EEG Biofeedback Training for Sleep Disorders
“There ain’t no way to find out why a snorer can’t hear himself snore.”
– Mark Twain, Tom Sawyer Abroad
Clinical evidence now exists for the remediation of a variety of sleep disorders with EEG biofeedback training, including those sleep problems which may be ascribable to neurological immaturity of childhood, or correlated with attentional problems: bedwetting, sleep walking and talking, night terrors, anxiety-related difficulties falling asleep, and insomnia. Among adult sleep disorders, promising evidence exists for remediation of insomnia and sleep apnea.
Many of the conditions helped with EEG biofeedback are correlated with disorders of sleep. This includes epilepsy, anxiety and depression, closed head injury, hyperactivity and attention deficit disorder, chronic pain, and Tourette Syndrome. Even when poor sleep is not the cause for referral for biofeedback, it is often mentioned as a problem during the intake interview. The first reported signs of change upon initiating EEG training often relate to the quality of sleep. We believe that the principal mechanism of efficacy of EEG training is that it normalizes self-regulation of physiological arousal, and the beneficial effects of the training on sleep can be explained in the same manner. When self-regulation is deficient, this should be apparent when arousal level is least tightly regulated, i.e. during sleep in general, and during transitions between sleep stages in particular. Nothing so cogently demonstrates that EEG biofeedback confers a new competence to the brain–as opposed to a consciously applied tool to the patient–than its efficacy in remediating disorders of sleep.
Bedwetting is among the most common symptoms seen in our clinical population, which consists largely of persons with attentional deficits (bedwetting is seen in 30% of institutionalized children; i.e. there is a high correlation with minor neurological deficits). In more than 90% of children under twelve with this condition, remediation is expected within the first twenty sessions of training. In older children and in adults, the problem is more resistant to remediation. It may take more training sessions than in younger children. We have seen much lower incidence of sleep walking, sleep talking, and night terrors. However, remediation is also observed for these conditions. Excessive fears about falling asleep, or about sleeping in one’s own bed, usually remediate very quickly with the onset of training.
There is an intimate connection of insomnia with disorders of arousal such as anxiety and depression. The success of EEG training in effecting improved self-regulation of arousal should, therefore, be expected to result in improved regulation of sleep in these cases, and that is what we observe.
Sleep apnea is generally thought to consist of a central, neurological component, and a somatic, obstructive component, the latter due to the fact that the condition closely correlates with obesity. Obstructive sleep apnea has historically been treated surgically, with rather poor outcomes, so that surgery is now gradually being abandoned in favor of a breathing aid device which provides continuous positive airway pressure (CPAP). EEG training has been successful in fully remediating apnea episodes in adult males, even in the absence of any other behavioral changes such as weight loss. The condition is seen as arising from cortical underarousal. Only a few cases have been studied.