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.

Showing Up

I’ve been rather absent for the past three weeks, at least in this space. COVID-19 showed up for a close family member so it has been all-hands-on deck for a few weeks now.

Yet, here we are. A new year, another moment in these particular days that we may not be liking so much.

What I don’t like so much now and maybe in the past as well, is there seems to be this one way to be. A particular way to show up in the world, in any given moment. Whether in times of crisis or just the regular days of work, being part of a family, in relationships, or on my yoga mat.

“This, … is the way it’s to be done. This, … is the way to show up.”

Fortunately, or unfortunately for me, I was never much good with the status quo. At times I can tune in to this quickly. On other occasions it takes a long while before I get the sense that what might be well and good for one, doesn’t feel quite right for me. I’m hoping that as I head into my 60th year on this planet the gap between the two is shortening.

There is always a message, a signal trying to capture my attention and act as a guide. The harder part is listening. Even harder is acting on it.

Why is that?

Well, there does seem to be a cultural or societal expectation to go along with the crowd. We look for cues outside ourself. What is the other person doing, saying? How are they responding? From a young age we’re often taught to fit in. Be nice. Say yes. Maybe don’t say anything at all. Grin and bear it. Smile through the pain or discomfort. Do what others do. Again, “this… is the way to show up”.

Yet times are changing. A slow but forward motion allowing for difference. Celebrating it, even. This might be in terms of looks or gender but also a general movement to change other beliefs. That it might be okay to express who we are. What we feel. What we believe. How we see the world, that what we feel in our own uniqueness, matters.

As I think about another year’s passing what is becoming clearer to me is, there is only … right now. Now is the time to show up.

Which doesn’t therefore mean, my way, is the way. It doesn’t mean anyone or anything else is wrong. It’s only that what will be right and well for one, is not the same for another. Funny enough last year I created an online program exploring just that. It’s interesting to notice that often what I teach, is what I most needed to learn for myself.

Here’s what I’m learning these days.

It can be useful to have a place where I can simply show up with whatever I feel, wherever I’m at. Happy smiley faces not required. That in this New Year I don’t have to be better, more enlightened, 10lbs lighter, happy, smiling, fit or always be in a good mood. Trying to sustain all that these days might be quite a challenge.

That I have permission to do, be, what feels most right.

Maybe the same is true for you.

Warming up

Warm thoughts

As you lay in bed, you might imagine your first cup of coffee or tea. You might prefer warm water with lemon, fresh ginger, a touch of honey. Perhaps a spicy chai. The ritual of running water, filling the kettle, getting out your favorite cup, warming it first with some hot water. Waiting for it to brew. The smell. The first taste. How it warms your hands, your body as it makes its way, particularly on these cold days.

When you go to actually make it in a few minutes, maybe notice more fully and appreciate this very simple way to begin your day. What pleasure it brings. What you notice in your body. Perhaps a feeling of warmth, or of a softening somewhere.

Maybe before climbing out of bed you imagine something else. Taking a few moments to think about a loved one, warms you. Maybe you imagine sitting by the fire with friends. Perhaps you place hand on heart and offer yourself a few minutes of love, compassion… and that warms you.

Warm waters

What about including warmth in the morning in the way of a hot bath, or shower. Really sensing how it feels. The wakening spray of water landing upon you or warm waters, surrounding you. Maybe you notice the sounds. See the steam rising. Feel the water’s cleansing, soft, fluid properties. This warm and tender waking of your body and your senses.

Warm foods

Perhaps, warm foods. Many people these days are into green smoothies and such. I enjoy a light breakfast of crisp greens, bright ripe tomatoes and a boiled egg in the summer. But as we move into the cooler months it might be useful to bring some warmth to food. Just being cooked makes food easier to digest on these slow, sluggish days. Maybe hot oatmeal, toast, biscuits, whatever you prefer. Waffles with the sweetness of local maple syrup, or baked fruit like plums or apples, spiced up as you like.

Fiery, perhaps

Or perhaps your thoughts on any particular morning lean towards the injustices of the world around you and you feel this fiery, hot, anger welling up inside. And that’s what warms you up, gets you moving forward in your day. Who knows?

I get that it’s not always sunshine and rainbows, hot tea, warm baths, clean water that we are privileged to enjoy.

Yet, finding these small moments of warmth, calm, building some resilience to greet the day and whatever that means for you, might be useful.

Or maybe it’s just in the noticing what fuels you, that counts.

To Breathe

Can you bring your attention to your breath? What do you notice?

Immediately following these two questions, your breath is likely to change somewhat. Just bringing your attention to it, is enough to alter it a little.

Walk into most yoga classes and there are often very specific instructions given as to how to breathe. I’ve done this as well when teaching. I still do from time to time, so I’m not saying to never do so. Yet, we might consider when and why it might be useful and appropriate.

Might we begin by just noticing it?

Leave it be.

Allow your breath to respond… rather than consider it is another thing to be fixed. Or regulated, standardized, conformed to. Imposed upon. Being asked to disregard your own natural need or rhythm, during a given experience or situation.

If you’d like to follow along, here’s a 4-min recording you might use to explore your breath early one morning. Or maybe another time during the day. There’s no right or wrong here. Rather, an opportunity to tune in to what might be a place of noticing what we feel, what ‘state of being’ we’re in, what we are experiencing. (Click the link below. You may be directed to another link, or not, depending on where/how you’re viewing it.)

With consistent practice of this checking in with your breath, your body, you might find a pattern. Maybe a baseline of some kind. This might be easier in the morning before you’ve moved or thought too much about the day ahead. But it may be at another time that works well for you.

What does your breath feel like? And then later in the day, notice when it changes. And it surely will from time to time.

Be curious. Check it out. See what you notice. I’d love to hear how it goes for you.

#morningpractice #mornings #breath #breathe #needs #baseline #kindness #compassion #curiosity #feelintoit #feeling #noticing #awareness #time #space #slowdown #yogatherapy #yogatoolsforlife #JRFU #JustRightForYou #startsmall #goslow

Softening

While still in bed you might consider one place to soften in your body.

Notice where you feel some tension or tightness. Stiffness or rigidity. Perhaps you can begin to soften your jaw a little, your eyes, or maybe soften your breath.

It might be useful to imagine or bring to mind a memory you have of a safe, warm, lovely place. I imagine my toes in soft sand, and that they are as soft and supple as when I was a wee toddler.

I turn over and feel the softness of the duvet cover, my pillow.

Maybe I imagine something soft like the these strange little plants (pictured above) that I seem to be obsessed with. Of them blowing softly in the breeze.

Maybe I imagine the soft snow, landing on my face, as I go out for a walk.

Life is hard enough. Might we move towards, bring in, feel in some way, a touch of softness to it.

Even by just imagining it to be so.

#morningpractice #mornings #softening #notice #nourish #touch #stiffness #rigidity #breath #breeze #imagine #yogatherapy #yogatoolsforlife #JRFU #JustRightForYou #startsmall #goslow

Nourishing, Responsive Breath

I could really go on and on about breath, from many different angles and actually have been sent down the rabbit hole for a few days now wondering how I might approach this, in a single blog post.

Our breath, the in-breath and the out-breath happen quite naturally, right?  Of course, they do. It is one of the most important things necessary to our survival. We do not have to think about it. It is just one of the many wonderous systems in our body, working behind the scenes.

However, if you look at how a baby breathes, and how many of us older folks breathe, you might notice a difference. How in babies and young children it almost seems like their whole body moves when they breathe. How their big, soft bellies expand with each inhale. For us, often, not so much.

What’s different?

There could be a whole mess of reasons, but the one I’ll explore here is one you’ve perhaps been exploring over the past week.

Muscular tension might be involved when we hold our breath, or when it doesn’t flow so freely.

What might create this tension?

Last week, I suggested you might explore ordinary movements  you do in a day (like making your bed, maybe it’s vacuuming, perhaps while brushing your teeth) and are they perhaps a little beyond what feels easeful for you? It might be the way you feel while doing something, when rushed. When it feels like there’s not enough time and space to do so (maybe when you’re eating, for instance). Tension might have something to do with your thoughts and emotions. The context in which you live, the people you connect with, while talking, using (or not using) your voice.  

Generally, muscles and tissues may become strained, fatigued over time if they are recruited, or over-recruited, ‘switched on’ a lot. We may not be aware of this, particularly if ongoing over a long period of time. It often becomes our usual ‘pattern’ rather than what might be a responding or releasing (and relaxing) as required.

There are also some areas of the body where this tension might get in the way of a full, easeful, ‘natural’ breath we see in a baby. I think of the stomach or belly area for one. How many people unconsciously hold or constrict in this area for a multitude of reasons? This, which happens to be the area containing your primary breathing muscle, the respiratory diaphragm. Or might someone hold tension unconsciously in their pelvic floor (diaphragm) muscles, again for a variety of reasons?  I think of all those ‘core exercises’ we’ve been told are good for us or how often women socially, culturally, ‘suck in their stomach. Or perhaps you’ve been told to do kegels at one time or another, or hold, strengthen or tighten up your pelvic floor muscles. Which may be useful. Or maybe not.

Both diaphragms are meant to move with each breath yet with tension and tightness in one or both, might this change how we breathe?

Holding tension might not allow for a full, deep breath such as when our respiratory diaphragm moves down, creating the in-breath. Maybe, we hold tension in the pelvic floor, without realizing it and again, not allowing for optimal breath.

Now, think about what is more important to our body, to our brain, but breathing. And how this regular intake of oxygen not only provides nourishment our body needs to survive, but it also forms or influences our physiological state. For instance if we are under threat, or even perceived threat there are immediate changes to our physiology, including our breath, that takes place to aid in our survival.

Which is all great when we’ve broken a bone, need to pull our hand away from fire, stay clear of toxic fumes or something similar. Back in the old days, we would need all our senses, these sensations, to help us stay clear of dangerous predators like tigers and the like.

What happens now though, is often we are unaware of:

1. The threats (real or perceived) that we encounter on a daily basis. These aren’t likely threats like running from tigers, but threats in terms of our relationships, our jobs, our finances, our communities, our environment. How much of the news do you see, threatens your sense of safety? Does this create a sense of tension, stress, holding of your breath perhaps, in your body?

2. The response of your nervous system and subsequent physiology that accompanies this. You may have read that stress is not good for the immune system, for your mental health, etc. but there are also effects on other areas or systems that occur including your pain system. If pain is meant to protect you, yet you ‘feel’ threatened, stressed, and tense might that turn UP the volume of pain? Have you ever noticed a correlation (not saying cause, here) in your stress levels and your pain?

Conversely, how might a sense of safety, turn DOWN the volume of pain? Even a few simple words from a parent to a child such as “you’ll be okay” often turns down a pain response.

  • Can we learn to notice our breath and what that might tell us about how we feel?
  • Can we find a breath that is supportive for us, when it’s called upon?
  • Can we find a breath that is supportive for for us, when we need rest, find calm, sleep?

There is no right or wrong in this.

Rather, can we find a responsive, flexible breath that supports us for whatever it is we’d like to do? To live in an optimal state of health? As a first step, can be begin to notice this at all?

If you’d like to read in-depth about the breath, yoga therapy, current findings, and research about breath related to pain care, you might check out Chapter 8 by Shelly Prosko, in Yoga and Science in Pain Care – Treating the Person in Pain.

Personally, attention to breath and subsequent practices has had the most influence I find, when working with people who experience persistent pain. Time and time again. Though as Shelly rightly points out “the practices must be individualized to meet the unique needs of the person.” Telling people to take big, deep breaths, may not be ‘the answer’ or ‘the fix’ for everyone which is often what I see out in the main stream media. Suggesting there is some kind of ‘ideal’ breath, for all people, at all times.

I was looking at this tree (pictured above) in my back yard at lunch time today. It sways and flows. Appears strong, yet supple. Not rigid, brittle, tight or constricted. Takes in nourishment, gives back some. Might we be like this tree … A breath in. A breath out. Responding as need be, in any given moment to what life is asking of us.

I’ll be diving into this in more detail with information, a little bit of research and experiential practices in Week 4 of my upcoming online ‘Creating New Pathways‘ course. Want to learn more?

Interested to learn more about this thing called ‘yoga therapy’? Some FAQ’s plus links for ways yoga therapy can help, information for healthcare providers, where we’re at in terms of current research and yoga, yoga therapy.

Breath Holding, an Inquiry

Tofino, BC

I was having a discussion with a client this week about the breath and how we breathe. We were talking about the relationship between our body, our breath and how breath moves in relationship to gravity. The forces of gravity, the loads we feel.

Breath awareness is often a focus in yoga. Both in yoga classes and also in a more therapeutic practice of yoga. We spend a lot of time noticing breath, feeling the breath as it moves. Noticing the length of breath, the inhales, the exhales. Where we feel the breath move, in our body.

Taking a different path, perhaps we can explore how breath might not always be moving, or moving so well. As in when you’re holding your breath. Which you might not readily notice throughout the day, unless you pay attention to it.

The basis of this inquiry is from Donna Farhi’s The Breathing Book (highly recommend the book). She states the purpose of the inquiry being:

To identify the situations and activities in which you most commonly engage in breath holding. We don’t usually recognize how much tension we invest in simple activities such as talking or cooking because we don’t recognize the situation as terribly stressful. You may be surprised and disconcerted to discover that you hold your breath in almost every conceivable situation.

Let’s check this out.

Starting today and for the rest of this week, take notice of when you hold your breath. What you’re doing when you hold your breath. Where you are, who you’re with. Make a mental note, or actually write it down so you don’t forget.

You may notice it when you’re speaking on the phone with someone. Perhaps your boss. Or you may notice it when you’re leaning over to make your bed. Or you may notice you hold your breath when your attention is really focused on something, like when driving down busy streets.

Then, you might want to see if you can change it in some way. Just breathe a little more freely if you can. Try not to judge anything, just notice.

I’ve noticed this pattern of breath holding in myself, particularly, in these days. Before I started wearing a mask I would sometimes catch myself holding my breath as I walked by someone. Or when I felt they were standing too near to me. I suspect there was some fear involved in my response. It’s like I didn’t want to take breath in, at that moment.

We’ll do more specific explorations, next week. And maybe get a little curious about how this might affect or influence pain.

Check back with me on Monday (June 29th) for more. In the meantime, keep noticing.

What outcome, or benefit might you expect from attending Pain Care Yoga classes?

don't lose hope picWell, much like anything, it depends. The answer is rarely straightforward and definitive.

As mentioned in the last post everyone comes in with their own experience of pain,  history,  individual, unique life circumstances. What might be helpful for one, will not likely be the same for another.

Below are a few comments made during a recent class, which illustrates this difference, for each person.

“I slept so much better all last week.”

“I’m not really using my cane anymore. My leg feels stronger, and I have no pain.”

“My back went out last week for a couple of days. I was flat on my back, so I used one of the (breath-awareness-distraction) practices and it really helped me get through it.”

And your back now? – Me

“It’s fine, now.”

“I’m so surprised. Normally I cannot walk around without my shoes on.”

Did you feel pain, while we were doing this (walking exploration, practice)? – Me

“No, I had no pain at all.”

I can’t say what will happen for you, or for another. Most often though, people will begin to experience feelings of calm, safety, less or no pain during class. And, some will begin to transition those responses and feelings into their daily lives.

Like most things in life, what we do, what we practice, we get better at. I would say the same, in this case. If you only practice during our class, for an hour a week, you may not see as much progress, notice as much difference. However, if you do a little, each day, I bet your experience will be similar to these others.

What I highlight to people, from both their comments and experiences is that something changed. To get curious about that, and realize they created the change.

It wasn’t something done to them.

From there, they begin to feel some hope. Perhaps a little empowered and more able to start exploring and learn to self-manage or resolve their persistent pain.

If you’re interested in how this might work for you, the next 6-week series of Pain Care Yoga classes begin at the end of February. I’m also available for one-to-one in-person or ‘zoom’ online sessions and would love to hear from you.