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Review
. 2025 Oct;34(5):e70071.
doi: 10.1111/jsr.70071. Epub 2025 May 15.

The Future of Non-Invasive Brain Stimulation in Sleep Medicine

Lukas B Krone  1   2 , Seo Ho Song  3 , Valeria Jaramillo  4   5   6 , Ines R Violante  7
Affiliations
Review

The Future of Non-Invasive Brain Stimulation in Sleep Medicine

Lukas B Krone et al. J Sleep Res. 2025 Oct.

Abstract

Non-invasive brain stimulation (NIBS) methods carry particular appeal as non-pharmacological approaches to inducing or improving sleep. However, intense research efforts to use transcranial magnetic stimulation (TMS) and electrical stimulation (tES) for sleep modulation have not yet delivered evidence-based NIBS treatments in sleep medicine. The main obstacles lie in insufficiently robust stimulation protocols that affect neurophysiological and self-reported sleep parameters, inadequately controlled-and explained-placebo effects, and heterogeneity in patient populations and outcome parameters. Recent technological advances, e.g., transcranial ultrasound stimulation (TUS) and temporal interference stimulation (TIS), make deep brain structures feasible targets. Real-time approaches, e.g., closed-loop auditory stimulation (CLAS), demonstrate efficacious modulation of different sleep oscillations by tuning stimulation to ongoing brain activity. The identification of sleep-regulatory regions and cell types in the cerebral cortex and thalamus provides new specific targets. To turn this neuroscientific progress into therapeutic advancement, conceptual reframing is warranted. Chronic insomnia may not be optimally suited to demonstrate NIBS efficacy due to the mismatch between self-reported symptoms and polysomnographic sleep parameters. More feasible initial approaches could be to (1) modulate specific sleep oscillations to promote specific sleep functions, (2) modify nightmares and traumatic memories with targeted memory reactivation, (3) increase 'wake intensity' in patients with depression to improve daytime fatigue and elevate sleep pressure and (4) disrupt pathological activity in sleep-dependent epilepsies. Effective treatments in these areas of sleep medicine seem in reach but require rigorously designed clinical trials to identify which NIBS strategies bring real benefit in sleep medicine.

Keywords: neuromodulation; sleep disorders; sleep interventions; sleep treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Established (transcranial magnetic stimulation, transcranial electrical stimulation; green) and newly emerging tools (sensory stimulation, transcranial focused ultrasound, transcranial temporal interference; violet) for neuromodulation.
FIGURE 2
FIGURE 2
Optimal features of a non‐invasive brain stimulation device for sleep neuromodulation.
FIGURE 3
FIGURE 3
Feasible applications for first non‐invasive brain stimulation therapies in sleep medicine.
See this image and copyright information in PMC

References

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MeSH terms