Sleep as a symptom - the importance of sleep and how Neurofeedback can help with sleep problems.

We all know of the importance of sleep, which we notice in particular when we have problems with it: Difficulties falling asleep and sleeping through the night, constantly waking up and having trouble getting back to sleep - sleep disorders are multifaceted, and so are their causes. In this blog post we want to explain why sleep is so important, what the consequences of poor sleep can be and how Neurofeedback can help with sleep problems.

 

If you sleep a lot, you sleep well, right?

Of course, it's not quite that simple. The need for sleep differs according to age and gender. Generally, women need more sleep than men and children more than adults. But also other factors influence our need for sleep such as season, habit, health or life circumstances (Hirshkowitz et al., 2015). In Central Europe, the average sleep duration is seven hours per day, varying between five and nine hours. However, the duration of sleep does not necessarily say anything about the quality of sleep and the feeling of being refreshed (Crönlein et al., 2017). Whether we feel refreshed and fit throughout the day depends primarily on our subjective perception.

 

What are the different sleep types?  

Science distinguishes between three chronotypes: Evening, morning and normal type. These differ in their time of peak performance, alertness and sleep preference (Crönlein et al., 2017). As the word already suggests, the morning type is particularly efficient in the morning hours and has difficulty staying awake for a long time in the evening. The evening type on the other side can achieve high performance especially at a later hour and finds the morning hours torturous. However, these two extreme types are rather rare (Crönlein et al., 2017). The normal type is most often found in society. These people wake up neither particularly early nor late, so they are a mixed type of the "lark" (morning type) and "owl" (evening type).

 

How do we know when we need to sleep?

Clearly, when we are tired. But why do we get tired? Regardless of whether we are evening, morning or normal type, our tiredness and the urge to sleep is caused by two factors: the circadian rhythm and the hormone adenosine. The circadian rhythm is, so to speak, the "inner clock" that our organism and all our cells follow. It lasts about 24 hours (hence the term circadian, which is derived from the Latin word circa, roughly meaning day). Among other things, this circadian rhythm influences hormone release and metabolic processes, including the sleep-wake rhythm. By releasing the hormone melatonin this rhythm signals the body to sleep. But melatonin is not the only thing that makes us tired. Our cells work at full speed all day and need energy. This produces adenosine. The longer the day, the more adenosine accumulates in the body. And the more adenosine accumulates  in the body, the higher the sleep pressure becomes and we get tired. During sleep, the adenosine is broken down again and the sleep pressure decreases over night. When we wake up, the process starts all over again (Birbaumer & Schmidt, 2010).

 

What happens in case of a lack of sleep - sleep as a symptom

Different types of sleep disorders can be distinguished: Insomnias, hypersomnias, parasomnias, sleep-wake rhythm disorders or motor disorders such as restless leg syndrome (Spiegelhalder, Backhaus & Riemann, 2011). Between 2010 and 2017, the number of sleep disorders among working people increased by 66%, with about one in ten people suffering from insomniac complaints (DAK, 2017). These include problems falling asleep, sleeping through the night and not getting restful sleep.

Who can’t relate? Stress at work, bad sleep at night which causes low performance at work the next day - a vicious circle. It seems logical that this is not good for our organism, but what exactly are the consequences of sleep disorders? If we do not sleep well, increased risk of falling asleep, a lack of energy and motivation, tension, headaches, moods and concentration problems can be the consequence (DAK, 2017). And mental disorders can also worsen as a result of lack of sleep (Crönlein et al., 2017). Sleep quality and an exact assessment of sleep problems are therefore an important part of the assessment before Neurofeedback therapy.

Sleep as a symptom - How neurofeedback can help 

Because sleep problems often occur as a symptom of other diseases, Neurofeedback can be used for various sleep problems. Especially at the beginning of Neurofeedback therapy, sleep is an important indicator to determine suitable starting positions for ILF Neurofeedback. It makes a difference whether patients have difficulties falling asleep or problems sleeping through the night, which means they need better regulation of the sleep phases. A combination of both can also be present. It influences which electrode positions one starts with in ILF Neurofeedback. 

Furthermore, sleep disorders are a well-describable symptom that causes a high level of suffering for many of those affected. The effects are noticeable in everyday life. Sleep is therefore often a symptom where the first treatment successes with ILF Neurofeedback can become visible quickly. For many patients, being able to fall asleep or sleep through the night "at last" brings a significant improvement to everyday life.

Studies also support the positive effects of Neurofeedback on sleep disorders. For example, study participants reported a subjective improvement in their sleep quality and better performance during the day (Hammer et al., 2011; Schabus et al., 2013). Neurofeedback can also minimise sleep latency, i.e. the time needed from going to bed to actually falling asleep (Wu et al., 2021). Another study shows that sleep problems in burnout patients could be improved (Kratzke et al., 2020). 

ADHD patients in particular report sleep problems repeatedly. An improvement of these problems was observed through SMR Neurofeedback training (Arns, Feddema & Kenemans, 2014). An explanation for this is given in a review article by Arns & Kenemans (2014), in which the effects of Neurofeedback on the so-called sleep spindle circuit are discussed. Increased sleep spindle density leads to a normalisation of insomnia, which in turn reduces ADHD symptoms. "In a [...] randomised controlled trial, 27 healthy adults were trained with SMR conditioning to improve sleep and declarative learning. After 10 sessions, positive changes were observed in sleep parameters such as sleep spindles and latency to fall asleep" (author's translation, Hoedlmoser et al., 2008).

Sleep problems were also improved in a patient treated with ILF Neurofeedback in a virtual reality setting. These improvements persisted after a one-year follow-up. (Orakpo et al., 2021). In another case study, treatment with ILF Neurofeedback in the virtual reality setting improved a patient's pain-related insomnia. Again, the sustained improvement was confirmed after one year (Orakpo et al., 2022).

Based on current research and clinical experience, Neurofeedback can be a useful therapeutic component in the treatment of insomnia or symptoms of disturbed sleep. We are currently working with other researchers to support further Neurofeedback studies. 

For more detailed information on Neurofeedback and scientific work, please contact us.

 

 

 

Sources:

Arns, M., Feddema, I. & Kenemans, J. L. (2014) Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency. Front. Hum. Neurosci. 8, 1–10.

Birbaumer, N., Schmidt, R. (2010) Wach-Schlaf-Rhythmus und Aufmerksamkeit, in: Schmidt, R. F.,Lang, F.,Heckmann, M. (Hrsg.), Physiologie des Menschen, 31., überarbeitete und aktualisierte Auflage, Heidelberg, Springer Medizin-Verlag, 181–200.

Crönlein T, Galetke W, Young P. (2017) Schlaf und Schlafmedizin – Grundlagen. In: Crönlein T, Galetke W, Young P, Hrsg. Schlafmedizin 1×1. Berlin, Heidelberg: Springer Berlin, Heidelberg.

Hammer, B. U., Colbert, A. P., Brown, K. A. & Ilioi, E. C. (2011). Neurofeedback for insomnia: A pilot study of Z-score SMR and individualized protocols. Appl. Psychophysiol. Biofeedback 36, 251–264.

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Hoedlmoser, K., Pecherstorfer, T., Gruber,G., Anderer, P., Doppelmayr, M., Klimesch, W., Schabus, M. (2008) Instrumental Conditioning of Human Sensorimotor Rhythm (12-15 Hz) and Its Impact on Sleep as Well as Declarative Learning. SLEEP 31, 1401–1408.

Kratzke, I. M., Campbell, A., Yefimov, M. N., Mosaly, P. R., Adapa, K., Meltzer-Brody, S., Farrell, T. M., Mazur, L. M. (2020) Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout. Journal of the American College of Surgeons 232, 74-80.

Marschall, J., Hildebrandt, S., Sydow, H., Nolting, H.-D. (2017) Gesundheitsreport 2017. Analyse der Arbeitsunfähigkeitsdaten. Update: Schlafstörungen, 1. Auflage, Heidelberg, Neckar, medhochzwei Verlag.

Orakpo, N., Vieux, U. & Castro-nuñez, C. (2021) Case Report : Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Front. Hum. Neurosci 12, 3–7.

Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J., Arrington, K. (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci 16, 1-5.

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Wu, Y., Fang, S., Chen, S., Tai, C. & Tsai, P. (2021) Effects of Neurofeedback on Fibromyalgia : A Randomized Controlled Trial. Pain Manag. Nurs. 21, 755-763.