Z Score Neurofeedback for Insomnia. A New Look at an Old Workhorse: Sensorimotor Neurofeedback.
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A New Look at an Old Workhorse:
Barbara U. Hammer, Ph.D., Agatha P. Colbert, M.D., Kimberly A. Brown, MSOM, Helfgott Research Institute, National College of Natural Medicine, Portland, OR, Elena C. Ilioi, Psychology Honours, McGill University, Montreal, Quebec, Canada,
The authors wish to thank the Helfgott Research Institute of the National college of Natural Medicine for its support of this research, and William L. Gregory, Ph.D. for providing our statistical analysis. We appreciate of the generous time, energy, and support provided by our Research Assistants who helped in the development and conduct of the investigation: Sean E. Griffith of the Psychology Department at Duke University and Tineke Malus of the Natural College of Natural Medicine. This study was not supported by any industry funding.
Effects on Health and Daytime Funcitoning:
Compared to their better sleeping counterparts, these people are more likely to report being unable to do the following because they are too sleepy:
o Work well and efficiently (25%)
o Exercise (30%)
o Eat healthy (22% )
o Have sex (16% )
o Engage in leisure activities (28% )
October, 2009 (Cohen, 2009) found immunity to rhinovirus correlated with the amount of sleep in healthy adults.
1. Graded association with average sleep
duration: participants with <7 hours of sleep were
2.94 times (95% confidence interval [CI], 1.18-7.30) more
likely to develop a cold than those with 8 hours or more
2. The association with SE was also
graded: participants with less than 92% efficiency were 5.50
times (95% CI, 2.08-14.48) more likely to develop a cold
than those with 98% or more efficiency
Primary Insomnia (DSM 307.44): Complaints of Difficulty Falling Asleep, Staying Asleep or Awakening too early, or Non-restorative Sleep which occurs for at least one month duration and:
1. Causes significant distress or impairment in social, occupational, or other important areas of daytime functioning.
2. Does not occur exclusively during the course of Narcolepsy, Breathing-Related Disorder, Circadian Rhythm Sleep Disorder or a Parasomnia.
3. Does not occur exclusively during the course of another mental disorder.
4. Is not due to the direct physiological effects of a substance or general medical condition.
Waking SMR correlated +.64 with SE &
-.64 with SOL
1981, Hauri et al:
Compared EMG & Theta & SMR biofeedback
Only SMR significantly improved Sleep
Tense Insomniacs benefited from Theta BFD
Peter Hauri (Mayo Clinic): SMR Neurofeedback in 1980’s used Analog Equipment not feasible for general clinical use:
Too Time consuming
“Time to revisit SMR for Insomnia with Digital equipment and new training methods.”
This was the exact purpose of our study, which had been given IRB approval just the previous month-in August, 2008!
Purpose–Compare effectiveness of SMR NFB and (a sequential, quantitative EEG) an EEG guided (IND) protocol for amelioration of Insomnia
Methods –RCT single-blind study.
Intervention –Groups received 15 20-minute sessions of Z-Score NFB.
Pre-post measures –Mental health (MMPI-2-RF and PDSQ), Quality of Life Index (QOLI), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sQEEG.
2 Primary Approaches Reflected in our 2 Groups
1. Symptom Based:
2. 2-19 Channel QEEG/Brain Map Guided
20+ Telephone Screening –unpaid, recruited over 4 months
Exclusions—use of sleep aids, psychotropic meds, mental or physical disorders that could interfere, prior NFB, enrolled in another sleep study, pregnant
15 Passed Telephone Screening
12 Invited to enter study
2 Declined to start- personal/extraneous reasons
2 Dropped out- personal/external reasons ≤8 visits
MMPI-2 RF--Most widely researched, used measure of psychopathology. Newest version
Psychiatric Diagnostic Screening Questionnaire- PDSQ—Guide to depth clinical interview to confirm absent Dx
Quality of Life Index-QOLI—Measures positive mental health=daytime function
Actiwatch--Records movement/lack of movement. 3 days pre vs post. Multiple technical difficulties prevent use of data.
Physiological training toward Norm Z=0
Insomnia Severity Index
There is a hint of an interaction, p < .18, change differs between the treatment groups. The IND group does not change as much as the SMR group. It suggests IND is certainly not better than SMR, and it may be the other way around.
Pre to Post treatment Time change is sig, F(1,6) = 55.6, p < .0001.Covariates not significant
Time by group interaction is marginally significant, F(1,6) = 4.5, p < .08. SMR is better.
Pre to Post Change over time is sig, F(1,6) = 15.8, p < .007. Covariates not significant
No interaction with treatment. No treatment is better than the other.
Pre to Post Time change is significant, F(1,6) = 9.6, p < .02. Covariates not significant
Pre to Post Time by group interaction tends toward sig, p < .23. SMR slightly better.
Waves Pre PostSignificance
Delta 107 42 p<.001
Beta 54 33 p<.01
Hi Beta 21 17 p<.11
Delta: Pre to post changes 107/304 vs 42/304 yields Z =6.0, p < .001, signif.
Beta: Pre to post 54/304 vs 33/304 yields Z = 2.6, p < .01, significant
Hi Beta: Pre to post not significant, p < .11, not significant
Changes in Borderline Profile -004
Overall T score: Pre=54.11, Post=50.56. Three excessive Scale scores reduced to Normal: Demoralization, Dysfunctional Negative, Aberrant Ex
Changes in Borderline Profile -010
Overall level Pre=73.3, Post=50.22 yielding >23 pt. reduction=very significant statistically & clinically
5) sQEEG improvement demonstrates daytime physiological normalization
6) All subjects tolerated 9 weeks of Z Score NFB
7) 15 sessions of NFB safe
8) Non-Invasive, non-pharmacological
9) SMR Easily replicated and practical for clinic use
10) Robust effects
11) QEEG or sQEEG may offer useful Biomarkers for Insomnia