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Wang H, Hou Y, Zhan S, Li N, Liu J, Song P, Wang Y, Wang H. EEG Biofeedback Decreases Theta and Beta Power While Increasing Alpha Power in Insomniacs: An Open-Label Study. Brain Sci 2023; 13:1542. [PMID: 38002502 PMCID: PMC10670123 DOI: 10.3390/brainsci13111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Insomnia, often associated with anxiety and depression, is a prevalent sleep disorder. Biofeedback (BFB) treatment can help patients gain voluntary control over physiological events such as by utilizing electroencephalography (EEG) and electromyography (EMG) power. Previous studies have rarely predicted biofeedback efficacy by measuring the changes in relative EEG power; therefore, we investigated the clinical efficacy of biofeedback for insomnia and its potential neural mechanisms. We administered biofeedback to 82 patients with insomnia, of whom 68 completed 10 sessions and 14 completed 20 sessions. The average age of the participants was 49.38 ± 12.78 years, with 26 men and 56 women. Each biofeedback session consisted of 5 min of EMG and 30 min of EEG feedback, with 2 min of data recorded before and after the session. Sessions were conducted every other day, and four scale measures were taken before the first, fifth, and tenth sessions and after the twentieth session. After 20 sessions of biofeedback treatment, scores on the Pittsburgh Sleep Quality Index (PSQI) were significantly reduced compared with those before treatment (-5.5 ± 1.43,t = -3.85, p = 0.006), and scores on the Beck Depression Inventory (BDI-II) (-7.15 ± 2.43, t = -2.94, p = 0.012) and the State-Trait Anxiety Inventory (STAI) (STAI-S: -12.36 ± 3.40, t = -3.63, p = 0.003; and STAI-T: -9.86 ± 2.38, t = -4.41, p = 0.001) were significantly lower after treatment than before treatment. Beta and theta power were significantly reduced after treatment, compared with before treatment (F = 6.25, p = 0.014; and F = 11.91, p = 0.001). Alpha power was increased after treatment, compared with before treatment, but the difference was not prominently significant (p > 0.05). EMG activity was significantly decreased after treatment, compared with before treatment (F = 2.11, p = 0.015). Our findings suggest that BFB treatment based on alpha power and prefrontal EMG relieves insomnia as well as anxiety and depression and may be associated with increased alpha power, decreased beta and theta power, and decreased EMG power.
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Affiliation(s)
- Huicong Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
- Hebei Hospital of Xuanwu Hospital, Capital Medical University, Shijiazhuang 050030, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang 050030, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Ning Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Penghui Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
- Hebei Hospital of Xuanwu Hospital, Capital Medical University, Shijiazhuang 050030, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang 050030, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (H.W.); (Y.H.); (S.Z.); (N.L.); (J.L.); (P.S.)
- Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
- Center for Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
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Drager LF, Assis M, Bacelar AFR, Poyares DLR, Conway SG, Pires GN, de Azevedo AP, Carissimi A, Eckeli AL, Pentagna Á, Almeida CMO, Franco CMR, Sobreira EST, Stelzer FG, Mendes GM, Minhoto GR, Linares IMP, Sousa KMM, Gitaí LLG, Sukys-Claudino L, Sobreira-Neto MA, Zanini MA, Margis R, Martinez SCG. 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association. Sleep Sci 2023; 16:507-549. [PMID: 38370879 PMCID: PMC10869237 DOI: 10.1055/s-0043-1776281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
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Affiliation(s)
- Luciano Ferreira Drager
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Assis
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
| | - Andrea Frota Rego Bacelar
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
| | - Dalva Lucia Rollemberg Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | - Silvia Gonçalves Conway
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | | | - Alicia Carissimi
- Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
- Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
| | - Allan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Álvaro Pentagna
- Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Emmanuelle Silva Tavares Sobreira
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
- Universidade Federal do Ceará, Fortaleza, CE, Brazil.
- Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
| | - Fernando Gustavo Stelzer
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | - Ila Marques Porto Linares
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Ksdy Maiara Moura Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
| | | | - Lucia Sukys-Claudino
- Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | | | - Marcio Andrei Zanini
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
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Kremer S, Blue T. Biofeedback as an Adjunct or Alternative Intervention to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:85-93. [PMID: 36764789 DOI: 10.1016/j.jsmc.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Insomnia is highly prevalent and comorbid with many disorders. However, insomnia is underdiagnosed and undertreated in many populations. Cognitive behavioral therapy for insomnia (CBT-I) is not appropriate or sufficient for some individuals. Biofeedback has demonstrated efficacy in a range of disorders, including insomnia. The authors discuss the history and rationale for the use of biofeedback in the treatment of insomnia and other comorbid disorders. The article also presents current research on biofeedback for insomnia and comorbid disorders with recommendations for using biofeedback as an adjunct or alternative intervention to CBT-I.
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Affiliation(s)
- Stephanie Kremer
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, 300 Medical Plaza, Suite 3200A, Los Angeles, CA 90095, USA.
| | - Tanecia Blue
- VA Pacific Islands Healthcare System, 459 Patterson Road, Honolulu, HI 96819, USA
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Bard HA, O'Driscoll C, Miller CB, Henry AL, Cape J, Espie CA. Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia. Sleep Med 2023; 101:505-514. [PMID: 36527942 DOI: 10.1016/j.sleep.2022.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES Insomnia, depression, and anxiety show high rates of comorbidity and functional impairment. Transdiagnostic symptom interactions may be implicated in this comorbidity. This network analysis sought to assess how symptoms of insomnia, depression, and anxiety may interact and individually predict impairment across several domains for individuals with insomnia. METHODS Baseline psychometric data from a randomised controlled trial were analysed (N = 1711). A regularized partial correlation network was estimated from the symptom data. Centrality (symptom connectivity), community structure (symptom clustering), and bridging (inter-community connectivity) were assessed. The replicability of the network model was assessed via confirmatory analyses in a holdout sample. Separately, Shapley values were estimated to determine the relative importance of each symptom in predicting functioning (i.e., psychological wellbeing, psychosocial functioning, and physical health impairment). RESULTS The most connected nodes were uncontrollable worrying; trouble relaxing; and depressed mood/hopelessness. Five communities were identified with trouble relaxing identified as the bridge symptom between communities. The model showed good fit in the holdout sample. Low energy and depressive affect symptoms (feelings of failure/guilt; depressed mood/hopelessness; anhedonia) were key predictors in the relative importance analysis across multiple domains of impairment. CONCLUSION Trouble relaxing may be of clinical and transdiagnostic significance in the context of insomnia. In terms of how symptoms relate to functioning, it was clear that, while low energy and feelings of failure/guilt were prominent predictors, a range of symptoms are associated with functional impairment. Consideration of both symptoms and functional impairment across domains may be useful in determining targets for treatment. CLINICAL TRIAL REGISTRATION This is a secondary analysis of an original clinical trial. TRIAL REGISTRATION NUMBER ISRCTN60530898. Registry URL: https://www.isrctn.com/ISRCTN60530898.
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Affiliation(s)
- H Ariel Bard
- Centre for Outcomes Research & Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
| | - Ciarán O'Driscoll
- Centre for Outcomes Research & Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK.
| | - Christopher B Miller
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, CA, USA & London, UK
| | - Alasdair L Henry
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, CA, USA & London, UK
| | - John Cape
- Centre for Outcomes Research & Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
| | - Colin A Espie
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, CA, USA & London, UK
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García HBÁ, Correa UJ. Intervención psicológica en trastornos del sueño: una revisión actualizada. CLÍNICA CONTEMPORÁNEA 2020. [DOI: 10.5093/cc2020a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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