Applied Psychophysiology and Biofeedback

, Volume 36, Issue 4, pp 251–264

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

  • Barbara U. Hammer
  • Agatha P. Colbert
  • Kimberly A. Brown
  • Elena C. Ilioi
Article

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.

Keywords

Neurofeedback Z-Score EEG Sleep Insomnia QEEG SMR Biofeedback 

References

  1. Actiwatch [Apparatus and Software]. (2008). Bend, OR: Philips Respironics.Google Scholar
  2. 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.
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  4. Andrasik, F. (2010). Editor’s note: Focus on QEEG… and EEG. Applied Psychophysiology and Biofeedback, 35(1), 1.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. Bootzin, R. R., & Perlis, M. L. (1992). Nonpharmacologic treatments of insomnia disorder. Journal of Clinical Psychiatry, 53(Supplement), 37–41.PubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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
  13. 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.PubMedCrossRefGoogle Scholar
  14. Cortoos, A., Verstraeten, E., & Cluydts, R. (2006). Neurophysiological aspects of primary insomnia disorder: Implications for its treatment. Sleep Medicine Review, 10(4), 255–266.CrossRefGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. Demos, J. N. (2006). DCN-128 (V. 1.0) [Computer Software] Brattleboro, VT: EEG Vermont. Retrieved from http://eegvermont.com/.
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. Hauri, P. (1981). Treating psychophysiologic insomnia disorder with biofeedback. Archives of General Psychiatry, 38(7), 752–758.PubMedGoogle Scholar
  23. Hauri, P. J. (2008). EEG Biofeedback in the treatment of insomnia: A historical perspective. Applied Psychophysiology and Biofeedback, 33(4), 246.Google Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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
  30. National Sleep Foundation. (2009). Sleep in America poll, summary of findings. Retrieved from www.sleepfoundation.org.
  31. Paquet, J., Kawinska, A., & Carrier, J. (2007). Wake detection capacity of actigraphy during sleep. Sleep, 30(10), 1362–1369.PubMedGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. Philippens, I. H., & Vanwersch, R. A. (2010). Neurofeedback training on sensorimotor rhythm in marmoset monkeys. Neuroreport, 21(5), 328–332.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. Sterman, M. B., & Egner, T. (2006). Foundation and practice of neurofeedback for the treatment of epilepsy. Applied Psychophysiology and Biofeedback, 31(1), 21–35.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. Thatcher, R. (2009). NeuroGuide (2.5.9) [Computer software]. St. Petersburg, FL: Applied Neuroscience, Inc. Retrieved from http://www.appliedneuroscience.com/.
  41. 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.CrossRefGoogle Scholar
  42. Tononi, G., & Cirelli, C. (2006). Sleep function and synaptic homeostasis. Sleep Medicine Review, 10(1), 49–62.CrossRefGoogle Scholar
  43. Vallieres, A., & Morin, C. M. (2003). Actigraphy in the assessment of insomnia disorder. Sleep, 26(7), 902–906.PubMedGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Barbara U. Hammer
    • 1
  • Agatha P. Colbert
    • 1
  • Kimberly A. Brown
    • 2
  • Elena C. Ilioi
    • 3
  1. 1.Department of Psychophysiology, Helfgott Research InstituteNational College of Natural MedicinePortlandUSA
  2. 2.Helfgott Research InstituteNational College of Natural MedicinePortlandUSA
  3. 3.Department of PsychologyMcGill UniversityMontrealCanada

Personalised recommendations