Applied Psychophysiology and Biofeedback

, Volume 44, Issue 4, pp 259–269 | Cite as

Biofeedback Therapies for Chronic Insomnia: A Systematic Review

  • Denise Lima Medeiros MeloEmail author
  • Luciane Bizari Coin Carvalho
  • Lucila Bizari Fernandes Prado
  • Gilmar Fernandes Prado


The treatment of insomnia is still a challenge in clinical practice. This systematic review of randomized and quasi-randomized clinical trials aims to summarize the evidence for the use of biofeedback techniques in the treatment of chronic insomnia. Studies that compared biofeedback with other techniques of cognitive behavioral therapy, placebo, or absence of treatment were selected. The outcomes evaluated included sleep onset latency, total sleep time, sleep fragmentation, sleep efficiency and subjective sleep quality. Comparing to placebo and absence of treatment, some studies suggest possible benefits from the use of biofeedback for chronic insomnia in decreasing sleep onset latency and number of awakenings; however, there was marked divergence among included studies. There was no evidence of improvement in total sleep time, sleep efficiency and subjective sleep quality. Moreover, the maintenance of long-term benefits lacks evidence for any outcome. In the majority of outcomes evaluated, no significant differences in the effectiveness of biofeedback compared with other cognitive behavioral therapy techniques were observed. This systematic review found conflicting evidence for the effectiveness of biofeedback techniques in the treatment of chronic insomnia. Inter- and intra-group clinical heterogeneity among studies could be a reasonable explanation for the divergent results. These findings emphasize the need of performing further randomized clinical trials of higher methodological quality in order to better delineate the effectiveness of biofeedback on chronic insomnia treatment.


Insomnia Disorders of initiating and maintaining sleep Biofeedback Neurofeedback 



Confidence interval


Descriptors in health science


Diagnostic and statistical manual of mental disorders, 4th edition—text revision




International classification of diseases, 10th revision


International classification of sleep disorders, 3th edition


Mean difference


Medical subject heading




Sleep onset latency


Total sleep time


Complaince with ethical standards

Conflict of interest

The authors received no financial support for this study and have no conflict of interest to declare.

Supplementary material

10484_2019_9442_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Denise Lima Medeiros Melo
    • 1
    Email author
  • Luciane Bizari Coin Carvalho
    • 1
  • Lucila Bizari Fernandes Prado
    • 1
  • Gilmar Fernandes Prado
    • 1
  1. 1.Department of NeurologyNeuro-Sono Sleep Center, Federal University of Sao Paulo–UNIFESPSão PauloBrazil

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