Presented by: Dawen Lim Prof. Dato Dr. See Ching Mey Loh Guan Lye - - PowerPoint PPT Presentation

Presented by: Dawen Lim

• Prof. Dato’ Dr. See Ching Mey

Loh Guan Lye Specialists Centre

Did you sleep well last night?

Insomnia definition

• According to National Sleep Foundation:
• Insomnia is difficulty falling asleep or staying asleep,

even when a person has the chance to do so.

• According to DSM-5 (Diagnostic and Statistical

Manual of Mental Disorders, Fifth Edition [DSM-5], 2013):

• Dissatisfaction with sleep quantity or quality with

complaints of difficulty initiating or maintaining sleep.

Types of insomnia:

National Institute of Mental Health (NIMH, 1984):

• Not a symptom or side-effect of another

medical condition

Primary insomnia

• Has an underlying cause (e.g. depression,

anxiety)

Secondary insomnia

• May last for a few days to a week

Transient insomnia

• May last to one month

Acute insomnia

• Usually persists more than a month

Chronic insomnia

Facts about insomnia:

• The most prevalent sleep disorder in the general

population.

• About 30% of adults have symptoms of insomnia and

10% have severe insomnia.

• 2005 NIH Conference on insomnia declared insomnia

an epidemic:

• Illness, accidents, healthcare utilization, and industrial

expenses.

• Pharmacotherapy is limited due to negative side effects.

Causes of insomnia:

Treatments for insomnia:

• Cognitive Behavioral Therapy (CBT):
• demonstrated only 70% of efficacy
• difficult to administer – requiring specialized training &

many sessions

• challenges remain primarily in service delivery system
• Medications
• sleeping pills – cause headache, weakness & irritability
• Melatonin
• cause daytime sleepiness & dizziness

Neurofeedback and Insomnia

• Non-invasive
• Innovative
• Effective
• Complementary

Neurofeedback and Insomnia

• Neurofeedback (NFB) has a powerful ability to

positively impact on sleep.

• Based on operant conditioning by using positive

reinforcement to train the brain.

• Participants are rewarded when the prescribed EEG

activity is reached (Sherlin et al., 2011).

• To improve sleep by rewarding the brain for creating

healthier brainwave patterns.

Neurofeedback and Insomnia

• The early neurofeedback training protocols have been

shown to be effective therapy for insomnia (Okunala, O’Malley & O’Malley, 2007).

• Participants can gain control over different EEG

components & thereby increase the performance level with training protocols, resulting in improved sleep & attention (Egner & Gruzelier, 2004).

Neurofeedback and Insomnia

• Insomniacs have different EEG during stage 1 sleep

compared to normal sleepers.

• Reduced delta, theta and alpha activity, but higher

levels of beta activities (Cortoos et al., 2010).

• Experience elevated cognitive arousal – delaying the

transition from wakefulness state to sleep (Bonnet, 2015):

• Psychological stressors

Reduced delta activity Reduced alpha activity Reduced theta activity Increased beta activity

Neurofeedback and Insomnia

• EEG profile of insomniacs showed increased levels of

beta activity during sleep onset period (Bastien et al., 2003):

• cognitive hyper arousal
• similar to “racing thoughts”
• Human brains involved in sleep regulation, arousal &

attention are closely related (Brown et al., 2001).

My presenting problems:

• Insomnia for about 2 years
• Difficulties in falling asleep & remaining asleep
• Problem with concentration (inattention)
• Stress
• Irritability
• Consumed melatonin supplements but the effects did

not last long

My symptoms of insomnia:

Difficulties in falling asleep & awakening too early Daytime tiredness

• r sleepiness

Difficulty paying attention, focusing on tasks & remembering Irritability & impatient Ongoing worries about sleep

My underlying causes of insomnia:

• Racing thoughts
• fast & repetitive thoughts patterns in the background
• like a “film” plays in my mind
• Rumination
• over think about situations or life events
• Stress
• commuting (heavy traffic)
• hectic schedule (time management)

Neurofeedback Intervention

• Training protocols used:

Protocols Objectives

CZ SMR To improve attention & concentration C4 Delta To calm emotions & to reduce impulsivity T3-T4 Delta To improve sleep & to reduce stress

Neurofeedback Intervention

• Undergone 20 sessions of NFB training for the past 5

months.

• Each sessions consisted of:
• 3 periods of CZ SMR training
• 3 periods of C4 delta training
• 4 periods of T3-T4 delta training
• SMR training at central region for activation
• Beta training resulted in alertness at night & stay awake
• Delta (slow waves) training for calming effects

Outcome of Intervention

• Average readings of CZ SMR training

Outcome of Intervention

• Inhibited: theta & hi-beta
• Rewarding: SMR (low beta)
• High theta brainwaves in session 1, 2 and 4; but

tremendously decreased in session 6.

• Excessive theta brainwaves indicate daydreaming and

sleepiness

• difficulty in focusing a task
• There is an overall increase in SMR brainwaves.
• The low range of beta activity is often associated with

quiet, focus & introverted concentration.

Outcome of Intervention

• Average readings of C4 Delta training

Outcome of Intervention

• Inhibited: beta & hi-beta
• Rewarding: delta
• High beta & hi-beta activities in the 1st & 2nd session;

hi-beta spiked in session 3 & 12.

• Beta activities decreased in session 3 can be observed.
• Hi-beta is associated with significant stress, anxiety,

high energy and high arousal.

• There is an overall improvement in delta brainwaves

and reduced in hi-beta activity.

Outcome of Intervention

• Average readings of T3-T4 Delta training

Outcome of Intervention

• Inhibited: beta & hi-beta
• Rewarding: delta
• High beta & hi-beta activities in session 1, 2 & 3; hi-

beta spiked in session 8.

• Delta brainwave is dominant from session 3 onwards;

beta & hi-beta activities decreased remarkably in session 4.

• The gaps between delta, beta & hi-beta brainwaves

widen.

Outcome of Intervention

Before Neurofeedback After Neurofeedback

Difficulties in falling asleep & remaining sleep Fall asleep within 5 minutes and sleeping hours has been prolonged from 6 hours to 7.5 hours (at least). Problem with concentration (inattention) Concentration improved. Able to focus on work better during the day. Stress Able to better cope with stress. Irritability Calmer, more patient & less impulsive.

How to improve your sleep?

NFB Training Cut caffeine Eat lightly

Get a workout Establish a rhythm

Put away your electronic devices

References



American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.



Bastien, C. H., LeBlanc, M., Carrier, J., & Morin, C. M. (2003). Sleep EEG power spectra, insomnia, and chronic use of benzodiazepines. Sleep, 26(3), 313-317.



Bonnet, M. H. (2015). Hyperarousal and insomnia. Sleep medicine reviews, 14(1).



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



Egner, T., & Gruzelier, J. H. (2004). EEG biofeedback of low beta components. Frequency-specific effects on variables of attention and event-related brain potentials. Clinical Neurophysiology; 115: 131-

• 139. [PubMed: 14706480]



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



National Institute of Mental Health. (1984). Drugs and Insomnia: The Use of Medications to Promote

• Sleep. JAMA. 251(18). 2410-2414. ISSN: 0098-7484



Okunola, O., O'Malley, E., & O'Malley, M. (2007). Effectiveness of neurofeedback training in chronic insomnia, Sleep, 30(Supplement):A265



Sherlin, L. H., Arns, M., Lubar, J., Heinrich, H., Kerson, C., Strehl, U., & Sterman, M. B. (2011). Neurofeedback and basic learning theory: Implications for research and practice. Journal of Neurotherapy, 15, 292-304.

THANK YOU!

True silence is the rest of the mind, and is to the spirit what sleep is to the body, nourishment and refreshment. William Penn