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Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols

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Abstract

Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p < .005), Pittsburgh Sleep Quality Inventory (PSQI p < .0001), PSQI Sleep Efficiency (p < .007), and Quality of Life Inventory (p < .02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p < .001) which were lowered post-treatment (paired z-tests p < .001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.

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References

  • Actiwatch [Apparatus and Software]. (2008). Bend, OR: Philips Respironics.

  • American Academy of Sleep Medicine (2009, October 1). Elderly women sleep better than they think, men sleep worse. ScienceDaily. Retrieved December 18, 2009, from http://www.sciencedaily.com/releases/2009/10/091001081207.htm.

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • Andrasik, F. (2010). Editor’s note: Focus on QEEG… and EEG. Applied Psychophysiology and Biofeedback, 35(1), 1.

    Article  PubMed  Google Scholar 

  • Backhaus, J., Junghanns, K., Broocks, A., Riemann, D., & Hohagen, F. (2002). Test-retest reliability and validity of the Pittsburgh sleep quality index in primary insomnia disorder. Journal of Psychosomatic Research, 53(3), 737–740.

    Article  PubMed  Google Scholar 

  • Bastien, C. H., Vallieres, A., & Morin, C. M. (2001). Validation of the insomnia disorder severity index as an outcome measure for insomnia disorder research. Sleep Medicine, 2(4), 297–307.

    Article  PubMed  Google Scholar 

  • Bootzin, R. R., & Perlis, M. L. (1992). Nonpharmacologic treatments of insomnia disorder. Journal of Clinical Psychiatry, 53(Supplement), 37–41.

    PubMed  Google Scholar 

  • Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia disorder. Sleep, 29(9), 1155–1173.

    PubMed  Google Scholar 

  • Buysse, D. J., Reynolds, C. F., I. I. I., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

    Article  PubMed  Google Scholar 

  • Cohen, S., Doyle, W. J., Alper, C. M., Janicki-Deverts, D., & Turner, R. B. (2009). Sleep habits and susceptibility to the common cold. Archives of Internal Medicine, 169(1), 62–67.

    Article  PubMed  Google Scholar 

  • Collura, T., Guan, J., Tarrent, J., Bailey, J., & Starr, R. (2010). EEG biofeedback case studies using live z-score training and a normative database. Journal of Neurotherapy, 14(1), 22–46.

    Article  Google Scholar 

  • Collura, T., Thatcher, R., Smith, M. L., Lambos, W., & Stark, C. (2009). EEG biofeedback training using live z-scores and a normative database. Philadelphia: Elsevier.

    Google Scholar 

  • Cortoos, A., De Valck, E., Arns, M., Breteler, M. H., & Cluydts, R. (2010). An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia disorder. Applied Psychophysiology and Biofeedback, 35(2), 125–134.

    Article  PubMed  Google Scholar 

  • Cortoos, A., Verstraeten, E., & Cluydts, R. (2006). Neurophysiological aspects of primary insomnia disorder: Implications for its treatment. Sleep Medicine Review, 10(4), 255–266.

    Article  Google Scholar 

  • Daley, M., Morin, C. M., LeBlanc, M., Gregoire, J. P., & Savard, J. (2009). The economic burden of insomnia disorder: Direct and indirect costs for individuals with insomnia disorder syndrome, ainsomnia disorder symptoms, and good sleepers. Sleep, 32(1), 55–64.

    PubMed  Google Scholar 

  • Demos, J. N. (2006). DCN-128 (V. 1.0) [Computer Software] Brattleboro, VT: EEG Vermont. Retrieved from http://eegvermont.com/.

  • Edinger, J. D., Means, M. K., Stechuchak, K. M., & Olsen, M. K. (2004). A pilot study of inexpensive sleep-assessment devices. Behavioral Sleep Medicine, 2(1), 41–49.

    Article  PubMed  Google Scholar 

  • Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., Paweleck, J. K., Greenstone, A., et al. (2005). Predictive and treatment validity of life satisfaction and the quality of life inventory. Assessment, 12(1), 66–78.

    Article  PubMed  Google Scholar 

  • Gervais, R. O., Ben-Porath, Y. S., Wygant, D. B., & Green, P. (2007). Development and validation of a response bias scale (rbs) for the mmpi-2. Assessment, 14(2), 196–208.

    Article  PubMed  Google Scholar 

  • Hammond, D. C., & Kirk, L. (2008). First, do no harm: Adverse effects and the need for practice standards in neurofeedback. Journal of Neurotherapy, 12(1), 79–88.

    Article  Google Scholar 

  • Harvey, A. G., & Tang, N. K. (2003). Cognitive behaviour therapy for primary insomnia disorder: Can we rest yet? Sleep Medicine Review, 7(3), 237–262.

    Article  Google Scholar 

  • Hauri, P. (1981). Treating psychophysiologic insomnia disorder with biofeedback. Archives of General Psychiatry, 38(7), 752–758.

    PubMed  Google Scholar 

  • Hauri, P. J. (2008). EEG Biofeedback in the treatment of insomnia: A historical perspective. Applied Psychophysiology and Biofeedback, 33(4), 246.

    Google Scholar 

  • Hauri, P. J., Percy, L., Hellekson, C., Hartmann, E., & Russ, D. (1982). The treatment of psychophysiologic insomnia disorder with biofeedback: A replication study. Biofeedback and Self Regulation, 7(2), 223–235.

    Article  PubMed  Google Scholar 

  • Hoedlmoser, K., Pecherstorfer, T., Gruber, G., Anderer, P., Doppelmayr, M., Klimesch, W., et al. (2008). Instrumental conditioning of human sensorimotor rhythm (12–15 Hz) and its impact on sleep as well as declarative learning. Sleep, 31(10), 1401–1408.

    PubMed  Google Scholar 

  • Lichstein, K. L., Stone, K. C., Donaldson, J., Nau, S. D., Soeffing, J. P., Murray, D., et al. (2006). Actigraphy validation with insomnia disorder. Sleep, 29(2), 232–239.

    PubMed  Google Scholar 

  • McCrae, C. S., Taylor, D. J., Smith, M. T., & Perlis, M. L. (2010). The future of behavioral sleep medicine: A report on the presentations given at the Ponte Vedra behavioral sleep medicine consensus conference, March 27–29, 2009. Behavioral Sleep Medicine, 8(2), 74–89.

    Article  PubMed  Google Scholar 

  • Morgenthaler, T., Alessi, C., Friedman, L., Owens, J., Kapur, V., Boehlecke, B., et al. (2007). Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: An update for 2007. Sleep, 30(4), 519–529.

    PubMed  Google Scholar 

  • National Institutes of Health. (2005). State-of-the science conference statement on manifestations and management of chronic insomnia disorder in adults, June 13–15, 2005. Sleep, 28(9), 1049–1057.

    Google Scholar 

  • National Sleep Foundation. (2009). Sleep in America poll, summary of findings. Retrieved from www.sleepfoundation.org.

  • Paquet, J., Kawinska, A., & Carrier, J. (2007). Wake detection capacity of actigraphy during sleep. Sleep, 30(10), 1362–1369.

    PubMed  Google Scholar 

  • Perlis, M. L., Kehr, E. L., Smith, M. T., Andrews, P. J., Orff, H., & Giles, D. E. (2001). Temporal and stagewise distribution of high frequency EEG activity in patients with primary and secondary insomnia disorder and in good sleeper controls. Journal of Sleep Research, 10(2), 93–104.

    Article  PubMed  Google Scholar 

  • Philippens, I. H., & Vanwersch, R. A. (2010). Neurofeedback training on sensorimotor rhythm in marmoset monkeys. Neuroreport, 21(5), 328–332.

    Article  PubMed  Google Scholar 

  • Ros, T., Moseley, M., Bloom, P. A., Benjamin, L., Parkinson, L. A., & Gruzelier, J. H. (2009). Optimizing microsurgical skills with EEG neurofeedback. BMC Neuroscience, 10, 87. doi:10.1186/1471-2202-10-87.

    Article  PubMed  Google Scholar 

  • Ros, T., Munneke, M. A., Ruge, D., Gruzelier, J. H., & Rothwell, J. C. (2010). Endogenous control of waking brain rhythms induces neuroplasticity in humans. European Journal of Neuroscience, 31(4), 770–778.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., & Clemente, C. D. (1962). Forebrain inhibitory mechanisms: Sleep patterns induced by basal forebrain stimulation in the behaving cat. Experimental Neurology, 6, 103–117.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., & Egner, T. (2006). Foundation and practice of neurofeedback for the treatment of epilepsy. Applied Psychophysiology and Biofeedback, 31(1), 21–35.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., Howe, R. C., & Macdonald, L. R. (1970). Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science, 167(921), 1146–1148.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., LoPresti, R. W., & Fairchild, M. D. (2010). Electroencephalographic and behavioral studies of monomethyl hydrazine toxicity in the cat. Journal of Neurotherapy, 14(4), 293–300.

    Article  Google Scholar 

  • Thatcher, R. (2009). NeuroGuide (2.5.9) [Computer software]. St. Petersburg, FL: Applied Neuroscience, Inc. Retrieved from http://www.appliedneuroscience.com/.

  • Thatcher, R., Walker, R., Biber, C., North, D., Curtin, M., & Curtin, R. (2003). Sensitivity and specificity of an EEG normative database: Validation and clinical correlation. Journal of Neurotherapy, 7(3/4), 87–121.

    Article  Google Scholar 

  • Tononi, G., & Cirelli, C. (2006). Sleep function and synaptic homeostasis. Sleep Medicine Review, 10(1), 49–62.

    Article  Google Scholar 

  • Vallieres, A., & Morin, C. M. (2003). Actigraphy in the assessment of insomnia disorder. Sleep, 26(7), 902–906.

    PubMed  Google Scholar 

  • Whitsett, S. F., Lubar, J. F., Holder, G. S., Pamplin, W. E., & Shabsin, H. S. (1982). A double-blind investigation of the relationship between seizure activity and the sleep EEG following EEG biofeedback training. Biofeedback and Self-Regulation, 7, 193–209.

    Article  PubMed  Google Scholar 

  • Zimmerman, M., & Chelminski, I. (2006). A scale to screen for DSM-IV Axis I disorders in psychiatric out-patients: Performance of the Psychiatric Diagnostic Screening Questionnaire. Psychological Medicine, 36(11), 1601–1611.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to the Helfgott Research Institute of the National College of Natural Medicine in Portland, Oregon for its generous support of this research. We especially appreciate the assistance of William L. Gregory and Heather Jaskirat Wild on the statistical analyses, Mark L. Smith and Nancy Wigton on the design of the neurofeedback protocols, and the generous support of our research assistants, Sean E. Griffith and Tineke Malus. In addition, we thank all participants in this study, including those who took the time to complete the telephone screening and the extended screening sessions but who were not offered the opportunity to participate and receive treatment.

Conflict of interest

None of the authors has any financial conflicts of interest.

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Authors and Affiliations

  1. Department of Psychophysiology, Helfgott Research Institute, National College of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201-4848, USA

    Barbara U. Hammer & Agatha P. Colbert

  2. Helfgott Research Institute, National College of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201-4848, USA

    Kimberly A. Brown

  3. Department of Psychology, McGill University, Montreal, QC, Canada

    Elena C. Ilioi

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  1. Barbara U. Hammer
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  2. Agatha P. Colbert
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  3. Kimberly A. Brown
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  4. Elena C. Ilioi
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Correspondence to Barbara U. Hammer.

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Hammer, B.U., Colbert, A.P., Brown, K.A. et al. Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols. Appl Psychophysiol Biofeedback 36, 251–264 (2011). https://doi.org/10.1007/s10484-011-9165-y

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