Biofeedback of alveolar carbon dioxide tension and levels of arousal.

This is a preliminary study designed to investigate the potential usefulness of alveolar (lung) CO2 feedback training in promoting sleep onset in primary insomniacs. The present study was undertaken to determine if normal subjects could, without obvious manipulation of breathing, bring alveolar (lung) CO2 tension under voluntary control using biofeedback techniques and, if so, whether this control would be accompanied by shifts in level of wakefulness. Subjects participated in five baseline and five training sessions in which EEG, alveolar CO2 tension, and thoracic/abdominal respiratory movement were monitored. The feedback consisted of a pitch-modulated tone plus visual scores. We found that CO2 tension in awake portions of "up" trials was significantly higher than for awake portions of "down" trials (p less than .01), indicating that learning had occurred. In the initial trials, when subjects raised CO2 tension they became drowsy and often fell asleep, and when they lowered CO2 tension they aroused themselves. However, when subjects were awakened immediately upon falling asleep, there developed a decoupling of EEG and CO2 changes. The presence of such a decoupling phenomenon makes it unclear whether CO2 feedback will be useful in promoting sleep onset in primary insomniacs.