This is the next post in the series on sleep disorders. So far, we covered the importance of sleep, neuroscience brain waves, sleep stages, healthy sleep habits, and types and causes of Insomnia.

In this post let’s see how Yoga (Yogasana and Pranayama) can be used as a therapy for insomnia. Please note that this information is not a health or medical advice. Always consult a qualified medical professional or qualified health provider regarding any questions you may have about a medical condition, and before commencing a therapy like this. Also, Yoga should be practiced under the guidance of an experienced teacher, who will assess the overall health condition, make recommendations and prepare sequences.

In this post, we will focus only on Yogasana and Pranayama for primary insomnia that is caused by stress, anxiety and/or depression. This may be helpful in secondary insomnia as well, but in such a case one needs to focus on therapy for the primary medical condition first.

So, what needs to be cured?

As we saw in the previous post, the insomnia is concomitant with one or more of stress, anxiety, and depression, and possibly some other conditions as well. Hence there is no single set of yoga poses or a sequence as this is a highly individualized problem, and hence all conditions need to be assessed together. At a root level, we are dealing with a combination of the following issues. Because of the lack of good quality sleep, the brain is not getting enough time to be in REM and deep sleep, making this a vicious cycle, that needs to be broken.

• Imbalance of the Autonomic nervous system – Nervous system is aggravated and shifted towards sympathetic stress response.
• An elevated level of stress hormones – the body and mind both are stressed as if some fearful event is imminent, causing a high level of stress hormones, elevated blood pressure/heartbeats.
• Emotional disturbances caused by agitated Amygdala, the part of the brain that processes emotions. Amygdala is also the one that creates a stress response. It activates the sympathetic nervous system respective of whether anxiety is Cortex-based or Amygdala-based (as described in a previous post). So, Amygdala sensitivity is key in insomnia, as it is either directly involved in causing insomnia because of emotional distress, or aggravate insomnia triggered by some other causes.
• Cognitive disturbances caused by hyperactive Prefrontal Cortex, the part of the brain that deals with cognition. An important point to note is that it is not the number of thoughts but the rapid changes in thought pattern that creates anxiety. Anxiety itself is a vast topic that will be covered in a future post.

How Yoga Helps?

The practice of yoga can be helpful to insomniacs to not only alleviate the symptoms but get rid of the root cause itself. The yoga for Insomnia can be like killing several birds with a single stone. This will not only alleviate stress – the primary cause, but also help with improving physical, physiological and emotional conditions that otherwise aggravate symptoms of insomnia.

The practice of Yoga is not only curative but also preventive. It brings physical wellbeing, physiological balance and emotional stability. So these poses can also help a healthy person, who is feeling stressed – as a preventive measure.

This is how Yoga helps in insomnia:

• Muscle Relaxation – Normally the body holds stress in various muscles – jaw, neck, shoulder, chest, abdomen and lower back. Such physical tension in muscles is interpreted by the brain as if you are not safe and need to be alert to face the danger. Tight muscles also increase Amygdala activation. Yoga poses will pull tension out of these muscles and send relaxation signals to the brain – creating a feeling of safety. Amygdala will also calm down. Overall, this will downregulate the sympathetic nervous system. It is important to note that other exercises e.g. aerobics, in moderation will also do similar work.
• Light Exercising – Light yoga poses or mild exercising are also useful to burns off extra Adrenaline in the blood. Exercising appears to affect Serotonin found in Amygdala. Serotonin is a key neurotransmitter that stabilizes mood, feelings of well-being, and happiness. These activities have to be done by insomniacs in the morning only, as exercising in the evening may stimulate the nervous system, which actually needs to be calmed down before going to bed.
• Neuro Reflexes – As covered in various posts previously, different Yoga poses activate neuro reflexes like Baro-reflex and Ocular-vagal reflex. These poses help the brain stimulate the parasympathetic relaxation response. This calms down the flow of thoughts in the Prefrontal Cortex, and soothe the agitated Amygdala to bring emotional balance.
• Diaphragmatic Breathing – There is nothing as rapid as the effect of diaphragmatic breathing to bring a positive state of the mind. It works much faster than any medicine like an antidepressant – remember the link between body, breath and mind.
  • The restorative yoga poses that promote deep diaphragmatic breathing also bring relaxation to the mind, calm the nervous system and lower the level of stress hormones like Cortisol, Adrenaline and Adrenocorticotropic hormone (ACTH).
  • Deep breathing reduces the activation of Amygdala.
  • The diaphragmatic breathing keeps a good balance between oxygen and carbon dioxide in the blood. Otherwise, in insomniacs, chest breathing is quite common (see post on the breathing) which keeps the sympathetic nervous system perpetually ON. The hyperventilation created by chest breathing also decreases the carbon dioxide level in the blood beyond normal.
• Gut-brain Axis – It is now known that a bidirectional communication system between the gastrointestinal (GI) tract and the brain exists. This is called the Gut-brain axis. Over the past few years, scientific interest in the gut-brain axis has increased, mostly due to identification of the gut microbiota as a key player in this communication. The results of many neuroscience studies show that gut microbiota composition is influenced by emotional and physiological stress. Also, microbiota composition affects various nervous system activities such as stress response, behavior, and mood. Scientific evidence is yet to be established on the influence of various Yogasanas in maintaining a healthy Gut-brain axis. But it is very well known that Yogasanas that focus on pelvic-abdominal region have a therapeutic effect on the mind – improving the mood, creating a positive attitude and bring emotional balance.

Which Yoga Poses?

The poses mentioned here are known to produce therapeutic effects mentioned above. These are just guidelines. The selection of poses and their sequence needs to be carefully worked out according to the conditions, and needs to be modified as the therapy progresses.

Muscle Relaxing Poses

• Tadasana/Urdhava Hastasana cycle
• Surya Namaskara cycle
• Swastikasana/Parsva Swastikasana cycle
• Baddha Konasana
• Upavishta Konasana – it increases positivity and stimulate pelvic area.
• Supta Padangusthasana I – it is known to relax the entire central nervous system, and release tension in muscles of leg, pelvis and abdomen – the latter two being the target of stress accumulation.

Forward Bends

Forward bends produce a relaxing effect on the nervous system. Because the body is horizontal, the difference in pressure senses by Barorecpetors located in the Carotid artery and those located in the Aortic arch is reduced. This brings down the pulse rate and blood pressure. The sympathetic nervous system, if in overdrive mode, is pacified and the tone of the nervous system moves towards parasympathetic mode. If the cause of insomnia is Cortex-based anxiety, forward bends are particularly effective. The Prefrontal Cortex, which becomes hyperactive with negative or worrying thoughts, is relaxed. All the following poses have to be supported with props (as in Iyengar Yoga).

• Adho Mukha Svanasana (head supported on a bolster).
• Adho Mukha Virasana (bolster between the legs, knees spread and entire torso spread over the bolster. You can keep a sandbag on the back for relaxing the back muscles.
• Adho Mukha Swastikasana (head rested on chair and arms folded over the head)
• Paschmottanasana (head supported on a bolster or a chair)
• Janu Sirsasana (head supported on a bolster or a chair)

Reclining Poses

Reclining asanas are restful poses that soothe the body and refresh the mind. In routine Yoga practice, these poses are performed towards the end for cooling down and prepare for Pranayama. But in the case of insomnia and other stress-related ailments, they are helpful at the beginning of the session. After a long or stressful day, they help relax the body, breath and mind, and bring them in sync to set up the tone for a therapy session. These poses primarily focus on the opening of the pelvic-abdominal area to improve functioning of the Gut-brain axis.

• Supta Baddha Konasana (with bolster support)
• Supta Swastikasana (with bolster support)

Inversions

Any Yogasana session without inversion is incomplete – particularly when you are dealing with ailments associated with the nervous system. And, if the cause of insomnia is hormonal, inversions are more effective as they directly affect the endocrine system.

• Uttanasana (head supported)
• Prasarita Padottanasana (head supported)
• Sirsasana (on a rope)
• Sarvangasana (on a chair)
• Setu Bandha Sarvangasana (on a bolster)
• Viparita Karani (supported on a wall)

Savasana

Never avoid Savasana. Place a sandbag or wooden brick on the abdomen just below the rib cage. This will encourage diaphragmatic breathing and extend the exhalations.

Pranayama

Pranayama should be introduced very slowly if the person is not familiar. It can be overwhelming if someone has anxiety.

• Ujjayi (with prolonged exhalation)
• Viloma II

Key Guidelines

• A deeply restorative yoga practice just before bedtime can be highly relaxing. It can be done about a half-hour before bedtime. It should be done with the support of props only. Mild stretching is okay.
• In all restorative forward bends, gently press your forehead into the bolster or blanket. Make sure that your forehead skin moves toward eyeballs. This will activate the Ocular-vagal reflex.
• In restorative reclining poses and Savasana, you can use eye pillow to enhance relaxation.
• Crepe Bandage over the head will increase the relaxation effect.
• Supported forward bends can be done just before going to bed.
• Many times, excitement may keep you awake as your Prefrontal Cortex and/or Amygdala are overactive. With just a few minutes of forward bends you will feel calm and this will help you go to sleep.
• When you feel anxious or agitated and not able to fall asleep, or have difficulty going to sleep when your sleep is disturbed, you can do forward bends for a few minutes. However, if you continue to feel anxious and agitated, try supported Supta Baddha Konasana, Supta Swastikasana or Setubandha Sarvangasana. If those also don’t work, Viparita Karani can be the ultimate!
• Weights and bandages can be used to apply gentle pressure to remove the tension built upon the muscles and relax them. This will prevent any stress signals going to the brain.
• People with stress at the office should practice restorative sessions in the evening to help them bring back the homeostatic balance of the nervous system.

A Medical practitioner’s approval is recommended before practicing any therapy like Yoga. Also, do not stop any medication. Yoga should be practiced under the guidance of an experienced yoga teacher.