Sleep, Alzheimer’s Disease and Yoga

by Nina

Sun Behind Clouds by Melina Meza

One of the worst fears I think we all share about getting older is of developing dementia. Just recently I had a long phone conversation with a woman who is trying to deal with a mother in the early stages of Alzheimer’s Disease, and it was just so sad. I had some advice for her, but no solutions, of course. Then I heard a news piece on NPR “Brains Sweep Themselves Clean of Toxins During Sleep”  that gave me  glimmer of hope.

Scientists have been trying to figure out the purpose of sleep for a very long time. A recent study “Sleep Drives Metabolite Clearance from the Adult Brain”  published in Science Magazine, proposed a fascinating new theory. The team of researchers from the University of Rochester discovered that while the brain sleeps it clears out harmful toxins, a process that may reduce the risk of Alzheimer's. According to the NPR interview, during sleep, the flow of cerebrospinal fluid in the brain increases dramatically, washing away harmful waste proteins that build up between brain cells during waking hours. Professor of Neurosurgery and an author of the study, Dr. Maiken Nedergaard, said, "It's like a dishwasher."

The waste proteins getting washed away during sleep are toxic to brain cells, which could explain why we don't think clearly after a sleepless night and why a prolonged lack of sleep can actually kill an animal or a person. The results appear to offer the best explanation yet of why animals and people need sleep.

“Thus, the restorative function of sleep may be a consequence of the enhanced removal of potentially neurotoxic waste products that accumulate in the awake central nervous system.” Lulu Xie, et al.

Alzheimer's Disease researchers say this research could help explain a number of recent findings related to sleep and AD. Dr. Randall Bateman, Professor of Neurology  at Washington University said this about beta amyloid, which is the main component of certain deposits found in the brains of patients with Alzheimer's Disease.

"Beta amyloid concentrations continue to increase while a person is awake. And then after people go to sleep that concentration of beta amyloid decreases. This report provides a beautiful mechanism by which this may be happening.”

The team of scientists discovered the cleaning process while studying the brains of sleeping mice. Dr. Nedergaard said that during sleep the system that circulates cerebrospinal fluid through the brain and nervous system was "pumping fluid into the brain and removing fluid from the brain in a very rapid pace.” When the mice went to sleep, their brain cells actually shrank, making it easier for the fluid to circulate. But when the mice woke up, their brain cells enlarged again and the flow between cells slowed dramatically.

The researchers speculated that the reason the brain doesn’t do this cleaning all the time is because the cleaning uses a lot of energy, and it’s probably not possible for the brain both to clean itself and at the same time be aware of its surroundings, talk, move, and so on. So getting enough sleep—which we already know is vital for our physical and mental health—may be one key to preventing Alzheimer’s Disease as you age.

But what does all this have to do with yoga? Well, if you’re having trouble sleeping, yoga can help with that. Because insomnia is so often related to stress, yoga’s stress management techniques can help you quiet your nervous system so you fall asleep more quickly and sleep more soundly. For  information on how yoga can help you sleep better, see Yoga for Insomnia, Part 1  and Day to Night: Yoga for Better Sleep. The Supported Inverted poses I wrote about recently (see All About Supported Inversions) are poses that I've found particularly helpful.

We’re so careful here at YFHA not to make any false promises and of course as this research is new, we can’t promise that getting enough sleep will definitely make a difference for you. But encouraging you to get a good night’s sleep can’t be harmful in any way, and if this gives you more motivation to practice stress management techniques, which are helpful for preventing a whole host of health problems, we’re doing you a favor. And if you'd like to add an additional practices to encourage brain health, start meditating on a regular basis (see Meditation and Brain Strength) and keep practicing your yoga asanas (see Yoga for Brain Health?). 

Yoga for Better Sleep: Workshop and Tip

by Nina

Cairns by Nina Zolotow

I don’t teach workshops very often, but when I do, I focus on topics I really care about. My upcoming workshop on Saturday April 6th, 2-5pm at Brentwood Yoga Center focuses on one of my favorite topics: Yoga for Better Sleep. (to register, go to http://brentwoodyogacenter.com/workshops ) This is topic is dear to my heart because, well, it’s something I have to practice myself on a regular basis. Even small amounts of stress can disrupt my ability to fall sleep or to sleep soundly (interestingly, that’s something that seems to run in my family). Fortunately I’ve learned a number of techniques both for reducing my stress levels in general and for lulling myself to sleep while I’m in bed. And my feeling about teaching these techniques to others is that if I’ve helped just one person to achieve better sleep, than I’ve been successful!

I’ve written about this topic in general on the blog (see Day to Night and Yoga for Insomnia, Part 1). But the other night as I was lying in bed not sleeping, I realized that if I had to choose one single technique above all the others, it would be the breath practice I turn to almost automatically these days. And I decided then and there I wanted to share it with you all.

For most of us, what is happening when we’re lying in bed sleepless is that our minds are churning, thinking about the day’s events, ruminating about the past or worrying about the future, which stimulates our nervous systems. Turning our minds to a neutral focus, such as the breath, allows us to let go—at least temporarily—of those disturbing thoughts and helps calm the nervous system, switching on the relaxation response. And in my case, after 10 to 20 minutes of breath practice, I almost always end up drifting back to sleep.

Start by practicing simple breath awareness. This means focusing your mind on how your breath moves in your body, perhaps on how your belly rises and falls with your breath or, if it’s easier, how your chest moves with your breath. You could also focus on the more subtle sensations, such as the feeling of your breath moving in and out or your nostrils or, if you prefer, the sound your breath makes in your body. I actually like to lie on my back with my hands on my  belly because that makes it very easy for me to feel the movement in my abdomen.

For some of you, this simple practice may be enough. For myself, I like to use a more structured technique of extending my exhalation. Extending the exhalation in particular helps calm the nervous system (your heart rate slows on your exhalation) but I also find it engages my mind more completely. To do this, when you reach the end of your exhalation, simply add a beat or two—without straining—before turning on to your inhalation. Keep it relaxed and easy. And if the practice aggravates you, simply return to your natural breath.

If at any point you realize your attention has wandered from your breath (it will, of course), simply—and without self judgment—bring your attention back to your breath.

I confess that, in addition to all that, I also count my breaths. I got the idea from Baxter who showed me a technique using your fingers that he learned when he studied at the Krishnamacharya Yoga Madiram. This really helps me keep my mind engaged, and when I start to really lose track of where I am, that’s when I’m starting to fall asleep. However, this may be, well, too anal for you. (Hey, I’m just trying to be honest about what I really do—and what really works for me.) Basically, you need to experiment and see what works for you. Maybe you’ll even come up with new variations. If whatever you are doing is working, then it’s right for you.

You can do this breath practice every night when you get into bed or just on those nights when you start to realize—it sometimes takes a while catch yourself—that you’re having trouble falling asleep or are wide awake in the middle of the night.

I have more tricks up my sleeve and hope to share them with some of you in person at my April workshop, but in the meantime, if I help just one person.....

Ancestral Health Symposium 2012: Evolutionarily sound diets and lifestyles may revolutionize health care

The Ancestral Health Symposium 2012 was very interesting on many levels. Aaron Blaisdell and the team of volunteers really did a superb job at organizing the Symposium. Boston is a great city with an excellent public transportation system, something that is always great for meetings, and a great choice for the Symposium. Needless to say, so was Harvard. Even though the program was packed there were plenty of opportunities to meet and talk with several people during the breaks.

We had our panel “New Technologies and New Opportunities”, which Paul Jaminet moderated. The panelists were Chris Keller, Chris Kresser, Dan Pardi, and myself. The first photo below, by Bobby Gill, shows Chris Keller speaking; I am on the far left looking at the screen. The second photo, by Beth Mazur, shows all the panelists. The third photo, also by Bobby Gill, shows a group of us talking to Stephan Guyenet after his presentation.

I talked a bit toward the end of the panel about the importance of taking nonlinearity into consideration in analyses of health data, but ended up being remembered later for saying that “men are women with a few design flaws”. I said that to highlight the strong protective effect of being female in terms of health, which was clear from the model I was discussing.

There is a good evolutionary reason for the protective effect of being female. Evolution is a population phenomenon. Genes do not evolve; neither do individuals. Populations evolve through the spread or disappearance of genotypes. A healthy population with 99 men and 1 woman will probably disappear quickly, and so will its gene pool. A healthy population with 99 women and 1 man will probably thrive, even with the drag of inbreeding depression. Under harsh environmental conditions, the rate of female-to-male births goes up, in some cases quite a lot.

I was able to talk to, or at least meet briefly face-to-face with, many of the people that I have interacted with online on this blog and other blogs. Just to name a few: Miki Ben-Dor, Aaron Blaisdell, Emily Deans, Andreas Eenfeldt, Glenn Ellmers, Benjamin Gebhard, Stephan Guyenet, Dallas Hartwig, Melissa Hartwig, Paul Jaminet, Chris Keller, Chris Kresser, Mathieu Lalonde, Robert Lustig, Chris Masterjohn, Beth Mazur, Denise Minger, Jimmy Moore, Katherine Morrison, Richard Nikoley, Dan Pardi, Kamal Patel, David Pendergrass, Mark Sisson, Mary Beth Smrtic, J. Stanton, Carlos Andres Toro, and Grayson Wheatley.

It would have been nice to have Peter (from Hyperlipid) there, as I think a lot of the attendants are fans. I attended Jamie Scott’s very interesting talk, but ended up not being able to chat with him. This is a pity because we share some common experiences – e.g., I lived in New Zealand for a few years. I did have the opportunity to talk at some length with J. Stanton, who is an inspiration. It was also great to exchange some ideas with my panelists, Miki Ben-Dor, Emily Deans, Stephan Guyenet, Chris Masterjohn, Kamal Patel, and David Pendergrass. I wish I had more time to talk with Denise Minger, who is clearly a very nice person in addition to being very smart. Talking about a smart person, it was also nice chatting a bit with Richard Nikoley; a successful entrepreneur who is in the enviable position of doing what he feels like doing.

I could not help but notice a tendency among some participants (perhaps many, judging from online threads) to pay a lot of attention to how other people looked in a very judgmental way. That person is too fat, his/her face is too red, she/he looks too old etc. So was this supposed to be the Ancestral Health Pageant 2012? There is nothing wrong with looking good. But many people adopt an evolution-inspired lifestyle because they are quite unhealthy to start with. And this includes some of the presenters. It takes time to change one’s health, relapses occur, and no one is getting younger. Moreover, some of the presenters’ ideas and advice may have much more dramatic positive effects on people other than themselves, because of their own pre-existing conditions. The ideas and advice are still solid.

A message that I think this Symposium conveyed particularly well was that an evolutionarily sound diet and lifestyle can truly revolutionize our health care system. Robb Wolf’s talk in particular, based on his recent experience in Nevada with law enforcement officers, made this point very effectively. The title of the talk is “How Markets and Evolution Can Revolutionize Medicine”. One very interesting idea he put forth was that establishments like gyms could expand the range of support activities they offer their customers, officially becoming the beginning of the health care chain. There are already health insurance plans that offer premium reductions for those who go to gyms. Being part of the health care chain would be different and a significant step forward - diet and exercise are powerful "drugs".

One thing that caught me a bit off-guard was Robb’s strong advocacy of the use of a drug, namely metformin (a.k.a. glucophage); even preventively in some special cases, such as with sleep-deprived law enforcement officers. I have to listen to that talk again when it is up online, to make sure that I understood it correctly. It seems to me that changing the nature of shift work among law enforcement officers, at least partially, may be a better target; current practices appear not only to impair the officers’ health but also their effectiveness in law enforcement activities. Besides, I think we need to better understand the nature and functions of cortisol, which is viewed by many as a hormone that exists only to do us harm.

Sleep deprivation is associated with an elevation in cortisol production. Elevated cortisol levels lead over time to visceral fat accumulation, which promotes systemic inflammation. Systemic inflammation is possibly the root cause of most diseases of civilization. But cortisol itself has powerful anti-inflammatory properties, and visceral fat is generally easy to mobilize through intense exercise – probably one of the key reasons why we have visceral fat. I think we need to understand this situation a bit better before thinking about preventive uses of metformin, which nevertheless is a drug that seems to do wonders in the treatment of type 2 diabetes.

Beth Mazur was kind enough to put up a post with links to various Ancestral Health Symposium 2012 summary posts, as well as pictures. Paul Jaminet has a post with an insightful discussion of our panel at the Symposium.

Day to Night: Yoga for Better Sleep

by Nina

This morning I was talking with Bonnie Maeda, RN and Shari Ser, PT about the workshop we’re going to be teaching on yoga for sleep disorders at the Berkeley Yoga Room, Saturday, June 16, from 2 to 5 (see here for registration information). When I described my 24-hour approach to practicing yoga for better sleep to them, they were very enthusiastic. So I'm going to share it with you today.

Yes, yoga in general is relaxing, but some poses are more relaxing than others while some poses and practices are actually quite stimulating. So if you’re having trouble sleeping, I recommend you plan out your day regarding which poses you do when. I mean, if you’ve been suffering from insomnia, you wouldn’t drink a double espresso right before bed, would you? Standing poses, backbends and vinyasa flows can be almost as stimulating, so a strong practice including those poses done just before bed can keep you awake (trust me, I've tried it). But those poses help keep you strong and flexible, as well as reducing stress by releasing physical tension from your body, so you wouldn’t want to eliminate those poses entirely from your practice. On the other hand, there are relaxing practices you can do right in bed either before sleep or in the middle of the night that will help you fall asleep more quickly and sleep more deeply.

Buddha in My Garden by Michele Macartney-Filgate

Here's how to plan out your day:

Day Time
Getting exercise is important for improving your sleep. So during the day, walk, run, swim, cycle, or do a strong yoga practice that includes forceful, stimulating poses, including standing poses, backbends, twists, and/or Sun Salutations and vinyasa flows.

Early Evening
After work or in the early evening, if you’re up for practicing, it’s best to do poses and practices that calm your nervous system, such as forward bends, inverted poses, and restorative yoga. Meditation, Relaxation pose with a mental focus, and yoga nidra (yogic sleep) are also good stress reducers. If you want to use a guided relaxation, see the Relaxation Tracks tab on at the top of the blog. From this point on it’s best to avoid the simulating poses and practices.

Before Bed
Turn off the TV early or put your book down, and take some time before you get into bed for conscious relaxation. Switching your nervous system from fight or flight to relaxation mode before getting into bed will help you fall asleep more quickly and sleep more deeply. Supported inverted poses, such as Legs Up the Wall pose, Easy Inverted pose (see here), and Bridge pose with straight legs, will calm your nervous system. Some people also like to meditate or practice seated breath awareness before getting into bed.

In Bed
For people suffering from insomnia, just getting into bed can trigger a new bout of stress. If you find your thoughts are racing and you are worrying about falling asleep, you can practice a body scan (Relaxation pose with a mental focus), where you conscious relax various parts of your body. Or you can work with your breath, either practicing general breath awareness or any form of pranayama that lengthens or emphasizes the exhalation. Practicing conscious relaxation before falling asleep will help you sleep more deeply. See my post Yoga You Can Do In Bed for more information on yoga you can do before falling asleep.

In the Middle of the Night
All of us insomniacs are familiar with the terrible moment in the middle of the night when we realize we’re wide awake and the possibility of returning to sleep feels hopeless. However, the worst thing you can do is lie there worrying about not falling back to sleep. Instead, return to the same practices you do before falling asleep, such as Relaxation pose with a mental focus, breath awareness, or extending the exhalation. Although it takes some discipline to focus on these practices (for some reason, worrying seems so much easier in the middle of the night), many people, including me, find that 10 to 20 minutes of practice allows us to fall back into a deep sleep.

Some practitioners I know do soothing poses in the middle of the night, such as supported forward beds (in bed with pillows) or even Legs Up the Wall pose. You can try this if seems appealing; just make sure you move slowly, stay warm, and keep the lights as low as possible. You could even play a guided relaxation track at this point. Again, see my post Yoga You Can Do In Bed for more information.

Morning
Good morning! I hope you slept better last night. Now, if you feel like gently stimulating your nervous system by moving with your breath, doing a few standing poses, or even doing a full yoga practice, go for it!

Three Happy Endings: Yoga for Better Sleep

by Nina

My friend Liz has a chronic disease but she takes great care of herself. She eats a healthy diet, and, when she is up to it, takes long walks and yoga classes at her neighborhood yoga studio. Because she has sleep problems, she recently decided to start practicing yoga at home as well, after she comes home at night. “It works!” she told me happily. “I sleep like a baby after doing yoga.” Today I decided to ask her what kind of yoga she does, and she said something very interesting. “It depends on what time I get home.” She went on to explain, “If I get home around 6:00 pm, I’ll do some flow yoga, with poses like Warrior 1, 2, and 3, and Half Moon pose. But If can’t practice until 8:00 or 8:30, that’s counter productive.”

“That makes perfect sense to me,” I said.

“Really?” Liz looked intrigued.

“Yes,” I explained. “Standing poses and vinyasa yoga are stimulating to your nervous system. When you stand up, your blood pressure has to rise to keep the blood pumping up toward your head. So if you do stimulating poses too close to bedtime, it’s going to be hard to go to sleep soon afterward. It’s like drinking a cup of coffee too late in the day.” Then I asked her what kind of poses she does if she can’t practice until 8:00 or 8:30.”

“Legs Up the Wall pose,” she replied. “And Shoulderstand and Plow pose. I also like to do that restorative yoga pose where you lie back on a bolster with your knees apart and the soles of your feet touching.”

“That’s perfect!” I said. “The first three are inverted poses, which automatically trigger the relaxation response. These are exactly the poses that are best to do right before bed to help you to sleep better. And that restorative pose is Supta Baddha Konasana or Reclined Bound Angle Pose, and it’s one of the most soothing and relaxing restorative poses.”

Flowers in the Shade by Brad Gibson

I went on to tell her that this is exactly the way I teach yoga for better sleep. It is important to get exercise during the day, but any vigorous exercise, including yoga, too late in the day can be over stimulating. So if you are having sleep problems, this is something you should consider when you are planning your day. Do your vigorous exercise, including standing poses, flow yoga, and backbends, earlier in the day. And try doing inverted poses, forward bends, or restorative yoga in the evening before bed to see if they help improve your sleep.

There’s no hard and fast rules, however. Liz discovered the best times for herself to practice vigorous versus relaxing yoga by experimenting. And the only way for you to find out the best times for yourself is by going through a similar process. However, I can tell you that if you take a nighttime yoga class and have difficulty sleeping afterward, when you come home, instead of getting right into bed, try practicing your favorite calming pose first and see if that helps.

Liz improving her sleep by practicing yoga at home is just one of the happy endings to this story. The second happy ending is that she made her home yoga practice her own by experimenting, observing, and coming up with her own yoga solutions that suited her particular needs and concerns. That, I told her, is advanced practice.

The third happy ending is that I asked Liz for her permission to write about her today, and she said yes. Thanks, Liz!

Never go to bed angry

by Nina

On Tuesday I read a short little piece in the NY Times questioning the adage “Never go to bed angry” (see here). It was one of those bottom line pieces, and the bottom line was this:

“Going to sleep upset or disturbed preserves the emotion, research suggests.”

In the cited study in The Journal of Neuroscience, scientists exposed 106 men and women to images that elicited various emotions. In some cases the emotions were negative and in other cases the emotions were positive or neutral. The researchers then looked at what happened 12 hours later when the subjects were shown both new images and the previous ones, either in the morning after a night of sleep, or at the end of a full day of wakefulness. The conclusion was:

“The scientists found that staying awake blunted the emotional response to seeing the upsetting images again. But when the subjects were shown the disturbing images after a night of sleep, their response was just as strong as when they had first seen them—suggesting that sleep “protected” the emotional response.”

That doesn’t sound good, does it? Going to bed angry and waking up angry is not only an unpleasant experience for you, but it probably doesn’t enhance your relationships with the people around you. Besides, it's also not a good idea to go to bed angry if you are concerned about getting a good night's sleep. Your stress levels will be high and your sleep, if you can sleep, will be restless—maybe filled with upsetting dreams—and you won’t feel rested in the morning.

But very probably you—unlike the people in the study—can’t just put away an “upsetting image” when you are very angry. In fact, the chances are you’ll keep having one angry thought after another, and with each angry thought you’ll get another jolt of adrenaline (that’s why they call it the “fight or flight response,” people), keeping your stress levels as high as they were before.

Santa Barbara Botanical Gardens: A Detail by Joan Webster

The good news is that Baxter says it takes only about 90 seconds to clear the adrenaline released in your system by an angry thought if you switch to a more neutral topic. So to put away your anger, he recommends a structured breath practice, in which you measure your inhalations and exhalations, and count your breaths to engage your mind. If you combine this type of breath practice with a supported inversion (such as Legs Up the Wall pose) or a supported forward bend (if you find those soothing), both of which help switch your nervous system to relaxation mode, you’ll get a double dose of calm.

You could also use a guided relaxation (see here) as a way to engage your mind and relax your nervous system at the same time.

Conscious Relaxation vs. Sleep

by Nina

Did you ever wake up in the middle of the night with your heart racing, short of breath, mouth dry, and thoughts racing? Maybe you just had a nightmare. Or maybe your mind was spinning, worrying about some difficulty at home or at work, or even about a disaster somewhere else in the world. Then you know intuitively that sleep is not necessarily “relaxing.”
 

Dr. Herbert Bensen, who originally discovered the relaxation response (see here for information), tells us that sleep, although necessary for our physical and emotional wellbeing, is a very different state than conscious relaxation. He identified the following four basic differences:

1. Dreams can actually cause stress through nightmares and anxiety dreams. During conscious relaxation on the other hand, your production of stress hormones gradually decreases, and other symptoms of stress, including both the physical and emotional sensations, subside.

2. During conscious relaxation, oxygen consumption decreases 10 to 20 percent during the first 3 minutes of practice while during sleep it decreases only 8 percent after about 4 or 5 hours. This reduced need for oxygen reflects the fact that during conscious relaxation your body is in rest and digest mode, not in stress mode where you are preparing to run or fight.

3.    During conscious relaxation, there is a marked decrease in blood lactate, a substance associated with anxiety attacks. Blood-lactate levels fall rapidly within the first 10 minutes of conscious relaxation, while sleep has no effect on blood-lactate levels. As you relax, your thoughts stop racing and your mind quiets while your body is resting and digesting.

4.    Alpha waves (slow brain waves) increase in intensity and frequency during conscious relaxation, but are not commonly found during sleep. Dr. Roger Cole, a sleep researcher and long-time yoga teacher, says that during rest or meditation our brain waves may slow to the alpha rhythm (8-12 cycles per second), during which we remain quietly aware of ourselves and our surroundings, without a lot of self-directed mental processing. Sometimes they may slow even further to the theta rhythm (4-7 cycles per second), during which we may get a “floating” feeling, dreamlike mental imagery, and withdrawal from the outside world. There is still much that is unknown about these unique states, but what is known is that regular practice of conscious relaxation helps foster ongoing feelings of serenity, contentment, and even happiness.

Now you can see why taking a nap or sleeping in on Sunday morning just won’t produce the same results as yoga. On the other hand, practicing conscious relaxation on a regular basis will not only provide you with immediate relief, it can also reduce your overall stress levels, so you can maintain your health and face the difficulties that life presents with greater equanimity. To be honest, I don’t practice conscious relaxation just because I’m hoping that it will reduce my chances of getting heart disease or having a stroke in the future (although that’s definitely a bonus), I do it because it makes my life better, right here, right now.

Naushon Meadow by Brad Gibson

Furthermore, as anti-intuitive as it might seem, relaxing while you are awake can even help you sleep better. When you are under great stress, it is difficult to fall asleep. Or, if you can fall asleep (because you are so tired) you often can’t stay asleep. To sleep well, your nervous system needs to be relaxed (if you are in a state of stress, you will be wakeful and alert, watching for danger) and your mind needs to be quiet (if your thoughts are racing, reviewing the past or worrying about the future, you will have a hard time settling down). But conscious relaxation, especially practiced before bed, will relax your nervous system and quiet your mind. And any of the methods I listed in my Monday post will produce these results. See here for further information.