The chicken or the egg?

This question about what comes first. The onset of chronic pain (and/or other conditions) from sleep disturbance or the relevance of sleep disturbance due to chronic pain?

Here’s some of what we know about sleep …

Sleep complaints are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia – the most commonly diagnosed disorder of sleep impairment – suffer from chronic pain. Further, both chronic pain and sleep disturbances share an array of physical and mental health comorbidities, such as obesity, type 2 diabetes and depression.” 1

One study found that “women who endorse frequent, “sleep problems,” defined as frequently difficult falling asleep or having a sleep disorder, were significantly more likely to develop fibromyalgia 10 years later.” 2

Also, in another how “sleep disturbance temporally preceded increases in pain, … in “temporomandibular disorder (TMD).” 3

Similar research is being conducted in terms of cancer pain, for depression, PTSD and ageing (including Alzheimer’s and dementia).

I knew poor sleep to be a contributing factor for people who live with chronic pain. What I didn’t know was how it affects not only physical health but mental health.

What’s piqued my interest is in new studies where a trend has emerged suggesting that sleep disturbance may be a stronger predictor for pain than pain of sleep disturbance.” 4

…several longitudinal studies convincingly demonstrate that insomnia symptoms significantly increase the risk of developing future chronic pain disorders in previously pain-free individuals, whereas existing pain is not a strong predictor of new incident cases of insomnia.” 5

Not just a stronger predictor for pain, but also in terms of mental health conditions.

This bidirectionality or said another way, “what came first, the chicken or the egg?”

Lots of studies to examine obviously, but here’s one on the positive side “Quality sleep has also been shown to predict chronic widespread pain symptom resolution over 15 months.” 6

Researchers will continue to find out more and doctors will refer out to specialists in many areas. Pretty much the gold standard for treating insomnia now is CBTi or Cognitive Behavioral Therapy for Insomnia.

Yet, there are things you can learn to do for yourself, that will help.

Curious about this? Exploring some practices, tools and gaining resources that can support you in getting a better night’s sleep. What stress and the nervous system have to do with sleep? Or how you might find rest during the day?

I’m offering a 4-week workshop starting Feb. 16th at 7:30pm ET.

You’ll have some time and space to explore, experience what might be helpful for you all in the comfort of your own home. Online. Change into some comfy clothes, grab a warm cup of herbal tea and join in. Anyone can follow along. We’ll be rolling on the floor a little, expending energy maybe by rocking and swaying, taking some breaths together. And learning “all the things your parents/doctors/friends/colleagues never told you… about sleep.” There’s a lot more to it than just laying your head down on a pillow, each night.

References:

  1. 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
  2. Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012 Jan;64(1):281-4. doi: 10.1002/art.33346. PMID: 22081440.
  3. Quartana PJ, Wickwire EM, Klick B, Grace E, Smith MT. Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis. Pain. 2010 May;149(2):325-331. doi: 10.1016/j.pain.2010.02.029. Epub 2010 Mar 31. PMID: 20359824.
  4. 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
  5. 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
  6. K. A. Davies, G. J. Macfarlane, B. I. Nicholl, C. Dickens, R. Morriss, D. Ray, J. McBeth Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology (Oxford) 2008 Dec; 47(12): 1809–1813. doi: 10.1093/rheumatology/ken389

You’re not sleeping either?

woman in red long sleeve shirt sitting on chair while leaning on laptop
Photo by Andrea Piacquadio on Pexels.com

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.

  • 404 responses
  • 74 comments about issues with sleep.
  • 224 neither menopausal or perimenopausal
  • 95 perimenopausal
  • 51 menopausal
  • 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 info@yogatoolsforlife.com. 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.

References:

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

Just, Calm Down

It was probably my first year as a yoga teacher, 10 years ago now, when I had a student in my class I so clearly recall would get up and leave as soon as it was time for Savasana. I’ve been trying to remember what I offered her in terms of advice but it escapes me now. Likely, I didn’t have much to offer. Yet I did empathize and understand why she left, unable to stay in this ‘corpse pose’ as it’s often called.

Ask the same of people when they are told to “just” sit still and meditate. Particularly if they’re experiencing anxiety, or high levels of stress and notice what happens.

Or telling a young child having a full-blown meltdown to “just” calm down.

The last thing anyone can do in these moments is calm down. There are likely to be many reasons for the state in which people find themselves and can’t calm themselves, but the ‘state’ is the important piece.

If someone is in a state of arousal, a natural nervous system response, telling them to do the opposite may not be helpful. It might add to the stress or leave them feeling ashamed about not being able to control their emotions or behavior. All this movement, powerful breathwork (sobbing), yelling, screaming, stomping of feet, tossing and turning the body in an attempt to express feelings and emotions going on inside (insert here: toddler meltdown).

There are some ways, practices or movements that enable calming down or a relaxation response. But it might be something just the opposite that’s needed to even begin this shift. Maybe what was needed, in this particular situation, is a mobilized response. We need both… to survive and engage in the wide variety of experience life is going to throw our way.

Recognizing the state is the first piece. Having some tools and options to choose from that might be helpful to you in the moment, could be a good thing to practice.

Today, I would have a few suggestions should this person turn up in my yoga class and find it a struggle being in corpse pose.

I’m kicking off a workshop in February all about SLEEP. Deep rest. How one might get to a place of settling in… for the night. Or for Savasana. Or if you’re having a hard time with routine, uncertainty, stress in these days you might find it helpful as well. I’d love for you to join in so stay tuned here, or you can sign up at yogatoolsforlife.com.

Habits of ours. Helpful or not?

What else might you do to prepare for sleep?

You might want to get a little curious about current habits. Perhaps life-long ones.

For example, I have never showered or bathed at night as I prefer it in the morning to get set for the day. It also helps me to wake up. But I am finding lately that a warm shower at night, the warmth feels awfully good. Perhaps it feels, or symbolizes in some way, that I’m washing away the day and stepping into sleep renewed. Refreshed.

Sipping on a warm beverage might be appealing. A herbal tea, water, lemon & honey, warm milk on its own or with turmeric. These might feel soothing and satisfying for you in some way. A ritual that becomes a way to mark the end of day, the coming into rest and restoration.

Maybe a foot massage might feel good. I have no formal training in massage, yet I’ve been doing this for a while now. It only takes a couple of minutes, but there is something about the massaging of the feet that makes me go “ahhhhhhhh……..”. I have to say in our travels that anywhere and everywhere we see foot massage on offer, people are lined up and waiting!

You can incorporate using oil with the massage, maybe even warming the oil beforehand. I tend to use almond oil, but you might like coconut or another of your choice.  I don’t choose to warm the oil, but rather just pour a little on my hands and then massage my feet in any old way, for about 3-5 minutes on each foot. (You’ll want to put some loose socks on afterwards, so as not to get oil on your bedsheets.) Then just notice… Try doing this 3 times a week and see what it feels like for you. I have noticed that while others may hold tension in their jaw, their shoulders, back or hips the tension I feel, what keeps me awake at night, is the inability to relax my feet.

Other soft, turning-inwards things you might try?

Sit by candlelight. Our natural circadian rhythms are disrupted by all the artificial light surrounding and available to us. Then there are all these screens. Do you know there are night settings you can change on your phone or laptop so you’re not having to stare at such a bright screen?

You might read, color, knit, or some other quiet, introspective activity. We tend to spend a LOT of time on screens these days, so anything other than, might be a place to explore.

Tomorrow we’ll lean into some practices you can do when nothing else works. When you are frustrated, can’t get to sleep, can’t get back to sleep. It’s all about distraction. How might we get our brain to turn off, or at least shift the focus of attention to something else.

Turning off, turning in

If you’re feeling stressed or wound up at the end of your day it might be helpful to notice, perhaps try to shift it, BEFORE trying to head off to sleep.

Let me preface this by saying you may not be ready for slow, restful or focusing-in practices. It may be that you feel the need to move in ways that burn off energy. Maybe rocking or swaying from side-to-side, bouncing a little, shaking things out. Perhaps some dancing in the dark… might be what’s needed in the moment.

However, if you’d like to try some ways to calm the nervous system you might practice one of these restful poses. Or maybe do them after the movement mentioned above. Something like legs up the wall, providing support and perhaps release for the back muscles, or tension elsewhere in the body. Or maybe the beginnings of turning inward, so a forward fold on a chair, or over a bolster.

This doesn’t have to take a long time. You may want to stay in one of these poses for 5 to 10 minutes. See what happens.

Notice the length and the quality of your breath. Notice if it shifts at all, while in the pose.

Notice your thoughts. Feelings.

Maybe it’s helpful for you to listen to calming music, be in a place with lowered, soft lighting.

Taking a few minutes may help to make the transition into sleep a little more easeful. Try it. I’d love to know if anything changes at all for you.

Balancing Act

In preparation for sleep at the end of your day, it might be another time to check in with how you’re feeling.

You might feel fully exhausted, in which case you may have an easier time falling asleep. Yet, even if you’re physically exhausted there is also a possibility of being in a mobilized, or upregulated state in your nervous system.

  • You may have been going full speed ahead with what feels like a million things required of you on any given day. Trying to balance what seems like never-ending demands.
  • Maybe you’ve just had an emotional or stress-filled conversation with someone.
  • You might be feeling some of the long-term stress from these strange times of Covid-19.
  • Maybe you ate a big meal late in the evening as you didn’t had time to do so, earlier.

Your body, your physiology, automatically changes and/or responds to what is going on, what is required in a given moment of time. First of all it takes some awareness to even notice what the state of being, or the state of your nervous system, is. If you’re in fight, flight or freeze (a more sympathetic nervous system response) sleep might not come so easily. However, if you can learn to shift into a more parasympathetic type response (the rest and digest response) it might make the transition to sleep more easeful.

The first step is in the noticing.

Perhaps you can do a body scan to notice what you feel. Bringing your awareness slowly to each part of your body, noticing any sensation you feel or any thoughts or feelings that arise as you do this. Or you may come to know through noticing the quality of your breath. Or perhaps noticing your thoughts and emotions.

People often have difficult going to sleep. More so these days, I find. You might want to look at it, approach it, in a way that requires some preparation. We need both types of nervous systems responses. We have stresses in our life, we need to mobilize. Yet, how might we find some balance and what practices might be helpful in the evening to downregulate our system. To allow for rest and build capacity to meet the challenges of our days. What might make the transition, more easeful? We’ll dig into a few this week.

More than one thing

Taking a brief pause again until Monday, Dec 7th before offering up some evening practices. If you’ve been following along you might want to return to some of the daytime options below.

Nov. 23 What goes unnoticed

Nov. 24   Riding the waves

Nov. 26   Move. Maybe slowly, softly, gently

Nov. 27   Nourishment

Nov. 29   Re-store. Re-set. Re-new.

Nov. 30   Transitions

Or to the morning practice options as noted here.

Again, this is not to say you should be doing “ALL OF THE THINGS”. Particularly as some of THE THINGS likely won’t resonate or feel right for you in your life as it is today. We all have different lives, environments, needs, bodies, histories.

Which is why getting curious and exploratory can be useful rather than having someone tell you this is THE THING that will work for you. In my experience, if THE THING worked for everyone we wouldn’t have 1 in 4 people living with chronic pain, or so many other conditions or concerns. What if you’re told ‘just do this’ and it doesn’t work? Maybe you end up feeling like you failed in some way (once again), rather than perhaps it wasn’t what was right for you.

If you’d like the opportunity to work with me, I currently offer private 1:1 sessions. Stay tuned for new offerings coming your way in the New Year! Sign up on the yogatoolsforlife website, or follow along on Facebook or Instagram.

Transitions

I can recall when our son came home to visit after living on his own in Europe for a couple of years and he had acquired a new habit. That being changing from his work clothes to his inside clothes. They were kind of like pajamas, only a bit dressier. It seemed strange at first. I’d not seen him walking around the house dressed like that since, well, a very long time ago. I guess I can relate a little thinking back many years ago and coming  home, changing out of my ‘corporate suit’ and into something more comfortable. At least I think I did. Did I, or did I move straight into doing stuff with the kids, tidying up, cooking dinner? This leaving of one job or role and straight into another?

When practicing yoga it is often the transitions where problems occur in terms of difficulty or even injury. I wonder if it’s because we’re already thinking about the next ‘pose’ rather than giving much thought to how we might get there.

I think it’s where we often face our greatest challenges. Transitions. How do we ‘go across’ from one thing to another.

Child to teenager. To cohabitating with a partner, moving into parenthood perhaps. Then it often feels like 20 years zip by and we’re confronted with children leaving, the possibility of retirement. Other big transitions in the mix like illness, career changes, loss of loved ones, jobs, homes, maybe moving.

But back to even just the simplest of these. How might you transition from your work day and whatever that is for you… into the evening? Does your 5 o’clock look like a big energy crash? A wild and untamed household? Too many demands on your time, yet again?

How might you make it supportive in some way? Less overwhelming?

If you’ve spent your day where conversation is required non-stop, maybe you recognize your need for quiet. If you’ve been working alone where there is no conversation, you may be in need of connection. How might you meet those needs? And if you’ve others to consider during these transitions – how might you somehow meet in the middle?

I surely don’t have all the answers.

It might be worthwhile to consider though.

Creating some kind of ritual might be helpful. We have rituals around big life changes, or at least we used to. Weddings, funerals, rites of passage.

What might you do? Perhaps it is about changing your clothes. Or slowing down, having a cup of tea, or some kind of (prepared in advance) snack so you’re not reaching for the cookies or chips, or whatever’s nearest to your fingertips.

How do you move from one thing to the next? This going across? How do you know one thing is ending and a new one is beginning? It makes sense to first bring some awareness that it’s even happening. From there, perhaps making choices that might support it in some way. So, it’s more easeful. Less frantic.

What ideas do you have, do you use? I’d be interested in your strategies.

Re-store. Re-set. Re-new.

I remember the first restorative yoga I attended. Taught by the lovely Olivia Kulla, back in my Doha days. I thought I would feel all so sleepy, y’know? After the supportive poses, soft music, candle light. Basically having so much support, someone to “tuck me in” so to say. Allow me to fully rest.

What I didn’t realize is that afterwards I didn’t feel sleepy at all. During, yes. But after I felt energized. Rested. Ready to move forward with whatever I needed to do. It was a fascinating experience.

It was a good lesson in doing less. How less might be more.

Valuable.

Though I no longer practice strength or power styles of yoga like Ashtanga or even a flow-style of yoga I do like to get my sweat on. Take me on a good hike. Some downhill skiing and I’ll be right with you. I’m not against high-powered, cardio building stuff.

Yet, there is something about resting.

Not sleeping. Not watching TV. Not scrolling on the phone. But shutting out what can be overwhelming sensory information that bombards us from every angle these days.

Why not slip into some rest, mid-day? All the suggestions below take only minutes. Like 5 minutes or less. (Though of course if you have more time, you could do them for longer.)

  • A little legs ups the wall, pose.
  • Supported child’s pose (it even sounds sweet and supportive). This, is restorative yoga.
  • A 5 minute meditation. Maybe using an App like Calm or Insight Timer.
  • Stand up and sway from side to side, gazing out the window. Maybe you bounce a little, shake out the arms, legs, fingers, feet.
  • Close your eyes. Massage around your eyes, temples. Maybe into your neck and jaw. The back of your neck.
  • Nadi shodhana or equal nostril breathing. I’ve had clients say how energized they feel after this. However, it might also be used to help fall asleep, so notice how it shifts your energy.
  • My favorite is laying down on the floor. Perhaps a blanket folded, to support the head. Maybe a pillow under my knees which often feels good for the low back. And just rest. I always suggest laying on the floor, rather than a bed, or sofa. If you can notice it, find the support of your body’s structure (bones) on a hard surface. This might allow for the muscles to release any ‘holding’ or tension… and to relax.

Why not do one of these for 5 minutes a day, either before or after lunch (one might feel better for you) and notice what you notice. What feels right and do-able for you?

Restorative yoga. It seems these days it’s often combined with yin, or slow or gentle yoga, or perhaps confused with these. Yet in the trainings I’ve done in the style it’s not about stretching. It’s not about holding. Rather, all about support.

As you can see from the suggestions, it doesn’t have to be restorative yoga but perhaps making some time and space to do something else, take a break, might be useful. What does providing some mid-day support or rest feel like, to you? Let me know how it goes.

Riding the Waves

I can imagine it is difficult these days to feel safe. Find stable ground.

Creating a sense of safety for yourself, like anything, will be unique to you based on your life, your history, experience or environment. Now more than ever, probably a challenge.

For me, getting close to the ground helps. That is, literally. close to the ground. Sitting on the floor with lots of support below helps me to feel secure. Find stability. Another way for me is to find something familiar. That might be my breath. Noticing each inhale, each exhale. Yet for someone who is asthmatic or perhaps experiences anxiety, focusing on the breath might not be ‘the thing’.

Maybe it’s sitting next to your dog, or cat. Perhaps feeling the rhythm of their breath, their purring helps calm your nervous system. Providing that felt sense of safety. We often do that with those we love and care for. Just ‘being with’ them, sitting next to, holding each other’s gaze. Hearing a soft familiar voice might be soothing.

What is helpful to you? You might want to notice that during your day. And if you feel safe, how do you know that? What do you notice or feel in your body? Maybe your breath is long and slow, your muscles soft and relaxed. Your heart rate or blood pressure isn’t noticeable.

If you’re finding it hard to notice, try the opposite. It might be a different experience and one not always welcome but what do you feel, when you’re not safe? How do you know that? Where do you feel it? Hard to breathe, muscles tense, heart beating fast, sweaty palms?

What do you notice about your pain, in either of these states? Or your emotions, thoughts? It might be something worthwhile exploring, during your days. Having an anchor, a place or practice to go to when it feels like these big waves keep crashing down one after another, relentless at times, can be useful.

Hopefully the days will become more certain in the months to come, but it the meantime, this might be a useful practice to cultivate.

#dailypractice #daytime #safety #grounding #stability #breath #waves #uncertainty