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 Primary insomnia medical condition Secondary • Has an underlying cause (e.g. depression, anxiety) insomnia Transient insomnia • May last for a few days to a week Acute insomnia • May last to one month Chronic insomnia • Usually persists more than a month
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 theta activity Reduced delta activity Reduced Increased alpha beta activity 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 Difficulty paying falling asleep & Daytime tiredness attention, awakening too or sleepiness focusing on tasks early & remembering Irritability & Ongoing worries impatient 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 1 st & 2 nd 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 & Fall asleep within 5 minutes and remaining sleep sleeping hours has been prolonged from 6 hours to 7.5 hours (at least). Problem with concentration Concentration improved. Able to (inattention) focus on work better during the day. Stress Able to better cope with stress. Irritability Calmer, more patient & less impulsive.
NFB Training Put away your Cut electronic caffeine devices How to improve your sleep? Establish Eat lightly a rhythm Get a workout
References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th 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
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