Summary: Yes, yoga and tai chi can help insomnia. New studies indicate that compared standard treatment, yoga, tai chi, light aerobic exercise help insomnia most.
Key Points:
- Insomnia and the result – sleep deprivation – is directly related to significant negative consequences for physical, emotional, and mental health.
- Experts indicate insomnia is a significant problem for people with clinical mental health diagnoses – including substance use disorder (SUD) a.k.a. addiction.
- New studies show specific types of exercise offer the most benefit for people with insomnia.
Mental Health, Addiction, and Insomnia
Studies show the following psychiatric diagnoses commonly co-occur with insomnia and various subclinical sleep disturbances:
- Depression: insomnia can exacerbate symptoms of depression and increase risk of suicidality
- Personality disorders: in disorders associated with psychosis, insomnia has a negative impact on thought, decision-making, and cognition.
- Anxiety disorders: insomnia is identified as a problems in most anxiety disorders, including generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD)
- Addiction: insomnia is identified as a problem in most addiction disorders, with a high prevalence among people with alcohol addiction, called alcohol use disorder (AUD).
Problems falling and staying asleep are frequent among people in addiction treatment. Among the general population of adults worldwide, research shows the following prevalence of insomnia:
- Oceania: 19.2%
- North America: 16.2%
- Europe: 9.9%
- Overall, adjusted worldwide rate: 12.4%
However, the prevalence of insomnia among people with mental health disorders is far higher. Data from the study “Prevalence and Associated Factors of Insomnia in Adult Psychiatric Patients: A Hospital-Based Study,” shows the following facts about sleep problems among people with clinical mental health disorders:
- Overall: 44%
- Depression: 56%
- Bipolar disorder: 53%
- Anxiety: 52%
- Schizophrenia: 34%
- Substance use disorder: 30%
- Obsessive-compulsive disorder (OCD): 25%
In addition, data from the study “Bidirectional Associations Between Sleep and Addiction Across Populations,” shows the following facts about sleep problems among people inn addiction treatment, and substance use among people in treatment for insomnia:
- 72% of people in treatment for addiction report significant sleep disturbance
- 30% of people in treatment for insomnia report using alcohol or substances to help them get to sleep
The most recent data show that insomnia is a significant problem among people with mental health disorders and addiction disorders, with high prevalence – 70 percent – among people in treatment for alcohol and drug addiction.
Treatment for Insomnia: What Works?
In most cases, the most effective treatment for co-occurring insomnia and mental health disorders includes cognitive behavioral therapy tailored for insomnia (CBTi), changes in lifestyle such as diet, exercise, and sleep hygiene, and, in some cases, short-term prescription medication. But these approaches aren’t effective for all people in mental health or addiction treatment, which means that people with insomnia may experience symptoms that decrease their chances at successful healing and recovery.
In 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a treatment brief called “Treating Sleep Problems of People in Recovery From Substance Use Disorders”
Nonpharmacological Treatments for Insomnia: SAMHSA
- Meditation: mindfulness-based approaches.
- Stress reduction: progressive muscular relaxation.
- Psychotherapy: CBTi, a.k.a. cognitive behavioral therapy for insomnia.
- Sleep hygiene: improving sleep environment and bedtime habits
- Exercise: daily activity, includes vigorous, moderate, and low intensity activity
Since then, experts have examined these interventions more closely in order to understand the nuances of insomnia treatment and what works best in specific situations. In our work in addiction treatment, we prefer the nonpharmacological treatments listed above, and prefer lifestyle interventions that include mindfulness.
That’s why we want to offer information on the question we pose in the title of this article – can yoga and tai chi help insomnia – and share the latest facts on whether typical treatment or tai chi and yoga help insomnia more effectively.
That’s why a new study caught our attention, which offers new insight gathered in the decade since the publication of the SAMHSA treatment brief on treating sleep disorders for people with addiction.
The Latest Study: Typical Treatment for Insomnia, or Exercise?
The large-scale review paper, “Effects of Various Exercise Interventions in Insomnia Patients: A Systematic Review and Network Meta-Analysis,” released by the British Journal of Medicine (BMJ), created an experiment to assess the impact of various types of exercise on people with insomnia. Here’s how the research team describes the goal of the study:
“To compare the effectiveness of different exercise interventions in improving sleep quality and alleviating insomnia severity among patients with insomnia.”
To determine the effectiveness of each type of exercise, researchers examined data from over 20 studies with more than 1,300 patients. Researchers analyzed information on over a dozen types of exercise, with a focus on seven (7) types of exercise:
- Yoga
- Tai chi
- Walking and/or jogging
- Aerobic activity combined with weight training
- Weight training alone
- Aerobic exercise combined with psychotherapy
- Other types of moderate activity
The research team used a variety of evidence-based measures to measure sleep, including:
- Standard Sleep Metrics
- Standard Insomnia Metrics
- Individual sleep records
- Electroencephalograms (EEG)
- Wearable sleep monitors
For comparison, researchers examined results for the types of exercise they studied against no treatment, typical care, common lifestyle changes, psychotherapy, and various alternative treatments common in complementary medicine, such as deep tissue massage, acupuncture, and others.
Can yoga and tai chi help insomnia?
Let’s find out.
What’s the Best Non-Medication Treatment for Insomnia?
When we talk to our patients about exercise and insomnia in addiction treatment, we often see and hear two opposing viewpoints. Among people in treatment who’ve used exercise to try to get to sleep before, roughly half say they use exercise to become so physically exhausted sleep comes easily, while the other half say their exercise is more about stress relief and literally working out negative emotions or emotional distress, as opposed to exercising to the brink of exhaustion.
Before we read this study, we predicted a combination of both would likely yield the best results – a combination of intensity and mindful stress reduction – but the experimental results clearly showed one approach was more effective than the other.
The approach that worked best?
Yoga.
Data showed that for patients with clinical insomnia, the practice of yoga led to:
- Over 1.5 more hours of sleep, on average
- Better sleep efficiency, measured as a ratio of time spent sleeping to time spent in bed.
- Almost an hour less time awake in the middle of the night, i.e. time spent not being able to fall back asleep after unplanned/unwanted waking during sleep time.
- Better time falling asleep: yoga was associated with falling asleep less than half an hour after going to bed.
Although that data surprised us, we were also surprised by the next most effective approach.
The approach that worked second best?
Tai chi
For patients with clinical insomnia, the practice of tai chi led to:
- Nearly an hour more sleep – around 50 minutes – on average
- Better sleep overall, as measured by Standard Sleep Metrics
- Better time falling asleep: tai chi was also associated with falling asleep less than half an hour after going to bed.
- Over half an hour less time awake in the middle of the night, i.e. time spent not being able to fall back asleep after unplanned/unwanted waking during sleep time.
The results showed conclusively that yoga and tai chi were the best approaches for reducing insomnia and improving sleep. However, we still predicted that activity such as a combination of weight lifting and aerobic exercise, or possibly weight lifting alone, would appear high in the results. Again, the results surprised us.
The approach that worked third best?
Walking and jogging.
Among people with insomnia, walking and jogging was associated with a meaningful decrease in the severity of sleep disturbance, as compared to standard treatment. Finally, data showed perhaps the most important outcome of the entire study:
In comparison to typical treatment for insomnia, people who practiced tai chi showed the largest improvements across all metrics, the improvements persisted for two years after the beginning of the study.
We’ll discuss these results below.
Why Do Yoga and Tai Chi Help Insomnia?
At face value, it’s clear that relaxation and stress reduction are valuable components of the impact of exercise on insomnia, as opposed to exercising to the point of physical exhaustion. In the online science magazine Science Daily, members of the study team offered the following possible explanations:
- Yoga: breath work, physical awareness, and attentional training may lead to changes in brain activity that reduce symptoms of depression and anxiety, thereby improving sleep.
- Tai chi: previous research shows tai chi can reduce activity in the sympathetic nervous system, which can reduce hyperarousal associated with depressive and anxiety disorders. The research team also proposed that the combination of movement with mindfulness may improve emotion regulation. Researcher proposed that the long-term benefits of tai chi may be explained by cumulative reduction in inflammation and inflammatory chemicals in the body, which are associated with increased symptoms of depression and anxiety.
- Walking and jogging: researchers propose the increase in energy expenditure, which reduces levels of circulating cortisol, and increases in hormone melatonin, may both improve time spent in healthy, restful sleep.
We’ll note here that these improvements all appeared in the context of receiving helpful guidance on basic sleep hygiene. In the context of addiction treatment, SAMHSA offers helpful suggestions for improving sleep hygiene, which we’ve adapted here.
Sleep Hygiene: SAMHSA Top Tips
- Be consistent. Try to go to sleep and get up at the same time every day, without much variation for weekends or nonwork days.
- Do your best to align sleep time with natural cycles of light and dark. When you go to sleep closer to sunset, and get up closer to sunrise, sleep improves.
- Get plenty of exercise and activity every day.
- Make any naps short and avoid naps in the late afternoon/evening.
- Avoid eating right before bedtime.
- Avoid caffeine and nicotine before bedtime, eliminating consumption several hours before bed.
- Create relaxing bedtime rituals that help you calm down, unwind, and leave the any daily stress behind. Mindful breathing and relaxation work well.
- Consider making your bedroom for sleeping only. Experts say watching TV in bed, hanging out on your phone in bed, and particularly doing things like reading work emails or using your laptop to pay bills – while in your bed before trying to go to sleep – are counterproductive, and reduce chances of getting a good night sleep.
- Keep your bedroom as dark and quiet as possible, and err on the side of being cool, temperature-wise, as opposed to being warm.
- Avoid staying in bed if you’re not sleeping. When you don’t fall asleep within about half an hour, get out of bed, find something relaxing to do in another part of the house, then come back to bed and try again.
Those are excellent sleep hygiene tips, tailored for people in addiction treatment. We’ll close this article below, with a summary of key takeaways and final thoughts from the authors of the insomnia study.
How We Can Use This Information to Help Patients in Addiction Treatment
One thing we can do is use this study as a reminder that the presence of insomnia can impair progress in addiction treatment and increase risk of relapse. According to SAMHSA, all addiction treatment providers should help people with co-occurring insomnia and addiction by taking the following steps:
- Screen any patients in addiction treatment for insomnia
- Educate patients about the basics of good sleep hygiene
- Ensure medication or other medical conditions aren’t the cause of insomnia
Based on this new research, we can add one more item to that list:
Offer patients classes in tai chi and yoga and offer ample opportunities for easy jogging and walking during addiction treatment.
Those are things we can and already do offer, in slightly modified forms, in our treatment plans. Yoga, tai chi, and breathwork are part of our curriculum, and now we have the evidence to show they not only help as complementary supports for addiction treatment, but yoga and tai chi can also help insomnia in general.
Here’s how the study authors characterize their findings:
“This study provides comprehensive comparative evidence supporting the efficacy of exercise interventions in improving sleep outcomes among individuals with insomnia. Among the various modalities examined, yoga, Tai Chi, and walking or jogging appear to be particularly effective.”
That’s the official word, right from the scientists, themselves. We’re encouraged that this research validates components of our treatment programs we consider important, and more motivated than ever to continue offering support that improves treatment outcomes and helps boost overall health and wellbeing.
Resources: Online Help and Information on Insomnia
If you need additional information on insomnia, please refer to the following helpful resources:
- The National Institutes of Health (NIH):
- The National Heart, Lung, and Blood Institute (NHLBI):
- Centers for Disease Control (CDC):
