# Transcutaneous vagal nerve stimulation improvement of sleep quality in veterans with PTSD with or without history of mild TBI

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

Problem: Post traumatic stress disorder (PTSD) severely limits quality of life. Current PTSD treatments have
limited and variable efficacy. New and more effective treatments are necessary. Patients with PTSD often have
disrupted sleep. These patients are more likely to wake up multiple times a night, and have decreased slow
wave sleep and increased REM sleep. Further, autonomic and behavioral components during sleep are
consistent with a continued fight or flight state while asleep. This includes higher heart rate, lower
parasympathetic tone, and greater likelihood of nightmares. PTSD is also associated with higher insomnia
severity scores as well as regional neurotransmitter disruptions in systems critical for the regulation of affect.
Poor sleep quality is associated with poor health outcomes that overlap with those that are experienced in
PTSD. These include associations with the development of cardiovascular disease, diabetes and inflammatory
diseases including arthritis. Effective treatment of sleep problems in this population could have substantial
impact on these symptoms and improve quality of life. Heterogeneity in PTSD, including hyperarousal
symptom expression and prior occurring mild traumatic brain injury (mTBI), may influence individual
differences in treatment response. mTBI is a common occurring preceding injury to PTSD and damage to
limbic white matter structures may influence presentation of PTSD.
Current pharmacological approaches often have side effects like negative impacts on sleep architecture,
addiction, and cognitive performance consequences. Further, Veterans often report that they use alcohol and
other drugs in order to fall asleep and stop nightmares, compounding the issue. Vagal nerve stimulation (VNS)
approaches have potential, especially in this population to improve sleep quality and to also improve
hyperarousal symptoms of PTSD.
Vagal nerve stimulation (VNS) induces activation of the parasympathetic nervous system and suppression of
amygdala activity, addressing the core components of hyperarousal symptoms of PTSD. Conventional VNS
requires neurosurgery. However, we will investigate a novel, non-invasive approach: transcutaneous vagal
nerve stimulation (tVNS). tVNS has a high potential for success in this population.
Preliminary work. Our pilot data demonstrate increased slow wave sleep, and decreased REM sleep and
sleep latency after one hour of tVNS at “lights out.” The mechanism for this may be the result of decreasing
hyperarousal symptoms during the first hour of sleep; all participants showed increased high frequency heart
rate variability during tVNS compared with sham. We have also previously demonstrated tVNS improvement of
hyperarousal signs of PTSD including upregulation of parasympathetic nervous system and attenuation of
sympathetic nervous system activity during ‘startle’ in Veterans with PTSD with or without history of mTBI.
Plan Our objective is to use tVNS in Veterans with PTSD with or without his...

## Key facts

- **NIH application ID:** 10020802
- **Project number:** 5I01RX003140-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** John B Williamson
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020802

## Citation

> US National Institutes of Health, RePORTER application 10020802, Transcutaneous vagal nerve stimulation improvement of sleep quality in veterans with PTSD with or without history of mild TBI (5I01RX003140-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10020802. Licensed CC0.

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