Insights - Cleveland Clinic

Kumar Budur, md
Biofeedback: a Useful tool for psychophysiological Insomnia
By Kumar Budur, md
sleep
everyone has occasional nights when racing thoughts and worries keep them awake, but persistent life stress
and anxiety can trigger insomnia that is disabling. psychophysiological insomnia accounts for about 15 percent
of the chronic insomnia seen at sleep disorders centers, and can be very difficult to treat. hypnotic medications,
typically the first line of treatment, have many limitations and often are ineffective.
Cleveland Clinic’s Sleep Disorders Center recently
has incorporated biofeedback therapy in its interdisciplinary
approach to this difficult problem. Novel
application of this tried-and-true technology helps
patients learn to relax — both at night and during the
day. We are one of just three centers offering this type
of approach to stress-and-anxiety-related insomnia in
the United States.
Biofeedback therapy involves the monitoring of body
functions that reflect tension and arousal (heart rate,
blood pressure, body temperature and muscle activity).
Brain activity is monitored with electroencephalogram
(EEG). All of this information is displayed
for the patient, who then is instructed on how to
perform relaxation techniques such as deep breathing,
progressive muscle relaxation and meditation.
The patient receives immediate feedback as to the
impact of relaxation on the multiple psychophysiologic
measures clearly displayed on monitors. Such a
quantitative display of progress encourages patients
to continue with the relaxation techniques, yielding
even greater results.
Patients are educated to continue these techniques
at home for maximum achievement of nighttime
restfulness. Since many are “night owls,” they also are
coached to readjust their body clocks to be less active
in the evening hours.
Although biofeedback therapy has long been used for
insomnia, research on its efficacy is limited and no
guidelines are available on patient characteristics, or
ideal number or type of sessions.
This prompted us to perform a retrospective chart
review of 30 patients with a primary diagnosis of psychophysiological
insomnia referred for biofeedbackbased
treatment. Seventy percent rated themselves
as “very much improved” or “improved” after three
sessions. They reported sleeping better without medications.
Patients with problems of somatized tension
responded best. Many also stated that relaxation
techniques helped them cope with daytime stress and
anxiety, allowing them, we believe, to overcome this
important component of the cycle of insomnia.
Kumar Budur, MD, is a psychiatrist and sleep specialist
with joint appointments in the Department of Psychiatry
and Psychology and Cleveland Clinic’s Sleep Disorders
Center. His specialty interests include insomnias, parasomnias,
circadian rhythm sleep disorders and sleep/psychiatry
disorders. He can be contacted at 216.444.0915 or
budurk@ccf.org.
12 INsIghts | ClEvElaNd ClINIC dEpartmENt of psyChIatry aNd psyChology 2008
80%
70%
60%
50%
40%
30%
20%
10%
0%
Very Much Improved
Biofeedback for Insomnia:
After 3 Sessions
no Improvement