Reading: Use Yoga to Fight Insomnia

For many women, sleep has been one of the casualties of the COVID-19 pandemic. According to Loren Fishman, MD, a specialist in physical medicine and rehabilitation on staff at Columbia Medical School in New York City, if you are struggling with insomnia the antidote may be as simple as striking a yoga pose and doing a breathing exercise. 

“Sleep has never been a big problem for me,” says Dr. Fishman, an avid yogi who has written several books and many academic journal articles about the use of yoga to treat a range of medical conditions. “But when I do get a little insomniac, yoga does the trick. I learned and devised my own method in India.” Here, Dr. Fishman explains how you can stretch, breathe, and meditate your way to better sleep. 

CoveyClub: Research has shown that people who practice yoga regularly sleep better and have a better quality of life. What have you found with your own patients and students regarding yoga and insomnia? 

People who do yoga are generally healthier and have less distractions from sleeping, so these kinds of studies are hard to control. But many well-designed studies indicate that yoga helps with sleep. No matter what you do in yoga, you turn off the adrenergic system of flight or flight, and turn on the parasympathetic nervous system, the rest and digest system. And there are ways in which specific yoga poses do this in spades, very powerfully and very quickly. The yoga I recommend for insomnia — that I have been giving to patients for 40 years — helps 90 percent of them to sleep significantly better, usually immediately, but at the longest after two or three weeks.

CoveyClub: What happens biologically in the body when you do yoga, and how is this compatible with sleep?

Dr. Fishman: In general, yoga stretches muscles, and signals go from those stretched muscles to relaxation centers in the brain and just cause a general relaxation. The body has a checks and balance system: When you stretch your muscle, the first thing the muscle does is pull back, but in the longer run, there is a stronger reflex that overwhelms that response — the muscle relaxes.  Body relaxation is a wonderful inducement to sleep.

CoveyClub: What are the specific poses that best help to battle insomnia?

Dr. Fishman: The specific yoga that I recommend can be done in bed, takes about five to seven minutes, and involves a breathing exercise, a stretching exercise, and if you need it, a short meditation (but most people don’t need it). The stretching exercise, which I recommend doing first, is called Supta Padangusthasana (“asana” means pose). While lying flat on your back (supine or “supta”),  take one leg as high as it goes, keeping knee straight and keeping your head down. Do that with each leg, maybe 30 seconds each.

Then you do a breathing exercise, also lying there on your back.  What you do is take a deep breath in, puffing out your chest, and then, keep the puffiness of the chest while you exhale. You breathe in in little two-second segments, breathe in and stop, breathe in further and stop. You don’t stop by closing your throat or using your tongue or closing your mouth tight — you stop by preventing your diaphragm from descending any further, like a piston. Don’t accelerate the breathing — keep a consistent level of inhale — until you get at least three breaths. That’s Viloma 2. Viloma 1 is pretty much the same but in reverse. (Loma means grain and viloma means against the grain, and that’s what this breathing is — you don’t usually puff out your chest when you exhale.) To do Viloma 1, breathe in keeping the chest puffy, breathe out for two seconds and stop, then further and stop. You do that three times also. Believe it or not, that is usually enough. 

The third exercise is a meditation based on ten concepts — nine of which come from the Vairagya Shaman of Kashmir.  I’ve had the audacity to add one. They are Love, Radiance, Unity, Health, Strength, Abundance, Wisdom, Light as Air (make your body light-as-air), Inner space, and Trust (that’s the one I added). You bring them before your mind and you watch them fade. One at a time, for roughly 30 seconds each, you watch them fade, and it gives you a certain intimacy with your own mind. When you first start doing this you may shine a light on the words you’ve written down, but after a few days you know them by heart. 

CoveyClub: Why do these poses and exercises work? 

Dr. Fishman: The main inlet to activate the parasympathetic nervous system is the vagus nerve (in Latin, vagus means the wanderer, like a vagabond). What this nerve does is it wanders all over the body, and there is input to the pancreas, the intestine, the liver, the esophagus, the heart and the lungs.  The part that goes to the lungs is encased in two different membranes: the visceral pleura that attaches to the lungs themselves, and the parietal pleura, which attaches to the abdominal wall. The way the breathing works is that when you puff out your chest and then breathe out or breathe in, you separate those two membranes. This greatly stimulates the vagus nerve — and that puts you to sleep. 

The Supta Padangusthasana works by the stretch mechanism of getting your brain to quiet down,  and causing the muscles to relax. The Vairagya concepts can structure a thrilling and deepening meditation, but here, in your bed, they function more like counting sheep. Passively reviewing the concepts and watching their natural attenuation is soothing and keeps the mind from more mischievous obstacles to sleep. 

CoveyClub: Is it best to do these poses just before bedtime? 

Dr. Fishman: You can do this before bed if you can’t fall asleep, or in the middle of the night if you can’t fall back asleep. 

Also, for the 10 percent of people in whom this doesn’t work, I recommend getting up and doing 20 minutes of yoga: Involving yourself in these deft and graceful maneuvers for a slightly longer period of time will have the same effect of relaxing the muscles, but even more pervasively. I would start with simple standing poses like Vrikshasana (tree) and Trikonasana (triangle) and possibly Parsvakonasana (side-angle pose), then Sirsasana or Sarvangasana (headstand or shoulder stand), then one or two back bends such as Salabhasana (locust) or Setu Bandhasana (bridge), then a few forward bends such as Janu Sirsasana (head to knee) and Upavista Konasana (legs spread forward bend), and then a twist or two (Marichyasana, Matsyendrasana). Then go straight to bed. 

CoveyClub:  We all relish getting a good night’s sleep, but as a specialist in rehabilitative medicine, can you address the importance of sleep in recovery — and to health in general? 

Dr. Fishman: There are good studies that show that you can’t really develop your best immune reaction if you don’t sleep seven or eight hours. They’ve done studies where they’ve given the flu vaccine, and you get 40 percent less antibodies in subjects who don’t sleep eight hours — that’s almost half the immune response one hopes to see. A large European study of almost 25,000 individuals found that sleeping six hours or less was associated with a 40 percent increased risk of developing cancer. Another study (at the University of Chicago) of 75,000 women across an 11-year period showed a 200 percent increase in the speed and size of cancer growth in those who slept less than six hours. And a study at the Surrey Sleep Research Center in England found that the activity of 711 genes was reduced in people who slept six hours or less, meaning you’re not functioning at full capacity. Whatever those genes were doing, they ain’t doing.

CoveyClub: Many women are suffering from insomnia right now because of pandemic-induced anxiety. Yoga not only helps combat insomnia, but also helps reduce anxiety, right? 

Dr. Fishman: Yes, yoga activates the parasympathetic nervous system, which is the system associated with lower anxiety, and also affects parts of the brain with definite relaxing and anxiety-lowering results. The pandemic makes everyone scared they’re going to get COVID-19 — or die from it,  or communicate it to their children, or their grandparents. Many are also economically bereft, they are deprived of all their social interactions, and they’re sedentary because they’re not getting around as much. For all these reasons, there is much more insomnia than there was before. People are sleeping less — and they’re eating more. I have a book called Yoga for Weight Loss coming out at the beginning of next year.

You can find a video demonstration of the yoga for sleep exercises on Dr. Fishman’s website, YIP.org.  If you register for a free trial of Yoga Injury Prevention, which provides yoga dos and don’ts — as well as beneficial poses — for many medical conditions, you can access the video under “insomnia.”