Yoga For Insomnia

By Akiko Kuwajima - Akiko is a Yoga teacher & Yoga therapist from Yogapoint and she has a rich experience in teaching and practicing yoga.

INTRODUCTION

The Great East Japan Earthquake and Tsunami was something we, Japanese had never experienced before and brought a tremendous impact and shock to many of us. More than 18,000 people were dead; and more than 430,000 people were forced into emergency shelters. The grief and stress caused by the sudden life change and the traumatic experience of the earthquake and tsunami are resulting chromic depression, prolonged mental disorder and insomnia. Suicide attempts have been also increasing. In this paper, yoga therapy for those who have been suffering from insomnia after the tsunami is explored.

WHATIS INSOMNIA?

Insomnia is often defined as sleeping difficulties—difficulty falling asleep and/or staying asleep or sleep of poor quality. Various causes contribute to insomnia, such as use of psychoactive drugs, caffeine, nicotine, amphetamines, cocaine; hormone shifts (including menstruation and menopause); life events including fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child, bereavement; disturbance of the circadian rhythm (such as shift work and jet lag); certain neurological disorders; medical conditions including hyperthyroidism and rheumatoid arthritis; and poor sleep hygiene, e.g., noise. In case of insomnia of the traumatic experience of tsunami, the following are the causes of insomnia:

1.     Feeling of grief and loss

Many of their houses destroyed, friends disappeared, one or both parents killed, their children killed or disappeared, siblings and other close family members missing. The feeling of grief and loss is always with those who survived the tsunami. There is also the shock of identifying bodies for victims as well as aid workers.

2.     Feeling of guiltabout surviving

Many of them tried to escape together though, only some were saved. Many of them are captured by the feeling of guilt about surviving.

3.     Continued earthquakes and flashbacks

Earthquakes (small to medium scale) have been continuously happening; and the tsunami siren keeps them awake and alert. Even a small earthquake brings them flash backs of the tsunami, which greatly contribute to insomnia.

4.     Fears of radiation

Parents, many traumatised themselves, have struggled to keep their own fears in themselves as they try to soothe their children. Children have been also stressed as many of them cannot play outside because of the radiation problem, which further brings tense and anxiety to the parents. Fears of radiation are also extended to farm and sea products. Many people in the earthquake affected areas are making living from either agricultural products or fishery. The radiation problems directly threaten their living.

5.     Fears of future

Many victims lost their jobs, houses and precious belongings. Some are also suffering from loans of their lost houses. Uncertainty of the future is always with them. Many are feeling lost completely and cannot find any hope in their futures.

6.     Loneliness

Many are suffering from loss and facing loneliness. Suicide attempts have been increasing. A survey shows an 18 per cent national increase in suicides. In May, 3,281 people killed themselves, 499 more than the same month in 2010. Loneliness is greatly contributing to this figure.

Physiologically, major depression leads to alternations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality. Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nightmare levels of circulating cortisol and adrenocorticotropic hormone. They also elevate metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. This maybe a contributing factor of long-term insomnia.

                Potential complications of insomnia include lower performance, slowed reaction time, risk of depression, risk of anxiety disorder, poor immune system function, high blood pressure, risk of heart diseases, risk of diabetes and obesity.

                Medicines such as sleep tablets and other sedatives are available to induce sleep. However, the most important thing is to identify or rule out medical and psychological causes; and eliminate them. Without which, insomnia could not be cured totally. In case of people suffering from the traumatic experience of the tsunami, the elimination of the above mentioned “causes” is significant.

BENEFITS OF YOGA THERAPY FOR INSOMNIA

Yoga therapy brings numbers of benefits to people suffering from the trauma and insomnia. Various techniques of yoga are available. Patients receive total relaxation and positivity through yoga therapy. Although those sleeping tablets may help to induce sleep, there may be risks of side effects. In addition, they work on the “symptom” of the body, but not eliminate the “cause” of it. On the other hand, yoga has no side effects, but good ones only. It is also possible to change the life style through yoga. The causes of insomnia will be removed by the continuous practices of yoga.

DIFFERENT YOGA TECHNIQUES FOR INSOMNIA

In this section, the following five techniques of yoga are presented, namely, yoga nidra;Omkar and mantra chanting; Asana, P

pranayama and shatkarma; Meditation; and life style & diet.

1.        YOGA NIDRA

One of the most important and effective practices of yoga for insomnia is yoga nidra (or yogic sleep) as it brings deeper relaxation on both mental and emotional levels. Half an hour practice of yoga nidra is equivalent to four hours of deep sleep. The great aspect of yoga nidra is that there is no contraindication, e.g., anyone can practice it. It is also possible to remove stress, pain, emotional blockages, and even bad habits through the practices of yoga nidra. Also, some experiments showed the increase of memory function and learning capacity. Yoga nidra has been applied for treatments of various diseases, including cancer, chronic diseases, psychological disorders, drug addiction, alcoholism and so on.

The process of yoga nidra is as follows:

①    Relaxation of the body

②    Resolve

③    Rotation of consciousness

④    Awareness of the breath

⑤    Feelings and sensations

⑥    Visualization

⑦    Ending (with remembering the resolve)

The important processes of yoga nidra in this case are: resolve (process number two above) and visualization (process number six above):

Resolve (or sankalpa)

The purpose of resolve is not to fulfill desires, but to create strength in the structure of mind; and to influence and transform the whole life pattern physically, mentally, emotionally and spiritually. For insomnia patients, it will bringpositive effects if they could have a positive and clear resolve and plant it in their mind. It is important to make sure that the patient takes this sincerely as the result depends on their sincerity to attain the goal of the resolve. Also, it should be planted when the mind is relaxed and ready to accept and absorb it.

Visualization

Visualization is essential as it relieves pain by stimulating the pituitary gland to release its own potent pain—suppressing compounds. Visualization has to take place when the patient is in sub-conscious level. It is important that the instructor brings the patient to the sub-conscious level by the time of visualization, e.g., the processes of the above number three (rotation of consciousness), four (awareness of the breath), and five (feelings and sensations) are also important in this regard. The visualization should be created following the sequence of the below three phrases:

The first part of visualization: “Before the tsunami event”

Description of “before the tsunami”, including happy memories with their family and friends should take place first. It is ideal to draw their happy memory with their lost ones during the initial counseling with the patient and create the script accordingly.

The second part of visualization: “Actual description of the tsunami”

The description of the tsunami event follows after the description of the happy memory. It is again, ideal to receive the information of the patient’s experience of the tsunami during the counseling and incorporated it into this visualization part.

The last part of visualization: “Let ‘it’ go and focus on the present”

Lastly, it is important to ensure that “it is all over now” and “let it go”. It encourages them to remove their sad memories of tsunami from their sub-conscious mind. After this ensuring part, the visualization must finish with an image that evokes profound feeling of peace and calmness. In case of Japanese people suffering from the traumatic experience of tsunami, sakura (or cherry blossom) would be one of them as it represents the beginning of the spring, e.g., “new start” or “new beginning”.

A sample visualization is attached as an appendix. Although in yoga nidra, we occasionally insert a sentence to make that the practitioners should be awake during the practice. However, in case of the patients suffering from insomnia, it might not be necessary to repeat such sentences. It will be ideal to conduct yoga nidra before they go to bed as they can totally relax themselves during the practice of yoga nidra, which is necessary to fall into asleep. The instructor also has to make sure to arrange the ideal environment before the practice (light, temperature, noise, etc.).

2.        OMKAR AND MANTRA CHANTING

Omkar chanting brings positive effects to the patient. The vibration of this sound brings calmness in the mind. The cellsof the body would be harmonized as each cell of the body is made by various atoms which carry electrons—vibrations. Even listening to the chanting helps to reduce blood pressure.

However, in Japan, there is a great challenge to promote this universal sound as many of us remind of a cult group of “AUM Shinrikyo” (currently known as Aleph). Their religious practices were referred as “yoga”, with a mission of spreading the word of “salvation”. This group manufactured chemical weapons and attached Tokyo subways in 1995, killing and affecting many people. This brought people’s great misunderstanding on yoga, although yoga has regained its reputation and popularity recently. It would be one of the great reasons why some Japanese still believe that yoga is a religion and they refrain from learning more about yoga. It shall be possible to slowly introduce omkar as one of the useful techniques of yoga therapy. However, in order to avoid any unnecessary misunderstanding, it would be better to include this omkarin yoga nidra, or just let the patient listen to the vibrations of the om. Probably, in Japan, instead of omkar chanting, mantra chanting will be easier to practice. Mahamrityunjaya mantra will be excellent for the patients suffering from insomnia as it provides healing and balancing effects. Gayatri mantra will be effective especially in the morning as it increases pranic energy and stabilize emotion.

3.        ASANA, PRANAYAMA AND SHATKARMA

All asanas, pranayamas and shatkarma are beneficial for the treatment of insomnia. A brief introduction and benefits of each practice are presented below.

Benefits of asana practices

In the Yoga Sutra of Patanjali, asana is defined as “comfortable and steady postures (sthiram sukham aasanam)”. In this contest, one can develop control of the body through the asana practices andfurther enable to control the mind as well. More importantly, insomnia patients can develop awareness on their body and mind, which is beneficial for the treatment of insomnia.

Benefits of pranayama practices

Pranayama is generally defined as breath control. The ‘prana’ means ‘vital energy’ or ‘life force’; ‘yama’ means ‘to control’; and ‘ayama’ means ‘extension’ or ‘expansion’. As such, pranayama utilizes breathing to influence the flow of prana or life force. Through the practices of pranayama, patients gain great benefit of controlling their mind. However, it is important for patients to start practicing deep breathing for preparation of pranayama. Deep breathing practices bring patients various benefits—calmness, relaxation, more oxygen to organs, massage effects on inner organs and so on.

Benefits of shatkarma

‘Shat’ means ‘six’ and ‘karma’ means ‘action’; the shatkarma consists of six groups of purification or cleansing practices to attain physical and mental balance. It is also used to balance the three doshas or humours in the body (kapha, pitta and vata). According to both ayurveda and hatha yoga, an imbalance in the doshas will result in illness. It is essential to be personally instructed as to how and when to perform them, according to individual limitations and needs. For patients of insomnia suffering from tsunami experience, vaman dhauti (regurgitative cleaning) is especially recommended as it helps to release the suppressed emotional stress along removing excess mucus and accumulated acidity from the stomach.

The following should be checked before the practice of asanas, pranayamas and shatkarmas:

√ Make sure if the patient has complications, such as hypertension, diabetes, high blood pressure, injuries, any other health issues before the practice; and choose asanas, pranayamas and shatkarmas accordingly.

√ Make sure to have warm-up and preparatory movements before practicing asanas. Also, it is important to provide alternative poses for patients who have less flexibility of the body so that nobody feels lost during the asana practices.

√ If necessary, use supporting tools such as cushions, blanket and strap or towel.

√ Obtain feedback from the patient after each practice and make sure the patient feels no pain or uneasiness throughout the practice.

In appendix II, a sample sixty minutes long practice program is presented.

4.        MEDITATION

Meditation practices harmonize our perceptions, thinking, emotions and behaviours. It is good to make a balance between the body and the mind. Ideally, the patients sits in any comfortable meditation posture and practice meditation. However, if this is difficult, the following mindfulness practices could be suggested:

√ Awareness of breathing in their daily life. They can practice this anytime, anywhere. This is beneficial for patients as they can know more about their own bodies.

√ Mindfulness eating, working, talking, listening and any daily routine, encouraging the patients to focus on the ‘present’ moment. This is again, an important practice as many of them do not exactly present at the moment, e.g., they are captured by their past or worrying about future.

√ Encourage the patient to do other “mediation-in-motion” practices. In Japan, there are many traditions which can be considered as “meditation” practices, such as tea ceremony, Japanese flower arrangement and Japanese calligraphy. Patients may find it easier and enjoyable to start practicing meditation with these traditions.

5.        LIFE STYLE AND DIET

Karma yoga life style is highly recommended to the patient. Many patients have difficulty to accept the situation they are in and worry about the future. They are hardly in the present moment. Karma yoga leads the patients to accept themselves as they are; accept the world and the surrounding environment; accept their past and all events. Through the acceptance, patients can live in the present moment and be able to approach realistically toward their problems. Furthermore, patients will find the meaning in their lives that will give them more strength and positive energy to overcome the experience of the tsunami. As patients get involved in the present moment and focus on “here and now”, their understanding toward themselves as well as other people will be enriched. They will nourish their ability to see the situation from others point of view. These aspects cannot be attainted by the practice of asanas only. Karma yoga directly connects to daily life of the patients; and gives a more relaxed and understanding attitude towards life and other people.

Diet is essential as our boy is what we eat and it brings impact to the mind as well. Patients should avoid caffeine and alcohol intakes as they contribute to sleep difficulties. Yogic diet is highly recommended. However, it is probably difficult for many Japanese, especially those based in areas affected by the tsunami, as many of them make living by fishery. Considering this, the practice of Ms. Hatsume Sato could be recommended to the patients suffering from insomnia. Ms. Hatsume, the founder of Mori-no-Ischia, a forest retreat in northern Japan, has been helping thousands of people to recover from depression through her insightful conversation and traditional Japanese homemade cooking using natural ingredients. People who have eaten her legendary ‘Omusubi’ or rice-ball give up the idea of suicide and receive strength to face their problems. Why it is so special? It is because her thought is always with each ingredient until the very end of the cooking. She believes that each ingredient or life has ‘heart’ in it. Her way of cooking is sincere and fully of love and gratitude to each ingredient or life. For example, when she cuts a bunch of spinach, she does not cut them at random, instead, she re-bundles each leaf into one before cutting; and when she cuts them into pieces, she pour her ‘heart’ into each piece of the spinach and tries to connect to the ‘heart’ of the spinach. It will totally change everything whether we think the existence of ‘heart’ is the most important thing or just a delusion. She cooks a simple meal only, but people who eat her heartfelt meal cry and unload their burdens in their hearts. “How to cook” and “how we appreciate the food” bring significant change to our body and mind.

CONCLUSION

                In Japan, for most of them, yoga means “asana” and the other aspects of yoga (such as yama, niyama, pranayama, meditation, etc.) are not known. Many of them also feel that yoga is not suitable for them as they think their bodies are not flexible enough to practice yoga. Some even consider that yoga is religion. Unfortunately the incident of AUM Shinrikyo contributed on this with great extent. These misunderstanding on yoga will be one of the great challenges to overcome to further promote yoga in Japan.

The greatest aspect of yoga therapy is that it has no side effects (or it has only good side effects). It does have limitations, however, considering various benefits and long-time effectiveness of yoga, the author believes that yoga has great potential as a supplemental therapy to modern medicine. The case of insomnia is one of the best examples that yoga therapy can play a significant role on treatment.

Lastly, yoga contributes to build healthier society. Japan is aged society and is also known as one of the very ‘stressed’ countries that drives more than 30,000 people to suicide every year. It is greatly anticipated that yoga plays a role as preventive medicine and leads people to live healthy and happy on the present moment.

APPENDIXI: A Sample Visualization Part of Yoga Nidra for People Suffering from Traumatic Experience of Tsunami

Now, you are going to travel into your past. It is February. Outside, it is snowing. Everywhere is covered by snow. It is very cold. But you are inside the house with your family. Warm and safe there. You are enjoying chatting with your family. You feel warm and happy there. Life is going very well with you. No worry about your finance. No worry about your health. You have everything you need. Your friends and family, close to you. You have nothing to worry about the future.(Pause)

Now, you are travelling to March 11^th. You feel a strong shake of the earth. Books are falling down off the shelf. You hear the crashing sound of dishes…(pause)…the shake has been subsided…(pause). You hear someone is shouting outside. You have to run. Tsunami is coming. You run, run, and run up to the hill. When you reach to the top of the hill, you see dark and huge waves of the ocean, approaching. They swallow your house, your friends’ houses and your whole town…everything under the ocean.(Pause)

Now, you are back to the present. It is all over now. Everything is over. So, forget about it. You are safe now. So, forget about it. There is nothing to worry about. There is no need to feel guilty to survive, either. Just let it go. Let it all go…(gentle music* starts). Now you hear music. With this music, let everything go. Let it all go.

(Music continues for a few minutes.)

(Music stops.)

Now, imagine that you are walking inside a beautiful and quiet park in early morning. You see a beautiful blue sky above and feel a comfortable gentle breeze on your skin. It is April, the beginning of spring. You see cherry blossom everywhere. You approach a huge cherry tree and sit under the tree. You see cherry petals are falling down gently on your body. The ground is full of cherry petals. You close your eyes there. You feel the morning flesh air is gently stroking your face. You hear birds are happily singing. You feel the lively energy of the spring. Full of energy. Full of warm energy.

(End of visualization part and continues to resolve part of yoga nidra.)

*Note: Music can be selected by the patient. A considerable calming and relaxing effects would be expected whenever they hear the same music in their daily life.

APPENDIX II: A Sample Yoga Program for Insomnia (60 minutes)

Note: The above program is for a patient who has no complications and is capable of any asanas and pranayama practices.

ACKNOWLEDGMENT

The author thanks to all teachers and staff at Yoga Vidya Gurukul and all classmates at Yoga Therapy Course (batch 12). A special thanks goes to Guruji, who kindly gave his insightful comments on yoga nidra and with his great experiences treating many patients, helped the author to create one for people suffering from insomnia of tsunami event.