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Help for Insomnia

Get a good night's sleep by retiring old habits and starting a gentle, bedtime yoga practice.

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For years Jamie Moscowitz lay awake in bed every night, often for hours. There, in the dark, her mind would spin. She cut out caffeine and even took sleeping pills to see if that would ease her insomnia, but neither remedied the problem.

Then, about a year ago, Moscowitz, who lives in New York City, attended a workshop offered by yoga-for-sleep specialist Ann Dyer. Participants were asked to examine their daily exercise and dietary patterns that might affect sleep and to describe how they typically spent the last few hours of the day. Moscowitz emerged with a new understanding of how her habits—like staying up late working on the computer or falling asleep in front of the television—were fueling her sleeplessness. And she discovered something that sleep scientists have verified: Insomnia can be managed, even cured, with behavioral changes and with relaxation techniques such as yoga.

The key to healing sleep disorders, Dyer says, is to cultivate healthy habits. “Regularity and rhythm are friends to sleep,” she explains. “Going to sleep and waking up at the same time each day, eating at the same time each day, doing yoga at the same time each day. The more rhythmic your life is, and the less scattershot it is, the easier it is to sleep well.”

Moscowitz now follows some steadfast rules. At 9 p.m., she turns off the computer and, for the next hour, focuses only on relaxation, steering clear of the TV and telephone. She heads to bed at the same time every night and practices a yoga sequence designed to calm the nervous system and turn her attention inward (based on a sequence Dyer teaches, it includes Legs-up-the-Wall Pose and a series of gentle, supported forward bends). At last, Moscowitz is sleeping through the night.

Sleep Medicine

According to the National Center for Sleep Disorders Research at the National Institutes of Health, 10 to 15 percent of American adults suffer from chronic insomnia, which is defined as sleeplessness lasting for more than a month. An estimated 30 to 40 percent of the U.S. population experiences some form of insomnia each year, most commonly chronic-intermittent insomnia, where periods, (days or weeks), of insomnia alternate with periods of good rest.

Researchers have discovered that behavioral changes including relaxation techniques designed to increase body-mind awareness can be a balm for restless sleepers. Unfortunately “sleep medicine is not extensively taught in medical schools,” says Sat Bir Khalsa, an assistant professor of medicine at Harvard Medical School and a yoga and sleep disorders researcher at Brigham and Women’s Hospital in Boston. Khalsa is troubled by the tendency of many doctors to prescribe insomnia medication. “Drugs may not treat the underlying problem—when people stop taking pills, often the insomnia returns,” Khalsa says. “Pills have their place in certain situations, but behavioral treatment is often a permanent fix.”

What’s Keeping You Up?

Many roads lead to insomnia. Often the cause is obvious, such as the stress brought on from relationship woes or the loss of a job. Stimulants like caffeine and some medications can also bring about sleeplessness. And other factors, such as lifestyle, diet, room temperature, even bedding, can contribute as well. But sometimes the causes of a person’s insomnia are unclear. And in those cases researchers and doctors don’t fully understand why something as natural as sleeping becomes elusive.

During a bout of chronic insomnia the nervous, endocrine, and cognitive systems are in a high state of arousal. People typically experience this in the form of whirling thoughts, short or uneven breathing, and muscle tension. Sometimes you can fall asleep even with those symptoms, but after a few hours, when the extreme, head-nodding exhaustion wears off, you wake up. The response is physiological—if you’re tense and your body is aroused, it’s difficult for the parasympathetic nervous system, which regulates relaxation, to override the stress-reactive sympathetic nervous system.

To address this, Roger Cole, a sleep research scientist and Iyengar Yoga teacher in Del Mar, California, designed a program that uses yoga and behavioral changes to help train your body to sleep.

“If you are going to fall asleep, you have to set up local conditions for sleep,” says Cole, who also writes Yoga Journal‘s Anatomy column. This means keeping your sleeping space adequately dark and comfortable, and your skin warm but your core cool. Also, you must feel calm. Anxiety activates the amygdala, a part of the brain involved with the regulation of emotions and that can signal other parts of the brain to trigger physical stress reactions, such as a racing heart, high blood pressure, and tense muscles, Cole says. This activation keeps your internal systems buzzing and, literally, warm. For the body’s internal temperature to cool enough to encourage rest, brain activity has to slow down. That’s where behavioral training comes in.

Basic Training

Cole recommends that people with insomnia do a vigorous yoga practice that builds up a sweat in the late afternoon or early evening. Vigorous exercise heats the body. But from the time the exercise is finished until bedtime, the body gradually loses heat. By bedtime, the core has cooled but the skin is still warm, promoting the ideal body-temperature balance for sleep promotion.

Like Dyer, Cole recommends taking a few minutes right before bed to do a gentle yoga sequence designed specifically for sleep and meditation to calm the mind and help ease the transition to slumber. For some chronic insomniacs, Cole also advises a program of sleep restriction combined with cognitive therapy, which helps calm the overstimulated amygdala and trains the brain to associate bed with restful sleep.

Scheduled to Sleep

The program requires estimating how much time you spend actually sleeping each night, as opposed to the time you spend tossing, turning—and, perhaps, praying for sleep. Stay in bed only for that amount of time, sticking to a strict schedule and refraining from napping during the day. If, for example, you’ve managed to sleep no more than four hours a night for a while, your assigned sleep time is four hours. If you wake up during this time and can’t get back to sleep quickly, you get out of bed and do something relaxing in another room. When you feel ready to sleep again, head back to bed, but only until your assigned wake-up time, no matter how little sleep you’ve had.

If you are that four-hour sleeper, and your assigned bedtime is 11 p.m., then you’ll get up at 3 a.m. Keep this up for a few days and you’ll retrain your body to sleep till your designated time. Once you’ve slept solidly for three or four nights in a row, you can gradually increase those designated sleep hours as needed. Cole says that people who stick to this program experience insomnia relief within a couple of weeks and usually see lasting results after about six weeks.

Others have remedied their sleep troubles with less extreme measures, by breaking sleep-robbing habits and forming new, more healthful ones. Moscowitz says she immediately felt the effects of the simple lifestyle changes she made; she began to feel less anxious, and her body felt more open and relaxed. And if she did wake up, she didn’t worry as much. “I remember the first time I went to bed at 10 and slept through to 5 a.m. I felt so proud of myself!”

Keeping to her new schedule isn’t always easy, but Moscowitz knows it holds the cure for her insomnia. “If don’t stick with it, I really feel the difference.

Ease into Sleep

Whether you experience chronic or intermittent insomnia, a program of relaxing asana and easy meditation performed at bedtime can help you slow down mind and body and ease the transition into slumber, says yoga teacher and sleep scientist Roger Cole.

Cole suggests starting in Salamba Paschimottanasana (Supported Seated Forward Bend). Sit on several folded blankets or a bolster, facing a chair. Place a blanket or other padding on the chair, and lean forward, resting your head and arms on the seat. Stay there for three to five minutes. If you have time, experiment with other supported forward bends (seated or standing), with your head resting on a chair, block, or pillow. Or fold over your hips in Balasana (Child’s Pose), with your head supported.

Next, slowly move into supported Viparita Karani (Legs-up-the-Wall Pose), using a folded blanket or two to support your pelvis and sacrum; let the tailbone hang off the edge of the blanket. Relax here for 10 to 20 minutes.

Before lying down to sleep, sit cross-legged in Sukhasana (Easy Pose), with your pelvis elevated on one or more folded blankets and your back against a wall, spine long, and shoulders relaxed. Allow your thoughts to arise and just watch them float by. When you notice that you’ve begun to follow a thought, simply notice that this has happened. This thought-watching becomes your new thought to watch, without judgment. Start with five minutes and try sitting for longer periods over time.

And then, when it’s time to sleep, cover your eyes with something that provides both darkness and very gentle pressure, like an eye bag.

Writer Rachel Brahinsky is based in San Francisco, California.