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Infra-slow EEG neurofeedback for insomnia: a single-case experimental study in primary care
Arne Edvardsson1,2, Michael G Smith1, Sindre Engelbrekt Rolstad3
1School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Frontiers in Human Neuroscience
|July 31, 2026
Summary
Infra-slow neurofeedback (ISF-NF) shows promise as a feasible primary care intervention for insomnia, with some patients experiencing improved sleep quality and reduced depressive symptoms. Further research is needed to confirm efficacy.
Area of Science:
- Neuroscience
- Primary Care Medicine
- Sleep Medicine
Background:
- Insomnia is a common and debilitating condition in primary care settings.
- Infra-slow neurofeedback (ISF-NF) is a potential intervention for stress-related sleep issues.
- Empirical data on ISF-NF for insomnia in primary care is limited.
Purpose of the Study:
- To assess the feasibility and acceptability of ISF-NF for insomnia in primary care.
- To evaluate the preliminary therapeutic effects of ISF-NF on insomnia symptoms.
- To utilize a single-case experimental design for detailed outcome analysis.
Main Methods:
- Employed a single-case experimental design with repeated measures.
- Enrolled 10 primary care patients with insomnia and comorbidities.
- Administered 12 weekly ISF-NF sessions with individualized parameter adjustments.
- Assessed daily sleep quality (BSRSQA) and collected standardized questionnaires (PSQI, PHQ-9, GAD-7) at multiple time points.
- Analyzed data using visual analysis, Tau-U statistics, and descriptive wearable sleep metrics.
Main Results:
- Visual analysis indicated heterogeneous but interpretable sleep quality improvements in some participants.
- Five of eight participants achieved statistically significant Tau-U effects (p < 0.05).
- Group analyses showed reductions in sleep problems (PSQI) and depressive symptoms (PHQ-9) post-intervention, with partial relapse at follow-up.
- High adherence and acceptability were reported, with few adverse effects.
- Wearable data showed variability but suggested improvements in sleep consolidation and timing for some.
Conclusions:
- ISF-NF appears feasible and well-tolerated in primary care for insomnia.
- Preliminary evidence suggests potential benefits for a subset of patients.
- Individualized ISF-NF parameter adjustment and single-case analysis are valuable for adaptive interventions.
- Controlled trials are necessary to establish efficacy and elucidate mechanisms.
