Yoga Therapy for Trauma-Related Insomnia

*Disclaimer: This post is not indicative of an actual client. It is a representation of a typical client experience during my Yoga Therapy Case Study research project of insomnia and trauma. All names have been changed for confidentiality.

Traumatic experiences can negatively affect the quality and duration of sleep. Trauma is an extreme form of stress which precipitates a sustained neurobiological response that creates the conditions for chronic insomnia.

Witnessing an adverse event, as in the case of trauma, sensitizes the central nervous system’s activation or arousal centers, leading to pronounced central nervous system hyperarousal or activation. These central nervous system and physiological changes disrupt the normal sleep-wake system (Sinha, 2016).

Often times, the brain is overstimulated after a trauma and may experience an influx of adrenaline and cortisol. These sustained hormonal shifts can make it difficult to fall and stay asleep. Further, people who have experienced trauma or post-traumatic stress disorder (PTSD) may experience flashbacks and nightmares which can startle one awake and make it difficult to fall back asleep (Sweeney, 2021). 

The sustained hormonal and physiological shifts, when coupled with a nervous system that is now on hyper-alert following an adverse event or experience are at odds with the natural conditions for rest.  

When you seek support for insomnia I complete a thorough personal history to learn more about the causes of your sleep problem.

When I first met with George(*), his physiological system was on sympathetic over-drive. While these symptoms had improved from the time of the initial trauma months ago; there remained residue of the trauma that impacted his sleep. These symptoms also influenced his readiness and confidence to return to the workplace.

George struggled with both sleep initiation and maintenance, waking every hour to every couple of hours with nightmares and physiological symptoms of trauma and anxiety including excessive sweating. He would soak through the bed sheets every evening and had to get out of bed and change the sheets. In exploring the nature of his nightmares, he described both flashbacks of the trauma, along with stories of being incompetent or of feeling weak and unable to face what came to him.

We also reviewed lifestyle factors that influence sleep including food habits and daily routines. Since the trauma event, George spent the majority of the day indoors with limited natural light exposure and spent time in bed during both the day and evening watching television.  

Cause (Hetu)

The cause (hetu) of insomnia was the thoughts and behaviours that had developed and been maintained since the trauma / stress event. These included heavy meals before bed, an inconsistent sleep routine, watching television before / in bed, staying indoors all day / limited daylight exposure, sedentary routine, napping and thought patterns related to weakness and loss of control.

Therapeutic Goals (Hanam)

Using George’s own language, he stated that he wished “to learn to calm down” in the short term. In the long term (sodhanam), he stated: “hoping it’ll give me some coping strategies for work”.

The immediate short term goal is to provide symptomatic relief (samanam). This is established through learning to evoke the parasympathetic (rest and digest) response in gradual steps. Once George develops the self-efficacy to evoke the restful state, he will be able to increase his functioning; including his sleep and his daily functioning with his ultimate goal of returning to a work environment.

Therapeutic Tools (Upayam)

With a deeper understanding of George’s presentation and problem areas, along with his goals (where he is, and where he wants to go), we can select the tools to bring about the desired goal (Upayam).

For George, the tools of yoga therapy and the approach was delivered systematically to develop increased self-efficacy and confidence gradually. The first step included providing education about the nervous system to slowly alter deeply-rooted thoughts and beliefs related to weakness. This included teaching George that the way that his body responded at the time of the trauma is completely normal and is how our bodies are evolutionarily and biologically designed.

We began with short practices to notice sensations of well-being and rest compared to sensations of distress and alarm. These practices included trauma resiliency and trauma-informed yoga skills of grounding and building inner resources (bhavana).

George particularly gravitated towards grounding and immediately noticed the shift in his nervous system. When asking him to describe the sensations of his body, at times of alert / activation / anxiety, he described feeling a black corset tightening around his chest. When he practiced grounding, he was able to feel an openness in his chest, relaxation of his muscles and a deeper breathing pattern. He quickly and easily integrated a grounding practice into every day functioning and frequently throughout the day to reduce the effects of stress on his sleep.

The tools of yoga therapy included a short and simple asana practice completed all lying down to pacify all layers of the constitution. The practice incorporated slow movement coordinated with breathing and soft, non-vibratory sounds on the exhale and twists.

As insomnia can be both a vata dosa and pitta dosa imbalance, qualities of heavy and slow are required. Anti-vata protocols were provided including sipping warming teas with ginger, fennel and cumin seeds throughout the day to manage indigestion and using warming oils and a warm bath. Also, sitting up after eating at night to better engage digestion and this, along with a PM relaxing practice evoked the parasympathetic response to engage digestion and digestive fire.

Yoga therapy and occupational therapy are ideal approaches to address insomnia as they addresses lifestyle factors and routines. In George’s case, new thoughts and behaviours that have been maintained since the trauma are perpetuating insomnia. George was provided a sleep diary to comprehensively evaluate his sleep behaviours. Strategies included addressing sleep routine, and developing a specific arising time. We also worked to ensure that the bed is a strong cue for sleep by avoiding technology in the bed and using the bed only for sleeping. We investigated feelings and sensations associated with watching news programming compared to other, more restful activities.

Eventually, George practiced a yoga nidra audio that was provided which was personalized to integrate grounding (which was highly effective for him) and bhavana to counter feelings of shame and weakness. Due to the effect of nightmares on waking, nightmare re-scripting was integrated within the yoga nidra script. Nightmare rescripting is a psychotherapeutic technique that involves rehearsing a new nightmare script by asking questions such as “what would you prefer to feel in that moment”, “how would the story need to change for you to feel that way”. The new story is then integrated in the yoga nidra script which is then practiced over time.

While a model of trauma-informed yoga nidra is shown in research studies to resolve symptoms associated with PTSD (Integrative Restoration or iRest), it was clear that George’s attention span or focus would not tolerate iRest and rather, a traditional yoga nidra with nightmare re-scripting story was developed for his unique presentation. The audio nidra included a story for nightmare rescripting that led him to a solution whereby he stepped into his inner strength. Prior to sleep he imagined himself feeling confident and competent; feelings that were in contrast to his nightmares.

Effects

George had improvements in both sleep initiation and maintenance, with absolute resolution of nightmares after one session of yoga nidra with nightmare re-scripting. He no longer woke in the night. After session 3, he stated: “I’ve been feeling good”; “I’ve been sleeping great”; “no nightmares”, “good dreams”. He stated that he felt some resolution and closure related to the trauma. He no longer dreamt about being unsuccessful, incompetent or being low in confidence; now practicing visualization after a body scan to imagine himself confident, successful and “go to bed thinking positive things”.

George expressed feeling less socially isolated and started a job placement. Physiological symptoms of anxiety including hand trembling and profuse sweating had improved and with improvements in self-awareness he was feeling more confident to manage his symptoms in various functional roles and settings.

With improved awareness, George learned that he has some sense of mastery over his own body and mind.

This sense of self-efficacy is an important component of any yoga therapy process in that you are empowered; that there is something that you can do to change your state, if and when you need to.

If you’re interested in journeying deeper to create personalised restful conditions to sleep better, contact me to learn about how I can support you.

References

Sinha, S. (2016). Trauma-induced insomnia: A novel model for trauma and sleep research. Sleep  Medicine Reviews, 25, 74-83.

Sweeney, M. (2021). Trauma and Sleep: How to Cope. Retrieved from the Start Sleeping website: https://startsleeping.org/trauma-and-sleep/#