Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain by Fisher Sebern F

Author:Fisher, Sebern F. [Fisher, Sebern F.]
Language: eng
Format: epub
Publisher: W. W. Norton & Company
Published: 2014-04-20T16:00:00+00:00

For most patients with developmental trauma, problems with sleep fall almost entirely in the right-hand column. Their sleep is also overaroused. You would expect these symptoms, like all other symptoms of overarousal, to slowly but clearly remit. Neurofeedback is considered very effective for regulating sleep and when it is going to work, you will typically see these changes early in the process. Sometimes, however, and more so with this population, normalizing sleep may take many sessions and, in a few cases, sleep remains elusive. I am one of those cases. My original goal when I went for my weekend training marathon was to sleep normally. I was a vigilant sleeper. I could startle awake when my partner entered the room, even when he did so very quietly. The vigilance is long gone, but I still sleep poorly, a bad habit that persists in some stubborn or as yet untouched oscillatory realm. By contrast, my 96-year-old friend who trained to quiet neuropathic pain reported “sleeping like a baby” for the first time in her life from the first session on.

Sleep is an excellent indicator of the flexibility of the CNS. When training helps patients normalize their sleep and does so quickly, it predicts that the training will go well. These individuals are receptive to training. Sammy, whose nights were consumed by night terrors, slept for 12 hours every night after his first session. Even though neurofeedback has not normalized my sleep—nothing has—it is no worse, and I am no longer reactive to being awake when I should be asleep. As in all things, the magnitude and significance of any problem diminish when we are no longer reactive to it.

Brain instability often manifests in what are seen as the most disruptive sleep problems. Sleep talking and sleepwalking, common in these childhoods, are symptoms of failure in the neurological mechanism that facilitates sleep paralysis, which stops us from acting out what we are dreaming. Sammy didn’t sleep. He crawled on the floor of his foster parents’ bedroom calling out “No! No! No!” for hours, terrified and unconscious. They could not wake him and he had no apparent memory for these events when he would awake at 5:00 A.M ., sometimes collapsed over his hands and knees. We could hardly call that sleep.

The brain is most vulnerable to seizure or other unstable firing patterns when we are negotiating the state change from waking to sleeping and from sleeping to waking. Seizure patients are most prone to seizure during these transitions, and patients with developmental trauma can also come up against their own instability particularly as they are falling asleep, when they begin to orient toward waking usually around 3:00 A.M. , and again as they begin to wake up in the morning. As mentioned, they can fail to engage normal sleep paralysis and they can also have trouble pulling out of it when it is engaged. Three of my patients reported experiences in which they were awake for several minutes but unable to move.

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