Association pour la Diffusion du Neurofeedback en France

 Le neurofeedback pour l'insomnie

Pourcentage de praticiens rapportant une amélioration d'au moins 40% des symptômes chez leurs patients, concernant les troubles du sommeil :

52,3 % au bout de 10 séances.
83,3% au-delà de 20 séances.

Résultats d'une étude indépendante effectuée à l'Université de Victoria (Canada) par Charlène Zietsma, Ph. D, en décembre 2008. Etude réalisée auprès de plusieurs centaines de praticiens utilisant le logiciel NeurOptimal™ de la société Zengar Institute, totalisant 1,2 millions d'heures de séances de neurofeedback. Cliquez ici pour accéder à l'étude complète (en anglais).
La valeur de 40% d'amélioration est retenue comme étant ce que l'on peut espérer de mieux grâce à la plupart des médicaments, pour la plupart des symptômes évalués dans l'étude. C'est aussi un niveau d'amélioration suffisamment satisfaisant pour justifier d'entreprendre une série de séances de neurofeedback.
 

 Recherches scientifiques sur le neurofeedback et l'insomnie, répertoriées dans la base PubMed

PubMed est le principal moteur de recherche des publications scientifiques de biologie et de médecine. Concernant le neurofeedback, les conclusions des études publiées sont souvent prudentes par principe, un peu dépassées (cf. date de l'étude), et bien en deçà de ce qui est observé aujourd'hui sur le terrain. La technologie mise en œuvre chez les praticiens est en effet bien plus avancée que celle utilisée pour les études scientifiques de validation qui s'appuient sur des protocoles de neurofeedback déjà bien connus, donc anciens. Dans le domaine du neurofeedback, c'est la technologie qui "tire" la science officielle en avant, et non pas l'inverse.

Les sociétés qui développent les équipements de neurofeedback n'ont pas les moyens financiers des laboratoires qui produisent les médicaments, et elles ne peuvent financer ces études officielles, ce qui explique leur nombre restreint. Pour le développement et l'amélioration constante des équipements de neurofeedback, ces sociétés s'appuient plutôt sur leurs recherches internes et sur les résultats cliniques rapportés par les praticiens.

Dans la base PubMed, les cinq études résumées ci-dessous concluent :

1.	"...les groupes de neurofeedback ont vu leur sommeil et leur fonctionnement quotidien s'améliorer. A la fin du traitement, tous les participants dormaient normalement."
2.	"...une amélioration significative de la durée de sommeil nocturne est apparue uniquement suite au neurofeedback... les résultats sur le sommeil à domicile ont montré une amélioration globale uniquement pour ceux qui avaient fait du neurofeedback..."
3.	"...le neurofeedback [...] pourrait être un traitement prometteur. Les résultats préliminaires pour l'insomnie et les succès obtenus pour d'autres troubles suggèrent que ce traitement peut avoir les effets stabilisants nécessaires sur l'activité cérébrale EEG, pouvant permettre le retour à la normale du fonctionnement de jour comme de nuit."
4.	"D'après les résultats sur le sommeil à domicile, le neurofeedback [...] semble un traitement efficace pour l'insomnie."
5.	"L'apprentissage dû au neurofeedback est corrélé de façon significative avec l'amélioration du sommeil..."

Liste des études :

 1. Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols.
Hammer BU, Colbert AP, Brown KA, Ilioi EC.
Department of Psychophysiology, Helfgott Research Institute, National College of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201-4848, USA, barbhammer37@yahoo.com.
Appl Psychophysiol Biofeedback. 2011 Jul 26. [Epub ahead of print]

Abstract
Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p < .005), Pittsburgh Sleep Quality Inventory (PSQI p < .0001), PSQI Sleep Efficiency (p < .007), and Quality of Life Inventory (p < .02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p < .001) which were lowered post-treatment (paired z-tests p < .001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.

PMID: 21789650 [PubMed - as supplied by publisher]

 2. An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia.
Cortoos A, De Valck E, Arns M, Breteler MH, Cluydts R.
Research Unit Biological Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium. acortoos@vub.ac.be
Sleep Med Rev. 2006 Aug;10(4):255-66. Epub 2006 Jun 27.

Abstract
Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventeen insomnia patients were randomly assigned to either a tele-neurofeedback (n = 9) or an electromyography tele-biofeedback (n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements.

PMID: 19826944 [PubMed - indexed for MEDLINE]

 3. Neurophysiological aspects of primary insomnia: implications for its treatment.
Cortoos A, Verstraeten E, Cluydts R.
Department of Cognitive and Biological Psychology, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium. acortoos@vub.ac.be
Sleep Med Rev. 2006 Aug;10(4):255-66. Epub 2006 Jun 27.

Abstract
Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning.

PMID: 16807007 [PubMed - indexed for MEDLINE]

 4. The treatment of psychophysiologic insomnia with biofeedback: a replication study.
Hauri PJ, Percy L, Hellekson C, Hartmann E, Russ D.
Biofeedback Self Regul. 1982 Jun;7(2):223-35.

Abstract
To replicate a previous study, 16 psychophysiological insomniacs were randomly assigned to either Theta feedback or sensorimotor rhythm (SMR) feedback. Evaluations by home sleep logs and by 3 nights in the laboratory were done before biofeedback, immediately after biofeedback, and 9 months later. Results from this study replicate previous findings. Both Theta and SMR feedback seemed effective treatments of insomnia according to home sleep logs. According to evaluations at the sleep laboratory, tense and anxious insomniacs benefited only from Theta feedback but not from SMR feedback, while those who were relaxed at intake but still could not sleep benefited only from SMR but not from Theta feedback.

PMID: 7138954 [PubMed - indexed for MEDLINE]

 5. Treating psychophysiologic insomnia with biofeedback.
Hauri P.
Arch Gen Psychiatry. 1981 Jul;38(7):752-8.

Abstract
After evaluating 165 insomniacs, 48 psychophysiologic insomniacs were randomly assigned to one of the following four groups: electromyographic (EMG) feedback, combined EMG and theta feedback, sensorimotor rhythm (SMR) feedback, and no treatment (control). Sleep evaluations by home logs and in the laboratory were done before and after biofeedback and nine months later. No feedback group showed improved sleep significantly more than did the controls. The amount of feedback learning correlated significantly with sleep improvement for the SMR group but not for the other groups. Initial tension of the insomniacs correlated positively with sleep improvement for the EMG group, but negatively with sleep improvement for the SMR group. Those treated with the biofeedback that seemed appropriate for their specific deficiencies showed significant sleep improvements, while those who received inappropriate feedback did not. Appropriate biofeedback methods may be effective for specific types of insomnia, but these procedures offer no panacea for all poor sleep.

PMID: 7247638 [PubMed - indexed for MEDLINE]

Pour la liste complète des études concernant le neurofeedback répertoriées dans la base PubMed, cliquez ici.

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