Transcript of the interview between Miriam Bellamy and sleep expert Dr. Ed O’Malley.
Miriam:
Hey, neurofeedback moms. I am Miriam Bellamy. I am the mom who started this group, and I am the director of Whole Family Neurofeedback. We have just an incredible guest with us today. He’s gonna talk to us a lot about sleep. This is Dr. Ed O’Malley. He has his PhD in neurobiology from Cornell.
He’s been practicing in sleep medicine for 25 years clinically, in research settings and in academic settings. He has published book chapters and peer-reviewed journal publications. He has been a part of sleep medicine trials, and he’s been in the neurofeedback world for that long as well.
So, we’re gonna talk a lot about sleep today. As Ed and I have prepared for this, you know, we talked about how sleep is a family affair and this… this group knows a lot about that. So if you’re having difficulty with sleep or you have a child who’s having difficulty with sleep, Ed’s gonna talk to us about his three most important sleep tips.
We’re gonna talk about how he thinks neurofeedback fits into that. And then we’re gonna talk about the safety of neurofeedback. So if you’re with us, thank you very much. And let’s get started with some questions. Thanks for being with us, Ed.
Ed:
Hey, you’re welcome. Thanks for having me Miriam.
I always love to talk about sleep. So you just tell me where to begin and I’m happy to jump right in.
Miriam:
I can say first, too, the way I met Ed was that my daughter was struggling with sleep, and he really helped her. She didn’t do all the things… she didn’t need to do all the things that he was telling her to do [laughs]… but it made a difference. And actually now she is doing more of what he suggested, just because life sort of put her in that direction, and she’s doing a lot better with sleep, which is a huge relief.
Ed:
Let’s start with that. Because you know, that’s such an important feature of working with kids.
And their sleep, particularly the older ones, because once they hit adolescence, and you know as moms of adolescents… you just know they are their own people. And so one of the ways in is to find out what’s meaningful to them when they’re not with all their friends, and then also point out what are the benefits that will support whatever is important to them.
And that’s what she ended up doing was following what she could do within her own world. And that’s half the battle right there is getting them to do something that’s really gonna support their sleep within what they can do or what they perceive they can do.
Miriam:
Yeah, well, it’s worked beautifully. And like I said, just even the little… one of the things that you had recommended, she did it and it did help, but she had to make some of her own decisions… my almost 20 year old [laughs].
Ed:
We’ve all been there, so we know about that—making your own decisions.
Miriam:
Yes, for sure… So let’s talk about what are your top three tips for helping kids get to sleep, or for yourself.
Ed:
Well, you know, there is something about the commonality of what we do as physical, physiological organisms in the world. And so the first one should be no surprise for biological organisms. And that is light exposure.
Light is so critical to our bodies, to our minds. And it’s what we evolved with in the natural world. You know, it’s only recently that we’ve come indoors, and even more recently that we actually have had the ability to have light at night. So the electric light and even lamps, you know, began late 18th century or mid 19th century.
And before that we were just out in the light. And so we would arise with dawn, and we’d go to bed right after sunset. And our internal rhythms still wanna do that, but we are doing anything but that.
Miriam:
So my husband, out here in Colorado… I have to say my husband and I were like it, “Is it seven o’clock yet? Can we go to bed?” Because it’s dark at like five, and we wanna go to bed [laughs].
Ed:
You can imagine me talking to the adults in the wintertime and trying to get them to not have bright light exposure after sunset, because we all have things we need to do. Society demands. We have a schedule that’s more of a 16-hour day, no matter what season, but how can we then mitigate those effects?
And this works across the board. And so that is, you know… after sunset we really want to diminish the light exposure. We want to reduce it to some extent. And most importantly, we wanna pull the blues out of the light exposure we’re getting after sunset. And so all of our devices of course have really strong blue light components because that’s what makes our screens look like day.
That’s what daylight is. It has a strong blue, and that’s what dawn has. Once the sun comes up, there’s really strong blue light. And that strong blue light is what tells our internal rhythms it’s morning. Oh good.
And so to get back to the, the rhythm… so the sleep/wake schedule is really important. But the most important part of the sleep/wake schedule is the wake time. And that’s because when we get exposed to light in the morning, it sets our internal melatonin rhythm to come on. On average in a 16-hour-day person and an eight-hour-night sleeper, it comes on 16 hours later. So no matter what you’re doing during your day, the time you got up this morning will tell your melatonin rhythm when to come back.
Now, there are a lot of things we could do to keep that melatonin rhythm from coming back on. We have our phones. We have our tablets and, you know, back in the old days, we had TVs that we watched across the room, and light intensity drops by the fourth power of distance. And so I’m not gonna… you physicists out there can figure that out.
But yeah, when the TV’s across the room, it’s not nearly as impactful as having the laptop in bed with us, looking at a movie. That light’s coming in directly and really changing our rhythm. So if you’re having trouble falling asleep, and you are looking or working late or doing emails late or working on your phone late, then you need to recognize that you gotta pull blue light out of that. And there are two ways of doing it.
One is most of our devices now have this bedtime feature, which you could set from sunset to sunrise and it pulls the blues. It makes your screen look a little more orangey. And the oranges kind of don’t have much blue in them. And so they allow your brain both to continue its internal rhythm and to begin recognizing it’s sunset… it’s time for the brain to wind down.
So that’s one way, and the other way is to look really cool with these blue blocker sunglasses [puts on sunglasses, laughs]. And they have a side panel… they make them to go over your glasses like I’m wearing, or just regular size to wear, to block the blue light of what you’re receiving. So if you can’t pull it out of your devices and you have to do work at a certain hour, then go ahead and buy some of those for 15 bucks on Amazon.
Miriam:
Well, and one thing I learned from you is that… because I bought the clear-colored ones for my daughters once, which they never wore of course… but I learned from you that those don’t work, that you actually have to have this dark kind of one. Is there anything somebody can look for? How do they know they’re getting the right ones?
Ed:
They’re blue blocker sunglasses and they will look amber orangey like this. Am I getting it up to the screen?
Miriam:
Yeah, you got. Okay. It looks a little pinkish to me, but it’s more of an amber you’re saying.
Ed:
Yeah, it depends on your screen, but anything that’s clear is not working. And a lot of those proliferated during the pandemic, because people were spending so much time, like we are now, on our zoom screens. But what was happening was they proliferated… but they’ve done a couple of studies and they don’t seem to change any of the effect on tired eyes or any of that kind of thing, and they really don’t have much effect on shifting your rhythm.
Miriam:
So computer settings, tablet settings, iPhone settings, whatever phone settings, and then those glasses are real helps to go with that first tip, which is modify light when the sun sets.
You started to allude to your second tip, which I was really surprised about, but it makes a lot of sense, which is wake up time is essential to being able to go to sleep.
Ed:
Yeah, so in the eye, actually in the retina, you know, we use it for vision, right… color, shape, size, movement. But there are also a subset of cells in the retina that respond only to the presence or absence of light, and those cells project directly to the master biological clock, deeper in the brain and the hypothalamus.
And that little guy sends its signals back to the pineal gland, deeper in the brain, which is the home of melatonin production. So when light is present, that signal is going back to the pineal gland saying no melatonin. We’re not ready for it. It’s still daylight. It’s still daytime. And so in the morning, of course, after melatonin’s been on all night, it shuts down when light comes in first thing in the morning.
So if we get up and get ourselves out and get five minutes even of outdoor light exposure, thats way more intense than anything we can get indoors. That will set that strong signal that, “Hey it’s morning. Shut down melatonin and come back on 16 hours later, if you don’t mind.” And as long as you keep the blue lights out after sunset, 16 hours after you arose and got exposed to light it will come back on and tell your brain it’s time for bed. Let’s get sleepy.
Okay, so light’s really important. And actually the latest studies are really interesting. The latest studies are suggesting that sunset light exposure, so actually getting out in the light during sunset, even on cloudy days, those diminished blues… they’re kind of pulled out by sunset… cue your brain enough that it actually reduces the impact to any blue light you have later in the evening. That’s very new data, very new data.
Miriam:
So that, I mean, that’s profound on so many levels. And it’s talking about nature. We’re so removed, myself included.
Ed:
The simple meta recommendation would be, be more in nature. Get that sense… be more natural in that respect, morning, light, afternoon, evening light, and then afternoon light, doing some good relaxation during the day.
I don’t know if I mixed that in with my tips there somewhere but…
Miriam:
Not quite, but go ahead. It’s all right.
Ed:
We’re still working on the adults here and maybe the older adolescents… get out midday for that bright light, the brightest light we can get of the day in order to get enough vitamin D, which also supports our sleep.
Vitamin D is critically important for good sleep. Okay. And to ward off seasonal effective disorder, which happens right about now in the Northern hemisphere, as we move into the cold, the shortest days of sunlight, right? The solstice is only a few days away. So people’s mood gets depressed in the wintertime.
We don’t have enough light. So getting out when you can get some would be great. And then finally, of course, bookending it the end of the day. Always helpful.
Miriam:
Yeah. Nice. It sounds like a great day actually. Go outside for a few minutes in the morning. Stop what you’re doing… go back out there again. And then take a nice walk after dinner or something like that.
Ed:
Absolutely.
Miriam:
And then your third tip for moms and dads.
Ed:
Moms and dads. As you mentioned earlier, it’s a family affair. There’s no question that, you know, there are family systems at play, and when one part of the family system changes, the others do too.
It’s really helpful for you guys to get your relaxation, get your downtime to reduce your stress, to do the best you can to get your sleep, because that will make you more able to deal with the vagaries of your children and all the screaming and shouting and fighting that goes on.
Miriam:
[laughs] The vagaries. I love that. Keep going.
Ed:
Yes, very kind, right?
Miriam:
That’s one word for it.
Ed:
Yeah, but, you know, it’s important that we get our downtime. I do these presentations, and I have a slide that says that massage is not a luxury. It is a necessity. We need to do self care. We need to take care of ourselves so that we can care for others. The thing on the airplanes, when the oxygen mask comes down, you put it on yourself first before those you need to help because you need to be able to be strong enough and able to manage what’s going on in the world.
And look I’ve been there. I’ve got four kids. I know about sleep deprivation when the kids are young. So I hear you. Well, I’m probably not speaking to you at the moment because you’re just gonna get sleep whenever the hell you can. It’s hard for the newborn parents. There’s no question.
But I would speak to that, and I would say it’s really important if you have a partner that the two of you share what you can share. Even if you are doing the breastfeeding at night, you’re not the only one involved in the care of this baby. You need some downtime. You need to get some solid sleep. And so the hubby, the partner needs to take over at times and give you those breaks whenever they can.
Miriam:
And we need to let them? Is that part of that message?
Ed:
Yes. Yes, you need to let them. Some people need to let them. Some people need to, you know, go them into helping…
Miriam:
Yeah it’s the whole range.
Ed:
Sure. You need to share the duties because you need your sleep. You just need your sleep.
Miriam:
I just think it’s such an important point. And one that we talk about a lot, you know, here is taking care of self. It’s not… it’s not a luxury, right? It’s part of the well-functioning family system that you want is your own self care.
So talk to us about neurofeedback. You’ve got quite a history. And sleep. How did this start for you? Why did you start adding neurofeedback?
Ed:
So early on, you know, I found my niche in the sleep world. I mean, I’ve worked with all sleep disorders off the bat, but I really noticed that there was a paucity of insomnia management. People who didn’t have sleep apnea per se, didn’t have restless legs per se, or any major shift work, they were just having trouble sleeping.
And so one of the first things I did when, after my training, I went to run a sleep disorder center at Newark hospital in Connecticut, one of the teaching hospitals for Yale, and set up an insomnia center. And one of the first tools I wanted to look at was what do we have technologically that can help support these folks.
We had a lot of behavioral therapies, but they would only carry them so far. And while a lot of people did get better and they got better habits and they learned about their sleep and they stopped obsessing about it… there’s some really good strategies for improving your sleep… but when, when we did do sleep studies on these folks, you can see their brain activity was just really… a kind way of saying it would be “all over the place.” But it was very stressed brain activity, like really high activity that wasn’t coming down by morning like most brains would do.
And so I was looking for some kind of tool that might help us calm these brains. And so I heard of this… I had heard about this technology. I know a lot about biofeedback and I started doing some biofeedback, helping people learn about their internal rhythms by connecting those internal rhythms to some external source. And that signal they’re getting from outside themselves could help them know what was going on inside and they can sort of indirectly learn how to do some relaxing.
But I needed more. So I went out to this meeting out in California, and it was a great meeting. It was a meeting of neurofeedback practitioners. There were biofeedback practitioners there, too, but neurofeedback… I had heard some other stuff about this in the past, and I’d always wanted to just check into it. And I said, “Well, let me go see. This is a great meeting.”
And they had what’s called this newbie day, right? Where the newbies to the field could spend a full day, and all of the providers who were out there to date had like a half an hour, 45 minutes to present their story, you know, why their system works and what their system does. And I’m like, “Perfect. I don’t know enough about this. Let them teach me.”
So I go to the meeting, and it’s one after the other, and it starts at 8 so by lunchtime… we’re pretty, pretty worn out. And I’m seeing graphs and slides and like 57… like Heinz 57, the ketchup, you know… 57 varieties of disorders that you would have different protocols for different sensors and different locations, different frequencies, you would raise up and down, all this kind of stuff.
So after lunch at about 1 o’clock, 1:30 or so, Val comes. And Val Brown, who I understand most of you’ve seen a couple of interviews with him. He’s the founder of NeurOptimal. He comes on and, you know, most of the presenters prior to that were in like jackets and ties. And he comes on. He’s got jeans on. He’s got a T-shirt. He’s got his hand in his pockets, and he just casually walks to the front of the room.
And he goes, “You know… they’ve been making it out to be so much harder than it really is. It’s not that difficult.” And I went, “Oh, okay. Besides the postprandial snooze time I was ready for, now I came to work.” I sat up and I’m like, “Okay, tell me how simple this is, because my brain is swimming right now.”
And he presented the NeurOptimal, the basis for NeurOptimal, which is just really giving the brain information about the chaos it’s in and saying, “Hey, do you wanna keep doing that? Or do you want to find another way?”
And so I came back from that meeting. I was so stoked. I was psyched. And I said to my boss, you know… and I’m running the sleep center, but I’m in a hospital, big hospital… and I said, “Look, I gotta get one of these systems. This is incredible what it’ll do for the insomnia patients.”
And he said, “Well, I don’t know. How much does it cost?” And back then, I think it was like $3,500. And he goes “$3,500? Sure. I’m used to paying for MRIs, you know, 75 grand… Go ahead and get one.” And I have not looked back since. In fact, my latest system, I just replaced another one, it’s like “E O’Malley 27” because I have a lot of rental systems, and I have ones I’ve replaced over the years.
So I brought it into the insomnia center, and it was just remarkable. And I should say the reason I was looking for this is because insomnia, as we know, can have myriad underlying causes. So aside from potential sleep disorders, there are, you know, anyone with anxiety, depression, bipolar, PTSD… all of those mental or mood disorders, almost all, have a component of sleep issues.
And we now know from the most recent research that you need to treat both almost independently. If you’re not treating the insomnia at the same time you’re treating the depression, the depression will take that much longer to heal, and you may not get resolution. So treating the insomnia is just as important in any other disorder, as well as those who just are stressed by the world, which is another, you know… it’s a rough world out there these days, and I’m seeing a lot more people just with COVID issues, you know, worrying about it and all that.
Miriam:
So I heard a study on the radio, which, okay, a study on the radio. They were reporting on I think a legitimate study. I haven’t had a chance to look it up. But they said that people are more exhausted than they’ve ever been since the pandemic and don’t feel like they can get rested no matter what, right. So at least some of that’s gonna have to do with sleep.
Ed:
We, just living in 21st century Western society, we need to take our breaks during the day. We need to interrupt the stress that’s building, Miriam [laughs]. We need to do this no matter what. I mean, we can find five or 10 minutes. It just has to happen.
Otherwise what’s happening is we’re building up the stress, right? It builds up during the day. If we take even five or 10 minutes and just do some breathing, sitting in the chair, going nowhere… better to get outside, of course… but you’ll drop that level of acute arousals down somewhat. And then you’re gonna go back into that same crazy world. So the slope of that line is the same, but you are at a lower level than if you hadn’t done anything at all.
So if you can then do it a second time… I’m really pushing it now, I know… but if you could do it a second time… and I tell people, you know, first time do it during the circadian dip of the afternoon, when you’re reaching for that cup of coffee, the chocolate, or whatever. Back up, take five minutes, then do some deep breathing. Just close your eyes, wherever you’re sitting. Do some deep breathing, and then come back online. You’ll feel refreshed. And again, your level of arousal is lower.
And then at the end of the day, a great way to end the work day, if it ever ends, is to then do it before the evening starts. Before the kids start kicking in. Before dinner starts kicking in and all that stuff happens. It’s another great time to do it. And so that brings that level so much lower at bedtime than if you hadn’t done anything at all.
Some people say, “Oh, that doesn’t bother me at all. I fall asleep without a problem. And then I wake up at 3 in the morning and I’m awake for the next hour.” Or the sleep that used to be nice is now not as deep because that arousal level that we carry to bed with us, that stress, it’s gonna keep our sleep lighter. We keep going deeper and lighter. It keeps it from being steady and restorative, refreshing.
So we wake up, even when we’re getting what we think is the same amount of sleep, and we’re more exhausted because it’s not as refreshing and not as restoring.
Miriam:
I’ll tell you what, so I tell people my favorite time to do a neurofeedback session or an optimal session is that midday, like around two o’clock. It sort of morphed these days for me into a long lunch, and at the end I’ll do a session and then I’ll come back to work. But even for me, I mean, I know not everybody’s there, but starting to cook dinner is actually a relaxing time for me. It hasn’t been that before, but over the last like six months or so it’s just become this nice… another way to relax.
Could that count? Even though I’m doing something? It feels creative… I can’t wait for my daughter to get home from work. We can hear all the crazy stories.
Ed:
When I sit with my patients, I say to them, “When do you feel most relaxed during the day? What activities allow you to relax?” And it could be anything from riding a horse to cooking dinner to listening to heavy metal. And that’s what you do to relax. That works for you. That’s what I suggest you do. Okay. Because I can’t predict what’s gonna work for you. I don’t know what’s going on in your head, and I don’t wanna know half the time [laughs].
So it’s better that you tell me what works for you, and then we’ll work with that. And like, I even… you hear all over, the recommendations, sleep hygiene and all that, don’t have a TV in the bedroom…. I don’t say that. Especially if you already have one in the bedroom and that’s what you use to help yourself relax before sleep, keep the thing there if that’s what’s working for you.
Do you know the old advice columnist Ann Landers? She’s getting to be really dated now, but…
Miriam:
I’m older than I look. Yes, I know Ann Landers [laughs].
Ed:
I’m as old as I look, so there’s no question I know Ann Landers. But her favorite mantra was, “If it ain’t broke, don’t fix it.”
I give these webinars and presentations all the time, and I have all these different things to do about getting good sleep, and I say, “Well, wait a minute. If your sleep is already working, and you’re already fully restored by it… and you know that by being alert and aware all day, reasonably engaged, not irritable and cranky, and you get done what you need to get done and put off till tomorrow what you can’t get done instead of trying to do your emails up until 11:30… all of those are signs that you’re getting enough sleep.”
Miriam:
So the takeaway here is put off until tomorrow what you can.
Ed:
Yes, but there’s a good reason. There’s a good reason. You will more efficiently do it in like half the time the next day than if you try to stay up late and do it when your brain’s starting to close down and, like, what are you doing to me up here?
Miriam:
You’re exhausted. You’re fighting motivation. That’s a big one.
So tell us quickly about is neurofeedback safe. So the context of this question is people will post that they’re doing neurofeedback, either NeuroOptimal or they’re doing linear in a set in a clinic with a practitioner, and their child becomes anxious or starts being hyperactive and things like that.
And that anxiety spreads in this group. So can you speak to that? I mean, you’ve been at this for a very long time. Is neurofeedback safe?
Ed:
Neurofeedback is absolutely safe. When we talk about side effects, and I put quotes around them, because they’re really more like unwanted effects of neurofeedback, they’re way less than anything you can get from something as simple as aspirin. So drugs will always give you more potential harm than neurofeedback.
What’s happening in neurofeedback, whatever type you’re doing, is that when a kid has what looks like a side effect or an unwanted effect, it usually means they’re bumping up against whatever it is. That’s creating the issue for that brain, for that person, for that child.
And in order for them to get through it, they may need to face a fear. They may need to express something that they weren’t able to express. And that’s why they’re having these issues. These symptoms are coming out because of something they couldn’t get through or something they bumped into, or they have some PTSD from something you need to, in a sense at the brain level, sort of face it and move.
The parents, when that’s happening, the best thing they can do is either get a session themselves so that they’re not feeding back that anxiety to the child and making it even worse, because that will make it worse. And it will both help them and keep them from feeding it back. And even just that awareness that what’s happening is kind of what needs to. Now, if it continues, then maybe you need to go back and you need to work on something. Something may not be right, but that’s generally the exception and not the rule.
And I’ve run into it too. And so I usually educate parents upfront… and I wanna have that time, each time with the child and with the parent to hear what’s happened between sessions. What are the teachers saying? What’s the parent saying? What are the neighbors saying? And what does the child feel like is happening?
The child is so informative. Again, I go, what do they need? What do they feel like they need? And how can I address that? And when I give them that, they feel safe because they’ve been seen. They’ve been heard, and they’re able to then work with me. I haven’t had a child not able to do it in the office here with me, and that’s just because I listen to them. They’re not just little adults, right? They are children. That adolescent age… they’re halfway in between. So it takes a little more work.
But it’s doable. So start with that. Have the parents start with… There’s some issue that’s creating these symptoms that my child might bump up against and have some more symptoms first before crossing that threshold and getting to the other side, crossing the mountain to the other.
Miriam:
So that’s my most important work in many different ways. But even when somebody wants to rent and do the neurofeedback at home, I wanna know… I’ll educate the parents and say, “This, that or the other could come up. These are the kinds of things we see. The most important thing is that you don’t freak out.” That is the most important thing.
And sometimes I will discourage parents from renting because I can tell they’re gonna freak out and it’s not gonna help their child, and it is an investment… How we respond is just a huge, huge part of it.
Ed:
And if you’re gonna rent the system, then you do a few sessions first, then we’ll talk about how to do your child. They really need to do a couple to know what’s going on. Because as soon as they have any kind of negative response or reaction to the neurofeedback, the child’s gonna pick that up and go, “Okay, I’m not doing this. It’s either not safe or it’s dangerous or they don’t think it’s gonna work anyway, so why am I bothering.”
Miriam:
I have to say one other thing, because I’ve had a couple of times where they get the neurofeedback unit, they want it for the child but the child won’t do it. They’ll refuse to do it. So the parents do it, and the child gets better. I’ve seen this happen a couple of times. It’s so powerful, right?
Ed:
No, that is a good one. Luckily, I mean not luckily, but I haven’t seen it that often, but I have seen that too. I haven’t seen that too. Or the child begins to do it because they’re like, “Hey, they’re having all the fun. Let me try it out. They hooked it up to the big screen TV. I could do that. I could watch something on that big screen TV.”
So we have to be flexible, but yeah. It’s whole family. It’s whole family.
Miriam:
Yes it is. So if you’re interested in a consult with Dr. O’Malley, he will make himself available to any of our moms for a free phone consult. If you’re struggling with sleep, you have a child who’s struggling with sleep, he’ll spend some time with you on the phone and make recommendations for the best course, whether that’s working with him or if that’s him referring out.
So you can reach him at ed@youroptimalnature.com. You can also check out his website there. Any final words, Dr. O’Malley?
Ed:
Well if any dads slipped in, I’d be happy to listen to them too. Or if they hear this, you know, and they’re they’re not really listening…
Miriam:
[laughs] They’re here.
Ed:
Like Val would say, it’s all a lot simpler than they make it out to be. I would say that’s a good mantra for life, you know, go at it more simply. Let go of what you can let go of. Deal with what is right here in front of us. Stay out of fear as much as possible.
All we can do is what’s in front of us, right? We can plan for the future, but we’re doing it from here. We can look at the past and have it hamstring us, but that’s us from here in this moment. So what can we work with here? Let’s stick with that.
Miriam:
And I think what Neuroptimal can help with a lot… it helped me a lot with that… is moving towards not overthinking. It’s simpler than you think it is.
Thanks for being with us today. Appreciate it.
Ed:
Thank you for having me, Miriam. It was great talking to your audience, and I hope some people got something they can do that’ll help their sleep or their lives.
Miriam:
Yeah, me too.