# EEG-VLM: A Hierarchical Vision-Language Model with Multi-Level Feature Alignment and Visually Enhanced Language-Guided Reasoning for EEG Image-Based Sleep Stage Prediction

arXiv: https://arxiv.org/abs/2511.19155 · HTML: https://mlsanity.com/paper/2511.19155/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 18 of its 50 references that are in the map.
- First posted on arXiv 24 Nov 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 18 of 18)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [A Survey on Multimodal Large Language Models](https://mlsanity.com/paper/2306.13549/) (2023)
- [DeepSleepNet: a Model for Automatic Sleep Stage Scoring based on Raw Single-Channel EEG](https://mlsanity.com/paper/1703.04046/) (2017)
- [Can GPT-4V(ision) Serve Medical Applications? Case Studies on GPT-4V for Multimodal Medical Diagnosis](https://mlsanity.com/paper/2310.09909/) (2023)
- [Interpretability of machine learning based prediction models in healthcare](https://mlsanity.com/paper/2002.08596/) (2020)
- [SleepEEGNet: Automated Sleep Stage Scoring with Sequence to Sequence Deep Learning Approach](https://mlsanity.com/paper/1903.02108/) (2019)
- [Efficient Large Multi-modal Models via Visual Context Compression](https://mlsanity.com/paper/2406.20092/) (2024)
- [Joint Classification and Prediction CNN Framework for Automatic Sleep Stage Classification](https://mlsanity.com/paper/1805.06546/) (2018)
- [Decoding visual brain representations from electroencephalography through Knowledge Distillation and latent diffusion models](https://mlsanity.com/paper/2309.07149/) (2023)
- [Detection of Sleep Oxygen Desaturations from Electroencephalogram Signals](https://mlsanity.com/paper/2405.09566/) (2024)

## Built on by (most cited first, 3 of 3)

- [Beyond In-Domain Detection: SpikeScore for Cross-Domain Hallucination Detection](https://mlsanity.com/paper/2601.19245/) (2026)
- [RAICL: Retrieval-Augmented In-Context Learning for Vision-Language-Model Based EEG Seizure Detection](https://mlsanity.com/paper/2601.17844/) (2026)
- [SleepVLM: A Rule-Grounded Vision-Language Model for Auditable Sleep Staging](https://mlsanity.com/paper/2603.26738/) (2026)

## Abstract (arXiv)

Sleep stage classification based on electroencephalography (EEG) is fundamental for assessing sleep quality and diagnosing sleep-related disorders. However, most traditional machine learning methods rely heavily on prior knowledge and handcrafted features, while existing deep learning models still struggle to jointly capture fine-grained time-frequency patterns and achieve clinical interpretability. Recently, vision-language models (VLMs) have made significant progress in the medical domain, yet their performance remains constrained when applied to physiological waveform data, especially EEG signals, due to their limited visual understanding and insufficient reasoning capability. To address these challenges, we propose EEG-VLM, a hierarchical vision-language framework that integrates multi-level feature alignment with visually enhanced language-guided reasoning for interpretable EEG-based sleep stage classification. Specifically, a specialized visual enhancement module constructs high-level visual tokens from intermediate-layer features to extract rich semantic representations of EEG images. These tokens are further aligned with low-level CLIP features through a multi-level alignment mechanism, enhancing the VLM's image-processing capability. In addition, a Chain-of-Thought (CoT) reasoning strategy decomposes complex medical inference into interpretable logical steps, effectively simulating expert-like decision-making. Experimental results demonstrate that the proposed method significantly improves both the accuracy and interpretability of VLMs in EEG-based sleep stage classification, showing promising potential for automated and explainable EEG analysis in clinical settings.