Case Study: Sleep Disorders
AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Probable Efficacy for Insomnia. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000). Levels of evidence include: case reports, observational studies, randomized clinical trials, fMRI scans (Andrasik & Rime (2007), and so on. “Efficacy” determination of training or treatment effect is derived from systematic evaluation in controlled clinical trial (La Vaque et al (2002).
Case A
This case involved an eleven year old female who, from the age of two endured nightly sleep walking and talking, night terrors (would awaken screaming and not know she had done so), narcolepsy (would suddenly fall fast asleep sitting up during the day). The girl was generally fatigued most days due to poor quality of sleep. She had great difficulty waking from sleep in the mornings, requiring a half hour before gaining full wake-state consciousness. In addition, the girl was extremely verbally hyperactive, tended to be disorganized, and was often orally fixated with thumb-sucking, pencil chewing, etc. The girl was diagnosed with ADHD and Reactive Attachment issues (her father abandoned her at six months of age, and the girl still begged to sleep by her Mother’s side at night). She was bright but scholastically challenged. Prescribed stimulants proved partially helpful, and the girl’s Mother hoped to turn things around before her daughter entered her teen years.
After completing several Neurofeedback training sessions the Mother reported her daughter “slept like a log”, where previously she had tossed and turned all night long. Shortly thereafter the Mother cited physician supervised partial titration off of medication, since the girl was not as compulsively talkative and seemed to be getting more organized. As training ensued the Mother reported more improvements in the girl’s organizing and focusing, with less thumb-sucking and pen/pencil chewing. Later the Mother reported her daughter was able to sleep through the night in her own bed. Midway through her training program the girl was titrated off of her medication. The Mother reported her daughter was sleeping consistently more restfully with "no more sleep talking" when first awakened and faster arousal to a full wake-state. At discharge, per the Mother’s reports, the girl’s thumb-sucking was in remission, the verbal hyperactivity was markedly less problematic overall, and the girl was no longer fatigued during the day.
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Case B
This case involved a thirty-five year old male who, since adolescence, could sleep for eighteen hours at a time and never feel adequately rested. He complained of large, dark, puffy circles under his eyes, allergies, and very poor quality sleep. He had suffered a very unstable upbringing with a violent parent and was estranged from his family. The man described himself as a stoic who was not able to talk about feelings, and noted dissatisfaction with his inability to find a satisfying love concern.
After completing two Neurofeedback training sessions the man reported sleeping for only eight hours (as opposed to his usual sixteen) and declared that, to his surprise, he was “feeling more rested then I can remember”. As training progressed he reported continued satisfying sleep, and cited that he was dreaming for the first time in his life. Midway through the program he no longer had dark, puffy circles under his eyes. The man had started psychotherapy and was confronting his difficult past. Toward the end of training he reported crying spontaneously when seeing a sad movie, and was “feeling good about this”, as he considered it to be “a break-through of sorts”. By discharge the man reported that he was “dating a woman I feel very close to and just loving it!”.
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