Cheryl Fenner Brown, C-IAYT, E-RYT 500
This article also appeared in the Yoga U Online Wellness Blog, July 2019
​
Anxiety is one of the most prevalent side-effects along the entire spectrum of the cancer journey. Nearly all patients will experience anxiety at one point or another including after receiving a diagnosis, anticipating and receiving treatment, affording treatment, anticipating recurrence, ending treatment and becoming a long-term survivor. For many the fear of recurrence is very real and something that does not diminish with time. While the rate of recurrence varies depending on the type of cancer from early treated breast cancer as low as 5% to glioblastomas and ovarian cancers approaching an 85% recurrence rate or higher, up to7% 0f patients develop a disabling fear of recurrence that severely impedes quality of life.

Stress, Anxiety and Cancer

Cancer patients may experience generalized anxiety or other diagnoses such as phobias, panic attacks, OCD, health anxiety disorders and PTSD. Symptoms of these may vary but include increased heartrate, shortness of breath, muscle tightness, heightened pain, insomnia, sweating, nausea, restlessness and irritability. Also, how patients feel about their stress and anxiety impacts how much the stress affects their physical and mental health. One study out of Harvard reported that those who had high levels of stress and believed stress negatively impacted their health had 43% increased premature death rates over those who did not believe their high levels of stress was harmful.

The Stress Response & Immunity

The stress response or commonly called “fight or flight” response turns off the parasympathetic nervous system and reduce bodily functions not necessary for immediate self-preservation. This includes the lymphatic system, which in turn slows the immune response. As far back as 1965 psychiatrist George Solomon published some of the first findings in the field of psychoimmunology studying the link between stress levels and immune responses.

When stress is perceived as harmful and chronic it can inhibit immune function. However, when stress is perceived as an opportunity to rise to a challenge, it does not. When we experience as stressful event, whether it is the diagnosis of a life-threatening disease, or something as commonplace as getting cut off in traffic, the body responds automatically by secreting stress hormones. One of these is cortisol which raises blood sugar and metabolizes white blood cells to provide energy for the “fight or flight” response. Unfortunately, when stress becomes chronic, cortisol levels remain high even during rest and this can decrease immunity by inhibiting T-cell production and our T-cells are what protect the body from invading viruses, allergens and from mutated cancer cells.

When a challenge is perceived adrenaline is also produced. Adrenaline increases blood pressure and heartrate to create a rush of energy so we can respond to the challenge. But over time, sustained production of adrenaline causes a higher than normal baseline to be set by the body which taxes the organs, increases insulin production, and keeps blood pressure high.

Tend and Befriend Response

Fortunately, our bodies have a built-in mechanism for stress resilience, the hormone oxytocin. Also secreted as part of the stress response, oxytocin protects the cardiovascular system from the effects of stress, it works as an anti-inflammatory and keeps muscles more relaxed. Emotionally, oxytocin encourages us to seek support from others and helps us to notice when others are struggling, and when we do, more oxytocin is released.

Particularly for women, the “tend and befriend” response is tied to higher levels of oxytocin and causes us to ‘tend’ to those around us who are in need, and ‘befriend’ by seeking out social support. Better stress outcomes can be expected when patients have emotional and social support in place including support groups, therapy, education and wellness communities including yoga class communities, especially yoga classes for people managing cancer. Perhaps this speaks to why more women tend to seek out social support systems when undergoing diagnosis and treatment for cancer.

How Yoga Helps Anxiety

The good news is that yoga and other mindfulness practices modulate the stress response by lowering heartrate, blood pressure and respiration rates, and increasing heart rate variability which is an indicator of how well the body responds to and recovers from stressful events. More and more studies are being conducted showing the positive impacts of consistent yoga practice on mental and emotional well-being in cancer patients. Specifically, yoga has been shown to improve mood states, symptom reduction, stress reduction and improved quality of life. Besides improving these measurable health markers, yoga can lead to a sense of empowerment and mastery over the body and mind which can be an important factor in reducing stress and anxiety.

What follows is a simple sequence of yoga practices including setting intention, a mudra for anxiety, a simple sound practice to help calm the mind, a supported version of Balasana (Child’s Pose) to help you draw awareness inward and a calming pranayama practice. Done together these practices can help you to cope with the anxiety caused by diagnosis, treatment or survivorship and allow you to feel more like yourself.
​
Yoga Practice Tips

• Do a little yoga each day to give yourself the time and space to heal. Make yoga a permanent part of your life after cancer.
• Stay mindful of the body and breath throughout the practice. Only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
• For this practice a yoga mat and blanket and two or more bolsters or pillows will be helpful.

Setting Your Sankalpa with Anjali Mudra

Intention setting, or creating a sankalpa, is an important first step toward using yoga as a healing practice. It serves as a reminder of your goals during this time.

• Begin sitting in a comfortable seated position with your palms together at your heart. This is Anjali Mudra (prayer gesture) and helps to draw your awareness inward.
• Take a few deeper breaths and recall your current challenges. Recognize that challenges are opportunities for growth and healing.
• Begin to imagine the best possible outcome for your current situation, setting aside any feelings of doubt that arise.
• Allow your sankalpa to arise formed into a simple statement phrased in the present tense beginning with “I am … ”, or “My … ”. If you find it difficult to create an intention at this time, use the statement “I am calm and worry-free.” State your sankalpa silently three times and trust that it will manifest with patience and repetition.  

Adhi Mudra for Anxiety
 
Adhi translates to “first” because this mudra is the first mudra we do in the womb. It is a self-soothing gesture and comforts us during anxious times. Adhi mudra draws the excess mental activity down into the body where it can be processed and grounded. I also call this one of the “sneaky” mudras because you could easily hold your hands in this position during a difficult conversation and no one will know that you are doing something to ease your anxiety.

1. Hold your thumbs in the center of your palms and wrap your other fingers lightly around each thumb.
2. Rest the knuckles of the hands downward on your lap.
3. Soften your shoulders and release your forearms.
4. Hold this gesture for a few minutes and notice how it feels, then release the hands.

Vowel Spiral
 
Using your voice to create a shift in your mental state is a powerful tool to combat anxiety. This practice uses simple vowel sounds that cause vibration in specific parts of the torso and head. As awareness is drawn into these areas, the mind can be freed from circular thinking that might cause anxiety. As you chant, focus on what the sound feels like in the body, how the vowels sound, and how smooth the tone is. You may notice breaks and warbling in the tone if your mind wanders or if your exhalation is not smooth. Work to smooth out the tone and make sure that you stop sounding before you run completely out of breath, so you are left feeling relaxed, not breathless and rushed.
 
Chanting simple sounds is one of the fastest, most effective ways to center the mind and emotions. When you are anxious you can imagine that your cells are vibrating in dissonance at an atomic level. When you chant, you bring your atoms into resonance and harmony and you can truly feel the difference almost immediately. Give it a try!

1. Begin sitting in a comfortable position on the floor on a folded blanket, or in a chair.
2. Take a few moments to breathe naturally and allow your inhalations to flow down into your lower abdomen.
3. Bring one hand to your lower sternum, inhale naturally, then as you exhale chant an “Ahhh” sound (like ‘father’), noticing vibration in your mid-chest.
4. Move your hand to your upper sternum, inhale naturally, then as you exhale chant an “Aaa” sound (like ‘way’), noticing vibration at your heart center.
5. Move your hand to your belly, inhale naturally, then as you exhale chant an “Ooo” sound through very round lips (like ‘donut), noticing vibration at your navel center.
6. Move your hand to your forehead, inhale naturally, then as you exhale chant an “Eee” sound (like ‘free’), noticing vibration in your skull.
7. Move your hand to your hip point, inhale naturally, then as you exhale chant an “Uuu” sound (like ‘noodle’), noticing vibration in your pelvis, legs and feet.
8. Move your hand to the crown of your head, inhale naturally, then as you exhale chant an “Mmm” sound, noticing vibration at your crown.

Repeat the entire sequence two more times beginning and ending with the “Ahh” sound at the heart center. Observe how the vibration spirals from the heart outward toward the crown and pelvic floor.

Balasana (Supported Childs Pose)

Coming into a fetal position can feel like a balm for frayed nerves. It enables you to turn your awareness towards the internal landscape of sensation, breath and thought and away from the things outside of yourself that may be causing anxiety and stress. However, this pose can be difficult if the knees or hips are not comfortable in deep flexion. If you have access to bolsters or pillows, you can support your hips, thighs and torso so that Balasana (Supported Child’s Pose) can be maintained for several minutes in comfort and relaxation.

1. Place a folded blanket on your mat so you have something soft to kneel on.
2. Straddle one bolster as if you were sitting on a horse.
3. Place the second bolster perpendicular to the first in front of your knees.
4. Lengthen your torso forward so that your chest and belly are resting on the bolsters.
5. Turn your head to one side and rest your forearms on the floor or support your forehead on the backs of your stacked hands.
6. A third bolster may be helpful to place on top of the first two if you are not comfortable folding your torso forward into Balasana (Supported Child’s Pose). You want to place your torso so that your hips are at or below the level of your head. Additional bolsters can be straddled until you are comfortable.
7. If this version of Balasana (Supported Child’s Pose) is not comfortable, or you don’t have access to props, feel free to recline on your back with your knees drawn into your chest. It is the same posture in a different relationship to gravity.
8. Rest here for several minutes and practice breathing in and out in a slow and relaxed way.
9. Return to a seated position as soon as you begin to receive messages from your hips or knees that you need to come up; never stay past the point of comfort. 

Rechaka Kumbhaka Pranayama (Exhale Retention)
​
Conscious breathing is a simple yet effective way to shift your mindset when you are worrying or feeling anxious. It is an amazingly powerful tool that is always there for you when you have a few moments to focus on your breath. Bringing awareness to a slow, relaxed exhalation will activate the parasympathetic nervous system helping to reduce the effects of anxiety by reducing stress hormones, heartrate and blood pressure. The practice of lengthening the exhalation can increase the stress-reducing effects even more.

1. Recline comfortably with support under your head and knees if needed. Your blanket or pillow will come in handy here, or simply leave the knees bent.
2. Close your eyes and feel your breath moving smoothly in and out of your nostrils.
3. Place your hands on your lower belly and as you inhale, notice if there is a natural lifting of the abdomen, and a gentle softening of the belly on the exhale.
4. Take a normal length inhale, then slowly begin to lengthen your exhale by one or two beats. You do not need to count your breath but try to make the exhale slightly longer than your inhale.
5. This should only be done at a comfortable speed and pace, never to the point of breathlessness or frustration.
6. After five or so breaths with a longer exhalation, notice if there is a natural pause at the end of the exhale where the breath rests.
7. Inhale, long slow exhale, and then pause where the breath is neither moving in nor out.
8. Allow that rest to last for a few beats, then continue breathing.

​
Repeat this pattern for several minutes, then return to your normal everyday breath pattern.  

Savasana (Relaxation Pose)

It is important to give yourself a few minutes at the end of your practice to rest in stillness and silence so that the gifts of the practice can be fully integrated into your body and mind.

1. Recline with your legs extended and feet relaxed to sides. 
2. Rest your arms to the sides and turn your palms to face the ceiling. 
3. You may use support under your knees for low back pain or add a folded blanket under your head. Relax here for at least 5 minutes. 

​When you are ready to sit back up, take your time rolling over to your favorite side, resting there for a few moments while you repeat your sankalpa from the beginning of the practice. Then use the strength of your arms to press yourself back up to a seated position. Namaste’

Cheryl Fenner Brown, C-IAYT, E-RYT 500
Yhis article also appeared in the Yoga U Online Wellness Blog, May 2019
 
One of the most distressing side-effects of cancer treatment is lymphedema, a swelling of the extremities caused by damage to the lymphatic system. The lymphatic system is part of the immune system and consists of nodes, vessels and organs that transport lymph throughout the body. Lymph transports white blood cells through lymph nodes which are grouped in the throat, underarms, abdomen and groin. These nodes store cells that help to fight infection and filter the lymph before it returns to the bloodstream. If cancer treatment damages or removes lymph nodes, lymph builds up in the surrounding tissue causing painful swelling, or lymphedema.

During breast cancer treatment, lymph nodes are often removed and tested for cancerous cells. The symptoms of lymphedema may occur immediately or up to 5 years after treatment. According to one survey, between 50-75% of women who had lymph nodes removed as part of breast cancer treatment worried about developing the condition while less than 20% developed the condition (1).
Patients with lymphedema can experience a range of symptoms besides swelling of the limb and digits including pain, limited range of motion, increased risk of infection, sensitivity, hardening or thickening of the skin. (2) Lymphedema treatments include manual lymph drainage, elevation of the affected limb, compression garments, breathing exercises and movement. (3)

Yoga and Lymphedema

Unlike the circulatory system which has the pumping heart to move blood through the vessels, the lymphatic system relies on the body’s movements to circulate lymph. The deep diaphragmatic breathing and simple repetitive movements of the hands, arms, neck, torso and hips that are involved in many forms of yoga all help the lymph to flow optimally. Yoga also helps to increase range of motion and strength which can help to counter the impact of lymphedema, so long as the yoga is practiced slowly and gently.
There are a few yoga poses that are contraindicated for those with lymphedema; handstand (adho mukha vrksasana), forearm balance (pincha mayurasana), downward-facing dog (adho mukha svanasana), headstand (sirsasana), shoulderstand (sarvangasana), and plow (halasana) all put too much pressure on the arms, shoulders and neck and should be avoided. If the lower extremities are affected, poses that create too much compression on the legs should also be avoided such as lotus (padmasana) or child’s pose (balasana) with deeply bent knees.
​
Yoga Practice Tips

• Do a little yoga each day to give yourself the time and space to heal, and to help make yoga a part of your life after cancer.
• Stay mindful of the body and breath throughout the practice, and only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
• This sequence includes movements that mechanically squeeze and stretch the armpit, abdomen and groin areas to stimulate lymphatic flow.
• It is important to completely relax the muscles and rest in between active portions of each movement.
• For this practice a yoga mat, chair, and blanket or pillow will be helpful.

​Reclining Floor Flow
 
The reclining floor flow is a simple series of movements that massages the lymphatic structures in the armpits, abdomen and groins. It can also alleviate pain in the hips, lower spine and shoulders. This practice can be done on the floor or on a bed.
 

• Recline with your legs extended. As you inhale, raise your arms over your head to a comfortable position.
• As you exhale, draw your right knee towards your chest.
• On your next inhale, draw your right knee out and open your left arm out from your shoulder.
• Exhale and pass your knee across your body to your left hand and rotate your pelvis and lower spine to the left, turn your head to the right.
• Inhale and bring your leg and torso back to the center and extend your right foot upwards, clasping your hands behind your thigh.
• Exhale and draw your knee into your chest.
• Inhale and return to the starting position with arms extended over your head, and your legs long on the floor. Take a few breaths of rest here.

Repeat the entire sequence of movements with your left leg, alternating sides up to five times each. Be sure to rest for several breaths between each set of flowing movements.

Cat/Cow (Marjaiasana/Bitilasana)
​
This common series of poses is a simple way to move energy and lymph throughout the torso and can be done kneeling on the floor or seated in a chair.

• For the kneeling variation, pad the knees with a folded towel or blanket and bring your knees under your hips and hands just in front of your shoulders. If the wrists are uncomfortable, press the fists into the floor with the thumbs forward.
• From a neutral spinal position exhale and draw your belly in, round your back and release your head to look at your knees; this is Cat pose. Stay here for a few breaths and feel the stretch of your spinal muscles and the gentle compression of your organs.
• As you inhale begin to lengthen your pubic bone away from your navel and lift your heart, look forward being careful not to overarch your neck; this is Cow pose (shown). Stay here for a few breaths feeling the even extension of the spine.
• Begin to move with your breath, exhale into Cat pose, inhale into Cow pose, then relax into center for a few moments of rest.
• For the seated variation inhale into Cow pose, place your hands on your hips, draw your tailbone and shoulder blades back, stretch your abdomen forward, and lift your heart with your gaze going toward the ceiling.
• Exhale into Cat pose, draw your belly in and round your entire spine, release your chin towards your chest while you reach out and cup your knees with your hands.

Continue to move and breathe for 5 more rounds. Be sure to rest for several breaths between each set of flowing movement.

​Child’s Pose to Extended Hero’s Pose (Balasana to Utthita Virasana)
​
Moving from Child’s Pose (Balasana) to an extended spinal position mobilizes prana, or vital energy in the body and can help to activate stagnant lymph.

• Begin in an all-fours position and as you exhale release your hips back towards the heels into a crouched position or child’s pose (Balasana). Only go back as far as your knees will comfortably allow.
• As you inhale lift your head and chest, press your hips forward. Raise your hands to your heart, place them on your head, or reach your arms overhead into Extended Hero’s Pose (Utthita Virasana) as shown.
• Then as you exhale, fold forward placing your hands on the floor or release back into Child’s Pose (Balasana) if that feels comfortable.
• Take a few moments of rest before inhaling back into Extended Hero’s Pose (Utthita Virasana).

As you repeat this flowing movement five times with the breath, notice how you alternately stretch and compress both the groin, abdomen and armpits to encourage lymphatic flow.

Three-Part Breath (Dirga)
​
Breathing deeply is part of traditional lymphedema treatment as it increases the movement of the diaphragm and massages the lymph nodes located deep within the abdominal cavity. The full yogic breath, or Three-Part Breath can be practiced while seated in a chair or reclining on the floor or bed. I often imagine the breath like an elevator car moving up and down along an elevator shaft as I practice this pranayama.

• As you inhale notice a lifting, buoyant sensation in your torso. As you exhale notice a downward flowing sensation. Maintain these subtle directions as you continue.
• Inhale breath from your pelvic floor up to your navel; exhale the breath down to your pelvic floor.
• Then inhale from your pelvic floor up to your lower ribs. Exhale the breath down from your ribs to your pelvic floor.
• Then inhale from your pelvic floor up to the top of your chest as if your breath was being poured into your torso and filling you from to bottom to the top. Exhale and release your breath back down to your pelvic floor. It may be helpful to lightly touch the upper chest to provide a bit of feedback for the breath as shown.

Repeat for several more rounds of breath, then release any control over your breath and rest for a few moments, noticing the effects. Remember to stop and rest if you feel uncomfortable or breathless.

Instant Maui
​
Elevating the legs encourages lymphatic drainage back toward the torso and is very easy to do at home. Some doctors recommend that the legs be elevated above the heart for at least 30 minutes 3-4 times a day for maximum benefit (4). Take care when positioning your body to be sure that your feet are elevated above your knees, your knees above your hips, and your hips above your heart to ensure excess fluid travels back toward the torso where it can be re-circulated into the blood stream. This posture is also mild inversion that provides a change in our perspective encourages deeper breathing, energy absorption and relaxation.  Find a piece of furniture in your home such as a soft chair, sofa seat or ottoman to use for support.

• Recline in front of your furniture support and press your feet onto the edge of the seat.
• Lift your pelvis and place a block, pillow or folded blanket under your hips. The prop should be between the waistband of your pants and the tailbone. If it is too high or too low, it will not feel comfortable so find that sweet spot where your sacrum is parallel to the floor.
• Rest your arms slightly away from sides with the palms facing up.
• If the hips are elevated, it is best not to use a pillow for the head. If you have un-medicated high blood pressure, nausea, or this position makes you feel dizzy or uncomfortable, remove the prop out from under your pelvis and rest with the hips flat on the floor.

Rest here for fifteen to thirty minutes, feel free to set a timer if you are concerned that you might fall asleep. 

Even though lymphedema can be an uncomfortable side-effect of cancer treatment, these simple yoga practices can boost immunity, release tension, increase lymphatic drainage and help the body to find more balance. Happy practicing and namaste’.

References
​

• Journal of the American College of Surgeons, “Breast Cancer Patients’ Fear Exceeds Risk”, March 2013: Vol 216(3): 380-386.
• “Lymphedema”, Mayo Clinic, 2019, https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682
• Zuther, J., “Yoga for Lymphedema”, Lymphedema Blog, (2017), http://www.lymphedemablog.com/2017/03/02/yoga-for-lymphedema/
• Stearns, R. H., “Edema (swelling) (Beyond the Basics), 2019, UpToDate, https://www.uptodate.com/contents/edema-swelling-beyond-the-basics#H17

 

Cheryl Fenner Brown, C-IAYT, E-RYT 500
This article also appeared in the Yoga U Online Wellness Blog, February 2019

You probably know the feeling - lying in bed for hours on end looking at the clock with the mind swirling, chattering and generally keeping you from falling asleep. You re-play the events of the day getting caught in circular thoughts like “Why did I say that?”, “Why didn’t I stand up for myself at work?”, or “How am I going to pay my bills?”. The frustration of insomnia spills over into the next day and you find yourself reaching for another cup of coffee to make it through the day. One in four Americans experience insomnia every year, with 75% of those sufferers recovering without developing chronic insomnia (1).

Cancer, Insomina & Immunity

For cancer patients, the stress of diagnosis and treatment can be cause for greater insomnia. In fact, recently treated cancer patients are twice as likely to develop sleep disturbances as the general population (2). It is not only the swirling stressful thoughts that keep patients awake, but muscle and joint pain may prevent them from finding comfort and achieving deep restful sleep.  Many steroidal cancer medications can also cause insomnia, and patients often need prescription sleeping aids to overcome it.
Regular sleep is so important to every aspect of life, from physically feeling better to being able to think more clearly. From being in a better mood to being able to heal more quickly. Sleep enhances immunity at the cellular level allowing immune cells to be created and tissue to be repaired. Unfortunately, stressful sleep-less nights have both and an immediate and long-term detrimental effect on the health of the immune system. (3). For cancer patients or people whose immune systems are already compromised by treatments, sleep is an important part of supporting the body’s natural healing processes.

You Deserve Better Sleep

But how do we get better sleep? There are many ways to increase sleep hygiene including maintaining a set bedtime, creating a relaxing pre-sleep routine like taking a hot bath or drinking herbal tea, limiting light and electronic devices in the bedroom, and creating a warm inviting sleep environment. Yoga practices can also help improve sleep and over 55% of yoga practitioners report that yoga helps them sleep better (4). Specifically, we will be looking at practices that activate the parasympathetic nervous system, or “rest and digest” response. This part of the nervous system counteracts chronic over stimulation of the sympathetic nervous system, or “flight or fight” response caused by living in the modern world.

Yoga for Insomnia

The yoga practice that follows is a combination of practices to enable easier sleep. It consists of mudra to help quiet the late-night ruminations of the mind, gentle spinal movements to ease body aches, calming pranayama to release stress, and a mild inversion to initiate the relaxation response. Practice in the hour before you go to bed to take advantage of the sleep-inducing benefits.

Yoga Practice Tips

1. Do a little yoga each day to give yourself the time and space to heal. Make yoga a permanent part of your life after cancer.
2. Stay mindful of the body and breath throughout the practice. Only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
3. For this practice a yoga mat and two soft props (bolsters, blankets or pillows) will be helpful.

Stating Intention with Vajrapradama Mudra

​Stating an intention, or sankalpa, is an important first step toward using yoga as a healing practice. Combining intention with the following mudra that settles doubts by enhancing your ability to trust yourself can serve as a reminder of your goals during this time.

• Begin sitting in a comfortable seated position.
• Clasp your hands together  with your fingers on the outside.
• Open your palms towards your chest so that your thumbs reach upwards towards the ceiling.
• Loosen the webbing between your fingers and hold your hands in front of your heart center and notice the physical and energetic effects of this gesture.
• While holding Vajrapradama Mudra state your sankalpa three times silently. If you have difficulty formulating an intention, use the statement, “I deserve to be well-rested.”
• Hold the mudra for a few more breaths, then release the hands.

Apanasana
​
When a stiff and achy body contributes to sleepless nights, movement is often needed to release tension, ease pain, and relax muscles so that sleep can come more easily, especially if you experience occasional restless leg syndrome or cramping at night. Try this simple effective series of movements that can be done on the floor or reclining in bed.

• Begin lying on your back with your knees bent and your feet on the floor
• As you inhale extend your legs making sure that you do not feel strain in your lower back. If you feel strain, keep your knees bent and your feet on the floor.
• As you exhale draw your right knee towards your chest with your hands clasped in front of your shin, as shown.
• Then as you inhale extend your right leg back to the floor and either relax your arms to your sides or reach them over your head.
• As you exhale and inhale again, repeat the movement with your left leg.
• Alternate sides for five or more repetitions, relaxing into a flowing pattern with your breath. 

Reclining Twist
​
A gentle twist can be helpful for releasing muscular tension from the hips and lower back which may help you to be more comfortable when you recline to sleep. Try this version on the floor or on top of your bed.

• Recline on your back with your knees bent and your feet on the floor. You may find it helpful to place a bolster or block on the right side of your hips.
• Press your feet into the floor and slightly lift your hips up so that you can shift your hips a few inches to the left, then lay your hips back down.
• Draw your knees towards your chest and relax your legs to the right, using the prop under or between the knees as needed to keep both of your shoulders on the floor.
• Breathe into the left side of your abdomen and chest as you rest in this position up to 3 minutes.
• To come out of the posture, draw your left knee up followed by your right so that you are resting on your back again.
• Then place your feet on the floor and repeat the twist to the other side.

Chair Forward Fold
​
A gentle forward bend shares the tension relieving benefits of the reclining twist above as well as calming mental and emotional energy that can help to prepare the body and mind for sleep. Try this version with the head supported by a chair to ensure a sense of surrender and ease.

• Sit cross-legged in front of a chair seat using a folded blanket or bolster under your sit bones if it assists your ability to tilt your pelvis forward.
• Lengthen the front of your spine and place a bolster along the front of your body for support.
• Then lean forward from your hips and rest the bolster against the front edge of the chair seat.
• It may be more comfortable to turn your head to one side (as shown) and rest your arms on the seat, making sure to change the turn of your head half-way through the pose. Otherwise, you could place your forehead on your stacked hands, or rest your arms down by your sides.
• Rest in this position for up to 3 minutes so long as your hips and legs are comfortable. Breathe into the back of your body inhaling up your spine and exhaling down your spine. 
• To come out of the posture, engage your lower belly and draw your torso back upright.
• Repeat the posture with your other leg crossed on top. Notice that the leg that is on top or in front receives the most stretch in this pose. 

Chandra Bhedana (Left Nostril Breathing)
​
Different breathing patterns create different effects and here you will practice a pranayama that can calm a swirling mind. In this pattern you will breathe in through the left nostril which activates ida nadi. This left pranic channel is often called the moon channel and is cooler, calmer and more introspective than the right channel. You will then exhale through the right nostril which is associated with pingala nadi, the more active or solar channel. Imagine that you are allowing calming lunar energy to flow through your active busy mind.

• Begin seated comfortably and place the index and middle fingers of your dominant hand at the spot between your eyebrows.
• Use your thumb (or ring finger if you are left-handed) to close your right nostril and inhale through that side.
• Hold your breath in comfortably for a few seconds
• Then use your ring finger (or thumb if you are left handed) to close your left nostril and exhale through that side.
• Hold your breath out comfortably for a few seconds.
• Continue breathing with this pattern, inhaling through your left nostril and exhaling through your right nostril with slight pauses at the top of the inhalation and bottom of the exhalation.
• Can you feel that the inhalations are cooler than the exhalations?  Notice the effects of this breath as you continue for a few minutes.
• When you are finished, spend a few moments relaxing the breath back to its normal everyday pattern.

Legs in Chair

Elevating the legs before you go to sleep can help in several ways. It will relax the lower back and help to release deeply-held tension in the hips. The mild inversion also shifts the flow of blood from the feet towards the heart and sends a signal to the parasympathetic nervous system to activate the relaxation response. It takes some time for this internal shift to occur, so rest here for as long as you feel comfortable.

• Find a piece of furniture in your home such as a soft chair, sofa seat or ottoman that you can use for support. You might use the side of your bed or even lie with the feet up on your head board.
• Recline in front of your support and place your calves on the seat, supporting your head with a folded blanket or pillow if needed.
• Completely relax your legs and rest your arms slightly away from sides with the palms facing up.
• Rest here for at least ten minutes.
• If you do not want to fall asleep in this position, you might want to set a timer.
• Also make sure that you are warm enough, wear socks or cover yourself with a blanket. 

When you are ready to go to bed, take your time rolling over to your favorite side, resting there for a few moments while you repeat your sankalpa from the beginning of the practice. Then use the strength of your arms to press yourself back up to a seated position. Namaste’