Chronic insomnia is a common sleep disorder that significantly impacts patients’ quality of daily life as well as physical and mental health. This paper examines the potential utility of anesthetic sleep therapy for chronic insomnia, and, under certain circumstances, provides a comparative analysis of the strengths and limitations of this approach versus conventional insomnia therapies. This paper aims to highlight current developmental challenges in anesthetic sleep therapy for chronic insomnia, provide clinical practitioners with recommendations regarding the application of anesthetic sleep therapy in chronic insomnia management, and prospects for future advancements.
References
[1]
Zhang, H.J. and Zhang, X. (2017) Research Progress on Neuroimaging of Chronic Insomnia. Medicine & Philosophy, 38, 9-12.
[2]
Ellis, J.G., Perlis, M.L., Bastien, C.H., Gardani, M. and Espie, C.A. (2014) The Natural History of Insomnia: Acute Insomnia and First-Onset Depression. Sleep, 37, 97-106. https://doi.org/10.5665/sleep.3316
[3]
Liu, J., Qu, D.T., Wang, Y.X. and Xi, Y. (2020) The Impact of Chronic Insomnia in the Elderly on Blood Lipid Levels and Diseases. Chinese Journal of Gerontology, 40, 725-727.
[4]
Manber, R., Simpson, N. and Gumport, N.B. (2023) Perspectives on Increasing the Impact and Reach of CBT-I. Sleep, 46, 1-7. https://doi.org/10.1093/sleep/zsad168
[5]
Manconi, M., Ferri, R., Miano, S., Maestri, M., Bottasini, V., Zucconi, M., et al. (2017) Sleep Architecture in Insomniacs with Severe Benzodiazepine Abuse. Clinical Neurophysiology, 128, 875-881. https://doi.org/10.1016/j.clinph.2017.03.009
[6]
Jupe, T., Provi, K. and Giannopoulos, I. (2024) Sleep Architecture Disturbance Due to the Use of Benzodiazepines. European Psychiatry, 67, S775. https://doi.org/10.1192/j.eurpsy.2024.1614
[7]
Sousa Martins Silva, A., de Mendon？a, F.M.R., de Mendon？a, G.P.R.R., Souza, L.C., Galv？o, L.P., Paiva, H.S., et al. (2023) Benzodiazepines and Sleep Architecture: A Systematic Review. CNS & Neurological Disorders—Drug Targets, 22, 172-179. https://doi.org/10.2174/1871527320666210618103344
[8]
Guldenmund, P., Vanhaudenhuyse, A., Sanders, R.D., Sleigh, J., Bruno, M.A., Demertzi, A., et al. (2017) Brain Functional Connectivity Differentiates Dexmedetomidine from Propofol and Natural Sleep. British Journal of Anaesthesia, 119, 674-684. https://doi.org/10.1093/bja/aex257
[9]
Zhao, S.J., Ye, H.T., Ji, M.H. and Yang, J.J. (2025) Research Progress on the Effects of General Anesthetics on Sleep Phases. Journal of Clinical Anesthesiology, 41, 305-309.
[10]
Moody, O.A., Zhang, E.R., Vincent, K.F., Kato, R., Melonakos, E.D., Nehs, C.J., et al. (2021) The Neural Circuits Underlying General Anesthesia and Sleep. Anesthesia&Analgesia, 132, 1254-1264. https://doi.org/10.1213/ane.0000000000005361
[11]
Rabelo, F.A.W., Braga, A., Küpper, D.S., De Oliveira, J.A.A., Lopes, F.M., de Lima Mattos, P.L.V., et al. (2010) Propofol-Induced Sleep: Polysomnographic Evaluation of Patients with Obstructive Sleep Apnea and Controls. Otolaryngology—Head and Neck Surgery, 142, 218-224. https://doi.org/10.1016/j.otohns.2009.11.002
[12]
Picton, J.D., Marino, A.B. and Nealy, K.L. (2018) Benzodiazepine Use and Cognitive Decline in the Elderly. American Journal of Health-System Pharmacy, 75, e6-e12. https://doi.org/10.2146/ajhp160381
[13]
Murakoshi, A., Takaesu, Y., Komada, Y., Ishikawa, J. and Inoue, Y. (2015) Prevalence and Associated Factors of Hypnotics Dependence among Japanese Outpatients with Psychiatric Disorders. Psychiatry Research, 230, 958-963. https://doi.org/10.1016/j.psychres.2015.11.003
[14]
Tsunoda, K., Uchida, H., Suzuki, T., Watanabe, K., Yamashima, T. and Kashima, H. (2010) Effects of Discontinuing Benzodiazepine-Derivative Hypnotics on Postural Sway and Cognitive Functions in the Elderly. International Journal of Geriatric Psychiatry, 25, 1259-1265. https://doi.org/10.1002/gps.2465
[15]
Agrawal, R., Verma, S. and Halappanavar, M. (2021) Measuring the Effectiveness of Benzodiazepine Prescriptions Control in Community Setting Using Prescription Drug Monitoring Program (PDMP). Community Mental Health Journal, 57, 920-925. https://doi.org/10.1007/s10597-020-00686-5
[16]
Mondardini, M.C., Daverio, M., Caramelli, F., Conti, G., Zaggia, C., Lazzarini, R., etal. (2022) Dexmedetomidine for Prevention of Opioid/Benzodiazepine Withdrawal Syndrome in Pediatric Intensive Care Unit: Interim Analysis of a Randomized Controlled Trial. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 42, 145-153. https://doi.org/10.1002/phar.2654
[17]
Morton, S.U., Labrecque, M., Moline, M., Hansen, A. and Leeman, K. (2021) Reducing Benzodiazepine Exposure by Instituting a Guideline for Dexmedetomidine Usage in the Nicu. Pediatrics, 148, e2020041566. https://doi.org/10.1542/peds.2020-041566
[18]
Morin, C.M., Khullar, A., Robillard, R., Desautels, A., Mak, M.S.B., Dang-Vu, T.T., et al. (2024) Delphi Consensus Recommendations for the Management of Chronic Insomnia in Canada. SleepMedicine, 124, 598-605. https://doi.org/10.1016/j.sleep.2024.09.038
[19]
Xiao, Y., Cao, Y.N. and Hu, Y.M. (2024) Research Progress on the Effects of Anesthetic Drugs on Postoperative Sleep Disturbances. Medical Research and Battlefield Casualty Treatment, 37, 439-443.
[20]
Singh, M., Gali, B., Levine, M., Strohl, K. and Auckley, D. (2021) Integrating Sleep Knowledge into the Anesthesiology Curriculum. Anesthesia&Analgesia, 132, 1296-1305. https://doi.org/10.1213/ane.0000000000005490
[21]
Yue, X.F., Wang, A.Z., Hou, Y.P. and Fan, K. (2021) Effects of Propofol on Sleep Architecture and Sleep-Wake Systems in Rats. BehaviouralBrainResearch, 411, Article 113380. https://doi.org/10.1016/j.bbr.2021.113380
[22]
Huang, P., Cong, L., Lu, Z., Wang, S., Hang, Y., Huang, Z., et al. (2024) Postoperative Sleep Quality of Insomnia Patients after TIVA Anesthesia: A Prospective Study. Journal of PeriAnesthesia Nursing, 39, 73-78. https://doi.org/10.1016/j.jopan.2023.06.006
[23]
Xu, Z., Jiang, X., Li, W., Gao, D., Li, X. and Liu, J. (2011) Propofol-Induced Sleep: Efficacy and Safety in Patients with Refractory Chronic Primary Insomnia. Cell Biochemistry and Biophysics, 60, 161-166. https://doi.org/10.1007/s12013-010-9135-7
[24]
Zou, C.L., Gu, X.H. and Zhong, D.Q. (2011) Efficacy and Safety Management of Propofol-Induced Sleep Balance Technique in Treating Refractory Insomnia. Journal of Military Nursing, 28, 1-5.
[25]
Ma, Y., Miracca, G., Yu, X., Harding, E.C., Miao, A., Yustos, R., et al. (2019) Galanin Neurons Unite Sleep Homeostasis and Α2-Adrenergic Sedation. Current Biology, 29, 3315-3322.e3. https://doi.org/10.1016/j.cub.2019.07.087
[26]
Ramaswamy, S.M., Weerink, M.A.S., Struys, M.M.R.F. and Nagaraj, S.B. (2021) Dexmedetomidine-Induced Deep Sedation Mimics Non-Rapid Eye Movement Stage 3 Sleep: Large-Scale Validation Using Machine Learning. Sleep, 44, zsaa167. https://doi.org/10.1093/sleep/zsaa167
[27]
Lv, J., Wei, Y., Chen, Y., Zhang, X., Gong, Z., Jiang, Y., et al. (2017) Dexmedetomidine Attenuates Propofol-Induce Neuroapoptosis Partly via the Activation of the PI3K/Akt/GSK3β Pathway in the Hippocampus of Neonatal Rats. Environmental Toxicology and Pharmacology, 52, 121-128. https://doi.org/10.1016/j.etap.2017.03.017
[28]
Pan, X.L., Xi, Y.F., Liang, P. and Huang, J. (2022) Research Progress on Dexmedetomidine in the Diagnosis and Treatment of Sleep Disorders. Chinese Journal of Anesthesiology, 42, 508-512.
[29]
Ye, W.B., Zheng, J.Y., Deng, Y.T., et al. (2016) Evaluation of the Short-Term Therapeutic Effect of Dexmedetomidine Sedative Artificial Sleep Technique on Chronic Primary Insomnia. Guangdong Medical Journal, 37, 1178-1781.
[30]
Dai, Z., Xia, X.Q., Chen, Y.Y., Zhu, Y.L. and Chen, G.H. (2020) Effect of Dexmedetomidine-Induced Sleep Balance Technique on Cognitive Function in Elderly Patients with Refractory Insomnia. International Journal of Anesthesiology and Resuscitation, 41, 1028-1032.
[31]
An, J.X., Williams, J.P., Fang, Q.W., Wang, Y., Liu, H., Shi, L., et al. (2020) Feasibility of Patient-Controlled Sleep with Dexmedetomidine in Treating Chronic Intractable Insomnia. NatureandScienceofSleep, 12, 1033-1042. https://doi.org/10.2147/nss.s262991
[32]
Wang, Y., Zhi, J., Deng, X.M., et al. (2022) Effect of Intranasal Dexmedetomidine Spray on Postoperative Sleep Disturbances. Journal of Clinical Anesthesiology, 38, 477-481.
[33]
Wu, J., Liu, X., Ye, C., Hu, J., Ma, D. and Wang, E. (2023) Intranasal Dexmedetomidine Improves Postoperative Sleep Quality in Older Patients with Chronic Insomnia: A Randomized Double-Blind Controlled Trial. Frontiers in Pharmacology, 14, Article 1223746. https://doi.org/10.3389/fphar.2023.1223746
[34]
Duncan, W.C., Sarasso, S., Ferrarelli, F., Selter, J., Riedner, B.A., Hejazi, N.S., et al. (2013) Concomitant BDNF and Sleep Slow Wave Changes Indicate Ketamine-Induced Plasticity in Major Depressive Disorder. International Journal of Neuropsychopharmacology, 16, 301-311. https://doi.org/10.1017/s1461145712000545
[35]
Razoux, F., Garcia, R. and Léna, I. (2007) Ketamine, at a Dose That Disrupts Motor Behavior and Latent Inhibition, Enhances Prefrontal Cortex Synaptic Efficacy and Glutamate Release in the Nucleus Accumbens. Neuropsychopharmacology, 32, 719-727. https://doi.org/10.1038/sj.npp.1301057
[36]
Lorrain, D.S., Baccei, C.S., Bristow, L.J., Anderson, J.J. and Varney, M.A. (2003) Effects of Ketamine and N-Methyl-D-Aspartate on Glutamate and Dopamine Release in the Rat Prefrontal Cortex: Modulation by a Group II Selective Metabotropic Glutamate Receptor Agonist LY379268. Neuroscience, 117, 697-706. https://doi.org/10.1016/s0306-4522(02)00652-8
[37]
Liverant, G.I., Arditte Hall, K.A., Wieman, S.T., Pineles, S.L. and Pizzagalli, D.A. (2021) Associations between Insomnia and Reward Learning in Clinical Depression. Psychological Medicine, 52, 3540-3549. https://doi.org/10.1017/s003329172100026x
[38]
Song, B. and Zhu, J.C. (2021) Mechanisms of the Rapid Effects of Ketamine on Depression and Sleep Disturbances: A Narrative Review. Frontiers in Pharmacology, 12, Article 782457. https://doi.org/10.3389/fphar.2021.782457
[39]
Song, B. and Zhu, J. (2021) A Novel Application of Ketamine for Improving Perioperative Sleep Disturbances. Nature and Science of Sleep, 13, 2251-2266. https://doi.org/10.2147/nss.s341161
[40]
Liu, Y.S., Hu, Q.Y., Han, L., et al. (2024) Efficacy of Dexmedetomidine Combined with Esketamine in Treating Patients with Refractory Insomnia and Depression. Journal of Clinical Anesthesiology, 40, 357-362.
[41]
Koncz, S., Papp, N., Menczelesz, N., Pothorszki, D. and Bagdy, G. (2021) EEG and Sleep Effects of Tramadol Suggest Potential Antidepressant Effects with Different Mechanisms of Action. Pharmaceuticals, 14, Article 431. https://doi.org/10.3390/ph14050431
[42]
Walder, B., Tramèr, M.R. and Blois, R. (2001) The Effects of Two Single Doses of Tramadol on Sleep: A Randomized, Cross-Over Trial in Healthy Volunteers. European Journal of Anaesthesiology, 18, 36-42. https://doi.org/10.1097/00003643-200101000-00006
[43]
Fu, M., Chen, S., Xu, R., Chen, J., Chen, X., Gan, W., et al. (2022) Effects of Intravenous Analgesia Using Tramadol on Postoperative Depression State and Sleep Quality in Women Undergoing Abdominal Endoscopic Surgery: A Randomized Controlled Trial. Drug Design, Development and Therapy, 16, 1289-1300. https://doi.org/10.2147/dddt.s357773
[44]
Zhang, X., Huang, X. and Yang, J. (2024) Efficacy of Stellate Ganglion Block on Postoperative Sleep Disorder: A Systematic Review. Asian Journal of Surgery, 48, 1912-1913. https://doi.org/10.1016/j.asjsur.2024.09.072
[45]
Dai, D., Zheng, B., Yu, Z., Lin, S., Tang, Y., Chen, M., et al. (2021) Right Stellate Ganglion Block Improves Learning and Memory Dysfunction and Hippocampal Injury in Rats with Sleep Deprivation. BMC Anesthesiology, 21, Article No. 272. https://doi.org/10.1186/s12871-021-01486-4
[46]
Liu, Y., Zhang, L., Sun, Y., et al. (2023) Efficacy and Safety of Stellate Ganglion Block with Different Volumes of Ropivacaine to Improve Sleep Quality in Patients with Insomnia: A Comparative Study. European Review for Medical and Pharmacological Sciences, 27, 10233-10239.
[47]
Yan, S., Wang, Y., Yu, L., Xia, W., Xue, F., Yu, Y., et al. (2023) Stellate Ganglion Block Alleviates Postoperative Sleep Disturbance in Patients Undergoing Radical Surgery for Gastrointestinal Malignancies. JournalofClinicalSleepMedicine, 19, 1633-1642. https://doi.org/10.5664/jcsm.10632
[48]
Yan, S.T., Yu, L.Y., Yu, Y.L., Yuan, B., et al. (2023) Effect of Stellate Ganglion Block on Postoperative Sleep Disturbances in Elderly Patients Undergoing Laparoscopic Radical Surgery for Gastrointestinal Malignancies. Journal of Clinical Anesthesiology, 39, 486-491.
[49]
Wei, W., Wang, K.J., Zheng, J.Y., et al. (2022) Effect of Stellate Ganglion Block Combined with Auricular Point Sticking on Postoperative Sleep Disturbances in Patients Undergoing Hip Arthroplasty. Journal of Huazhong University of Science and Technology (Medical Sciences), 51, 520-525.
[50]
Gao, Z.F. and Li, Y. (2024) Effect of Stellate Ganglion Block Combined with Traditional Chinese Medicine Acupoint Application on Postoperative Sleep Disturbances after Lumbar Spine Surgery. Practical Pharmacy and Clinical Remedies, 27, 833-836.
[51]
Chen, Y.Q., Qiu, L.C., Wei, S.C., et al. (2020) Effect of Stellate Ganglion Block on Nighttime Sleep Quality in Patients with Primary Sleep Disorders. Chinese Journal of Anesthesiology, 40, 74-77.
[52]
Jiang, J., Jiao, Y., Gao, P., Yin, W., et al. (2021) Propofol Differentially Induces Unconsciousness and Respiratory Depression through Distinct Interactions between GABAA Receptor and GABAergic Neuron in Corresponding Nuclei. Acta Biochimica et Biophysica Sinica, 53, 1076-1087. https://doi.org/10.1093/abbs/gmab084
[53]
Goel, V., Patwardhan, A.M., Ibrahim, M., Howe, C.L., Schultz, D.M. and Shankar, H. (2019) Complications Associated with Stellate Ganglion Nerve Block: A Systematic Review. RegionalAnesthesia&PainMedicine, 44, 669-678. https://doi.org/10.1136/rapm-2018-100127
[54]
Xing, J.B., Deng, M.F., Zhang, X.J., et al. (2025) On Behalf of the Special Task Force for Clinical Practice of Stellate Ganglion Block for Insomnia, Guangdong Health Science Popularization Promotion Association. Expert Consensus on Clinical Practice of Stellate Ganglion Block for the Treatment of Insomnia. New Medicine, 56, 1155-1163.
