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만성 불면장애 환자들의 생리적 과각성 메커니즘을 설명하는 과각성 모델(Hyperarousal Model)은 수면과 각성 조절의 불안정 상태가 불면 증상의 발생과 관련이 있으며 만성불면장애 환자들이 다양한 형태의 신경 생리적 과각성을 나타낸다고 설명하고 있다. 선행연구들에서도 불면장애 환자들에게서 정상인보다 높은 고주파 대역의 뇌파를 나타낸다고 보고하고 있다. 이는 불면장애 환자의 과각성 상태를 시사하며, 이러한 과각성 뇌파패턴은 비회복적 수면을 야기한다. 이에 본 연구는 불면장애 환자들에게 나타나는 대표적인 고주파대역의 뇌파인 Beta파(18-30 Hz)감소 뉴로피드백을 실시하여 불면장애 환자들의 불면장애 증상에 효과가 있는지 확인하고자 하였다. 이를 위해 불면장애 관련 불면장애 관련 검사에서 불면장애를 시사하는 점수를 나타낸 참가자를 치료집단과 대기 통제 집단에 무선할당을 하였다. 치료집단(n=5)은 일주일에 1번씩 10회기의 뉴로피드백 치료를 받고, 대기 통제 집단(n= 9)은 10주 간 아무런 처치를 받지 않았다. 뉴로피드백치료의 효과측정을 위해 치료집단과 대기 통제 집단의 치료 전, 후의 휴식기 뇌파(개안, 폐안), 심박변이도, 불면장애 관련 검사 점수, Smart Wearable Device를 이용해 측정한 데이터를 비교하였다. 그 결과, 치료집단은 대기 통제 집단보다 Beta파, 심박률, 수면잠복기, 불면장애 관련 검사 점수 감소와 Alpha파, 총 수면시간, 수면효율 증가를 나타내었다. 본 연구는 만성 불면장애 환자들에게 나타나는 신경생리학적 과각성 지표인 Beta파를 이용한 최초의 뉴로피드백 프로토콜일 뿐 아니라 Beta파 감소가 불면장애 증상에 효과가 있다는 새로운 증거를 제시한다. Beta 감소 뉴로피드백 치료는 임산부, 장기적인 약물복용으로 인해 내성이 생긴 환자군, 노년층 등 특수한 환자군에게 안전하고 효과적이며 대안적인 비약물 치료가 될 것으로 기대된다. 뉴로피드백의 치료 효과는 환자의 불면장애 증상에 대한 통제감을 제공할 뿐 아니라 다른 정신질환과의 공존이환에 대한 위험성을 감소시킨다. 본 연구는 10회기 후 불면장애 증상의 개선을 확인하였는데, 불면장애 증상의 빠른 경감 효과는 환자들의 치료에 대한 동기를 강화시켜줄 뿐 아니라 치료의 윤리적인 측면에서 환자들의 시간과 비용을 부담을 줄일수 있다는 점에서 의의가 있다.
According to the "hyper-arousal" model of primary insomnia (PI), insomnia patients experience heightened physiological and cognitive arousal compared to normal people during both sleep and wakefulness. Previous studies have reported that insomnia patients show more high frequency electroencephalogram (EEG) signals than normal people. This suggests that hyper- arousal in insomnia, reflected in the high frequency EEG pattern, results in non-restorative sleep. Specifically, hyperarousal in PI results in increased beta activity that is associated with cortical arousal, resulting in non-restorative sleep. This study aimed to verify the efficacy of a beta-decrease neurofeedback (NF) protocol for insomnia. Participants were randomly assigned to an NF treatment or a wait-list control group. The NF treatment group received 10 sessions of NF (n=5), and the wait-list control group (n=9) group received no treatment. We compared the following parameters pre-and post-treatment, as well as 2-weeks following the final treatment: resting state EEG (eye-open, EO; eye-closed, EC), heart rate variability (HRV), sleep scales, sleep diaries, and Smart Wearable Device data. Results showed significantly decreased beta power, HRV, SL (sleep latency), sleep scale scores, increased alpha power, TST (total sleep time), SE (sleep effectiveness), and sleep satisfaction in the wait-list control group compared with the NF group. This study is the first neurofeedback protocol using “Beta power” as a marker of neurophysiological arousal in insomnia. Our findings provide new evidence for the efficacy of Beta in decreasing insomnia symptoms and add to the range of non-pharmacological insomnia intervention choices for pregnant, psychopharmacotherapy-resistant, and older people. Neurofeedback not only provides control of insomnia symptoms but also results in a decreased risk of psychological comorbidities. This study found improved insomnia symptoms after only 10 sessions of NF. Fast remission of insomnia symptoms may reinforce patients’ motivations for treatment, is more cost-effective, and can result in reduced treatment times.
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