HIRREM is administered through a series of sessions lasting about 90-120 minutes each. Each session is made up of three to ten protocols, each being 6-40 minutes in length, during which auditory feedback is provided to address specific locations and frequency bands. Protocols may be run with eyes open or eyes closed. Following the initial session, protocols for subsequent sessions are chosen based on data from the preceding session. Thus, there is not a standardized list of protocols for a course of HIRREM. The series of protocols across sessions is unique for each recipient.
During protocols, sensors are placed over the specific areas on the scalp corresponding with brain regions/lobes to be observed, with the recipient comfortably at rest, sitting or reclining. Frequencies and amplitudes are monitored in real time, and the dominant frequency within a chosen target frequency band is identified. The dominant frequency is assigned an auditory tone which is played back to the recipient via ear phones with as little as a 8 millisecond second delay. Since the brain is dynamic, with and constantly changing frequencies and amplitudes, the recipient hears a series of tones played back via the ear buds. It appears that the brain is quick to recognize that the tones reflect what is going on in itself at that moment. By giving the brain a chance to listen to itself, it appears to bring itself, on its own terms, to a state of equilibrium. Although the exact mechanism remains to be defined, this process appears to allow the brain a chance to relax and auto-calibrate its frequencies and amplitudes.
Each session includes multiple protocols to address several locations and frequencies. During protocols with eyes closed, the recipient is instructed to just relax, and might even fall asleep. During eyes open protocols the recipient can engage in a relaxing activity such as reading, or doing a word search. The choice of protocols during the initial session is based on data collected during the assessment. From that point on, data from the previous HIRREM session is analyzed and the Technologists choose protocols for the subsequent sessions depending on how the brain is responding. Since every individual’s brain is different, the exact series of protocols, as well as the number of HIRREM sessions needed, varies. The decision on the number of sessions needed typically depends on both the brain pattern, and changes in clinical symptoms reported by the recipient. About 10 sessions appear to be adequate for many recipients, while more may be required for others. For both our initial pilot research study for insomnia, and a later research study for migraine, participants averaged 10 sessions. Preliminary pilot data suggest that those with PTSD and TBI may require more sessions.
HIRREM uses an algorithm-based observation for the brain to view itself, providing an opportunity for recipient-unique auto-calibration and movement towards a more balanced state, rather than operant conditioning or entrainment techniques designed to try to train the brain toward a standardized or ideal pattern of frequencies and amplitudes. No active, cognitive involvement by the participant, or re-living of prior traumatic events, is needed to accomplish this process.
Many medications, such as opiates, benzodiazepines, antipsychotics, newer antidepressants, and some sleep medications, as well as alcohol and recreational drugs, affect brain frequencies and amplitudes. Some supplements and hormones may have similar effects. These factors may influence the initial assessment, as well as interfere with the process of balancing and quieting. For most of our HIRREM research studies, subjects with an ongoing need for some medications, alcohol, or recreational drugs are excluded from participation. Recipients of HIRREM are asked to avoid alcohol or recreational drugs during and for at least three weeks after completion of the HIRREM sessions. Follow-up, and additional data collection visits vary depending on which research project the subject is enrolled in.
Figure 4: Sensors and ear clips with paste are ready to use for a HIRREM assessment or session (left). A single sensor with paste (right, above), and an ear clip with paste (right, below) are also shown.
Figure 5: This figure shows an example of what the set up might look like for several protocols that could be run during a HIRREM session. Moving from the top left in a clockwise direction this demonstrates a protocol at the T3/T4 location with eyes open and reading during the protocol, a protocol at T3/T4 with eyes closed, and a protocol at FP1/FP2 with eyes closed.
Below are examples of what a HIRREM protocol might sound like. These are playback audio recordings from actual HIRREM protocols run at different scalp locations collected in Brain State Technologies’ Optimization Suite. These examples are included to illustrate the auditory tonal feedback. The brain changes so quickly and dynamically that the auditory feedback would not have the same effect for auto-calibration if they are replayed more than a few seconds after the recording, nor if listened to by other people.