The efficacy of biofeedback for the treatment of insomnia: a critical review

Nicole Lovato; Christopher B Miller; Christopher J Gordon; Ronald R Grunstein; Leon Lack

doi:10.1016/j.sleep.2018.12.011

The efficacy of biofeedback for the treatment of insomnia: a critical review

Sleep Med. 2019 Apr:56:192-200. doi: 10.1016/j.sleep.2018.12.011. Epub 2018 Dec 26.

Authors

Nicole Lovato¹, Christopher B Miller², Christopher J Gordon³, Ronald R Grunstein⁴, Leon Lack⁵

Affiliations

¹ Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia; CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia. Electronic address: nicole.lovato@flinders.edu.au.
² CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia.
³ CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.
⁴ CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁵ Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia; School of Psychology, Flinders University of South Australia, Australia.

PMID: 30846410
DOI: 10.1016/j.sleep.2018.12.011

Abstract

Background: The popularity of biofeedback as a non-pharmacological treatment option for insomnia has increased in recent times despite inconsistent empirical evidence for its therapeutic efficacy.

Objective: The purpose of the current review was to systematically assess the efficacy of using biofeedback to treat insomnia.

Methods and results: A search of electronic databases (PubMED, MEDLINE, OvidSP, Ovid EMBASE, PsychInfo, The Cochrane Library including Cochrane Reviews), clinical trials databases and registries (Clinical Trials Database [US], Australian New Zealand Clinical Trials Registry [ANZCTR]) and online journal (eg, SLEEP, Sleep Medicine) identified 92 studies. Of these, 50 publications were descriptive or review papers about use of biofeedback for the treatment of insomnia, while an additional 37 did not meet the detailed inclusion criteria (ie not original research, participants do not meet the diagnostic criteria for insomnia). Six full-text articles met inclusion criteria and were included in this review. Methodological flaws including poor study design (small sample size, lack of control group) limit the validity of the body of work in this field to date and fail adequately to account for other unspecified factors likely to drive the observed changes, such as care and attention of those administering the treatment, as well as the expectations and motivations of the patient.

Conclusion: There is an urgent need for future studies to clarify the role of unspecific placebo effects when reporting biofeedback effects for the treatment of insomnia.

Keywords: Biofeedback; Insomnia; Review; Treatment.

Publication types

Systematic Review

MeSH terms

Biofeedback, Psychology / methods*
Humans
Outcome and Process Assessment, Health Care*
Sleep Initiation and Maintenance Disorders / therapy*