Insomnia is a complex, often multi-faceted challenge in the field of psychiatry. Current therapies are far from perfect, leaving a massive unmet need. Insomnia is a prevalent sleep disorder characterized by difficulties in initiating or maintaining sleep, resulting in daytime impairment. Epidemiological studies indicate that insomnia affects approximately 10-30% of adults, with higher prevalence among women and older adults (Ohayon, 2002; Roth, 2007). Factors contributing to insomnia include psychiatric disorders, chronic medical conditions, and lifestyle choices, with the disorder often co-occurring with conditions such as anxiety and depression (Foley et al., 1995; Morin et al., 2006). Given its high prevalence and significant impact on health and quality of life, insomnia is a major public health concern (American Academy of Sleep Medicine, 2014). In the search for innovative therapies for insomnia, a growing body of research is shining a spotlight on stellate ganglion block (SGB), a procedure traditionally used for pain and sympathetic nervous system disorders. SGB involves injecting a local anesthetic near the stellate ganglion—a bundle of nerves in the neck—to modulate the overactive sympathetic nervous system, which is often linked to insomnia. There is a growing body of scientific evidence suggesting that SGB may offer benefit for insomnia.
Early Success Stories
Early case reports have highlighted the potential of SGB for treating intractable insomnia. Dong et al. (2018) described successful outcomes in patients whose chronic insomnia was resistant to standard therapies. These patients experienced significant improvements in sleep quality and duration following SGB, laying the groundwork for further investigation into this promising approach.
Evidence from Controlled Studies
Recent randomized controlled trials have strengthened the case for SGB as a viable treatment for sleep disorders. Gu et al. (2022) studied elderly patients recovering from thoracoscopic lung cancer surgery, a population often plagued by poor sleep. Their findings revealed that ultrasound-guided SGB markedly improved sleep quality in the early postoperative period compared to control groups, suggesting that SGB’s benefits may extend beyond chronic insomnia to include acute sleep disturbances in specific clinical settings.
Optimizing Treatment Parameters
One of the most comprehensive studies to date was conducted by Liu et al. (2023), who compared the effects of varying doses of the anesthetic used in SGB. They reported significant sleep improvements at multiple dosing levels, with minimal side effects, such as hoarseness or unintended nerve involvement.
Addressing Specific Populations
Insomnia in Menopause Beyond general insomnia, SGB has shown promise for targeted populations. Zu-Xi (2012) investigated the technique in 26 perimenopausal women, a group particularly susceptible to sleep disruptions. The results indicated significant improvements in sleep quality, further broadening the potential applications of SGB.
Challenges and Future Directions
While the evidence is encouraging, several limitations remain. The studies conducted thus far often involve small sample sizes and specific populations, making it difficult to generalize findings. Additionally, the long-term effects of SGB on sleep quality are not yet well understood. Variability in techniques, such as the choice of anesthetic and injection methods, further complicates the establishment of standardized protocols.
Conclusion
Stellate ganglion block is emerging as a novel and evidence-backed approach to treating insomnia, particularly for patients who have not responded to traditional therapies. This treatment option is already available for insomnia-sufferers, frustrated by lack of response from current treatment. That said, while multiple trials support its potential benefit, further research is necessary to comprehensively validate its benefit, fully understand its potential, and optimize its application.
About the Author
Dr. David George is founder of Neuregen, an Integrative Psychiatry and Neurologic Health Center in Scottsdale, Arizona offering an innovative program combining integrative psychiatry and brain rehabilitation therapies, with a focus on innovative treatments like stellate ganglion block. He routinely combines SGB with comprehensive brain-rehabilitation and mental health therapies. Learn more about his work at www.neuregen.com. References: American Academy of Sleep Medicine. (2014). The international classification of sleep disorders (ICSD-3). Darien, IL: American Academy of Sleep Medicine.
Dong, C., Xu, Z., Sun, P., & Yu, M. (2018). The effect of stellate ganglion block on sleeping in patients with intractable insomnia : cases report with successful treatment outcome.
Foley, D. J., Monjan, A. A., Brown, S. L., & Healey, M. (1995). Sleep complaints among the elderly: an epidemiological study of the national health interview survey. Sleep, 18(6), 425-432.
Gu, C., Zhai, M., Lü, A., Liu, L., Hu, H., Liu, X., Li, X., & Cheng, X. (2022). [Ultrasound-guided stellate ganglion block improves sleep quality in elderly patients early after thoracoscopic surgery for lung cancer: a randomized controlled study].. Nan fang yi ke da xue xue bao = Journal of Southern Medical University, 42 12, 1807-1814 . https://doi.org/10.12122/j.issn.1673-4254.2022.12.08.
Liu, Y., Zhang, L., Sun, Y., Zhao, J., Shen, Y., Wang, C., Luo, S., & Li, Y. (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 21, 10233-10239 . https://doi.org/10.26355/eurrev_202311_34298.
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J., & Mérette, C. (2006). Epidemiology of insomnia: a longitudinal study of a population-based sample. Sleep, 29(8), 885-891.
Ohayon, M. M. (2002). Epidemiology of insomnia: a longitudinal study of insomnia and its consequences. Sleep, 25(3), 302-309.
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5), 502-512.Zu-Xi, Z. (2012). Effect of stellate ganglion block in the treatment of 26 perimenopausal patients with insomnia. Hainan Medical Journal.
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