One of the basics of sleep hygiene is to sleep in a darkened room. Kind of a no-brainer.
However, what is a common reason people wake up in the night? If you’re like me, it’s often to go to the bathroom. Where are the brightest lights in your whole house? Likely the bathroom. Imagine the signal these bright lights are sending to your sleep systems?
Maybe you wake up for some other reason and next thing you know, you’re scrolling on your phone. Many are aware there’s a way to switch it from Light to Dark mode so perhaps the light won’t interfere with you getting back to sleep – too much.
Yet, what is the content you’re reading? Is it news? Social media? Is it something that might alert or arouse your nervous system or thoughts… late at night? Both, seem to have a way to wind things up for many.
These are a few of the things we will be exploring in Rest & Restore: Strategies for Sleep that begins Feb 16th. Each Tuesday night we’ll dig into some of the research around sleep. Then, explore some practices to help calm your sleep systems or change some unsupportive sleep patterns. Add in some quiet time and finally an opportunity to ask questions, connect with others should that be of interest you.
Though the sessions will be on Zoom, if you’re not a Zoom user or are experiencing Zoom fatigue, everything will be available for you to view on your own schedule, at your own convenience on the Teach:able platform.
Did you know “chronic insomnia is highly prevalent and affects approximately 30% of the general population?” 1
Or, that “approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder – most notably depression?” 2
That “sleep complaints are present in 67-88% of chronic pain disorders?” 3
I was aware of the third statistic, that sleep can be a contributing factor for people living with chronic pain. But why my interest in sleep, generally? I had (mostly) been a good sleeper yet started to experience disruptions to my sleep patterns over the past few years. Along came menopause and similar to many others I found myself in a cycle of wakefulness around 2, 3, 4 in the morning and went looking for solutions.
Last fall, however, something else happened. On a Facebook page I belong to, the subject of sleep was brought up. Well, the lack thereof.
I was curious if it was only menopausal women who were struggling with sleep, so I created a random poll. Within an hour or so, there were hundreds of responses.
74 comments about issues with sleep.
224 neither menopausal or perimenopausal
34 ‘other reasons’
Clearly a problem for many but I was surprised to learn that it wasn’t only my age group challenged by this issue. The poll wasn’t scientific and could just reflect the ages of people in the Facebook group. Yet, wow!
Of course people will at times need specific diagnosis, treatment and care from healthcare professionals. Yet, digging into some of the research and after some of the behavioral or environmental factors are addressed with general sleep hygiene information, a lot of what affects sleep has to do with stress and the nervous system (and other systems… circadian, homeostasis, etc.). Which you can learn to influence and modulate.
Would you be interested in exploring this thing called sleep? Safely, gently, with compassion and care you’ll get to experience and learn what might be helpful for you. In your own home, cozy in your pajamas … having some time and space to do so.
A 4-week workshop Rest & Restore: Strategies for Sleep starts Feb 16th!
What are the many factors or contributors that affect sleep? What does the research tell us? What can you do during the day, that will affect your sleep at night? What can you do when waking up from sleep? How might you find some rest in the day, if your sleep wasn’t that great?
If you’d like to join in, registration is now open.
I’ve tried to make it affordable at just $20 each week. If finances are really tight, reach out to me at firstname.lastname@example.org. If finances are plentiful, please reach out as well and look to sponsor someone else.
I’d love for you to join in. Experience and learn what might can be helpful, for you.
1. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-S10.
2. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-S10.
3. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
The second question people often ask me about Pain Care Yoga classes, after “who is it that comes to these classes” described here, is “what do you do in them”?
Pain is never just about one thing. You want to know what’s wrong. How you’re going to fix it. And how long it’s going to take. And rightly so, as having long-term pain often changes everything for you and how you live your life.
When it comes to pain, however, it is usually not that simple which is why searching for ‘the thing‘ usually doesn’t work in the long-term. Particularly if you’ve had pain for a long time. Which doesn’t mean to say that it can’t change. It can. We know what can help to bring about change, the best practices research points to.
Two key aspects, education … and movement, are important. So that’s what we do in these classes.
Some kind of education piece, usually at the start of the class, is provided. I only spend a few minutes on this, but it’s important to do so. One of the most common things I see with people in pain is the fear of moving. If I can help you to understand why it might be safe to move and why it’s important to do so, that’s a good place to begin.
“Current evidence supports the use of pain neuroscience education (PNE) for chronic musculoskeletal (MSK) disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.” 
Then, you practice. You get to experience how you might move, with guidance and guidelines, to learn what’s right for you. Which often won’t be the same as others in the room.
This is not a typical yoga class with sun salutations, downward dogs, lunges, forward folds, backbends. It is not even what I would call a ‘gentle yoga class’. Yes, we use slow, gentle movements. Yet, sometimes you might begin by just imagining the movement if you don’t yet feel safe to do it. Or you might practice it in your mind, plan out how you might go about it and if it feels right for you. It is always your choice to do or not do anything presented in class. You always get to decide how to move, how far to move, by using a slow, mindful exploration along with guidelines and principles utilized.
Most movements are fairly simple and modifications are always available. You’ll experience a lot of repetition, and rhythmic movements. Movements that cross the midline of the body. Movements that challenge your brain as well as challenging your body. You, anyone, can really begin wherever you’re at. With what’s right for you.
There will always be some kind of breathwork or a breath awareness piece in the practice. Again, it’s not so much about controlling the breath, rather what you might notice about your breath. How breath can be an indicator of your physical and emotional state at any given time. Also, learning how breath can help to bring about change to your nervous system, physiology, which can then change your experience of pain.
Like breath, awareness is key. So often when you are in pain the last thing you want to do is pay more attention to your body. But in fact, this paying attention is your guide to changing pain. It is in this noticing that you can begin to explore what the signals (or sensations) you feel might be indicating, what might be your unique contributors to pain, what might be the reasons for flare-ups. This practice is not only about noticing your body in class but then also paying attention to your whole self in your environment, in the larger world you live in.
There are many reasons, purposes and benefits to practice relaxation techniques. In most yoga classes this is done at the end of class. Though we’ll also do some kind of formal relaxation practice at the end, relaxation or creating a state of calm is facilitated right from the start.
It is when you are in a place of safety, when you are calm and relaxed, that change is likely to occur. It is this place of calm (a parasympathetic state) when you might first experience a change in your pain. Without this, it’s no different than trying to stretch, exercise, push through and strengthen your pain away, which seems not to work out so well.
If you’re interested in learning more, have any questions or would like to sign up for the next series of classes starting at the end of February, please get in touch here. I’d love for you to experience, how you might learn to change your pain. Or, if you prefer a one-to-one session, information can be found here.
 Adriaan Louw, Kory Zimney, Emilio J. Puentedura & Ina Diener(2016)The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature,Physiotherapy Theory and Practice,32:5,332-355,DOI: 10.1080/09593985.2016.1194646
Unhelpful beliefs about LBP are associated with greater levels of pain, disability, work absenteeism, medication use and healthcare seeking. Unhelpful beliefs are common in people with and without LBP, and can be reinforced by the media, industry groups and well-meaning clinicians.”
The purpose of the editorial (made free due to popular demand, read it here) and the infographic is to “identify 10 common unhelpful beliefs about LBP and outline how they may influence behavioral and psychological responses with pain”.
The authors are also “calling on clinicians to incorporate these into their interactions with patients.”
This is so important. It’s why I always include a touch of education and information as part of my Pain Care Yoga classes. When people are in pain, it’s difficult to understand why it might be safe to move, how important it is to move and how movement “doesn’t mean you are doing harm – FACT #5”.
I hope these FACTS will bring some curiosity to your beliefs. I hope you might consider what you believe and how they might influence your experience of pain, either positively or negatively.
Sometimes, however, information is not enough. I, we, can give you all the ‘FACTS’ but often until you experience that you CAN move without pain it’s difficult to change beliefs.
As called for in the editorial, I am personally committed to bringing evidence-informed information and education to the people I work with and hope to provide a new experience to get you moving again, with confidence.
Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet 2018;391:2368-83.
Buchbinder R, van Tulder M, Oberg B, et al. Low back pain: a call for action. The Lancet 2018;391:2384-8.
Similar to the current biopsychosocial model used in the medical community when working with people suffering from chronic or persistent pain, yoga therapists utilize a comparable framework or philosophy, that being the panca maya kosha model.
The felted model above (by my colleague @meyogalune) beautifully illustrates how we might look at, explore and peel back the many layers of our existence when working with someone therapeutically. We are, after all, more than a body of tissue and matter.
What does this mean, exactly?
Let me provide a very general, simplistic idea of what each represents:
Annamaya kosha. You can think of this generally, as the physical layer.
Pranamaya kosha, or the energetic layer.
Manomaya kosha, or the mental/emotional layer.
Vijnanamaya kosha, or the mind. We might also refer to this as intellect or wisdom.
Anandamaya kosha, or the spiritual, blissful layer. What I prefer to call the meaning and purpose of someone’s self, or life.
What happens sometimes in our current medical system is the person is looked at, evaluated by and treated in terms of the physical layer only or from a biomedical model, rather than a biopsychosocial model. This can be due to a multitude of reasons but I’ll highlight just a couple, below.
One, that may be surprising to you, is how many of our medical professionals are provided little training, specifically, in pain. (1) “In a review of 10 Canadian Universities across 7 provinces… 68% of programs were unable to specify any designated hours for pain educationand veterinary students were shown to receive 2-5 times more pain education than that of health science students (Watt-Watson et.al., 2009). Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain (Wideman et. al., 2019b).”
Another reason might also be lack of time that’s allocated to people given our over-burdened system and/or accessibility into “self-management programs that educate people about their condition and build their capacity to take action.” (2)
What is now understood about pain and as stated in the IASP definition, pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. ” You might think of it as an ‘actual, or potential threat to the system’, that system or organism, being YOU. Your whole person.
And often these threats to the system are just under your level of awareness. Or as David Butler says “DIMs and SIMs can hide in hard to find places”. Referencing DIMs as being the Danger in Me, while SIMs as being the Safety in Me. (If you want a brief explanation of this concept, here’s a link.)
We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger (Moseley and Butler 2015, pp14).
People sometimes think that their pain problem is, or must be, something physical. Or, sadly, they think or are told, that its all in their head. Pain is complex and by bringing a sense of curiosity to explore many areas, layers or koshas and how they might be affecting you either positively (perhaps a SIM) or negatively (maybe a DIM) we might just change this human experience, we call pain. Your experience of pain.
If you’re interested in exploring this further, I offer both private sessions or group classes utilizing this approach. Along with awareness, exploratory and gentle movement practices, I always add in an educational aspect or some yoga philosophy in line with what we know about pain and how you can learn to be your own best resource. Click here, to see my current schedule.
References above are from ‘A Report by the Canadian Pain Task Force, June 2019’. You can read the full report here, if interested.
(1) “…the current state of pain education in Canada remains inadequate across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts (NASME, 2019; Thompson et. al., 2018).” On page 21 of the report.
(2) “Research in 2005-2006 indicated the median wait time for a first appointment at a MPTC was 6 months….. In a recent update to this work, researchers found little change in the wait times, noting in 2017-2018 the median wait time still hovered around 5.5 months, with some people waiting up to 4 years to access to multidisciplinary pain care (Choinière et. al., 2019).” On page 18 of the report.
How might we blend yoga with science to provide pain care to people? A new book just released provides a way forward.
“Our vision is for this book to improve care for people living in pain, whether acute or chronic pain. We believe health care professionals and yoga therapists can enhance care through deeper understanding of pain, science and evidence-informed interventions. We also believe that professionals can enhance their work through integrating yoga concepts, practices and philosophies. As such, this book is meant to bridge yoga, pain science and evidence-informed rehabilitation … and will inform those committed to helping people with this largely undertreated issue that causes so much suffering in the world.” – Preface, Yoga and Science in Pain Care; Edited by Neil Pearson, Shelly Prosko, Marlysa Sullivan
The first chapter by Joletta Belton is about the “Lived Experience of Pain” highlighting to me the need to listen to, acknowledge and consider first, the person and their experience.
“The authors provide an integrated, in-depth understanding of how yoga therapy can be incorporated within a modern understanding of pain as an experience. The book encompasses perspectives from people living with pain, summarises research progress in the field, debates theories of pain and pain management, considers the many different yoga practices, describes pain biology, self-regulation and examines breath, body awareness, nutrition, emotions and response to pain, and above all, integrates concern for practitioners and people in pain as humans sharing an intangible experience together. The authors write about how yoga therapy can provide a uniting and compassionate approach to helping people learn to live well.”
– Bronwyn Lennox Thompson, PhD, MSc, DipOT, Postgraduate Academic Programme Leader, Pain and Pain Management, Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, NZ
There are a lot of yoga books on shelves these days. Yoga for this, yoga for that. You name it; it’s being written about. The trouble with this and certainly when talking about pain is the approach is about the condition, the problem, the illness or disease. What’s often left out is the person. Which may be one of the reasons why we fail in helping people.
After all, your pain is not the same as my pain. Not only is the physical aspect different, my body different, my genetics, my structure. Almost more important is the rest of ‘me’ that’s different from ‘you’.
My life history is different from yours. My environment is different from yours. My stressors are probably not your stressors. My understanding of pain probably differs from yours. My expectations, beliefs and thoughts about my pain will be different from yours. My social structures, friends, family, work-life will all be different. So how might we believe we can just apply this ‘fix’ to everyone who experiences pain? It just doesn’t make sense, when you think about it. Particularly when we understand that pain… is… complex.
We, therefore, should look to explore and be curious about all the things that might be contributing to your particular experience of pain. Similarly, individualize the care, tools, techniques and practices with what research tells us might be useful, to change your pain.
You may have had pain for years. Like 30+ years or more. Still, there is an opportunity for change based on what we know about pain and how it works. There is much still to learn but we can change the nervous system, We can change the brain. We can change physiology and most likely all three of these have been changed if your pain has been ongoing.
Pain can change. There is hope. I will keep saying this over and over and over again …
If you’re the type that likes read and learn about this yourself, order a copy of the book, here.
If you’re the type that would like to learn from me in person or in a class setting with others, check out my updated schedule for the fall, here. New classes starting in September!
Joletta Belton, as noted above, writes a blog “My Cuppa Joe” about the lived experience of pain. Among other things, she is a speaker, educator and advocate for people in pain. You can read her blog, here.
Bronwyn Lennox Thompson also writes a blog “Healthskills: For health professionals supporting chronic pain self management.” An exceptional resource for information, research, and discussion. You can check it out here.