About Sleep

How exactly do sleep and pain connect?

We know that pain impacts how we sleep, and emerging research shows that poor sleep impacts pain levels, increasing our sensitivity to pain and, separately, decreasing our brains’ analgesic response. A 2018 pilot study, featured in the New York Times, refers to sleep as "a novel therapeutic target for pain management." Since then, we've noticed a growing interest in sleep and sleep therapies.

Simply put: Back pain or another kind of pain interrupts sleep. It’s a brutal cycle: Bad sleep quality → less pain tolerance → worse sleep → more pain sensitivity. Pain and tension = poor sleep quality.

Good news: We can disrupt this cycle on both sides, by improving sleep and pain levels. This is where the right movements in the right doses, along with body-mind skills of yoga and mindfulness, can be helpful.

The specifics, if you’re a research geek like me: Sleep problems significantly increase the risk for reduced pain tolerance (in a 2015 study). And 83% of participants with chronic back pain suffered from insomnia, and almost one-third with daytime sleepiness that led to lower perceived quality of life (in a 2018 study). A large study of 3,508 participants confirmed that bad sleep worsens pain; bad pain worsens sleep (in another 2018 study).

I want to sleep better, yet there are so many other things I know I’m supposed to do to be healthier. Why prioritize sleep?

Sleep is the master key and “foundation” of health and our body systems: cardiovascular, metabolic, immune, reproductive…. Even our devices have a sleep mode and need to be recharged. Common wisdom (and one of my favorite quotations) holds that "almost everything will work again if you unplug it for a few minutes— including you," (from writer Anne Lamott).

I don’t have to tell you that making through the day is rough after a lousy night’s sleep, especially when we’re to perform at work and be our best selves at home.

What is more, insufficient or short sleep damages heart health and is linked to hypertension, heart attack, and stroke (especially among adults over 45); weight gain and obesity; dementia and Alzheimer’s disease; lowered immunity and susceptibility to infection and inflammation; and alterations in our genetic code.

In contrast, improved sleep benefits all our systems and health: libido and sexual function, digestive health, athletic performance, learning and memory, immunity, cancer survivorship, quality of life… and on and on. From seasonal cold prevention to our longevity.

This is why we prioritize sleep as part of our work together (acknowledging that sweet sleep can be extra-challenging if you have young kids). That’s why I work with building daily routines + breath + movement for sleep, rest, pain recovery… and play!

How exactly do I make better sleep happen?

More good news: There are ways to sleep better— and they don’t have to be patchwork, pills, or technological in nature. Rest is a skill that can be learned.

1. Get ready.

Decide whether you’re ready to prioritize sleep and rest. Our bodies (and societal norms) are so off-balance in rest, sleep, and our go-to energy sources often are part of the problem. If your previous sleep-fixes aren’t doing the trick any more, it’s a great time to change it up. Ready?

2. Catch the right clues.

Assess your sleep and rest habits and other things that influence sleep. (I can help with this.) Note your current patterns: sleep time, wake time, and all the times in between. Audit your inputs: caffeine, screen time, work, exercise or lack of activity, nutrition, travel, breathing patterns, how you de-stress, and other aspects of daily life that you may not have considered yet and can impact the nervous system, therefore rest and sleep.

3. Look ahead.

Look ahead for better sleep. If you want a good night’s sleep, start in the morning. Better yet, start the day or week before! Choices during the day can impact restfulness (or restlessness) that night. Simple (maybe not easy): start to go to bed and wake up at the same time each day. Create a joyful and relaxing pre-bed routine.

You will learn sleep skills and “pocket practice” portable tools for meeting sleepless or interrupted sleep with equanimity, breath rhythms, progressive relaxation, and before-bed / upon-waking movement sequences, and other ways of settling the busy, anxious or scattered mind.

4. Move.

Choose the right movements at the right times and in the right doses to promote sleep and reduce pain, which promotes sleep even more. In the RE/ST Method, therapeutic movement is essential as context and support for better sleep.

5. Simplify. Be gentle with yourself.

A simple sleep kit with gear, a basic plan, and a clear intention. Make small changes that are sustainable, and be patient with yourself as you practice, and refine. This helps quell the anxiety, frustration, and fear of not sleeping that can add to the suffering of sleeplessness.

If I didn’t get enough sleep, how can I make the day better?

Forgive. Not everyone sleeps well every night, and that’s OK.
Resist the urge to caffeinate or self-medicate (sedation ≠ sleep).
Lay off the sugary carbs, as that can set off the cycle again. Opt for the integrative practices (that you’ve learned with me!) to help with pain relief and calming the nervous system.
Gentle, just like you’d be with someone you love who hadn’t slept well. Do that for yourself.
Note. One route is to turn toward the feelings of exhaustion, anxiety or distractibility— with curiosity, of all things! What's needed, now?
Move. Find time, even if it’s 5-10 minutes (ideally upon getting up and again in the afternoon) for gentle/rhythmic movement.
Nap, briefly. (Yes, I’m in favor of planned napping within parameters; we can talk about this.) Or give yourself a restorative yoga posture, as privacy and time allow.
Let it go. When all else fails, remember that you will have another sleep opportunity soon in the future, maybe this evening, so the daytime choices and intakes matter.
Power down to power up, not power through. Sublime sleep for all!

What is sleep apnea?

Obstructive Sleep Apnea (OSA) refers to the airway becoming blocked multiple times a night during sleep, causing multiple, brief awakenings and disrupted sleep. With a host of short- and longer-term, life-threatening consequences: OSA is a primary cause of drowsy-driving accidents, as well as being linked to weight gain, heart problems, high blood pressure, and other poor health outcomes (see FAQ: Why should I prioritize sleep). It’s chronic, and often the person with OSA is unaware until a sleep partner points it out (snoring, gasping), or you notice a lot of daytime sleepiness. When you work with me, we assess your sleep routines and habits, and I may recommend that you also visit the National Sleep Foundation online, a great resource. For conditions of severe insomnia (more than three nights a week for more than three months) and sleep apnea, I strongly suggest you contact your primary care doctor or internist and ask for referral to a Sleep Clinic.

What about restless leg syndrome?

Restless Leg Syndrome (RLS), also known as Willis-Ekbom Disease, is a sensorimotor disorder that may affect sleep in the person with RLS, or by disturbing their sleep partner.

It’s characterized by a strong urge to move the legs in order to relieve unpleasant feelings. This urge happens when resting (think: seated on an airplane) and inactive (think: lying down in bed), and tends to be worse at night. In this way, RLS contributes to insomnia, as it can be hard to fall asleep and stay asleep. Research shows increased prevalence of mood disturbances, sleep disturbances, and impaired quality of life with RLS.

Studies of yoga therapy as an intervention for RLS show benefits in improved sleep, mood, and perceived stress, and decrease in RLS symptoms and severity. Research also recommends lifestyle changes: Sleep routines! Breath retraining (to address peripheral hypoxia). Relaxation techniques. Moderate physical activities (walking, stretching, yoga). Taking a bath, massage, heat or ice packs, and mentally challenging tasks before bed(!). I can support you in making these types of changes.

My mind won’t turn off so I can sleep, can therapeutic yoga or meditation help?

I know what you mean— thoughts and to-do lists, rehashing and rehearsing can be exhausting and yet keep us from rest. There’s a common misconception that meditation will "turn off" the mind. And yet, we can learn skills for the anxious or busy mind to incline toward sounder sleep and rest. The right selection and sequencing (and time of day) for simple movements and breathing also can help relax the nervous system and invite better sleep. Yes, therapeutic yoga and meditation can help befriend the body-mind and support better sleep, as well as offering natural recovery strategies when good sleep eludes us.