The withdrawal or modification of this stimulus is used as a negative punishment to inform the individual that his/her brain functioning is diverging from the training goal. There are many different types of NF, but they all have in common the use of visual and/or auditory stimuli (video, music, etc.) as positive reinforcement presented when electroencephalographic (EEG) activity corresponds to the training goal. NF is based on the principle of operative conditioning. In the case of NF, the physiological signals used and modulated are brainwaves. The client then uses this information to modify his/her physiological functioning. To do this, biofeedback uses various stimuli corresponding to one’s physiological characteristics and presents them to the client (feedback). NF is a sub-category of biofeedback, a technique where one learns to modulate bodily functions, such as heart rate, through feedback. Because hyperarousal has been identified as a predisposing and maintaining factor in insomnia disorder, it would be advisable to offer treatment, such as neurofeedback (NF), that aims to modulate hyperarousal and which could offer long-term benefits. While medication is recommended only as a short-term treatment for insomnia with non-equivocally lacking effectiveness in the long-term for treating insomnia, CBT-I focuses mainly on behaviors and cognition surrounding sleep. In that regard, Altena et al have shown a frontal hypoactivation after CBT-I, while Cervena et al have shown an increase in slow waves and a slight decrease in beta activity after CBT-I. The literature showing that CBT-I is effective at decreasing hyperarousal is also quite scarce. It is also important to note that only 60% of individuals receiving CBT-I are considered good sleepers after treatment. However, there is a lack of research establishing that CBT-I leads to significant changes in sleep onset latency (SOL). Several studies support the effectiveness of CBT-I in reducing insomnia symptoms, such as wakefulness after sleep onset (WASO) and sleep efficiency (SE). Unfortunately, long-term use of medication causes undesirable side effects, such as cognitive and motor coordination problems, physical dependence and rebound insomnia. Medication has been shown as effective for treating insomnia, while its effects are mainly short-term. According to Bonnet and Arand, insomnia is a hyperarousal disorder and its treatment should aim to decrease arousal.Ĭurrently, there are two main types of treatment: Medication or cognitive behavioural therapy for insomnia (CBT-I). For example, insomnia is linked to an increased heart rate, increased facial muscle tension and a higher rate of cortical activation. However, it is widely recognized that hyperarousal plays an important role in insomnia. Insomnia affects everyone differently, and the profile of individuals that suffer from it is very heterogeneous. Insomnia is also linked to multiple health problems, such respiratory and cardiac diseases. In fact, there is a 40% co-occurrence between insomnia symptoms and mental illness. Not only does insomnia causes distress, it is linked to multiple psychopathologies. These difficulties must be present at least 3 nights a week for the past 3 mo and must cause distress or impaired functioning. This dissatisfaction must be associated with difficulty falling asleep, maintaining sleep and/or waking up early in the morning. Insomnia is a sleep disorder characterized by a dissatisfaction with the quantity and/or quality of sleep. Furthermore, approximately 6%-13% of the general population meets all criteria necessary for the diagnosis of insomnia disorder. Sleep difficulties are very common, with an estimated one-third of adults around the world being dissatisfied with their sleep.
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