Anesthesia-Informed Approaches to Insomnia: Shared Neural Circuits, Biomimetic Sleep, and Emerging Interventional Strategies
Abstract
Background: Insomnia affects approximately 10-30% of adults, burdening quality of life, cognition, and health. Although cognitive behavioral therapy for insomnia (CBT-I) and approved pharmacotherapies remain standard care, limited accessibility, durability, and efficacy in refractory populations have motivated interest in mechanism-based alternatives, including approaches derived from anesthetic pharmacology.
Objective: This narrative review examines the convergent neural circuits underlying anesthesia-induced and physiological sleep, critically appraises evidence for anesthetic agents-dexmedetomidine, ketamine/esketamine, and propofol-delivered through non-traditional modalities, and evaluates perioperative sleep optimization, with explicit attention to evidence level and limitations.
Methods: We searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for English-language publications through June 2026. Evidence from randomized controlled trials (RCTs), systematic reviews, observational studies, case reports, and mechanistic studies was synthesized narratively and graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
Results: Dexmedetomidine induces "biomimetic sleep" via alpha-2 adrenergic agonism, resembling natural non-rapid eye movement stage 2 sleep more closely than propofol. However, most supporting evidence is mechanistic, perioperative, or from small pilot studies rather than insomnia-specific RCTs. Patient-controlled…
Read the paper
Related studies
- Tryptophan Metabolism and Gut-Brain Homeostasis
- Rationale for a Multi-Factorial Approach for the Reversal of Cognitive Decline in Alzheimer’s Disease and MCI: A Review
- Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit
- Relationship between sleep disorders and gut dysbiosis: what affects what?
- The role of CLOCK gene in psychiatric disorders: Evidence from human and animal research
- Genetic, Transcriptome, Proteomic, and Epidemiological Evidence for Blood-Brain Barrier Disruption and Polymicrobial Brain Invasion as Determinant Factors in Alzheimer’s Disease
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.