8 week follow-up. ISI score decreased from 25.0 ± 2.5 (mean ± SD) at baseline to 7.2 ± 4.7 at follow-up, representing a reduction of 17.8 ± 6.6 points. Each patient demonstrated a clinically meaningful reduction in ISI (≥6-point reduction). Some individuals reported reductions in nightmares and improvements in daytime alertness.

In this case series, VSS use was associated with clinically meaningful reductions in chronic insomnia severity in veterans with chronic TBI.