Sleep-improvement as a working mechanism for neurofeedback treatment in ADHD
Brain-activity of healthy children more ‘drowsy’ across last decade.
Nijmegen, November 12th, 2012 – Difficulty falling asleep and staying asleep are common symptoms in patients with ADHD, and these sleep complaints are often associated with attention and impulsivity problems, researchers from Utrecht University and research institute Brainclinics conclude in the scientific journal Neuroscience and Biobehavioural Reviews. The researchers in this article propose a neuro-anatomical model of neurofeedback, where neurofeedback results in falling asleep faster and better being able to maintain sleep, through an effect on so-called ‘sleep spindles’. At the same time, according to another study published in the Journal of Attention Disorders, over the last 10 years the brain activity of healthy children has become ‘drowsier’. This is most likely related to the fact that children sleep less, when compared to 10 years ago.
ADHD and sleep
Patients with ADHD often suffer from sleep problems, most often a difficulty falling asleep and maintaining sleep, but sometimes also more severe sleep problems such as sleep apnea (breathing problems) and restless legs syndrome. Specific treatment in ADHD subgroups with these two specific sleep disorders (apnea and restless legs syndrome) have been demonstrated to result in a greater reduction of ADHD symptoms compared to traditional ADHD treatment with medication (Ritalin). All these sleep disorders have in common a chronic reduction in the number of hours slept. Shorter sleep duration and sleep restriction have been clearly associated with attention problems and hence are suggested to explain the attention issues in these ADHD sub-groups. Furthermore, brain activity in ADHD patients during the day exhibit clear signs of drowsiness. Another study just published in the Journal of Attention Disorders found that healthy children over the last 10 years also exhibit more and more of these drowsiness brainwave patterns (Arns, Conners & Kraemer, 2012). Perhaps this also explains the increased ADHD prevalence in recent years. Of course, sleep problems are not the underlying problem in all ADHD patients, but at least in a substantial number of patients.
Neurofeedback, ADHD and sleep
Recent research suggests that neurofeedback has favorable and lasting treatment effects in ADHD. In neurofeedback a specific brain activity is trained and until recently it was unclear how this technique results in behavioral improvements in ADHD. Arns and Kenemans (2012) suggest that neurofeedback impacts on the brain system that becomes active during sleep, and is responsible for the generation of so-called “sleep spindles”. Several studies have demonstrated that after application of neurofeedback during the day, the brain activity during sleep is altered. This change consists of an increase in sleep spindles, resulting in faster sleep onset times and improved sleep maintenance. Arns and Kenemans suggest that specifically these improvements in sleep can be seen as the cause of the effectiveness of neurofeedback in ADHD.
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Arns, M. & Kenemans, J. L. (2012). Neurofeedback in ADHD and insomnia: Vigilance stabilization through sleep spindles and circadian networks. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2012.10.006
Arns, M. Conners, C. K. & Kraemer, H. C. (2012). A decade of EEG theta/beta ratio research in ADHD: A meta-analysis. Journal of Attention Disorders. doi:10.1177/1087054712460087