Bionic sleep therapy combined with multimodal management for chronic insomnia with alcohol withdrawal-related symptoms

Rationale: Patients who use alcohol as a sleep aid may experience withdrawal-related insomnia and hyperarousal, which can reinforce continued drinking. Bionic sleep therapy (BST) is an exploratory intervention using intravenous anesthetic and sedative agents under close monitoring to induce a brief, controllable, sleep-like state. It may provide short-term support for sleep initiation during early alcohol withdrawal. Patient concerns: A 71-year-old man had chronic insomnia for over 15 years and consumed 100 to 200 mL of Chinese baijiu nightly to initiate sleep, with additional alcohol after nocturnal awakenings. Repeated attempts to stop drinking were followed by worsening insomnia, restlessness, palpitations, diaphoresis, and intense alcohol craving, which improved after drinking. Diagnoses: Chronic insomnia with recurrent mild alcohol withdrawal-related symptoms and a high risk of complicated alcohol withdrawal. Interventions: The patient underwent 2 monitored BST sessions on hospital days 1 and 2 under continuous cardiorespiratory monitoring. Propofol (1 mg/kg) was administered intravenously for rapid induction, followed by a 60-minute dexmedetomidine infusion via an IV pump at 0.2 to 0.4 μg/kg/h. Multimodal treatment was intensified on hospital day 2, including cognitive behavioral therapy for insomnia, medication adjustment, and adjunctive neuromodulation. Outcomes: During the overall multimodal treatment course, on the night of the first BST session, the patient initiated sleep without alcohol and returned to sleep after a nocturnal awakening without further drinking. Polysomnography showed a total sleep time of 373 minutes and sleep efficiency of 85.6%. Following the second session, he consumed approximately 20 mL of alcohol after a nocturnal awakening before returning to sleep; sleep diary-reported sleep efficiency was 90.6%. Vital signs remained stable during both sessions, and no apparent anesthesia- or sedation-related adverse events occurred. No further alcohol intake was recorded from hospital day 3 to day 7. At discharge, subjective sleep efficiency was 87.7%, with improvements in sleep initiation, maintenance, and some daytime symptoms. Postdischarge follow-up data were unavailable. Lessons: BST using propofol and dexmedetomidine may warrant further investigation as an adjunct to multimodal management in patients with chronic insomnia, long-term alcohol use as a sleep aid, and withdrawal-related symptoms. However, improvements cannot be attributed specifically to BST, and its contribution and durability require prospective evaluation.