Peter Colvonen, PhD

HCPLive Five at SLEEP 2025 

 SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies,

 from June 9 – 11th in Seattle, Washington, to share new sleep medicine data.

As a part of HCPLive’s on-site coverage, the editorial team conducted > 15 interviews on various topics, from new pharmacotherapy treatments for OSA and AI in sleep medicine to changes to the restless legs syndrome (RLS) guidelines and the association between napping and mortality risk in older adults.

In this edition of the HCPLive Five, the team captured the top 5 interviews at the meeting, featuring research on a VeNS device for insomnia and PTSD, latest pharmacotherapy developments for sleep apnea, new RLS guidelines, the link between naps and mortality risk, and AD109 for obstructive sleep apnea (OSA).

VeNS Device Improves PTSD, Insomnia Symptoms in RCT, with Peter Colvonen, PhD

Peter Colvonen, PhD, an associate clinical professor at the University of California, San Diego, presented results from a randomized controlled trial showing that vestibular nerve stimulation (VeNS) significantly improved PTSD and insomnia symptoms. The 12-week trial involved over 380 adults with PTSD, many of whom face years-long waits for 1-on-1 therapy.

VeNS, a non-invasive, at-home device, led to significantly greater reductions in PTSD and Insomnia Severity Index scores compared to a sham. Colvonen emphasized its potential as an interim solution for patients stuck on long waitlists, highlighting VeNS as a scalable option to stabilize symptoms until gold-standard care becomes available.

Latest Pharmacotherapy Developments for Sleep Apnea, with Danny Eckert, PhD

Danny Eckert, PhD, a professor at Flinders University, highlighted emerging pharmacotherapies for obstructive sleep apnea (OSA), addressing both anatomical and non-anatomical causes. The FDA-approved GLP-1 agonist tirzepatide helps reduce OSA in obese patients through weight loss.

For non-obese individuals, AD109, a combination of aroxybutynin and atomoxetine, showed promise in a phase 3 trial, resolving OSA in 25% of patients. Eckert also discussed potassium channel blockers that reset airway reflexes and acetazolamide, which lowers loop gain and reduces OSA severity. These advances mark a shift toward personalized, drug-based OSA treatments, especially for patients who struggle with traditional therapies like CPAP.

RLS Guidelines Advise Against Dopamine Agonists, With John Winkelman, MD, PhD

John Winkelman, MD, PhD, chief of the sleep disorders clinical research program at Massachusetts General Hospital, discussed the AASM’s updated restless legs syndrome (RLS) guidelines, which now advise against routine use of dopamine agonists due to high augmentation risk. Up to 50% of patients on these drugs may experience symptom worsening over five years. The guidelines recommend iron therapies and alpha-2-delta ligands (gabapentin, gabapentin enacarbil, pregabalin) instead.

Winkelman emphasized identifying and managing exacerbating factors like antidepressants, antihistamines, or sleep apnea. He advises a slow, careful taper of dopamine agonists over 6–12 months, warning patients of temporary worsening but long-term improvement once off the medication.

Naps at Noon Linked to Mortality Risk in Older Adults, with Chenlu Gao, PhD

Chenlu Gao, PhD, from Massachusetts General Hospital and Harvard Medical School, presented findings linking longer, irregular, and early afternoon naps to increased all-cause mortality in middle-to-older adults. Using UK Biobank data from over 86,000 participants, the study found that greater nap duration, high day-to-day variability, and naps between 11 am–3 pm were associated with higher mortality risk over an 8-year follow-up.

Gao emphasized the study was observational and not causal—napping patterns may reflect underlying health issues like sleep disorders or chronic illness. She advised clinicians to address root causes of excessive napping rather than eliminating naps entirely.

AD109 Improves OSA in Phase 3 SynAIRgy Trial, With Patrick Strollo, MD

Patrick Strollo, MD, from the University of Pittsburgh Medical Center, presented phase 3 SynAIRgy trial results showing that AD109, a once-daily oral neuromuscular modulator, significantly improved obstructive sleep apnea (OSA). In the 26-week trial of 646 participants intolerant of CPAP, AD109 reduced apnea-hypopnea index (AHI) by 55.6% and improved oxygenation measures. More than half of participants had reduced OSA severity, and 22.3% achieved full disease control (AHI < 5).

AD109, a first-in-class combination of aroxybutynin and atomoxetine, works by enhancing upper airway muscle tone during sleep. Apnimed plans to submit an FDA application in early 2026, with additional phase 3 data expected later in 2025.

Articles

Sleep experts gathered at SLEEP 2025 to discuss advancements in sleep medicine, including new treatments and guidelines. Key topics included a VeNS device for PTSD and insomnia, pharmacotherapy for sleep apnea, updated RLS guidelines, and the link between napping and mortality risk. The VeNS device showed promise in reducing PTSD and insomnia symptoms, while new pharmacotherapies like AD109 and tirzepatide offered hope for OSA patients. Updated RLS guidelines advised against dopamine agonists, and research linked irregular naps to increased mortality risk, emphasizing the need to address underlying health issues.

Check out the top 5 interviews from SLEEP 2025.

spoke with Peter Colvonen, PhD, an associate clinical professor at the University of California, San Diego, about his late breaker on a randomized controlled trial that studied an electrical vestibular nerve stimulation (VeNS) for patients with both PTSD and

 experience insomnia. However, PTSD treatments do not target insomnia, and 70% of patients report sleep issues after trauma-focused treatment. Colvonen and his colleagues sought to assess the impact of a non-invasive, electrical vestibular nerve stimulation treatment for PTSD on insomnia symptoms.

“One of the issues we are facing is the amount of training it takes for CBTI and for PTSD,” Colvonen said.

Even though many PTSD treatment options exist, such as prolonged exposure, EMDR, eye movement, reprocessing, desensitization, and cognitive processing therapy, patients with PTSD outnumber trained providers. Colvonen said that, at the VA hospital, a thousand individuals are waiting for 1 on 1 treatment.

“So, the question is: what can we do to, maybe not cure, maybe not fix it, but give them some stability with a remote ambulatory system?” Colvonen said. “The premise is, can we give them something that will help them in the meantime, until they can see that [provider] 1 on 1. The average time between when you get diagnosed with PTSD and when you see somebody is minimum 2 years… maybe you're on a wait list. Can we give them something to help sustain them in that time? And so, that's where this late-breaking abstract really comes in.”

The double-blind, randomized, sham-controlled trial, completed on December 2, 2024, evaluated the efficacy and safety of VeNS. The study included US adults aged 22 – 80 years (mean age, 43.1 years) with PTSD; 56% were female. PTSD was confirmed with the Clinician-Administered PTSD Scale for DSM-5.

Colvonen and colleagues randomized participants 1:1 to receive an active (n = 191) or sham (n = 192) device. Participants completed daily 30-minute stimulation sessions for 12 weeks.

The study showed that participants receiving VeNS had greater mean reductions in PCL-5 scores than participants receiving sham, demonstrated through intention-to-treat (-21.99 vs. -16.93, 

= .024; and per protocol analyses (-24.62 vs. -17.31,

 = .002). The active group also had a greater mean reduction in ISI scores in both the intention-to-treat (-7.30 vs. -4.76, 

 = .003) and per protocol (-7.98 vs. -3.27, 

 <0.001) analyses. Moreover, significantly more participants on VeNS achieved a 6-point reduction in ISI (intention-to-treat: 59% vs 44%; 

“The sham device did work, but the active control was a much steeper, stronger slope than the sham device for the FDA trial,” Colvonen said. “So, it's not as good as, say, a 1-on-1 treatment, but the effect sizes are wonderful. I would absolutely start bringing this into the VA hospital where individuals are waiting, just give them something to help stabilize their sleep and PTSD while they're waiting…I'm really excited to bring it in for our waitlist while they're waiting for that gold standard 1-on-1.”

McKeown J, Colvonen P, Reel J, et al. Electrical Vestibular Nerve Stimulation for PTSD: Does It Improve Insomnia? Findings from a Randomized Controlled Trial. Late breaker was presented at SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, from June 8 – 12, 2025, in Seattle.

Videos

At SLEEP 2025, Colvonen discussed RCT findings that showed VeNS significantly improved PTSD and insomnia symptoms, offering a scalable solution for patients awaiting 1-on-1 care.

 VeNS Device Improves PTSD, Insomnia Symptoms in RCT, with Peter Colvonen, PhD

Treating Insomnia First May Be Key to Effective PTSD Therapy, with Peter Colvonen, PhD

, the 39th annual Associated Professional Sleep Societies meeting in Seattle, Washington, Peter Colvonen, PhD, presented on disordered 

sat down with Colvonen, an associate clinical professor at the University of California, San Diego, to discuss common, underrecognized sleep disturbances in individuals with PTSD and how to treat these patients.

“Historically, sleep was integrated into the definition of PTSD, so it was assumed that if you treat PTSD, the insomnia would go down, whereas, in fact, what we're seeing now is that's not the case,” Colvonen explained. “About 80% of veterans who go through the very best PTSD treatments still have insomnia on the other side. What we're seeing is actually an independent disorder, a fully independent disorder for insomnia.”

Colvonen added that fragmented sleep due to insomnia directly interferes with PTSD treatments. Insomnia interferes with treatments for various areas—anxiety, depression, learning, memory, recall, encoding, emotional processing, emotional coping, substance use, and suicidality.

“It makes insomnia a critically important disorder to go after if you want to be effective with PTSD [treatment,” he said.

He continued by saying that sleep improves emotional memory learning, which, in turn, improves PTSD symptoms. If a patient experiences insomnia and PTSD, Colvonen recommends ordering cognitive behavior therapy for insomnia (CBT-I) first.

“PTSD treatments really hard,” Colvonen said. “It's asking you to kind of relive and go through some of your worst memories. So, if you get that trust with helping out the CBTI, [they’ll] sleep right in the first 4 or 5 weeks, they're much more likely to walk with you in talking about their trauma as a clinician. I think that would be the take-home [message].”

When it comes to sleep disturbances in patients with PTSD, not only is insomnia common, but also obstructive sleep apnea (OSA). Several studies have shown that untreated OSA directly interferes with cognitive processing therapy and prolonged exposure.

“[With] making sure you're addressing the fragmented sleep of obstructive sleep apnea, you're going to have much better trajectories, both clinically… and statistically significant on your treatment.”