Advanced Biofeedback Center

Sleep Disorders (Insomnia, Restless Leg Syndrome, and Others)

Assessment of condition

Overview

Before beginning biofeedback training for any type of sleep disorder, you would do well to consult with your family physician, internist, or medical sleep specialist. (In some instances, pulmonologists [lung specialists] are board certified in sleep medicine. In other instances, neurologists [brain and nervous system specialists] are board certified in sleep medicine.) It is always a good idea to be evaluated appropriately by such specialists to rule out any physical or medical issue that may be preventing you from experiencing restorative sleep. Before even receiving biofeedback training, you may be referred for a sleep study (polysomnography study). This involves sleeping at a hospital or "free-standing" sleep laboratory. Your heart (EKG), brain (EEG), oxygen saturation, eye movements (EOG), and other aspects of your physiological functioning will be monitored during a typical sleep study. Most modern sleep labs store all of this data digitally, and the consulting sleep specialist will examine the data to determine if you suffer from some type of cardiac (heart), neurological (brain), pulmonary (lung, breathing), or other physical problem that is contributing to your sleep issue.

Some people show symptoms of sleep apnea --- a medical condition in which you literally stop breathing for periods of time during the night. Because every cell in our bodies needs oxygen, any momentary problem in breathing can lead to decreased oxygen saturation. This means that oxygen is not reaching those cells, and temporary reduction in oxygen can lead to damage to the brain, heart, lungs, and other vital organs in the body. Sleep apnea should be taken very seriously because it could contribute to a heart attack, stroke, narcolepsy (falling asleep when you should be awake, like while driving a car), and other medical issues. Other problems emerge when you stop breathing, even if it is momentary. These problems include lack of restorative sleep; you may not actually go through the various stages of sleep and therefore never quite feel "rested" when you awaken in the morning.

Decreased oxygen during sleep, abnormal sleep architecture, restless leg syndrome, snoring, and other sleep disturbances at night are associated with a number of attention, cognitive, behavioral, and mood disorders the next day.  Experts in Pediatric Sleep Disorders have observed that a proportion of children misdiagnosed with Attention Deficit Disorder are actually suffering from a sleep disorder as the primary cause of their attention, cognitive, mood, and behavioral disorders!

Only your personal physician, sleep specialist, otolaryngologist (ear-nose-throat specialist), or other doctor can verify if you may need more invasive treatments. Some patients elect to have their tonsils and adenoids removed, if they are obstructing your throat. Sometimes weight loss, quitting cigarette smoking, altering the position that you sleep (on your side or stomach, or sitting at a 45^o angle in a recliner), and other behavioral changes may be sufficient. If there are frequent problems with breathing, nasal infections, sore throats, and other such issues, your doctor can evaluate and treat you for these problems.

If all medical issues have been ruled out --- and you continue to have sleep disturbances --- then biofeedback may be considered to help you traverse through various brain waves states. These states are correlated with specific brain wave frequencies and are correlated with different stages of wakefulness and sleep. If you have been told that you are "negative" for sleep apnea or other serious medical problem by a physician, then biofeedback --- most likely EEG biofeedback (neurofeedback) --- would be recommended. There is also research being conducted to suggest that skin surface temperature (thermal) biofeedback can be used to cool down your "core" while you voluntarily warm your hands and feet.

Sensors

Gold-plated, non-invasive, comfortable EEG sensors would be used to assess predominant brain wave activity. A thermistor (a small "bead" attached to your finger) is a resistor that changes "resistance" with changes in temperature.

Where sensors are placed

EEG sensors would be placed on your ears, ear lobes, and on your scalp (on the top of your head along the sensorimotor strip of the brain). The thermistor (skin surface temperature sensor) would be attached to your index finger.

Behavioral intervention

Learning and behavioral change

The principal of operant conditioning --- one of the most well-researched learning principles in the field of psychology --- appears to explain why neurofeedback is an effective intervention for sleep issues.  You would actually learn how it feels mentally and physically to traverse through various brain wave states with relative ease. You would see the difference on the computer monitor when you would go from wakefulness (Beta wave activity [ > 13 Hz ]), to slight disengagement from your environment (Alpha wave activity [ 8 - 12 Hz] ), to deep meditation (Theta wave activity [ 4 - 7 Hz ]), and finally sleep (Delta wave activity [ 0.1 - 3 Hz ]). Should psychological issues, past trauma, fear, phobias, or other issues interfere with successful sleep, you would have the opportunity to "work through" these impediments to a "good night's sleep" and eventually resolve them.

Number of sessions

The number of sessions required to make significant changes in your sleep will vary among individuals. A minimum of 10 sessions is recommended.

Change in behavior

Goals

There may be several different goals for individuals receiving neurofeedback for sleep disorders. One obvious goal is to help you learn how to effortlessly transition from one brain wave state to the next, especially the brain wave frequencies that are associated with falling asleep, staying asleep, and experiencing restful, restorative sleep.  Your self-reports of "feeling rested" after a good night's sleep will be considered as partially meeting your goals. If you also report that you are thinking more clearly, have an elevated mood, have fewer instances of inattention or falling asleep during the day, and other evidence of a successful outcome, you will know that you have reached a significant goal.