現代人工作壓力大，長期的壓力可能會影響心理健康，產生焦慮憂鬱等情緒，進而造成慢性失眠。全台灣有兩百三十萬人失眠，這些失眠者中，有30%選擇吃藥，根據台灣衛服部統計，每年健保花費21億在安眠藥上，長期服用安眠藥可能會有抗藥性、依賴性的副作用，嚴重點可能會影響日常生活。美國FDA對三種安眠藥發出警示，分別為：eszopiclone（常見品牌名為Lunesta）、zaleplon（Sonata）和zolpidem（Ambien），他們認為這三種安眠藥與20起死亡及46則嚴重傷害有關，長期服用不只會造成身體負擔也可能增加意外發生的風險。
短期失眠可以透過服用安眠藥有效緩解，但長期服用安眠藥可能會有成癮性、依賴性等副作用，並造成身體負擔，長期失眠須由專業的醫生診斷，配合醫生診斷進行治療，除了服用藥物外，還可以搭配非藥物的失眠治療方法。現今有許多非藥物的失眠解決方法，如神經回饋、認知行為治療、睡眠限制治療、放鬆治療、生理回饋等。本研究以神經回饋訓練出發，希望幫助有慢性睡眠問題的民眾改善失眠。神經回饋訓練為利用腦機介面的方法反應出大腦腦波的變化，其主要的目的是讓使用者可以察覺大腦特定的活性進而讓使用者能夠從中自我學習來控制自己的腦波，目前已有相當多的研究顯示透過神經回饋訓練可有效地改善各種臨床症狀，如失眠、癲癇症、兒童過動症和焦慮等。
此研究除了透過主觀的睡眠問卷量表(ISI, PSQI, PSAS)以及客觀的睡眠評估(PSG, Actigraphy)比較受試者訓練前後的睡眠品質，還會交叉比對主客觀睡眠的表現，並且透過認知測驗了解訓練前後的記憶力變化。訓練前，受試者會帶兩周手錶量測居家睡眠品質，量測兩晚PSG，填寫主觀睡眠問卷，並做三項認知測驗(two-back, backward digit, word pair)，接著會進行為期六周，每周三次，共十八次的訓練，為了客觀評估訓練過程中的睡眠變化，受試者會帶著actigraphy直到訓練結束，18次訓練結束後，受試者會量測一晚PSG，填寫主觀睡眠問卷，做認知測驗，除了訓練前後的各項指標變化外，本研究還進行了為期半年的睡眠追蹤，受試者在訓練結束後一個月、三個月、六個月的時候回來填寫主觀睡眠問卷、評估客觀居家睡眠表現，以了解訓練結束後的睡眠變化。
本研究包含兩個族群的受試者，一個是16位精神科患者，這些患者有焦慮憂鬱等情緒問題，同時伴隨著慢性失眠，另一個是13位沒有失眠問題的健康人。患者經過神經回饋訓練後，主觀、客觀、情緒、認知皆有改善。主觀睡眠問卷方面，ISI(t=1.425, p=0.018)、PSQI(t=1, p=0.337)、PSAS(t=-0.943, p=0.364)皆顯著下降，ISI平均減少3.7分(從12.6±4.2分到8.9±3.9分)，68%的受試者ISI下降; PSQI平均減少3.6分(從11.2±3.1分到7.6±4.0分)，75%的受試者PSQI下降; PSAS平均減少9分(從35.9±12.5分到27.9±10.0分)，81.3%的受試者PSAS下降。情緒量表方面，HAM-A(t=6.441, p=0.001)及HAM-D(t=9.886, p=0.001)的分數皆顯著下降，與焦慮有關的HAM-A平均減少1.8分(從6.5±0.7分到4.7±1.2分)，87.5%的受試者HAM-A下降; 與憂鬱有關的HAM-D平均減少2.2分(從5±1.4分到2.8±1.1分)，87.5%的受試者HAM-D下降。客觀睡眠評估方面(PSG)，平均的睡眠效率提升3.5%，入睡延遲減少5分鐘。在睡眠效率低於85%的受試者中，有80%的人睡眠效率提升，平均提升10.8%; 入睡延遲大於三十分鐘的受試者中，全部的受試者入睡延遲時間皆減少，且平均減少時間高達35分鐘;對於睡眠容易中斷的受試者，透過此訓練也可以減少醒來的時間，WASO>30分鐘的受試者中，有87.5%的受試者WASO下降，平均減少20分鐘。認知方面，word pair的準確率(t=-4.659, p=0.001)有顯著提升，2-back及backward digit的準確率也有提升，只是沒有顯著，2-back平均提升5.1%(從50.8±20.8%到55.9±23.7%); backward digit平均提升5%(從64.9±20.0%到69.9±18.2%); word pair平均提升16.5%(從41.5±14.3%到58±15.7%)。本研究發現，神經回饋訓練除了可以幫助有情緒障礙的失眠者改善主觀及客觀的失眠問題外，還可以緩解焦慮憂鬱的情緒，改善認知功能。

Modern people are under a lot of pressure at work. Under stress for long-term may affect mental health, cause feelings of anxiety and depression, and lead to chronic insomnia. There are 2.3 million people in Taiwan with insomnia. Among these insomniacs, 30% choose to take medicine. According to the statistics of the Ministry of Health and Service, health insurance spends 2.1 billion on sleeping pills every year. Taking sleeping pills for a long time may have side effects of drug resistance and dependence, and serious points may affect daily life. The US FDA issued warnings on three sleeping pills, namely: eszopiclone (common brand name Lunesta), zaleplon (Sonata), and zolpidem (Ambien). They believe that these three sleeping pills are related to 20 deaths and 46 serious injuries. Taking medicines in the long-term will not only cause a physical burden but also increase the risk of accidents.
Short-term insomnia can be effectively alleviated by taking sleeping pills, but long-term use of sleeping pills may have side effects such as addiction, dependence, and cause physical burden. Long-term insomnia must be diagnosed by a professional doctor and treated with the doctor's diagnosis. In addition to taking drugs, it can also be combined with non-drug insomnia treatment methods. There are many non-pharmacological solutions for insomnia, such as neurological feedback training, cognitive behavioral therapy, sleep restriction therapy, relaxation therapy, and physiological feedback. This research is based on neurofeedback training, hoping to help people with chronic sleep problems to improve their insomnia. Neurofeedback training is the use of a brain-computer interface to reflect changes in brain waves. Its main purpose is to allow users to perceive specific brain activity so that users can learn from it to control their own brain waves. Quite a few studies have shown that neurofeedback training can effectively improve various clinical symptoms, such as insomnia, epilepsy, childhood hyperactivity and anxiety.
In addition to comparing subjects’ sleep quality before and after training through subjective sleep questionnaires (ISI, PSQI, PSAS) and objective sleep assessment (PSG, Actigraphy), this study also cross-compared subjective and objective sleep performance. Taking Cognitive tasks to understand the changes in memory before and after training. Before training, subjects will wear a actigraphy for two weeks to measure home sleep quality, measure PSG for two nights, fill out a subjective sleep questionnaire, and take three cognitive tasks (two-back task, backward digit span task, word pair association task). Then, a total of 18 training sessions, which is three times a week, lasts for six weeks will take. In order to objectively assess the sleep changes during training, the subjects are asked to wear actigraphy until the end of the training. After the 18 training sessions, the subjects will measure the PSG for one night, fill out the subjective sleep questionnaires and take cognitive tasks. In addition to the changes in various indicators before and after training, this study also conducted sleep tracking for half a year. Subjects come back to fill out the subjective sleep questionnaires and evaluate the objective home sleep performance to understand the sleep changes after the training.
This study recruited subjects from two ethnic groups, one was 16 psychiatric patients, these patients had emotional problems such as anxiety and depression, accompanied by chronic insomnia, and the other was 13 healthy people without insomnia. After the patients undergoes neurofeedback training, subjective, objective, emotional, and cognition have all improved. In terms of subjective sleep questionnaires, ISI (t=1.425, p=0.018), PSQI (t=1, p=0.337), PSAS (t=-0.943, p=0.364) all decreased significantly. ISI score decreased by an average of 3.7 points (from 12.6±4.2 points to 8.9±3.9 points), 68% of subjects had a drop in ISI scores; PSQI score decreased by an average of 3.6 points (from 11.2±3.1 points to 7.6±4.0 points), 75% of subjects had a drop in PSQI scores; PSAS score decreased by an average of 9 points (from 35.9±12.5 points to 27.9±10.0 points), 81.3% of subjects had a drop in PSAS scores. Regarding the emotional scale, the scores of HAM-A (t=6.441, p=0.001) and HAM-D (t=9.886, p=0.001) decreased significantly. HAM-A, which is anxiety related, decreased by an average of 1.8 points (from 6.5±0.7 points to 4.7±1.2 points) and 87.5% of patients had a drop in HAM-A scores. HAM-D, which is depression related, decreased by an average of 2.2 points (from 5±1.4 points to 2.8±1.1 points), 87.5% of subjects had a drop in HAM-D scores. On objective sleep assessment(PSG), average sleep efficiency of insomniacs was increased by 3.5%, and sleep latency was reduced by 5 minutes. Among the subjects whose sleep efficiency was lower than 85%, 80% of them improved their sleep efficiency with an average increase of 10.8%; among the subjects whose sleep latency was greater than 30 minutes, all of them had a reduced sleep latency, and the average reduction time was as high as 35 minutes. For subjects whose sleep was easily interrupted, this training could also reduce the time to wake up. Among subjects with WASO> 30 minutes, 87.5% of subjects have a decrease in WASO with an average reduction of 20 minutes. On cognitive tasks, the accuracy of word pair association task increased significantly (t=-4.659, p=0.001). The accuracy of two-back task and backward digit span task increased but it didn’t show statistically differences. Two-back increased by an average of 5.1% (from 50.8±20.8 % to 55.9±23.7 %); backward digit increased by an average of 5% (from 64.9±20.0 % to 69.9±18.2 %); word pair increased by an average of 16.5% (from 41.5±14.3 % to 58±15.7 %). Our study found that in addition to helping insomniacs with emotional problems improve subjective and objective sleep problems, neurofeedback training could also relieve their symptoms of anxiety and depression and improved their cognitive function.

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