At least 40 million Americans each year suffer from chronic, long-term sleep disorders, and an additional 20 million experience occasional sleep problems. Neurofeedback is a powerful tool for regulating sleep. Health professionals around the world report significant improvement in a large percentage of their clients using neurofeedback to treat chronic, long term sleep problems.
What are the most commonly reported sleep issues that improve with neurofeedback training?
- Insomnia – Difficulty falling asleep; difficulty maintaining sleep during the night
- Difficulty waking from sleep
- Difficulty getting to bed
- Not feeling rested after sleep
- Sleeping too long (over 10 hours)
- Physically restless sleep
- Bedwetting (Nocturnal enuresis)
- Restless leg syndrome – Leg discomfort or sleep causing movement & arousal
- Bruxism – teeth grinding during sleep
- Sleep terrors – Abrupt arousal with intense fear, difficult to awaken, no dream recall or memory of event
- Dysregulated sleep patterns/cycles (circadian rhythms)
Many of the conditions helped with EEG biofeedback are correlated with disorders of sleep. These include epilepsy, anxiety and depression, closed head injury, hyperactivity and attention deficit disorder, chronic pain and fibromyalgia, Tourette’s syndrome. Even when poor sleep is not the cause for referral for biofeedback, it is often mentioned as a problem during the intake interview. The first reported signs of change upon initiating EEG training often relate to the quality of sleep. We believe that the principal mechanism of efficacy of EEG training is that it normalizes self-regulation of physiological arousal, and the beneficial effects of the training on sleep can be explained in the same manner. When self-regulation is deficient, this should be apparent when arousal level is least tightly regulated, i.e. during sleep in general, and during transitions between sleep stages in particular. Nothing so cogently demonstrates that EEG biofeedback confers a new competence to the brain–as opposed to a consciously applied tool to the patient–than its efficacy in remediating disorders of sleep.
Bedwetting is among the most common symptoms seen in our clinical population, which consists largely of persons with attentional deficits (bedwetting is seen in 30% of institutionalized children; i.e. there is a high correlation with minor neurological deficits). In more than 90% of children under twelve with this condition, remediation is expected within the first twenty sessions of training. In older children and in adults, the problem is more resistant to remediation. It may take more training sessions than in younger children. We have seen much lower incidence of sleep walking, sleep talking, and night terrors. However, remediation is also observed for these conditions. Excessive fears about falling asleep, or about sleeping in one’s own bed, usually remediate very quickly with the onset of training.
There is an intimate connection of insomnia with disorders of arousal such as anxiety and depression. The success of EEG training in effecting improved self-regulation of arousal should, therefore, be expected to result in improved regulation of sleep in these cases, and that is what we observe.
Sleep apnea is generally thought to consist of a central, neurological component, and a somatic, obstructive component, the latter due to the fact that the condition closely correlates with obesity. Obstructive sleep apnea has historically been treated surgically, with rather poor outcomes, so that surgery is now gradually being abandoned in favor of a breathing aid device which provides continuous positive airway pressure (CPAP). EEG training has been successful in fully remediating apnea episodes in adult males, even in the absence of any other behavioral changes such as weight loss. The condition is seen as arising from cortical under arousal.
Neurofeedback training often helps these problems as it improves brain regulation. These are common reports: A 75 year-old reported recently that she “slept like a baby for the first time in 25 years” after neurofeedback training. Parents of children with ADHD often say it’s easier to get their kids to sleep. Depressed clients remark they have a much easier time getting going in the morning.
The role of the brain and sleep
The brain regulates sleep. Neuroscience has established the role of neuromodulator systems in the brainstem that play a role in maintaining awake states and, conversely, help the brain sleep. The EEG (brainwaves) clearly reflects changes in sleep stages. Training brainwaves using neurofeedback to decrease or increase slow brainwave activity, or to increase specific EEG activation patterns appears to help the brain normalize sleep. Based on reports from a large number of licensed health professionals the evidence shows that training the EEG impacts sleep regulatory mechanisms and people sleep better. Since sleep is complex and involves many systems, it is not possible to suggest that sleep problems always improve as a result of neurofeedback. But clinicians say that they routinely expect changes to occur in sleep patterns after appropriate training for a large percentage of their patients. As with any program, a complete sleep assessment is helpful. Sleep hygiene issues (including caffeine, alcohol and other behavioral factors) and other potential contributory factors such as possible sleep apnea also need to be carefully reviewed and corrected in combination with neurofeedback training.
Sleep is a good example of the research challenge of neurofeedback. There are good neurofeedback studies in ADHD, epilepsy and addiction. The fact that no significant studies exist on sleep and neurofeedback is remarkable. In virtually every study related to neurofeedback outcomes, changes to sleep are noted, but not always highlighted or even reported.
Sleep researchers are primarily unaware of neurofeedback and its implications for insomnia and other sleep disorders. Hopefully, cross-fertilization between clinically-oriented therapists and sleep researchers can occur. As in many academic areas, this kind of cross fertilization can take significant time and funding. Because of the vast amount of literature about brain regulation, sleep and the EEG, there is a solid basis for using neurofeedback with sleep problems. Hundreds of experienced licensed professionals have used this modality successfully to improve sleep for over 25 years.