Sleep disorder
Research Papers
Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia
Volitional neural modulation using neurofeedback has been indicated as a potential treatment for chronic conditions that involve peripheral and central neural dysregulation. Here we utilized neurofeedback in patients suffering from Fibromyalgia - a chronic pain syndrome that involves sleep disturbance and emotion dysregulation. These ancillary symptoms, which have an amplificating effect on pain, are known to be mediated by heightened limbic activity. In order to reliably probe limbic activity in a scalable manner fit for EEG-neurofeedback training, we utilized an Electrical Finger Print (EFP) model of amygdala-BOLD signal (termed Amyg-EFP), that has been successfully validated in our lab in the context of volitional neuromodulation. We anticipated that Amyg-EFP-neurofeedback training aimed at limbic down modulation would improve chronic pain in patients suffering from Fibromyalgia, by reducing sleep disorder improving emotion regulation. We further expected that improved clinical status would correspond with successful training as indicated by improved down modulation of the Amygdala-EFP signal. Thirty-Four Fibromyalgia patients (31F; age 35.6 ± 11.82) participated in a randomized placebo-controlled trial with biweekly Amyg-EFP-neurofeedback sessions or sham neurofeedback (n = 9) for a total duration of five consecutive weeks. Following training, participants in the real-neurofeedback group were divided into good (n = 13) or poor (n = 12) modulators according to their success in the neurofeedback training. Before and after treatment, self-reports on pain, depression, anxiety, fatigue and sleep quality were obtained, as well as objective sleep indices. Long-term clinical follow-up was made available, within up to three years of the neurofeedback training completion. REM latency and objective sleep quality index were robustly improved following the treatment course only in the real-neurofeedback group (time × group p < 0.05) and to a greater extent among good modulators (time × sub-group p < 0.05). In contrast, self-report measures did not reveal a treatment-specific response at the end of the neurofeedback training. However, the follow-up assessment revealed a delayed improvement in chronic pain and subjective sleep experience, evident only in the real-neurofeedback group (time × group p < 0.05). Moderation analysis showed that the enduring clinical effects on pain evident in the follow-up assessment were predicted by the immediate improvements following training in objective sleep and subjective affect measures. Our findings suggest that Amyg-EFP-neurofeedback that specifically targets limbic activity down modulation offers a successful principled approach for volitional EEG based neuromodulation treatment in Fibromyalgia patients. Importantly, it seems that via its immediate sleep improving effect, the neurofeedback training induced a delayed reduction in the target subjective symptom of chronic pain, far and beyond the immediate placebo effect. This indirect approach to chronic pain management reflects the substantial link between somatic and affective dysregulation that can be successfully targeted using neurofeedback.
View Full Paper →Comparison of the Effectiveness of Cognitive Behavioral Therapy and Neurofeedback: Reducing Insomnia Symptoms
INTRODUCTION: The term sleep disorder refers to difficulty in initiating sleep, maintaining it or a relaxing sleep despite having enough time to sleep. Cognitive behavioral therapy is a non-drug multi-dimensional treatment that targets behavioral and cognitive factors of this disorder. Some pieces of research have shown that psychiatric and neurological disorders can be distinguished from distinct EEG patterns and neuro-feedback can be used to make a change in these patterns. This study aimed to compare the cognitive behavioral therapy and neuro-feedback in the treatment of insomnia.METHODS: The sample included people, who had already been diagnosed insomnia by a psychiatrist in Isfahan, Iran. Random sampling was employed to choose the participants. Pittsburg sleep quality index (PSQI) was used for the selection of the participants, too. The sample included 40 patients who were randomly selected and interviewed and then diagnostic tests performed on the PSQI, and then they were divided into 3 groups. Data were analyzed using ANOVA. Following the implementation of the independent effect of the treatment was significant and one-way ANOVA with post hoc test L.S.D were carried out on CBT and controls (p = 0.001), CBT, neuro-feedback therapy (p = 0.003), neuro-feedback treatment and control (p = 0.001).RESULTS: It was shown that there was a significant difference between the groups. Based on the descriptive statistics of the 2 abovementioned treatments, neuro-feedback therapy in first position and cognitive-behavioral therapy were most effective in the second position, and the control group showed the lowest efficiency.CONCLUSIONS: Both treatments were significantly effective, and so we can use both neuro-feedback and CBT for the treatment of insomnia.
View Full Paper →An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia
Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventien insomnia patients were randomly assigned to either a tele-neurofeedback (n = 9) or an electromyography tele-biofeedback (n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements
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