Yoga and Sleep

The statistics around sleep are enough to give you nightmares. More than 50 million Americans suffer from chronic disorders of sleep and wakefulness, and 95 percent of these remain unidentified and undiagnosed.

On a societal level, the results of these impairments are staggering. One out of every six fatal traffic accidents and one out of eight crashes requiring hospitalization are due to drowsy driving, and disasters such as Chernobyl, Three Mile Island, Challenger, Bhopal, and Exxon Valdex were officially attributed to errors in judgment induced by sleepiness or fatigue. The annual cost of insomnia-related problems might be as high as $100 billion including direct and indirect costs such as consumption of medical services, increased accident risk, and lost workplace productivity. At a physiological level, sleep deprivation has multiple negative effects, including decreased cognitive function, immune function, endocrine function, and appetite control.

Traditional Treatment for Sleep Disorders

There are three major categories of sleep disorders: parasomnias, insomnia, and disorders of daytime sleepiness (see below for details). Treatment for these disorders can take several forms. In some cases, it’s possible to isolate and treat the underlying cause, such as sleep apnea (a breathing disorder that interferes with sleep), chronic pain, depression or anxiety. Conventional medical treatments for sleep apnea include bedside devices that aid respiration; treatments for insomnia include over-the-counter medications, including antihistamines, melatonin, and valerian, or more commonly and more effectively, prescription sleeping pills. However, these are not always effective over the long term and unwanted side effects are not uncommon.

Fortunately, for insomnia, which is the most prominent sleep disorder, there are now multiple well-validated and effective behavioral treatment approaches. One of these focuses on improving sleep hygiene using common-sense strategies to aid sleep, such as avoiding caffeine, alcohol, large meals, and vigorous exercise before bed; creating regular pre-sleep routines; and reducing light and noise in the bedroom. Insomniacs are often told to use their bed only for sleep and sex, not for reading, watching TV, working, or other sleep-incompatible behaviors, in order to retrain the mind/body in establishing the bedroom as a place for sleep. Cognitive therapy for sleep challenges dysfunctional thinking about sleep that’s common in insomniacs, replacing faulty beliefs and misperceptions with more constructive, less stressful thoughts.

Relaxation training for sleep disorders employs cognitive and/or somatic techniques to reduce tension and arousal, as it is now well-established insomniacs typically exhibit physiological hyperarousal of their neuroendocrine system. These techniques include mind-body practices such as progressive muscle relaxation, biofeedback, guided imagery, meditation, and yoga.

Yoga for Insomnia

There have been a growing number of studies on how insomnia is affected by mind-body interventions, such as meditation, mindfulness, cognitive behavioral therapy, and Mindfulness-Based Stress Reduction. These types of interventions have been shown to improve insomnia, increasing both sleep efficiency (the percent of time asleep in bed at night) and total sleep time. The research on the efficacy of yoga for improving sleep looks promising as well, which is not surprising, since yoga inherently combines a number of beneficial practices, including physical postures, breathing techniques, deep relaxation, and meditation/mindfulness practice. A study published in the journal Biological Psychology tracked subjective sleep quality and hormonal modulation in 26 long-term yoga practitioners (minimum three years of practice). The results indicated that long-term yoga practice is associated with better sleep quality and lower levels of the stress hormone cortisol.

In another study, published in the Journal of Ayurveda and Integrative Medicine, researchers looked at sleep quality and quality of life among older practitioners (aged 60 and up). Self-reported data revealed improvements in both areas. In a prospective research study of 120 residents in a home for the aged, participants were randomly allocated to three groups: a yoga group that practiced physical postures, relaxation techniques, and pranayama, and were given lectures on yoga philosophy; an Ayurveda group that was given an herbal preparation; and a control group. The groups were evaluated with self-assessment of sleep over a one-week period and again after three and six months of the respective interventions. The yoga group showed a significant decrease (average 10 minutes) in the time taken to fall asleep and an increase in the total number of hours slept (average of one hour) and in the feeling of being rested in the morning. The other groups showed no significant change.

In our study of chronic insomnia at Brigham and Women’s Hospital, using a self-care yoga breathing intervention, research subjects have been shown to exhibit statistically significant improvements in sleep characteristics after an eight-week intervention. Furthermore, our Kripalu Institute for Extraordinary Living studies of yoga in the public school setting reveal that sleep improvement is one of the common experiences that adolescents report after practicing yoga. Clearly, the efficacy of yoga for sleep and insomnia warrants further study—and suggests that regular yoga practitioners can rest easy.

The Three Types of Sleep Disorders

Parasomnias: a variety of odd and potentially harmful or disturbing behaviors during sleep, including night terrors, nightmares, sleep walking, sleep eating, nocturnal bruxism (grinding the teeth), hallucinations, and sleep paralysis, in which a person temporarily experiences an inability to move, speak, or react during while falling asleep or awakening.

Disorders of Daytime Sleepiness (Hypersomnolence): excessive daytime sleepiness. Underlying issues include central nervous system disorders such as narcolepsy or idiopathic hypersomnia, sleep disruption due to disorders such as sleep apnea or restless leg syndrome, and inadequate sleep duration due to self-imposed sleep restriction or shift work.

Insomnia: ongoing difficulty (at least six months) in falling asleep and/or staying asleep. The most prevalent among the sleep disorders, insomnia affects 23 percent of Americans and is a risk factor for the development of medical illnesses and psychiatric disorders, and directly causes cognitive impairment, higher health care costs, increased accident risk, higher absenteeism, and reduced quality of life.

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