Yoga and Insomnia

First published in What Doctor's Don't Tell You Magazine.

We all know the knock-on effects of a bad night’s sleep, but when insomnia becomes chronic it can affect our whole being and ability to function. The daytime fatigue it creates can send us reaching for sugar and stimulants, which in turn affect sleep.

Insomnia falls into two categories; difficulty falling asleep and waking in the night. It tends to be divided into primary insomnia, where sleeplessness is the main symptom and secondary, where sleep is affected by another condition e.g. arthritis, fibromyalgia and depression. From a holistic and psychoneuroimmunological (PNI) perspective - where our bodies work as one completely integrated system – the calming and soothing mechanisms that allow sleep have such far reaching effects on lowering inflammation, modulating immunity and regulating mood and motivation, that promoting sleep quality is a foundation of health; not just the absence of disease, but quality of life.

Even yoga practices during the day have shown to help with sleep; most studies for yoga have focussed on the effects of regular daily practice, rather than targeted evening sessions for insomnia. Yoga has shown to reduce stress (Health Psychology Review, 2015; 15:1-18), a key component of regulating sleep and also to raise our levels of the calming neurotransmitter GABA (gamma-amino butyric acid) (Journal of Alternative and Complementary Medicine, 2010: 1145–1152) which shuts off brain chatter, allowing both a calm mind during the day and allowing us to drop into sleep brainwaves later at night.

The research for yoga and sleep

A study published last year (J Clin Nurs, 2015 [Epub ahead of print]) to determine the impact of yoga on the quality of sleep and work stress of staff nurses employed by a general hospital in China, particularly where shift-work and disturbances to circadian (daily) rhythms were involved. 120 nurses were randomised into two groups: a yoga group and a non-yoga group. The yoga group performed yoga more than two times every week for 50-60 minutes after work hours and after six months, the yoga group had significantly better sleep quality and lower work stress compared with nurses in the non-yoga group.

Another study (Altern Ther Health Med, 2014;20(3):37-46) had looked at an ageing population (60 years and over) as undiagnosed and untreated insomnia can cause impaired daily function and reduced quality of life, as well as being a risk factor for accidents and falls in older adults. Compared with controls, the yoga group showed significant improvements in a range of subjective factors, including overall sleep quality (how refreshed they felt on waking), efficiency (percentage of actual sleep within a night-time), latency (time taken to fall asleep) and duration.

The improvements in this study were seen alongside increases in fatigue, vitality, general well-being and function in physical, emotional and social roles. Reductions were seen in depression, anxiety, stress, tension and anger. This reflection of improved stress coping is to be expected from yoga and could also be seen as a result of improved sleep itself. All of these outcomes are reflections of more engagement of the calming tone of the autonomic nervous system, the parasympathetic branch, aka ‘the rest and digest’ state, which allows sleep, healing and recovery.

This is where yoga’s aim to ‘still the mind” supports sleep, which yogis rate as second after food (and before balanced sexual energy) for health and life expectancy. Sleep is translated as nidra in Sanskrit and can be translated as “nurse, feminine, maternal, nourishing,” and seen as having the quality of gravity, earth and grounding.

The power of melatonin

Many evening activities like TV and screens stimulate the brain, body and nervous system, lowering or ceasing production of the vital sleep neurotransmitter melatonin. Melatonin doesn’t simply allow us to fall asleep and control our sleep-wake cycle, it is known to have many actions fundamental to health during our waking hours. In the immune system, it works as an anti-inflammatory, antioxidant and cancer protective agent. It also protects the energy production within each of our cells, within their power stations, the mitochondria, protecting against diseases like Alzheimer’s.

A study of thirty healthy men aged 25-35 years (J Altern Complement Med, 2004;10(2):261-8) who practised yoga for three months showed a rise in plasma melatonin, with the maximum night-time levels correlating with highest general wellbeing scores. So moving away from screens as early as possible, the latest at 9pm offers, us the time to create a regular evening yoga practice that has the opposite, sleep and health promoting effect.

Evening Yoga Practices to Support Sleep

You may feel you need a more physical practice before, even just 10-15 minutes of more active postures to move pent-up energy through and to calm any residual agitation from the day. Be intuitive to the particular needs of that day; if your energy is low, go with it and allow yourself to meet tiredness with kindness and compassion.

• Create a warm, safe space to practice with no interruption, so you feel able to drop down into deeper and more relaxed brainwaves and body state. Have blankets handy to cover yourself (where appropriate) to feel both cocooned and that you won’t be stimulated by a sudden drop in temperature.
• Be ready for bed as much as possible, with teeth cleaned and technology (including wi-fi) turned off – even with candlelight that doesn’t interfere with melatonin production as artificial light does.

Much of this practice is restorative; in yogic terms this means placing the body into completely supported positions, so we can let the experience unfold without stress or strain. There are also elements of passive stretching to open out connective tissue and allow the tension release in muscle that promotes sleep quality and quantity. These practices reduce the stress hormone cortisol, promote a sense of wellbeing and equanimity and invite the slow, deep breathing which raises levels of carbon dioxide, a natural sedative. Breathing into the belly supports the grounding quality that supports sleepiness, and encourages the body awareness that can soothe a busy brain.

Supported full inversion

The reclining and inverted postures included here are known to support the baroreflex (Indian J Physiol Pharmacol, 1998;42(2):205-13) which maintains the homeostatic mechanism of keeping blood pressure constant, needed to fall asleep. Standing postures inhibit it to excite and raise blood pressure. This full inversion places the heart above the head and the hips and legs above the heart, so there is the added calming bonus of the heart needing to pump less as gravity comes to its aid. Support the lower back fully and comfortably with a bolster or stack of towels, with the lower legs able to fully drop onto a chair seat. Close your eyes to move inwards and feel your breath and heart rate naturally slow down.

Inverted and supported back arch sequence

This sequence also includes tension release in the hips (chair-sitting creates tension there) where our bodies respond by letting go through other muscle groups. The more we can focus on breathing the more we can let go feelings of stress, rather than tense against them. Opening the front body makes room for full and spacious breath. Have a lower lift than shown if you need.

From lying, knees bent, place a bolster or stack of towels under the pelvis so the tailbone is dropping just over the edge and the lower back is completely comfortable; opening the feet out to where you feel this and can breathe most easily into the belly. With the arms placed wherever you feel most ease in body and shoulders, this pose can be useful for insomnia alone and held as long as feels right and between other poses here. 

1. Raising the right leg, take a belt around the front of the heel and raise that bind directly above the right hip, so the leg bones are stacked up vertically from gravity. Settle into breathing open the back of the leg and release across the lower back.
2. If your lower back is extremely happy, you may be able to lengthen out the left if you can feel heavy in the left thigh too; do not force this, come back to bent leg if any back compression.
3. From whichever previous position works for you, take the belt in just the right hand, inhale and then exhale it out to the side – just as far as you still feel an anchoring through the left side. Breathe length through that inner leg and around the hip. Draw back in whilst you still have space and do this sequence on the left.
4. Bring both feet up into the belt and start with them together, dropping the tailbone and opening the chest. Breathe to release the shoulders and you may feel able to widen the feet to about mat-width.
5. Drawing the legs in, counter the back arch by now letting the weight of the legs lift the tailbone with the knees dropping towards the armpits. Breathe space into the base of the skull, releasing the jaw and temples before rolling onto your side to come off the lift. Come to savasana or add in the next sequence for deeper calm.

Restful forward bend sequence

Forward bends are associated with mind calming and surrender. In these poses, the lower back is in ‘passive tension’, where each inhalation contracts it, whilst each exhalation releases it, allowing more depth into the pose. This adds to the attitude of allowing over forcing that is part of yoga philosophy. Pushing into forward bends creates a contraction that actually forms a barrier to stretching, the lung emptying of the exhale draws the diaphragm into the chest and creates a cave into the abdomen that gives us space to drop in further. Focussing into full and spacious out-breaths relaxes the back and tilts the pelvis forward. As stresses of the day can create breathing that is dominated by the in-breath, mindful attention exhaling into forward bends sets the scene for sleep.

Both the focus on the exhale and the opening of the back body (stimulating the liver and kidneys) activate the parasympathetic nervous system. When we also support the head during forward bends, we create the ability to let go of the weight of the head and soften the eyes, jaw and mind; key focuses in a sequence for sleep. Forehead pressure on a prop also provides a gentle forehead massage that stimulates the pituitary gland, which controls melatonin. This also activates the trigeminal nerve in the forehead, soothing the whole body via the vagus nerve.

Starting by opening the hips and lower back allows us to move more restfully into forward bends. Bring the soles of the feet together, knees out to the side with feet a good distance away from the groin so that you can round the back in, release the head and let go of doing.  

1. In these variations of upavistha konasana (wide-legged forward bend), there are options for you to find the pose that you can most release into. From sitting with legs comfortably wide, start by lifting up the spine from hands behind the hips. It is a good idea to sit on a block if you collapse backwards at all. This may be where you need to stay, even putting rolled towels under knees if tightness in the hamstrings prevents any softening or movement in the lower back. You may then be able to fold forward, bringing your head onto bolsters and props or a chair seat. Feet pointing to the ceiling in this and the next pose rotate the thigh bones slightly in and release the sacrum to engage the calming parasympathetic nervous system.
2. Bring the same considerations to a full forward bend or paschimottanasana (western stretch pose) with feet together. 
3. You can also pratcice a more restful version of paschimottanasana with a bolster under the knees. 
4. Release the back with any supported, lying twist before finishing with savasana (corpse pose) where you remain awake, but attuned to your breath and body. Feelng heaviness with the exhalation, lightness with the inhalation provides a focus that balances energy and invites letting go of any tensions left.

Find your perfect yoga routine

Routine exercise and activity is proven to help insomnia and extreme fatigue. Charlotte offers weekly online classes through Whole Health with Charlotte - click here for further details.