Overview & Efficacy

Both the National Institutes and the American Academy of Sleep Medicine have both stated that biofeedback used in conjunction with relaxation training can help sleep problems.

This therapy is rated as probably efficacious (level 3 on a scale of 1 - 5 with 5 being the best).
For more information on how efficacy is rated click here.

Why biofeedback would help this problem

Sleep disturbances including abnormally long time to fall asleep, frequent awakenings at night long enough to be remembered, and early awakening without being able to fall back to sleep are frequently related to stress, anxiety, and depression. These problems and the extra worried thinking associated with them cause the body's normal "fight or flight" physical responses to interfere with sleep. Biofeedback used in conjunction with relaxation training and other behavioral approaches to controlling anxiety such as cognitive restructuring (which helps people rethink just how threatening the very real stresses they need to deal with really are) helps people recognize when they are having exaggerated physical stress responses and what they are responding to. The techniques help people learn to control the responses so they are not larger than they need to be nor last longer than they have to.

Brief summary of evidence supporting the efficacy of biofeedback for insomnia

Yucha and Gilbert (2004) state that in 1996, an NIH Technology Assessment Panel examined existing research and concluded that several non-pharmacological techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but questioned whether the magnitude of the improvement in sleep onset and total sleep time were clinically significant. In 1998, the American Academy of Sleep Medicine recommended biofeedback along with progressive muscle relaxation for insomnia after reviewing the quality of research, using American Psychological Association research criteria. Biofeedback was rated "probably efficacious" along with sleep restriction and cognitive-behavioral therapy. (Morin et al., 1998) (Progressive muscle relaxation, stimulus control, and paradoxical intent were rated even higher.)

* Most of the information provided can be found in Carolyn Yucha and Christopher Gilbert's 2004 book Evidence Based Practice in Biofeedback Neurofeedback, AAPB, Wheat Ridge, CO.

Technical Papers & Abstracts

McLay, R. N., & Spira, J. L. (Dec. 2009). Use of a Portable Biofeedback Device to Improve Insomniain a Combat Zone, a Case Report. Applied Psychophysiol Biofeedback, 34(4),319-321. Retrieved from SpringerLink Database.

Cortoos, A., Verstraeten, E., & Cluydts, R.(Aug. 2006). Neurophysiological aspects of primary insomnia: Implications for its treatment. Sleep Medicine Reviews, 10(4), 255-266. Retrieved from Science Direct Database.

&Lorrain, D. (Jan. 2003) Trait anxiety and sleep-onset insomnia: Evaluation of treatment using anxiety management training. Journal of Psychosomatic Research, 54(1), 31-37. Retrieved from Science Direct Database.

Tozzo, C. A., Elfner, L. F., & May, J. G.(Aug. 1988). EEG biofeedback and relaxation training in the control of epileptic seizures. International Journal of Psychophysiology, 6(3), 185-194. Retrieved from Science Direct Database.

Johnson, R. K., & Meyer, R. G.(Sept. 1974). Phased biofeedback approach for epileptic seizure control. Journal of Behavior Therapy and Experimental Psychiatry,5(2), 185-187. Retrieved from Science Direct Database

Viens, M., Koninck, D., Mercier, P., St-Onge, M., & Lorrai, D. (Jan. 2003). Trait anxiety and sleep-onset insomnia: Evaluation of treatment using anxiety management training. Journal of Psychosomatic Research, 54(1),2003, 31-37. Retrieved from Science Direct Database

Lichstein, K. L.(Aug. 2006). Behavioral intervention for special insomnia populations: Hypnotic-dependent insomnia and comorbid insomnia. Sleep Medicine, 7(1), S27-S31. Retrieved from Science Direct Database.

Riemann, D., Perlis, M. L.(Jun. 2009). The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews, 13(3), 205-214. Retrieved from Science Direct Database.

Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 31(1), 45-55.

Morin, C. M. (1999) . Nonpharmacologic treatment of chronic insomnia. Sleep, 22(8), 1134-1156.

Hauri, P. (Jul. 1981) Treating psychophysiologic insomnia with biofeedback. Archives of General Psychiatry, 38(7), 752-758.

Hauri, P., Percy, L., & Hellekson, C. (1982) The treatment of psychophysiologic insomnia with biofeedback: A replication study, Applied Psychophysiology and Biofeedback. Springer Netherlands, 7(2).

Richard, R., & Rider, S. (1993). Behavioral techniques and biofeedback for insomnia. Bootzin and Rider, 315.

Ronald, C., & Howard, H. (1978) Insomnia: Effects of EMG biofeedback, relaxation training, and stimulus control. Behavioral Engineering. 5(2), 67-72.