A Pilot Study of Audio–Visual Stimulation as a Self-Care Treatment for Insomnia in Adults with Insomnia and Chronic Pain

Abstract

This pilot study tested the efficacy of an Audio-visual Stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre-post design. Participants self-administered a 30-minutes AVS program nightly at bedtime for one month. Sleep and pain were assessed at baseline and at the conclusion of the 4-week intervention phase. 9 adults (mean age 33 ± 15.8 years; female, 89%) completed the study. After using the AVS device for 4 weeks, significant improvement was seen in reported insomnia (ISI, p=.003), pain severity (BPI, p=.005), and pain interference with functioning (BPI, p=.001). Large effect sizes (Partial Eta2: .20–.94)(Cohen’s d: 0.44–1.45) were observed. The results of this pilot study suggest that the AVS program may be efficacious in decreasing both insomnia and pain symptoms. In order to better assess the efficacy of AVS for sleep promotion and possible pain reduction, more definitive randomized controlled trials will be needed. These should include appropriate sample sizes, objective measures of sleep and pain, and longitudinal follow-up.

Open-Loop Audio-Visual Stimulation (AVS): A Useful Tool for Management of Insomnia?

“…We then tested the same AVS program in nine adults (age 33 ± 15.8 years) with comorbid insomnia and comorbid chronic pain. Similar findings were observed; there was a significant improvement in sleep (Insomnia Severity Index, p = 0.003) and a reduction in pain severity (Brief Pain Inventory, p = 0.005), with large effect sizes (Partial g 2 0.20-0.94; Cohen's d 0.44-1.45; Tang et al 2014). In both pilot studies, the training effect (self-reported sleep improvement) was observed at the end of week one and persisted through the 1-month intervention.…”

“…Of the 20 studies reviewed in Huang's article, 9 studies used photic stimulation, 6 studies used auditory stimulation, and only 5 used both auditory and photic stimulation (AVS). Table 1 provides a summary of the five AVS studies (Howard et al 1986;Joyce and Siever 2000;Morse and Chow 1993;Olmstead 2005;Ossebaard 2000), and two additional AVS studies published after 2007 (Tang et al 2014;Tang et al 2015). Among the five studies taken from Huang's review, three aimed to reduce stress in adults and two focused on attention training in children with attention deficit and hyperactivity disorder (ADHD).…”

An fMRI Study of the Effects of Vibroacoustic Stimulation on Functional Connectivity in Patients with Insomnia

“…Another study showed that auditory stimulation enhances sleep spindles, thus enhancing sleep [16]. In addition, several small pilot studies utilized an audiovisual stimulation in patients with chronic insomnia and found significant improvements in insomnia symptoms and sleep quality [17,18]. Another approach utilized music developed from EEG patterns and similarly found substantial improvements in sleep patterns in patients with insomnia [19].…”

Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis

“…This striking level of comorbidity has suggested that the relationship between CP and sleep may be bidirectional [6, 7]. That is, pain may disturb the continuity of sleep, and insufficient sleep may reduce the tolerance of patients with CP [10]. Although the mechanism of CPRI is unclear, it is generally accompanied by an increase in excitability of the nervous system, so most current international guidelines recommend pharmacological management for CPRI relief, including sedative, anticonvulsants, opioids, and anti-inflammatory drugs (NSAIDs) [11].…”