P167 Modulation of corticothalamic sleep regulation by transcranial direct current stimulation is an area-specific effect

Krone, Lukas B.; Frase, Lukas; Selhausen, Peter; Zittel, S.; Jahn, Friederike; Piosczyk, Hannah; Feige, Bernd; Nitsche, Michael A.; Riemann, Dieter; Nissen, Christoph

doi:10.1016/j.clinph.2016.10.288

Cited by 1 publication

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“…Healthy sleep facilitates neural plasticity thought to consolidate newly acquired and initially unstable memories, whereas studies in insomnia patients have shown that these processes may be impaired. In particular, insomnia is associated with a reduction in SWS (Backhaus et al, 2006;Baglioni et al, 2016;Krone et al, 2017) and diminished sleeprelated consolidation of declarative and procedural memories. As impaired neuroplasticity favors the accumulation of neurotoxic proteins, neuroinflammation, and stress system alterations, insomnia is considered to be a causal factor in neurodegenerative (Shamim et al, 2019) and neuropsychiatric disorders (Palagini et al, 2019(Palagini et al, , 2020.…”

Section: Implications For Insomnia Disorder Pathophysiologymentioning

confidence: 99%

Pharmacotherapeutic management of insomnia and effects on sleep processes, neural plasticity, and brain systems modulating stress: A narrative review

Palagini

Bianchini

2022

Front. Neurosci.

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IntroductionInsomnia is a stress-related sleep disorder, may favor a state of allostatic overload impairing brain neuroplasticity, stress immune and endocrine pathways, and may contribute to mental and physical disorders. In this framework, assessing and targeting insomnia is of importance.AimSince maladaptive neuroplasticity and allostatic overload are hypothesized to be related to GABAergic alterations, compounds targeting GABA may play a key role. Accordingly, the aim of this review was to discuss the effect of GABAA receptor agonists, short-medium acting hypnotic benzodiazepines and the so called Z-drugs, at a molecular level.MethodLiterature searches were done according to PRISMA guidelines. Several combinations of terms were used such as “hypnotic benzodiazepines” or “brotizolam,” or “lormetazepam” or “temazepam” or “triazolam” or “zolpidem” or “zopiclone” or “zaleplon” or “eszopiclone” and “insomnia” and “effects on sleep” and “effect on brain plasticity” and “effect on stress system”. Given the complexity and heterogeneity of existing literature, we ended up with a narrative review.ResultsAmong short-medium acting compounds, triazolam has been the most studied and may regulate the stress system at central and peripheral levels. Among Z-drugs eszopiclone may regulate the stress system. Some compounds may produce more “physiological” sleep such as brotizolam, triazolam, and eszopiclone and probably may not impair sleep processes and related neural plasticity. In particular, triazolam, eszopiclone, and zaleplon studied in vivo in animal models did not alter neuroplasticity.ConclusionCurrent models of insomnia may lead us to revise the way in which we use hypnotic compounds in clinical practice. Specifically, compounds should target sleep processes, the stress system, and sustain neural plasticity. In this framework, among the short/medium acting hypnotic benzodiazepines, triazolam has been the most studied compound while among the Z-drugs eszopiclone has demonstrated interesting effects. Both offer potential new insight for treating insomnia.

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