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Biofeedback to Beat Insomnia

My enigmatic relationship with sleep first began in college, when my roommate, an otherwise charming person, surprised me with a major skeleton: She was a big-time snorer. Our room was on the ground floor, and if the windows were open, even passersby could hear her saws. After several tormented weeks I discovered two small objects that ushered me back to slumber and sanity: earplugs. Nearly a decade after graduating, I've depended on them to fall asleep, even when I'm alone, away from the noise of the city, or totally exhausted. My point is that habits, especially when it comes to sleep, die very hard.

But lately, not even earplugs have eased the intermittent insomnia that's been plaguing me. I fall asleep easily, but no matter how exhausted I am, my eyes pop open at 3 a.m., like clockwork. A few months back, I consulted an acupuncturist, who provided some relief, but once I stopped treatments the pattern reemerged. I've tried going to bed earlier, going to bed later, and doing various presleep rituals-all to no avail.

I've been intrigued by biofeedback -- a treatment that can be helpful for stress-related conditions, including insomnia -- and recently made an appointment with Saul Rosenthal, Ph.D., a clinical instructor at Harvard Medical School and one of 18 Massachusetts practitioners certified by the Biofeedback Certification Institute of America. At my first appointment he explains the goal: patients are taught to manipulate brain activity, blood pressure, heart rate, and other physiological responses. In other words, you learn to control your body, and stress levels, with your mind. To that end, patients are connected to an electromyogram (EMG), which uses sensors to measure muscle tension, and monitors that measure heart rate, breathing rate, hand temperature, and other bodily responses. Changes in tension are translated into a beeping sound or a visual display. By relating information gleaned from the EMG with a physical sensation, he says, patients can learn to make the sensation go away-usually with a combination of breathing technique and concentrated thought.

"Western medicine tends to split mind and body, but research shows that they are connected," says Rosenthal. And unlike Western medicine, which largely relies on treatments that happen to you, "biofeedback gives control back to the patient."

Seeing Your Stress
After we chat about my sleep troubles, Rosenthal leads me to his computer, where he connects sensors to my wrists, shoulders, middle and index fingers, and waist. These sensors monitor my response to stress by measuring my heart rate, muscle tension, sweat activity, and respiratory function (all of which increase under stress) as well as hand temperature, which tends to drop when a person is excited or anxious. I watch the monitor as Rosenthal guides me through stress-inducing activities: a bothersome memory about a situation at work, annoying sounds, and difficult math problems.

A series of waves appears on the screen, showing my stress peaks and valleys, and there are accompanying auditory beeps-the faster the beep, the higher my stress. The product looks like a lie detector test; in fact, lie detectors operate on some of the same principles as biofeedback devices. It's unnerving, and then somehow comforting, to see my emotions literally on display: There's my stress, right there -- I can reach out and touch it. I'm surprised to find out that my stress levels are more "average" than they feel, but as Rosenthal points out, that doesn't mean they're healthy. Still, I'd be interested to see how the sensors would respond when I'm experiencing a genuine mood swing, rather than a spontaneous, half-forced one.

The most important part of biofeedback isn't simply seeing your body's responses, but learning how to change them. While still hooked up to the machines, I practice relaxing my muscles and breathing with my diaphragm. This interrupts my body's stress response, as evidenced by long waves and slow beeps. Perhaps the best-known biofeedback exercises -- warming your hands by picturing them in front of a fire, or cooling them by imagining them in a bank of snow -- can help conditions ranging from migraines to irritable bowel syndrome to overall stress management. Similarly, "if you focus on your pulse, just think about it hard, you can allow it to get stronger or weaker," says Rosenthal. Eventu-ally, he adds, patients can attain these states without the monitor's help.

"Biofeedback is about learning to recognize the feeling of internal change," says Rosenthal. The EMG is a means to an end, he explains, but the goal is for a patient to learn to do it herself -- and not just in a therapist's office. "One of my goals as a clinician is to work myself out of a job."

Putting It Into Practice
Rosenthal tells me that low levels of chronic stress are likely what's affecting my sleep, which isn't exactly news. But I also learn that I breathe with my shoulders and hold my breath when I'm tense. "When reacting to physical stress, like the annoying sound, your tension increases but returns to baseline quickly," says Rosenthal. "But with the situation at work, you didn't recover quite as well, which suggests you hold on to emotions. Even after the event is over, you're still experiencing the stress from it." To help stop the reaction, he suggests I pay attention to my breathing during the day, and, when I can, to inhale and exhale to equal counts. These "micro-breaks" will help me release tension and gain control over my stress response, says Rosenthal.

Critics of biofeedback say that the use of the practice for stress is just a fancy (and pricier) alternative to meditation and relaxation training. But six treatments in I've come to appreciate the growing control I have over my sleep. Through the lens of biofeedback, my stress has become tangible-and therefore far less mysterious. Sure, there's an element of biofeedback that suites my type-A personality -- can I warm my hands faster today than I did last week? -- but its heavy focus on measured breathing has truly left me more even-keeled and better rested. Biofeedback is for people, like me, who like to see results. I'm still wearing the earplugs, but these days, they last throughout the night.

Text by Alyssa Giacobbe


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