Sleeping Soundly

Sleeping Soundly
By Noah Volz

In keeping up the body, sleep is regarded to produce as much happiness as food. Happiness and misery, growth and wasting, strength and weakness, virility and sterility, knowledge and ignorance, life and death all depend upon sleep. When indulged judiciously, sleep, endues the body with happiness and longevity, just as infallible intelligence is brought unto the Yogi by Sadhana (spirtitual practice).-Charaka

When we look at the daily activities that promote balance, Ayurveda identifies three pillars that must be well maintained in order to stay healthy. These are sleep, diet, and creativity. If we are sleeping well, eating constitutionally appropriate foods, and doing activities that give our life meaning than our physical, mental, and emotional well-being can be at its best. When is the last time your coworker or loved one reported having trouble sleeping? The Center for Disease Control (CDC) estimates that:

• Sleep difficulties are estimated to be the #1 health related problem in North America and affects over 40 million Americans.
• Over 50% of adults report trouble sleeping at least a few nights of the week.
• Lack of sleep leads to fatigue, obesity, high blood pressure, heart disease, shortened lifespan, depression, low immunity and is implicated in diabetes. (1)
  

Sleep is the key to good health and health maintenance. Without adequate sleep many other problems can start to occur. Determining the cause of sleep disorders and removing them will bring the body and mind back into balance. Some common causes of sleep disorders are:

1.   Irregular routine
2.   Mental / emotional stress
3.   Medications
4.   Pain
5.   Poor digestion
6.   Anxiety
7.   Depression (4)

There are over 70 types of sleep Disorders. The two major types of Insomnia are:

1.   Difficulty falling asleep (DFA) and anxiety.
2.   Early morning awakening (EMA). (5)

Both of these can be transient, short term, or chronic in duration. Common causes of insomnia include but are not limited to stress, anxiety, depression, medications, caffeine, nicotine, alcohol, chronic pain, changes in schedule, poor sleep hygiene, eating late, changes in activity, changes in health, or increased use of medication. 5

Ayurveda simplifies all these causes and looks at imbalances within the three constitutional principles: Vata, Pitta, and Kapha. For more information on these principles visit Banyan Botanicals. The common causes listed above increase biological and physiological factors that are associated with the Dosha’s of Vata and Pitta. We are all unique individuals for there is not a one size fits all prescriptions for everyone, but the following information may be useful for anyone who is having trouble sleeping.  

Stages of Sleep
During sleep, we usually pass through five phases of sleep: stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage 1 to REM sleep, then the cycle starts over again with stage 1. We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages.

• Stage 1: Which is light sleep, we drift in and out of sleep and can be awakened easily.
• Stage 2: Our eye movement’s stop and our brain waves become slower, with occasional bursts of rapid waves called sleep spindles. 
• Stage 3: Extremely slow brain waves called delta waves begin to appear, interspersed with smaller, faster waves. 
• Stage 4: The brain produces delta waves almost exclusively. 
• REM: our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.
  

Western Treatment
Western Medicine uses sleeping pills or antidepressants to treat sleep disorders such as Insomnia. Some common medications are:

• Prescription sleeping pills
• Hypnotics such as benzodiazepines (e.g. clonazepam, triazolam, estazolam, flurazepam) and pyrazolopyrimidines (e.g. zaleplon, zolpidem). Hypnotics with a rapid onset of action, such as zolpidem, zaleplon, and triazolam are used when the patient has difficulty in falling asleep. If the patient has difficulty maintaining sleep however, a hypnotic with a slower rate of elimination may be prescribed instead, such as temazepam, estazolam, and flurazepam. Although the risk of dependency is stated to be low in these hypnotics should be avoided in patients with a history of substance abuse. Rebound insomnia is a fairly common phenomenon when the drugs are withdrawn abruptly. – like Ambien, Lunesta and Rozerem
• Tricyclic antidepressants (e.g. amitriptyline, trazodone) if depression is a part of the symptom picture. These drugs are typically advised to be used for only transient and short-term insomnia, although in many cases end up being used on a long term basis. Many of these drugs interfere with the normal sleep cycle, inhibiting both REM and stage 4 NREM sleep, and thus can interfere with the restorative benefits of sleep.(3)
• Non-prescription or over-the-counter sleep aids and antihistamines
• Diphenhydramine (Benadryl). Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, dizziness and memory problems.
• Doxylamine (Unisom SleepTabs). Doxylamine is also a sedating antihistamine. Side effects are similar to diphenhydramine, including daytime drowsiness, dry mouth, dizziness and memory problems.
• Behavioral therapies
• Relaxation therapy- progressive relaxation caused by a sequential tensing and relaxing of the muscles which can calm down the mind.
• Biofeedback- Using a biofeedback machine the patient is able to monitor physiological processes and monitor them so that they can control them more easily. Three principle types that are commonly available to consumers are the:
• Electromyogram (EMG) measures muscle tension
• Temperature biofeedback monitors skin temperature. A decrease in body temperature is correlated with peripheral vasoconstriction that occurs with the ‘fight or flight’ response. 
• Galvanic skin response (GSH) measures electrical conductance in the skin. In heightened states of arousal most people will typically sweat, increase the electrical conductivity of the skin.
• Stimulus control therapy. Using the bedroom for only sleep activities and reducing light stimulus after 9pm.

Natural sleep aids

• Melatonin. The hormone melatonin helps control your natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild. The most common melatonin side effects include daytime sleepiness, dizziness and headaches. Other, less common melatonin side effects might include abdominal discomfort, mild anxiety, irritability, confusion and short-lasting feelings of depression.
• Valerian. Supplements made from this plant might reduce the amount of time it takes to fall asleep as well as promote better sleep overall. However, the active ingredient isn't clear and potency can vary. Side effects of valerian supplements might include headache, abdominal discomfort, excitability or uneasiness, and heart disturbances.
• Skullcap- Supplements made from this plant have been shown to help in cases of wakefulness and mental overwork. However, the potency can vary and it must be taken every 2-3 hours to be effective.
• Additional herbs include: Passionflower, chamomile, kava, lemon balam, sour date seed, schisandra berry.

Nutritional supplements

• Vitamins: B complex, 100-200 mg, taken before 12 pm
• Minerals: calcium/magnesium for RLS/PLMD, 1:1 ratio, 800-1200 mg each before bed; chromium, to control blood sugars, 200 mcg t.i.d. with meals
• 5-hydroxytryptophan is the direct precursor to serotonin, the neurotransmitter involved in sleep. It is available over the counter and helps promote deep, relaxed sleep and is also found in foods like turkey and nuts.

Ayurvedic view of insomnia
In the Ayurvedic view during sleep we contact the underlying field of energy and intelligence and allow our bodies and minds to find resonance with this infinite field so that when we awake we have a more firm connection with our life’s path. Ayurveda views restful sleep as important as diet and an essential pillar of good health. No imbalance in Ayurveda is purely one Dosha’s as many of the signs and symptoms can be related to multiple doshas. In general difficulty sleeping is associated with Vata or Pitta and sleeping too much are associated with Kapha. Lifestyle, Yoga, and Meditation routines can be implemented by all constitutional types to help establish healthy sleep patterns.

Meditation
Meditation is the most effective way to help with sleep disturbances. Getting competent instruction in a mantra based meditation can be really helpful

• Practice meditating two times a day for 5-20 minutes every day. The best times are before breakfast and before dinner.

Yoga
Practicing yoga is very therapeutic for sleep. One of the most calming and soothing postures or asanas for the entire nervous system is Savasana or Corpse Pose. This  is similar to relaxation therapy. This pose gives total relaxation to the body reducing physical, mental and emotional stress and strain and fatigue of all kinds.

Follow these simple steps for Savasana and practice before bedtime:

• Lie on your back, allowing the length of the neck to extend through the crown of the head.
• Allow the arms to rest 15 degrees away from the sides of the body, palms facing upwards.
• Relax the legs, allowing them to roll naturally open from the hip joint. Toes will be pointing away from each other.
• Draw an imaginary line down the center of the body, noticing the symmetry of shoulders and hips.
• Close the eyes and allow the eyeballs to soften back into their sockets.
• Breathe normally with full awareness. Make the breath soft and effortless.
• Allow the mind to descend toward the heart.
• Remain in this pose for 5-30 minutes.
• Slowly and gently bring awareness back to all parts of the body.

Lifestyle
Many of us feel like we are on the go all day long. Every action of the body and mind uses energy. One of the keys to relaxation is to reduce the number of stimuli to which we are subjected. Find some down time during each day to relax. Even just ten minutes a day can make the body and mind's transition to sleep easier when it's time for bed.

• Slow down and develop a regular daily routine. For more information on you’re your specific Dosha visit: Vata, Pitta, or Kapha
• Take walks in nature or get some other moderate exercise each day.

Diet

• eliminate coffee, tea, chocolate and caffeine-containing medications
• alcohol used as a sedative may cause night-time awakening due to rebound hypoglycemia
• rule out food sensitivities (e.g. cow’s milk, wheat, sugar, food additives and preservatives)

Aromatherapy

• Lavender, Ylang, Bergamot, Vetivert, Jasmine, Rose, Sandalwood

Difficulty Falling Asleep

Successful Ayurvedic healing always begins with removal of the cause. Though there are sometimes physiological and external factors that inhibit sound sleep, most causes of insomnia are psychological and come from a depletion of Ojas. Ojas is the physical substance in the body that allows you to connect with your purpose in life which will restore psychological balance. Ojas is depleted by Vata’s light and mobile qualities. This can make it difficult for the mind to rest and cause difficulty falling asleep. Establishing a bedtime routine will help to calm the mind before bed.

Bedtime Routine:

1.   Start 1/2 hour before bedtime and do warm oil massage with Vata Massage oil. 
2.   Take a warm bath or shower after applying the oil.
3.   Take 3/4 cup warm milk with 4 tablets of Stress Ease formula to bring about restful sleep
4.   Listen to relaxing music.
5.   Use appropriate aromatherapy oils to elicit sleep.
6.   Go to bed before 10PM
7.   Use the bedroom for sleep and sex only (no computers, no reading, etc.).
8.   No computers or television or staring into bright lights after 9 PM.
9.   Decrease intensity of the day.

Early Morning Awakening

EMA is most often associated with the mental pressure that disturbs sleep and forces awakening with a characteristic of being very clear and very wide awake as if ready to start one's day. This will occur in the Vata time of night between 2-4 AM because the intensity and activity of Pitta is able to move through the lightness of Vata and wake up the mind and body. Establishing a bedtime routine that will bring down the activity of Pitta will help the mind stay calm throughout the night.

Bedtime Routine:

1.   Start 1/2 hour before bedtime and do warm oil massage with Pitta Massage oil or Brahmi oil. 
2.   Take warm bath or shower after applying the oil. This may wake up the body more if Pitta is really high. If that is the case then only rub the oil on the head and scalp and leave it on overnight protecting the bed from oil.
3.   Take 3/4 cup warm milk with 4 tablets of Tranquil Mind formula to bring about restful sleep
4.   Listen to relaxing music.
5.   Use appropriate aromatherapy oils to elicit sleep.
6.   Go to bed before 10PM
7.   Use the bedroom for sleep and sex only (no computers, no reading, etc.).
8.   No computers or television or staring into bright lights after 9 PM.
9.   Decrease intensity of the day.

Each one of these individual factors is given priority based on the sleep patterns that the client presents with to bring about optimal results. If you are experiencing sleep disturbances also consider a Shirodhara treatment to reduce mental fatigue and relax the body and mind. Receiving 3-5 Shirodhara treatments early in the morning for 2-3 weeks will reduce mental/emotional stress, improve the body’s response to pain, and lead to deeper more restful sleep.

1. Brain Basics: Understanding Sleep. Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892. NIH Publication No.06-3440-c
2. When You Can't Sleep: The ABCs of ZZZs," by the National Sleep Foundation.
3. Prescription sleeping pills: What's right for you? Dec. 2, 2011 © 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.
4. Common Causes of Insomina. Jan. 7, 2011 © 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.
5. Definition of Insomnia. This content is provided by iMedix and is subject to iMedix Terms. The Questions and Answers are not endorsed or recommended and are made available by patients, not doctors.