Biofeedback for disorders of initiating and maintaining sleep.

Sleep disturbances are a frequent reason for pediatric consultation. When the disturbance persists in the form of delays in entering or maintaining sleep (DIMS), a vicious cycle develops. As part of the cycle, vigilance or arousal occurs, further inhibiting sleep occurrence. Persistent DIMS requires treatment to interrupt this self-perpetuating sequence. Interruption requires reduction in psychophysiological arousal and deconditioning of the events surrounding sleep. Electromyographic (EMG) and thermal biofeedback in conjunction with relaxation training were used with three children who maintained high levels of arousal resulting from stresses common to their developmental stages. Within seven sessions, all three patients showed attenuation of arousal and symptom abatement marked by uninterrupted sleep.