Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, medication-free treatment gaining traction for improving both depression and sleep quality. Recent research has taken the forefront on providing evidence that supports these incredible benefits.  

For example, a 2024 study of 975 patients receiving rTMS at two U.S. psychiatric clinics in the U.S. showed the following (1): 

• TMS improves sleep quality. Post-treatment sleep scores showed significant improvement (p<.001).
• Better sleep correlates with greater reductions in depression symptoms. The study found a moderate correlation (r= .318, p<.001) between sleep quality improvements and non-insomnia-related depressive symptom improvement.
• Having insomnia did not predict rTMS success. Patients with severe insomnia at the start of treatment had similar response rates to those without sleep problems.
• Taking sleep medication improves depression symptoms. Patients with significant insomnia who used sleep medications had better depression outcomes after rTMS compared to those who didn’t use sleep medications (p= .021).

While insomnia didn’t predict success, improving sleep during treatment may enhance results.

Should You Treat Insomnia Before Starting TMS?

From this study, researchers and experts believe that addressing sleep problems before and during treatment may improve results. After all, poor sleep affects many important brain functions, such as:

1. Brain Plasticity: rTMS works by stimulating neuroplasticity, the brain’s ability to adapt and reorganize to life experiences. Sleep deprivation impairs this process, potentially reducing rTMS effectiveness (2).
2. Cortisol Levels: Chronic insomnia increases stress hormones like cortisol, which disrupt emotional regulation and contribute to antidepressant resistance (3).
3. Neurotransmitter Function: Poor sleep lowers serotonin and dopamine levels, making it harder for rTMS to restore normal brain function.

While no large-scale trials have studied CBT-I alongside rTMS, early research suggests a potential benefit. Although more rTMS-specific research is needed, studies combining CBT-I with depression treatment show lasting benefits. For example, one small trial found that combining cognitive-behavioral therapy for insomnia (CBT-I) with antidepressant treatment improved response rates (4). Another study showed that two patients receiving TMS combined with CBT-I experienced full remission from depression (5).

Can Sleep Medications Improve TMS Results?

These studies also revealed that sleep medications may improve depression outcomes, even if sleep quality didn’t change much. This could be because:

• Sleep medications may help regulate the sleep cycle and associated neuroplasticity processes. 
• Sleep medications may boost the production of proteins such as brain-derived neurotrophic factor (BDNF), a protein essential for neural repair and neuroplasticity..
• Sleep medications may also reduce nighttime awakenings and stress-related hyperarousal, leading to fewer depressive symptoms overall.

 But not all medications work well with TMS. It is important to check with your doctor before combining treatments to ensure you find the right option for you.

Limitations of the Study

While research provides important information about how sleep impacts rTMS, several limitations should be considered.

• No Objective Sleep Tracking: Researchers relied on self-reported sleep quality, which may not fully reflect actual sleep disturbances. More accurate tools like actigraphy or EEG-based sleep analysis could provide better data.
• Incomplete Sleep Medication Data: Sleep medication use was linked to better depression outcomes. Researchers did not track the type, dosage, or duration of medications. Without those details, it’s unclear which sleep treatments work best.
• Unaccounted Lifestyle Factors: Other elements that may influence TMS effectiveness, such as caffeine, alcohol, or exercise, were not included. Chronic caffeine consumption, for example, has been shown to reduce rTMS-induced neuroplasticity.
• Variations in rTMS Protocols: Patients received different types of rTMS, including 5-Hz rTMS and intermittent theta burst stimulation (iTBS). Both are classified as “excitatory” treatments. Small differences in stimulation frequency and pulse numbers can change how the brain responds. Even slight adjustments may lead to different effects on depression and sleep.
• Limited Insomnia Classification: The study grouped patients into “low/no insomnia” and “high insomnia” based on a set threshold. However, insomnia has multiple forms and severities, and this method may not fully capture all sleep disturbances.

As you can see, while the research and findings are encouraging, more precise and controlled research is needed to fully understand how sleep treatments influence rTMS success.

 Why Sleep Improves Mental Health

Sleep is the foundation of mental and emotional health and comes with some powerful benefits

• Research shows that improved sleep lowers the risk of developing depression by up to five to ten times (6).
• Getting a good night’s rest also improves mood, memory, and coping skills.
• Improving your sleep will also strengthen the brain’s ability to adapt, learn, and heal.

To improve your sleep, here are some tips and tricks for you to try:

• Create an optimal sleep environment: A dark, quiet, and cool bedroom promotes deeper, uninterrupted sleep. The ideal temperature for sleep is 60-67°F (15-19°C), as cooler conditions support natural sleep cycles. Using blackout curtains or white noise machines can help block out distractions and keep the room peaceful throughout the night (7).
• Another important step is reducing blue light exposure before bed. Screens from phones, TVs, and tablets emit blue light, which suppresses melatonin and makes it harder to fall asleep. To prevent this, try using blue-light-blocking glasses, enabling night mode settings, or avoiding screens for at least an hour before bed (8).
• Caffeine and alcohol can also interfere with sleep. Caffeine stays in the system for 5-6 hours, meaning a late afternoon coffee can still affect sleep at night. While alcohol may initially make people feel sleepy, it disrupts REM sleep, leading to restless nights. Switching to caffeine-free herbal teas like chamomile or valerian root can promote relaxation and improve sleep quality.
• Relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation help lower stress levels and prepare the body for sleep. Practicing these techniques before bed can calm the nervous system and improve sleep consistency.
• Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the most effective treatment for those with chronic sleep problems. CBT-I may work better than sleep medications in the long run, as it focuses on changing negative thoughts and behaviors that disrupt sleep. Unlike medication, its effects last beyond treatment.
• Regular physical activity can also lead to better sleep. Exercise improves sleep efficiency and promotes deeper sleep cycles, helping to regulate the body’s natural sleep rhythm. However, intense workouts too close to bedtime may have the opposite effect, so it’s best to exercise earlier in the day.

Making small changes like these to your sleeping habits can lead to significant improvements in mental and physical health. Start by picking one and trying it out!

Experience The Difference Of Expert-led TMS Therapy

TMS Institute of Arizona provides research-backed, FDA-approved TMS therapy for depression. Treatment is non-invasive and medication-free, making it an effective option for those who have not improved with other methods. Care goes beyond just symptom relief, addressing factors like sleep health and lifestyle habits to support lasting results. 

In addition we have a team of board-certified specialists with extensive experience in TMS and high success rates in treatment-resistant depression. At TMS Institute of Arizona, you will receive real care and support as we work together to find an individualized solution that will set you on the path of recovery.

Break free from depression. Message us today to get started.

References

1. Kweon, J., Fukuda, A. M., Gobin, A. P., Haq, L., Carpenter, L. L., & Brown, J. C. (2024). Effect of sleep quality on repetitive transcranial magnetic stimulation outcomes in depression. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1458696
2. Kricheldorff, J., Göke, K., Maximilian Kiebs, Kasten, F. H., Herrmann, C. S., Witt, K., & Hurlemann, R. (2022). Evidence of Neuroplastic Changes after Transcranial Magnetic, Electric, and Deep Brain Stimulation. Brain Sciences, 12(7), 929–929. https://doi.org/10.3390/brainsci12070929
3. Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science, 8(3), 143–152. https://doi.org/10.1016/j.slsci.2015.09.002
4. Manber, R., Edinger, J. D., Gress, J. L., San, M. G., Kuo, T. F., & Kalista, T. (2008). Cognitive Behavioral Therapy for Insomnia Enhances Depression Outcome in Patients with Comorbid Major Depressive Disorder and Insomnia. SLEEP, 31(4), 489–495. https://doi.org/10.1093/sleep/31.4.489
5. Norred, M. A., Haselden, L. C., Sahlem, G. L., Wilkerson, A. K., Short, E. B., McTeague, L. M., & George, M. S. (2021). TMS and CBT-I for comorbid depression and insomnia. Exploring feasibility and tolerability of transcranial magnetic stimulation (TMS) and cognitive behavioral therapy for insomnia (CBT-I) for comorbid major depressive disorder and insomnia during the COVID-19 pandemic. Brain Stimulation, 14(6), 1508–1510. https://doi.org/10.1016/j.brs.2021.09.007
6. Colten, H. R., Altevogt, B. M., & US), M. (2025). Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK19961/
7. Strøm-Tejsen, P., Mathiasen, S., Bach, M., & Petersen, S. (2016, July). The effects of increased bedroom air temperature on sleep and next-day mental performance. ResearchGate; unknown. https://www.researchgate.net/publication/311675451_The_effects_of_increased_bedroom_air_temperature_on_sleep_and_next-day_mental_performance
8. Blue light has a dark side – Harvard Health. (2012, April 17). Harvard Health. https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side