By Steven T. Padgitt, Ph.D.

A physician referred a young woman in the last trimester of her second pregnancy to the Brain Wave Treatment Center of Santa Cruz for treatment of primary insomnia. Although the physical discomfort associated with pregnancy certainly increased her sleep problem, this young woman presented a history of insomnia that predated her pregnancy. The intake interview yielded the presence of characteristics commonly associated with primary insomnia. The problem for this patient began during early adulthood and the medical stressor that precipitated the current episode was her pregnancy. She experienced a gradual course of dysomnia development including an initial phase of progressive worsening over several weeks, to the point that she was dramatically sleep deprived at initial contact. She described the common cognitive symptoms of fear of and worry about not being able to sleep, inherent in primary insomnia. There were no apparent precipitating stressors.

On intake, information concerning environmental factors that might be influencing her sleep disorder was obtained. Home environmental sleep behavior and nocturnal habits, as well as the behavioral sleep patterns of her husband and her three year old child were discussed. Once the important variables related to her dysomnia were established, a brief educational process regarding sleep was initiated and relevant information about Neurofeedback was introduced.

The concept of electrical activity occurring in the brain and brain waves was introduced. The ranges and names of EEG activity were explained. The patient was told that entering sleep can be viewed as a skill, and involves slowing the electrical activity in the brain. She was informed that using EEG Biofeedback for her sleep disorder would facilitate her learning to increase the amplitude of slow brain wave (Theta) activity, and facilitate falling asleep. She was also told that the Neurofeedback involves the surface placement of several sensors (electrodes): one reference sensor on the back of her neck (at C-7), one reference sensor on her ear lobe, and an active sensor placement on the surface of her scalp - from which the EEG activity would be recorded. She was instructed to relax with her eyes closed, and listen to the computer tones which represent her having surpassed the Theta brain wave amplitude thresholds set during the training session. She was told that the computer tones she would hear were instantaneous verifications of her having produced the kind of brain wave activity that induces sleep, and that her memorizing the sensation of this increase in Theta activity would help her gain control of her sleep problem at home.

She was seen twice per week initially and then once a week as she became successful in sleeping at home. The amplitude level required for tonal reinforcement was increased in accordance with her enhanced performance. This shaping process resulted in enhanced Theta amplitudes and decreasing Alpha and Beta amplitudes, despite her high amplitude initial Alpha signature. In addition, the ongoing educational and de-mystification process related to sleep decreased her anxiety and worry about the sleep process. By the third session she was demonstrating a significant increase in her Biofeedback induced Theta amplitude and reported significant sleep improvement at home. Her ability to sleep increased dramatically mid treatment and was reinforced in later sessions.

The rapid learning of psychophysiological arousal reduction skills described in this case is consistent with the results achieved with a whole host of symptoms and disorders resulting from excessive psychophysiological arousal, including: anxiety based disorders Post Traumatic Stress Disorder and Acute Stress Reaction.