Biofeedback Therapies for Chronic Insomnia: A Systematic Review
The treatment of insomnia is still a challenge in clinical practice. This systematic review of randomized and quasi-randomized clinical trials aims to summarize the evidence for the use of biofeedback techniques in the treatment of chronic insomnia. Studies that compared biofeedback with other techniques of cognitive behavioral therapy, placebo, or absence of treatment were selected. The outcomes evaluated included sleep onset latency, total sleep time, sleep fragmentation, sleep efficiency and subjective sleep quality. Comparing to placebo and absence of treatment, some studies suggest possible benefits from the use of biofeedback for chronic insomnia in decreasing sleep onset latency and number of awakenings; however, there was marked divergence among included studies. There was no evidence of improvement in total sleep time, sleep efficiency and subjective sleep quality. Moreover, the maintenance of long-term benefits lacks evidence for any outcome. In the majority of outcomes evaluated, no significant differences in the effectiveness of biofeedback compared with other cognitive behavioral therapy techniques were observed. This systematic review found conflicting evidence for the effectiveness of biofeedback techniques in the treatment of chronic insomnia. Inter- and intra-group clinical heterogeneity among studies could be a reasonable explanation for the divergent results. These findings emphasize the need of performing further randomized clinical trials of higher methodological quality in order to better delineate the effectiveness of biofeedback on chronic insomnia treatment.
KeywordsInsomnia Disorders of initiating and maintaining sleep Biofeedback Neurofeedback
Descriptors in health science
Diagnostic and statistical manual of mental disorders, 4th edition—text revision
International classification of diseases, 10th revision
International classification of sleep disorders, 3th edition
Medical subject heading
Sleep onset latency
Total sleep time
Complaince with ethical standards
Conflict of interest
The authors received no financial support for this study and have no conflict of interest to declare.
- American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.). Darien, IL: American Academy of Sleep Medicine.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Press.Google Scholar
- Cortoos, A., De Weerdt, S., Pattyn, N., De Valck, E., Cluydts, R., & Vincken, W. (2010b). The effect of cognitive behavioural therapy for insomnia versus neurofeedback on subjective sleep in insomnia patients: An exploratory study. Journal of Sleep Research,19(Suppl. 2), 294.Google Scholar
- Neves-Neto, A. R. (2010). Biofeedback in cognitive-behavior therapy. Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo,55(3), 127–132.Google Scholar
- Querstret, D., Cropley, M., & Fife-Schaw, C. (2017). Internet-based instructor-led mindfulness for work-related rumination, fatigue, and sleep: Assessing facets of mindfulness as mechanisms of change. A randomized waitlist control trial. Journal of Occupational Health Psychology,22(2), 153–159.CrossRefGoogle Scholar
- The Cochrane Collaboration. (2011). In Higgins, J. P. T., Green, S. (Eds.), Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). Retrieved from www.cochrane-handbook.org.
- The Cochrane Collaboration. (2014). Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre.Google Scholar
- World Health Organization. (1991). International classification of diseases (ICD-10). Geneva: World Health Organization.Google Scholar