Non-invasive vestibular neuromodulation for chronic insomnia following hypoxic-ischemic brain injury: A case report
Madeline Tovar1*, Jason P. Caffrey1*, Darlene D. Makulski1,2
1H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
2Department of Physical Medicine and Rehabilitation, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
Keywords: Anoxic brain injury, rehabilitation, sleep dysregulation, vestibular system stimulation, wearable device.
Abstract
Sleep dysregulation occurs frequently after brain injury, although its management can be difficult, particularly when cognitive deficits limit behavioral interventions and medications may contribute to cognitive impairment. In this report, we present a 29-year-old male veteran with chronic severe insomnia and highly disruptive parasomnias persisting 11 years after hypoxic-ischemic brain injury (HIBI) following cardiac arrest. His symptoms were refractory to sleep hygiene interventions, multiple pharmacological regimens, and alternative therapies. He was initiated on nightly non-invasive electrical vestibular system stimulation (VSS). At one, seven, and 13-month follow-up, his caregiver reported marked improvement in nighttime sleep, resolution of parasomnias, and improved daytime cognitive engagement. His Insomnia Severity Index score improved from 25 (severe clinical insomnia) to 4 (no clinically significant insomnia), without adverse effects. In conclusion, this case suggests that VSS may represent a promising non-pharmacological treatment option for refractory insomnia after HIBI and warrants further prospective study in brain injury populations.
* These authors contributed equally to this work.
Citation: Tovar M, Caffrey JP, Makulski DD. Non-invasive vestibular neuromodulation for chronic insomnia following hypoxic-ischemic brain injury: A case report. Arch ISPRM 2026;1(x):i-v. https://doi.org/10.5606/archisprm.2026.75.