Tired of Insomnia? Sleep Medicine Expert Ed O’Malley talks about Neurofeedback.
June 16, 2012
Ed O’Malley holds a Ph.D. in neurobiology and is one of the nation’s leading experts in sleep medicine.
My graduate work was focused on brain studies in lab animals and I really wanted to get back to brain mapping humans. I needed a job and one opened up at NYU at the sleep disorder lab. After my stint at NYU, I was recruited by Norwalk Hospital in Connecticut to become the director of their insomnia lab. Norwalk is a teaching hospital for Yale and it’s where I became board certified in sleep medicine.
Norwalk recruited me to bring the lab into the 21st century by computerizing and utilizing the latest technology. The second was my specialty in insomnia. I bought my first NeurOptimal neurofeedback system specifically to use in the Norwalk insomnia lab. We eventually got six NeurOptimal systems and were running 100 sessions a month at the insomnia center.
I recently presented findings from a research study I did that incorporated NeurOptimal neurofeedback with behavioral therapy for insomnia. We found a couple things that were very interesting; first, on average it took only 15-16 NeurOptimal sessions to resolve our patients’ sleep issues. We also found that the neurofeedback training helped our subjects tolerate the standard cognitive behavioral therapy much better.
On average they were getting only about 30% of the optimal amount of sleep per night and they typically took up to an hour or more to fall asleep. Many were taking sleep medications. Since the insomnia population overlaps heavily with anxiety and depressive disorders, some of our patients were taking anti-depressants and anti-anxiety medications as well. We left them on their medications while immediately starting them on the neurofeedback. NeurOptimal was very effective in resolving sleep issues
EO: Traditionally, insomnia is considered “cured” when the patient is brought up to 85% of normal sleep; but honestly, that is still not a normal level of sleep. Almost every one of our patients by the end of the testing fell within “real” normal levels of sleep. They were all falling asleep within 15 minutes, which is also considered well within the normal range.
NO: What about all those test subjects taking medication?
EO: Everyone decreased their meds. By the end of the study, 90% of them went off their meds completely. Some decided to stay on their meds, but their sleep still improved.
NO: How widespread is insomnia within the general population?
EO: According to the American Academy of Sleep Medicine, more than 35% of people are struggling with some kind of sleep disorder. That number probably reflects the effects of the recent economic crunch.
NO: What other factors contribute to insomnia?
EO: Sleep therapists talk about the “Three Ps”.
Physiological factors: some people are just wired a little hotter and are more prone to sleep problems. Precipitation factors: external things like stress, divorce and job change. Perpetuating factors: these are trickier because they seem external but really involve internal factors as well. Basically, these are the behaviors that we ourselves intiate that end up perpetuating the problem.
NO: What would be an example of a “perpetuating factor”?
EO: Lying in bed for several hours, trying to fall asleep. The problem with that is the brain starts to associate your bed with things that aren’t falling sleep; like frustration, stress, concerns of the day, etc. So, continuing to lie there awake actually makes the problem worse. If you can’t sleep, it’s actually better to get up and do something distracting until you feel like you can.
NO: From your point of view, what is the most negative effect of poor sleep?
EO: Insomnia becomes a vicious cycle. The less we sleep, the more we think our sleep is broken. As we lose control of sleep, we become less able to deal with stress, which then further hinders solid sleep.
NO: What is a common misconception people have about sleep?
EO: The most important aspect of sleep is not bedtime; it’s wake time. The time when you wake up in morning basically sets the time when your brain will “turn off “ at night and allow you to sleep.
NO: Do you have any advice for someone struggling with his or her sleep?
EO: Don’t go to bed too early; it won’t work. And most importantly: take time during the day to de-stress.
SLEEP, Vol. 30, Abstract Supplement, 2007
EFFECTIVENESS OF NEUROFEEDBACK TRAINING IN CHRONIC INSOMNIA. Okunola O,1 O’Malley E,2 O’Malley M2 (1) Norwalk Hospital, Norwalk, Connecticut, Norwalk, CT, USA, (2) Nowalk Hospital, Norwalk, CT, USA
Introduction: The most effective treatment for chronic insomnia is cognitive behavior therapy (CBT). Though effective over the long term, CBT requires specialized training in behavioral sleep medicine therapies. Early neurofeedback (EEG biofeedback) training protocols have been shown to be effective therapy for insomnia (Hauri et al 1982). This training involves the use of real-time, processed electroencephalographic (EEG) activity for feedback to subjects for gradually reducing hyperarousability evident in the EEG. In this pilot study we evaluated the efficacy of a simple but comprehensive neurofeedback training protocol in chronic insomniacs in our Center. Our design utilized a retrospective analysis of clinical data to assess benefit of this training in a real world clinic population.
Methods: A retrospective data analysis of consecutive patients meeting chronic insomnia diagnosis (difficulty initiating and/or maintaining sleep for at least 3 months) and given neurofeedback training NeuroCare neurofeedback system (Zengar, Inc) integrated with CBT therapy was performed. Eight patients with complete sleep logs were included in data analysis. Patients lay on a reclined chair facing displayed LCD computer generated graphics synchronized to music heard over headphones. EEG data was collected from C3 and C4 referenced unilaterally to earlobe with separate grounds. Periods with high EEG variability triggered interruptions in the audiovisual datastream (negative feedback).
Results: Analyzing pre-post sleep log data with t-tests, all patients had significant improvement in total sleep time (5.1±0.8 to 6.4±1.0 hrs, p=0.002), sleep efficiency (70±9 to 91±5 %, p = 0.00004), wake after sleep onset (1.7±0.8 to 0.5±0.4 hrs, p=0.0003), and sleep onset latency (48±40 to 12±10 min, p=0.009). Conclusion: Neurofeedback training is an effective, integral component of CBT for insomnia. Further research is needed to determine the relative contribution of neurofeedback training to CBT for insomnia and it´s efficacy as monotherapy.
Support (optional): none Citation: Okunola O; O’Malley E; O’Malley M. Effectiveness of neurofeedback training in chronic insomnia.