Research Progress on the Neural Mechanisms and Brain Network Plasticity of Repetitive Transcranial Magnetic Stimulation in the Treatment of Chronic Insomnia

Gang Liu; Renchun  Liang

doi:10.62177/apjcmr.v2i2.1219

Authors

Gang Liu Hainan Normal University
Renchun Liang Hainan Normal University

DOI:

https://doi.org/10.62177/apjcmr.v2i2.1219

Keywords:

Chronic Insomnia, Repetitive Transcranial Magnetic Stimulation, Neural Mechanisms, Brain Network Plasticity, Functional Connectivity, Neuromodulation

Abstract

Chronic insomnia is a common sleep disorder characterized by difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening. Accumulating evidence suggests that chronic insomnia is not merely a consequence of sleep loss or psychological stress, but a neuropsychiatric disorder involving abnormal cortical excitability, neurotransmitter imbalance, hypothalamic–pituitary–adrenal axis hyperactivation, and disrupted large scale brain network connectivity. In recent years, repetitive transcranial magnetic stimulation, as a safe and noninvasive neuromodulation technique, has shown promising therapeutic potential in the treatment of chronic insomnia. By modulating cortical excitability, synaptic plasticity, neurotransmitter release, and functional connectivity among sleep related brain networks, repetitive transcranial magnetic stimulation may improve sleep initiation, sleep maintenance, and associated emotional symptoms. This review summarizes the neurophysiological basis of chronic insomnia, the mechanisms and stimulation parameters of repetitive transcranial magnetic stimulation, and recent advances in brain network plasticity research related to its therapeutic effects. Current evidence indicates that repetitive transcranial magnetic stimulation can suppress hyperactivity of the default mode network, enhance executive control network function, regulate salience network activity, and restore the integration of thalamocortical and limbic circuits. These network level changes provide objective neuroimaging support for the clinical benefits of repetitive transcranial magnetic stimulation in chronic insomnia. Future studies should combine individualized neuronavigated stimulation with multimodal neuroimaging and longitudinal follow up to clarify the spatiotemporal dynamics of brain network plasticity and optimize precision nonpharmacological interventions for chronic insomnia.

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