Sleep and Vigilance

, Volume 2, Issue 1, pp 39–44 | Cite as

Alternative Strategies for Managing Insomnia: The Case of Physical Exercise and Transcranial Direct Current Stimulation. A Narrative Review

  • María Fernanda Higuera-Hernández
  • Elena Reyes-Cuapio
  • Marissa Gutiérrez-Mendoza
  • Nuno Barbosa Rocha
  • André Barciela Veras
  • Henning Budde
  • Johanna Jesse
  • Sérgio Machado
  • Eric Murillo-Rodríguez


The sleep–wake cycle is a process regulated by multiple neurobiological mechanisms that in aberrant functioning provokes several sleep disturbances. Among the major categories of sleep disorders, insomnia represents one of the most reported in population. Pharmacological interventions aimed for treating this sleep disturbance include compounds such as antidepressants, antihistamines, sedative-hypnotics, among others. However, using pharmacological treatments increase undesirable side effects such as addiction to sleep-inducing drugs. Here, we review and summarize recent publications available in PubMed regarding the use of non-pharmacological/invasive means to control insomnia, including physical exercise and transcranial direct current stimulation (tDCS). Current data suggest that these two strategies efficiently manage insomnia, and in turn opens new approaches to develop therapeutical tools to diminish this pathology. Nevertheless, additional research is required to understand the neurobiological mechanism of action of physical exercise and tDCS in insomnia control.


Insomnia Physical exercise Sleep Stimulation Population 

1 Insomnia

The sleep–wake cycle displays abnormal features characterized and classified in multiple sleep disturbances. In this regard, the International Classification of the Sleep Disorders defines insomnia as a pathology characterized by difficulties in either initiating or maintaining sleep, waking up across the night or earlier than desired in the morning [1]. Epidemiological studies have reported that insomnia is one of the most sleep disturbances in population [2]. Despite that different pharmacological treatments have been developed for managing insomnia, including benzodiazepines, benzodiazepine-receptor agonists, etc. [3, 4, 5, 6], further side effects are often reported. Here, we review and summarize recent findings available in PubMed regarding the positive effects of using non-pharmacological/invasive means for managing insomnia, including physical exercise and transcranial direct current stimulation (tDCS).

2 Non-pharmacological Interventions for Managing Insomnia

Several reports have suggested that cognitive-behavioral therapy (CBT), mind–body therapies (such as yoga), light therapy, acupressure, physical exercise, tDCS, among others are becoming emerging/non-pharmacological options for managing insomnia [7, 8, 9, 10, 11, 12, 13]. In the following sections, we present a general overview of some recent publications regarding the uses of physical exercise and tDCS to control insomnia. In-depth examination of the use of less well-supported approaches (CBT, yoga, light therapy, acupressure, among others) is beyond the scope of this review.

2.1 Physical Exercise

Based in definition of insomnia, several approaches—including physical exercise—have been suggested for managing this sleep disorder. For instance, Crönlein [14] states that further research should define a standardized definition of sleep quality and use this definition to determine the effects of exercise and other interventions. Whether a standard definition of sleep quality is available, several studies have examined the effects of physical exercise in insomnia [15, 16, 17, 18]. In this regard, older subjects (55–65 years old) diagnosed with insomnia participated in physical exercise conditions (morning exercise). Under these circumstances, morning exercise diminished the insomnia by decreasing the number of sleep state transitions over the night. Similar results were observed on self-reported quality of sleep, by describing that individuals with a high fitness level, which was associated with regular physical activity and exercise, perceived higher sleep quality. In contrast, participants with a self-reported lack of physical activity evaluated their sleep quality as poor [17]. In line with this observation, the sleep quality of 5000 women over 10 years showed that subjects that had a higher level of physical activity reported lower risks of developing insomnia [18]. Other studies have indicated that prolonged time of daily physical activity significantly reduced the risk of insomnia [16]. In this regard, Dzierzewski et al. [19] found that moderate to vigorous physical activity influenced the subjective sleep quality.

The resulting effects of physical exercise in insomnia management are thought to be mediated by thermoregulation [20]. Sleep onset is associated with a decline in body temperature, which is increased if physical exercise is applied between 2 and 6 pm. In response, the mechanisms of heat dissipation are activated and sleep is improved. Thus, one would assume that heating the body leads to an improvement of sleep [21, 22].

In addition, a variety of factors that influence the effects of physical exercise in insomnia control, include intensity, type of physical exercise and timing. Several lines of evidence suggest that moderate-intensity physical aerobic exercise in the afternoon using a treadmill [running speed at 4 km/h (3-min warm-up) with increments of 0.5 km/h every minute up to voluntary exhaustion during 50 min], but not after high-intensity physical aerobic exercise (3 periods of 10 min of exercise on a treadmill alternating with 10 min of rest) or moderate resistance physical exercise (shoulder/chest/leg press, vertical traction, leg curl/extension, abdominal crunch, or lower back. Three sets of 10 repetitions with 90-s recovery intervals during 50 min), decreases insomnia [23]. However, contradictory findings are available. For instance, a study compared the effects of acute morning or evening aerobic step physical exercise in two subjective insomnia criteria: difficulty in initiating sleep and early morning awakening. Results showed that acute physical exercise in the morning decreased the difficulties for initiating sleep but subjective sleep quality did not change after the acute interventions [24, 25].

The role of physical exercise in insomnia control might engage functioning of hormones. It has been demonstrate that acute physical exercise is linked with insomnia symptoms via cortisol levels since the contents of this hormone have been found increased after acute high-intensity training [26, 27]. An elevated cortisol levels in the evening correlate with the number of bouts of nocturnal awakenings in insomnia patients [28]. However, chronic moderate aerobic exercise using treadmill with an initial velocity of 4 km/h, increasing speed by 0.5 km/h each minute until voluntary exhaustion (3 times/week/4 months) decreased the cortisol levels, reduced sleep onset latency, and significantly increased total sleep time [29]. Although the mechanisms that underlie the interrelation between physical exercise and hormones functioning remain to be fully characterized, it seems that physical exercise exerts control of insomnia.

An additional variable that influences the effects of physical exercise in insomnia control is the timing of the intervention since early morning awakening seems to be associated with an advanced core body temperature rhythm [30]. Other studies have demonstrated that chronic moderate to high-intensity physical exercise interventions (step aerobics exercise 3 times/week/10 weeks at an intensity of 75–85% of the heart rate reserve during 45 min) modified the circadian rhythm, which is related with melatonin levels of individuals [31]. Opposite findings have been described by showing that low-intensity/chronic physical exercise exerts negative effects on the secretion of melatonin [32]. Despite the current evidence describes the relationship among physical exercise and melatonin release [33, 34], further studies are needed to clarify the mechanism of action that implies the interrelation of these two variables.

Insomnia also has been associated with an impaired immune function, such as lower levels of immune cells [35, 36]. Thus, the relationship between immune system and physical exercise might explain the positive effects of physical exercise in insomnia management. Nehlsen-Cannarella et al. [37] examined the role of moderate physical exercise training on the immune response finding changes in immune system such as immunoglobulins and T-cell subpopulation after 6–15 weeks of training.

On the other hand, moderate aerobic exercise showed positive trends towards increased total sleep time and decreased of awakening during sleep time [38]. In addition, the effects of an aerobic physical exercise in older adults with mild sleep impairments have demonstrated that the 8-week long intervention of 2 aquatic exercise sessions of 60 min/week lead to significant benefits on the sleep onset latency and the sleep efficiency [39]. Similar findings have been reported in this regard. For example, randomized controlled trials with physical exercise training programmes between 10 and 16 weeks, consisting of moderate to vigorous aerobic or resistance training with a dataset of over 300 participants with sleeping problems, showed positive effects on sleep quality as well as a sleep latency reduction [40]. Moreover, Hartescu et al. [41], published the outcomes of a randomized controlled trial in which the insomniac participants were instructed to walk at moderate-intensity for at least 30 min/day/5 days/week over a period of 6 months. The results of this intervention reduced the severity of insomnia symptoms and a significantly elevated mood. Thus, greater insomnia symptoms predict greater improvements in mood state after physical exercise [42].

In overall, the available literature suggests that acute as well as moderate physical exercise controls insomnia [43, 44]. Moreover, it is worthy to mention that long-term moderate-intensity aerobic exercises have shown to be more effective in managing insomnia over a prolonged period of time [23, 45, 46, 47].

2.2 Transcranial Direct Current Stimulation for Insomnia

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that applies a low-intensity and continuous current that presumably induces cortical excitability changes [48]. tDCS has been used for multiple health purposes [48, 49, 50, 51, 52, 53]. Regarding the use of tDCS in insomnia, the role of prefronto-thalamic-cerebellar circuit on cognitive dysfunctions and sleep quality in euthymic bipolar disorder (BD) patients have showed that tDCS (2 mA) for 20 min/day during 3 consecutive weeks applied to left dorsolateral prefrontal cortex (DLPFC) and right cerebellar cortex improved sleep [54]. It has been suggested that DLPFC and cerebellum play a relevant role in modulating sleep [55, 56]. Similar findings were reported by Galbiati et al. [57] since the effects of anodal tDCS applied to left DLPFC on arousal of patients with idiopathic hypersomnia during the 4 weeks/3 times/week reduced excessive daytime sleepiness. These results suggest that tDCS may modulate sleepiness in idiopathic patients [55, 56, 57].

Emerging research has demonstrated that application of slow oscillatory tDCS compared to sham-slow oscillatory tDCS decreased waking time [58, 59, 60]. These findings suggest a putative sleep-stabilizing role for slow oscillatory after tDCS in insomniacs [61, 62]. Despite the mechanism of action of tDCS in insomnia control remains to be described, it is thought that nitric oxide (NO) might be engaged in the control of insomnia. Recent evidence has shown that release of NO promotes sleep [63]. Following this idea, the gap junction permeability of neurons may be affect by NO, which in turn could activate sleep-related neurons that project to several areas of the central nervous system, including cerebral cortex [64]. Thus, it is suspected that slow oscillatory tDCS would increase NO production leading to sleep promotion. Nevertheless, future studies should be aimed to address this assumption. Besides, wider parameters for tDCS stimulation might be focus of further reports.

3 Conclusions

Insomnia is a sleep disorder reported in general population [1, 2]. Despite the wide spectrum of pharmacological options for treating insomnia [3, 4, 5, 6, 65, 66], alternative non-pharmacological/invasive strategies for preventing and managing this sleep disturbance are emerging as an effective therapeutic option, including physical exercise as well as tDCS [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 54, 55, 56, 57, 60, 66, 67, 68] (Fig. 1).
Fig. 1

The use of non-pharmacological/invasive approaches for managing insomnia. Physical exercise and/or transcranial direct current stimulation have shown positive effects for treating insomnia

In this regard, physical exercise controls insomnia in different approaches. For example, subjects with a high fitness level linked with physical activity and exercise, self-perceived higher sleep quality [16, 17]. In addition, moderate-intensity physical aerobic exercise in the afternoon using a treadmill, but not after high-intensity physical aerobic exercise (intense physical exercise in treadmill) or moderate resistance physical exercise (weightlifting), control insomnia [23]. On the other side, the use of tDCS for treating insomnia has limited exploration. Despite that few papers have been published in this regard, common findings have been described: application of tDCS to DLPFC and right cerebellar cortex decreases insomnia [54, 57]. Although the revised evidence suggests that physical exercise and tDCS manages insomnia [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 54, 55, 56, 57, 60, 61, 62, 63, 64, 65, 66, 67, 68], further studies should be aimed to verify if these two strategies fulfill international guidelines for managing insomnia, including the American Academy of Sleep Medicine or the European Sleep Research Society recommendations [3, 69, 70]. Likewise, as one can assume, timing, duration, and type of physical exercise displays different effectiveness in insomnia control. Same criteria for using tDCS by variables such as time, duration and intensity of stimulation. An additional issue to be addressed is the possible long-term effects of using physical exercise or tDCS in insomnia. Finally, the lack of data describing the mechanism of action of physical exercise or tDCS represents a gray area that needs to be addressed (Table 1).
Table 1

Summary of some positive uses of physical exercise and transcranial direct current stimulation (tDCS) to control insomnia


Physical exercise

TDC stimulation


Insomnia symptoms

Decrease the symptoms of insomnia

Reduce the symptoms of insomnia

[7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 55, 56, 57, 58, 61, 67, 68, 69]

Long-term effects controlling insomnia

Not determined

Not determined

Not available

Neurobiological mechanism of action



Not available

However, no evidence is available regarding either the long-term effects of controlling insomnia or the neurobiological mechanism of action using physical exercise or tDCS



This work was supported by The University of California Institute for Mexico and the United States (UC MEXUS) and Consejo Nacional de Ciencia y Tecnología (CONACyT. Grant CN-17-19) and Escuela de Medicina, Universidad Anáhuac Mayab Grant (PresInvEMR2017) given to EM-R.

Compliance with Ethical Standards

Ethical standards

All data reported in this paper are from public repositories.

Conflict of interest

Authors declare no conflict of interest.


  1. 1.
    American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic coding manual, 3rd ed. Darien, IL, USA: American Academy of Sleep Medicine; 2014Google Scholar
  2. 2.
    Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22:S347–53.PubMedGoogle Scholar
  3. 3.
    Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:307–49.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Monti JM, Torterolo P, Perumal SRP. The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia. Sleep Med Rev. 2017;33:51–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Araújo T, Jarrin DC, Leanza Y, Vallières A, Morin CM. Qualitative studies of insomnia: current state of knowledge in the field. Sleep Med Rev. 2017;31:58–69.CrossRefPubMedGoogle Scholar
  6. 6.
    Doufas AG, Panagiotou OA, Panousis P, Wong SS, Ioannidis JPA. Insomnia from drug treatments: evidence from meta-analyses of randomized trials and concordance with prescribing information. Mayo Clin Proc. 2017;92:72–87.CrossRefPubMedGoogle Scholar
  7. 7.
    van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016;29:52–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Sadler P, McLaren S, Klein B, Jenkins M. Advancing cognitive behaviour therapy for older adults with comorbid insomnia and depression. Cogn Behav Ther. 2017;8:1–16.Google Scholar
  9. 9.
    Vitiello MV. Cognitive-behavioural therapy for insomnia is effective, safe and highly deployable. Evid Based Nurs. 2017;20:92.CrossRefPubMedGoogle Scholar
  10. 10.
    van Maanen A, Meijer AM, Smits MG, van der Heijden KB, Oort FJ. Effects of melatonin and bright light treatment in childhood chronic sleep onset insomnia with late melatonin onset: a randomized controlled study. Sleep. 2017;40(2).
  11. 11.
    Yeung WF, Ho FY, Chung KF, Zhang ZJ, Yu BY, Suen LK, Chan LY, Chen HY, Ho LM, Lao LX. Self-administered acupressure for insomnia disorder: a pilot randomized controlled trial. J Sleep Res. 2017 (In press).Google Scholar
  12. 12.
    Hayhoe S. Insomnia: can acupuncture help? Pain Manag. 2017;7:49–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Zhou ES, Gardiner P, Bertisch SM. Integrative medicine for insomnia. Med Clin North Am. 2017;101:865–79.CrossRefPubMedGoogle Scholar
  14. 14.
    Crönlein T. Insomnia and obesity. Curr Opin Psychiatry. 2016;29:409–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Chen LJ, Steptoe A, Chen YH, Ku PW, Lin CH. Physical activity, smoking, and the incidence of clinically diagnosed insomnia. Sleep Med. 2017;30:189–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Morita Y, Sasai-Sakuma T, Inoue Y. Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia. Sleep Med. 2017;34:200–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. Fitness and exercise as correlates of sleep complaints: is it all in our minds? Med Sci Sports Exerc. 2010;42:893–901.CrossRefPubMedGoogle Scholar
  18. 18.
    Spörndly-Nees S, Åsenlöf P, Lindberg E. High or increasing levels of physical activity protect women from future insomnia. Sleep Med. 2017;32:22–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Dzierzewski JM, Buman MP, Giacobbi PR, Roberts BL, Aiken-Morgan AT, Marsiske M, McCrae CS. Exercise and sleep in community-dwelling older adults: evidence for a reciprocal relationship. J Sleep Res. 2014;23:61–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Montgomery PI, Dennis J. Physical exercise for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2002;(4):CD003404. Scholar
  21. 21.
    Horne JA, Staff LHE. Exercise and sleep: body-heating effects. Sleep. 1983;6:36–46.CrossRefPubMedGoogle Scholar
  22. 22.
    Passos GS, Poyares DLR, Santana MG, Tufik S, Mello MT. Is exercise an alternative treatment for chronic insomnia? Clinics. 2012;67:653–60.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Passos GS, Poyares D, Santana MG, Tufik S, de Mello MT. Effect of chronic physical exercise on anxiety in patients with chronic primary insomnia. Sleep Med. 2009;10:S19.CrossRefGoogle Scholar
  24. 24.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;2:126–31.Google Scholar
  25. 25.
    Brand S, Kalak N, Gerber M, Kirov R, Pühse U, Holsboer-Trachsler E. High self-perceived exercise exertion before bedtime is associated with greater objectively assessed sleep efficiency. Sleep Med. 2014;15:1031–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Bonato M, La Torre A, Saresella M, Marventano I, Merati G, Vitale JA. Salivary cortisol concentration after high-intensity interval exercise: time of day and chronotype effect. Chronobiol Int. 2017;34:698–707.CrossRefPubMedGoogle Scholar
  27. 27.
    Budde H, Machado S, Ribeiro P, Wegner M. The cortisol response to exercise in young adults. Front Behav Neurosci. 2015;9:13.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Chen G, Xia L, Wang F, Li X, Jiao C. Patients with chronic insomnia have selective impairments in memory that are modulated by cortisol. Psychophysiology. 2016;53:1567–76.CrossRefPubMedGoogle Scholar
  29. 29.
    Passos GS, Poyares D, Santana MG, Teixeira AADS, Lira FS, Youngstedt SD, Santos RVT, Tufik S, De Mello MT. Exercise improves immune function, antidepressive response, and sleep quality in patients with chronic primary insomnia. Biomed Res Int. 2014;2014:1–7.CrossRefGoogle Scholar
  30. 30.
    Lack LC, Gradisar M, Van Someren EJW, Wright HR, Lushington K. The relationship between insomnia and body temperatures. Sleep Med Rev. 2008;12:307–17.CrossRefPubMedGoogle Scholar
  31. 31.
    Cai ZY, Chen KWC, Wen HJ. Effects of a group-based step aerobics training on sleep quality and melatonin levels in sleep-impaired postmenopausal women. J Strength Cond Res. 2014;28:2597–603.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim HJ, Kim DH. Effect of different exercise intensity on blood melatonin density in sleep disordered rats. J Korean Soc Phys Med. 2014;9:45–53.CrossRefGoogle Scholar
  33. 33.
    Atkinson G, Edwards B, Reilly T, Waterhouse J. Exercise as a synchroniser of human circadian rhythms: an update and discussion of the methodological problems. Eur J Appl Physiol. 2007;99:331–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Escames G, Ozturk G, Baño-Otálora B, Pozo MJ, Madrid JA, Reiter RJ, Serrano E, Concepción M, Acuña-Castroviejo D. Exercise and melatonin in humans: reciprocal benefits. J Pineal Res. 2012;52:1–11.CrossRefPubMedGoogle Scholar
  35. 35.
    Imeri L, Opp MR. How (and why) the immune system makes us sleep. Nat Rev Neurosci. 2009;10:199–210.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Cover H, Irwin M. Immunity and depression: insomnia, retardation, and reduction of natural killer cell activity. J Behav Med. 1994;17:217–23.CrossRefPubMedGoogle Scholar
  37. 37.
    Nehlsen-Cannarella SL, Nieman DC, Balk-Lamberton AJ, Markoff PA, Chritton DB, Gusewitch G, Lee JW. The effects of moderate exercise training on immune response. Med Sci Sports Exerc. 1991;23:64–70.CrossRefPubMedGoogle Scholar
  38. 38.
    Guilleminault C, Clerk A, Black J, Labanowski M, Pelayo R, Claman D. Nondrug treatment trials in psychophysiologic insomnia. Arch Intern Med. 1995;155:838–44.CrossRefPubMedGoogle Scholar
  39. 39.
    Chen LJ, Fox KR, Ku PW, Chang YW. Effects of aquatic exercise on sleep in older adults with mild sleep impairment: a randomized controlled trial. Int J Behav Med. 2016;23:501–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012;58:157–63.CrossRefPubMedGoogle Scholar
  41. 41.
    Hartescu I, Morgan K, Stevinson CD. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015;24:526–34.CrossRefPubMedGoogle Scholar
  42. 42.
    Rouleau CR, Horsley KJ, Morse E, Aggarwal S, Bacon SL, Campbell TS. The Association between insomnia symptoms and mood changes during exercise among patients enrolled in cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2015;35:409–16.CrossRefPubMedGoogle Scholar
  43. 43.
    Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38:427–49.CrossRefPubMedGoogle Scholar
  44. 44.
    Mendelson M, Borowik A, Michallet A, Perrin C, Monneret D, Faure P, Levy P, Pépin J, Wuyam B, Flore P. Sleep quality, sleep duration and physical activity in obese adolescents: effects of exercise training. Pediatr Obes. 2016;11:26–32.CrossRefPubMedGoogle Scholar
  45. 45.
    Schmitt A, Falkai P. Aerobic exercise in major psychiatric disorders: promises and challenges. Eur Arch Psychiatry Clin Neurosci. 2017;267:93–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11:934–40.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Patel SR, Zhu X, Storfer-Isser A, Mehra R, Jenny NS, Tracy R, Redline S. Sleep duration and biomarkers of inflammation. Sleep. 2009;32:200–4.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Lattari E, Costa SS, Campos C, De Oliveira AJ, Machado S, Neto GAM. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease? Neurosci Lett. 2017;63:6165–9.Google Scholar
  49. 49.
    Dondé C, Amad A, Nieto I, Brunoni AR, Neufeld NH, Bellivier F, Poulet E, Geoffroy PA. Transcranial direct-current stimulation (tDCS) for bipolar depression: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2017;78:123–31.CrossRefPubMedGoogle Scholar
  50. 50.
    Philip NS, Nelson BG, Frohlich F, Lim KO, Widge AS, Carpenter LL. Low-intensity transcranial current stimulation in psychiatry. Am J Psychiatry. 2017;174:628–39.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Göbel CH, Tronnier VM, Münte TF. Brain stimulation in obesity. Int J Obes. 2017 (In press).Google Scholar
  52. 52.
    ALHarbi MF, Armijo-Olivo S, Kim ES. Transcranial direct current stimulation (tDCS) to improve naming ability in post-stroke aphasia: a critical review. Behav Brain Res. 2017;332:7–15.CrossRefPubMedGoogle Scholar
  53. 53.
    Weinberger AB, Green AE, Chrysikou EG. Using transcranial direct current stimulation to enhance creative cognition: interactions between task, polarity, and stimulation site. Front Hum Neurosci. 2017;11:246.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Minichino A, Bersani FS, Spagnoli F, Corrado A, De Michele F, Calò WK, Primavera M, Yang B, Bernabei L, Macrì F. Prefronto-cerebellar transcranial direct current stimulation improves sleep quality in euthymic bipolar patients: a brief report. Behav Neurol. 2014;2014:876521.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    McKenna BS, Eyler LT. Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies. Clin Psychol Rev. 2012;32:650–63.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    DelRosso LM, Hoque R. The cerebellum and sleep. Neurol Clin. 2014;32:893–900.CrossRefPubMedGoogle Scholar
  57. 57.
    Galbiati A, Abutalebi J, Iannaccone S, Borsa VM, Musteata S, Zucconi M, Giora E, Ferini-Strambi L. The effects of transcranial direct current stimulation (tDCS) on idiopathic hypersomnia: a pilot study. Arch Ital Biol. 2016;154:1–5.CrossRefPubMedGoogle Scholar
  58. 58.
    de Sá AS, Campos C, Rocha NB, Yuan TF, Paes F, Arias-Carrión O, Carta MG, Nardi AE, Cheniaux E, Machado S. Neurobiology of bipolar disorder: abnormalities on cognitive and cortical functioning and biomarker levels. CNS Neurol Disord Targets. 2016;15:713–22.CrossRefGoogle Scholar
  59. 59.
    Pedroso JL, Braga-Neto P, Felício AC, Aquino CCH, Prado LB, Prado GFD, Barsottini OGP. Sleep disorders in cerebellar ataxias. Arq Neuropsiquiatr. 2011;69:253–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Saebipour MR, Joghataei MT, Yoonessi A, Sadeghniiat-Haghighi K, Khalighinejad N, Khademi S. Slow oscillating transcranial direct current stimulation during sleep has a sleep-stabilizing effect in chronic insomnia: a pilot study. J Sleep Res. 2015;24:518–25.CrossRefPubMedGoogle Scholar
  61. 61.
    Dang-Vu TT, Schabus M, Desseilles M, Albouy G, Boly M, Darsaud A, Gais S, Rauchs G, Sterpenich V, Vandewalle G. Spontaneous neural activity during human slow wave sleep. Proc Natl Acad Sci. 2008;105:15160–5.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Kaufmann C, Wehrle R, Wetter TC, Holsboer F, Auer DP, Pollmächer T, Czisch M. Brain activation and hypothalamic functional connectivity during human non-rapid eye movement sleep: an EEG/fMRI study. Brain. 2005;129:655–67.CrossRefPubMedGoogle Scholar
  63. 63.
    Morairty SR, Dittrich L, Pasumarthi RK, Valladao D, Heiss JE, Gerashchenko D, Kilduff TS. A role for cortical nNOS/NK1 neurons in coupling homeostatic sleep drive to EEG slow wave activity. Proc Natl Acad Sci. 2013;110:20272–7.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Gerashchenko D, Wisor JP, Kilduff TS. Sleep-active cells in the cerebral cortex and their role in slow-wave activity. Sleep Biol Rhythms. 2011;9:71–7.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Maness DL, Khan M. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2015;92:1058–64.PubMedGoogle Scholar
  66. 66.
    Hollenbach D, Broker R, Herlehy S, Stuber K. Non-pharmacological interventions for sleep quality and insomnia during pregnancy: a systematic review. J Can Chiropr Assoc. 2013;57:260–70.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Dolezal BA, Neufeld EV, Boland DM, Martin JL, Cooper CB. Interrelationship between sleep and exercise: a systematic review. Adv Prev Med. 2017;2017:1364387.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Milne S, Elkins MR. Exercise as an alternative treatment for chronic insomnia (PEDro synthesis). Br J Sports Med. 2017;51:479–80.CrossRefPubMedGoogle Scholar
  69. 69.
    Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:479–504.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia-Borreguero D, Gjerstad M, Gonçalves M, Hertenstein E, Jansson-Fröjmark M, Jennum PJ, Leger D, Nissen C, Parrino L, Paunio T, Pevernagie D, Verbraecken J, Weeß HG, Wichniak A, Zavalko I, Arnardottir ES, Deleanu OC, Strazisar B, Zoetmulder M, Spiegelhalder K. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 (In press).Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • María Fernanda Higuera-Hernández
    • 1
    • 2
    • 3
  • Elena Reyes-Cuapio
    • 1
    • 2
    • 3
    • 4
  • Marissa Gutiérrez-Mendoza
    • 1
    • 2
    • 3
  • Nuno Barbosa Rocha
    • 3
    • 5
  • André Barciela Veras
    • 3
    • 6
    • 7
  • Henning Budde
    • 3
    • 8
    • 9
    • 10
  • Johanna Jesse
    • 8
  • Sérgio Machado
    • 3
    • 6
    • 11
  • Eric Murillo-Rodríguez
    • 1
    • 2
    • 3
  1. 1.Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la SaludUniversidad Anáhuac MayabMéridaMexico
  2. 2.Grupo de Investigación en Envejecimiento, División Ciencias de la SaludUniversidad Anáhuac MayabMéridaMexico
  3. 3.Intercontinental Neuroscience Research GroupMéridaMexico
  4. 4.Escuela de Nutrición, División Ciencias de la SaludUniversidad Anáhuac MayabMéridaMexico
  5. 5.Faculty of Health SciencesPolytechnic Institute of PortoPortoPortugal
  6. 6.Laboratory of Panic and Respiration, Institute of PsychiatryFederal University of Rio de JaneiroRio de JaneiroBrazil
  7. 7.Postgraduate Program in Health PsychologyDom Bosco Catholic University Campo GrandeCampo GrandeBrazil
  8. 8.Faculty of Human SciencesMedical School HamburgHamburgGermany
  9. 9.Sports Science Department, Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), School of Science and EngineeringReykjavik UniversityReykjavíkIceland
  10. 10.Lithuanian Sports UniversityKaunasLithuania
  11. 11.Physical Activity Neuroscience LaboratoryPhysical Activity Sciences Postgraduate Program of Salgado de Oliveira UniversityNiteróiBrazil

Personalised recommendations