Bionic sleep therapy for refractory insomnia: a case report and literature review

The management of refractory insomnia remains a significant clinical challenge. This case report describes a novel intervention termed “Bionic Sleep Therapy,” involving the combined intravenous administration of propofol and dexmedetomidine, in a patient with severe, long-standing insomnia that had proven resistant to conventional multimodal treatments. A 49-year-old woman with a 21-year history of refractory insomnia, characterized by severe sleep initiation and maintenance difficulties accompanied by symptoms of anxiety and depression. Despite prior treatments including Cognitive Behavioral Therapy for Insomnia (CBT-I), various sedative-hypnotics, and Traditional Chinese Medicine (TCM), her symptoms persisted. She underwent “Bionic Sleep Therapy”—a target-controlled infusion of propofol and dexmedetomidine—over three sessions. Polysomnography (PSG) during therapy revealed a pharmacologically induced sleep-like state predominantly composed of N2 sleep architecture. Following the intervention, her objective sleep notably improved from a baseline of 0% to a peak of 51%. Concurrently, notable improvements were observed in her subjective sleep quality and daytime alertness scores, alongside a reduction in anxiety and depressive symptoms. Bionic Sleep Therapy, utilizing propofol and dexmedetomidine, may serve as a promising short-term bridging intervention for patients with refractory insomnia who are unresponsive to standard therapies. It appears to facilitate the breaking of the hyperarousal cycle and improve subjective sleep quality. However, given the pharmacological nature of the sleep induced, further large-scale, controlled studies are required to validate its long-term efficacy and safety profile.