Besides stress, I would say that the second most common complaint I hear from my diabetes clients is how they want to improve their sleep quality, but they don't know-how. Whether it's waking up with CGM alarms or a general feeling of sluggishness and brain fog, our sleep dramatically impacts whole-person health.
Sleep is a foundation on which all pillars of diabetes health rest - no pun intended. Inadequate sleep compromises the effectiveness of all essential health pillars like diet, exercise, mental health, and diabetes management. The leading causes of death in developed nations, heart disease, cancer, dementia, obesity, and diabetes, have causal links to sleeplessness (1).
The number one risk for people with diabetes is heart disease. In a 2011 study, tracking a half-million people from various ages and ethnicities from eight countries over 25 years, progressively shorter sleep increased the risk of developing or dying from heart disease by 45% (2).
In another study on non-diabetic individuals, participants were limited to four hours of sleep a night for six nights. By the end of the week, participants were 40% less effective at metabolizing glucose (3). For people with T1D, this might not seem relevant because we produce little, if any, insulin, but consider that insulin is insulin. The insulin you inject still is impacted by sleeplessness.
The primary mechanism behind sleep deprivation is a familiar perpetrator, the sympathetic nervous system. People with diabetes have less parasympathetic tone at night than non-diabetics, meaning we have a harder time turning off our nervous system's activation response (5). Left on for extended periods, and our nervous system becomes maladaptive, affecting every organ system in the body.
During sleep, our body regenerates the body and reorganizes the brain. Growth hormone - a great healer of the body because it replenishes the lining of our blood vessels - produced in deep sleep. During non-REM sleep, part of our sleep cycle, our brain sends calming signals to the sympathetic nervous system, preventing the type of stress responsible for insulin resistance, hypertension, and stroke (6).
There are many ways you can improve your sleep hygiene with yoga and lifestyle modifications. Here are my top 5:
(1) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 164.
(2) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 165.
(3) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 171.
(4) Bernardi, L., et al. "Impaired Circadian Modulation of Sympathovagal Activity in Diabetes. A Possible Explanation for Altered Temporal Onset of Cardiovascular Disease." Circulation, vol. 86, no. 5, Nov. 1992, pp. 1443–52. ahajournals.org (Atypon), doi:10.1161/01.CIR.86.5.1443.
(5) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 168.
A cooling practice just in time for the heat of the summer. This specialized pranayama and meditation combine the elemental forces of water with the physiologic response of the parasympathetic nervous system to refresh, calm and internalize your senses. If you're a Roaring Fork resident, join me this summer for the Complete Practice Pop-Up at King Yoga in Snowmass. The Complete Practice is a powerful mind-body program rooted in ancient tantric methodologies and adapted functional movement for the modern practitioner. It is for any earnest student curious about taking their yoga practice to the next level of energetic and spiritual advancement.
Your breath is a powerful tool for managing diabetes. It helps you re-establish balance in your nervous system. It quiets the mind and opens new neural pathways for expanding consciousness.
Learning how and why to breathe is an essential skill for anyone living with diabetes. Helping you avoid long-term complications and feel better right now.
In my book Yoga Therapy for Diabetes, I outline three essential pillars to Diabetes Mastery: self-awareness, self-regulation, and self-efficacy.
Let me clue you in on a bit of a secret. The breath is the primary tool of all three.
In this masterclass lecture, we'll go over the multi-dimensionality of the breath and how it serves your expansion, growth, and health with diabetes.
We make hundreds of decisions each day regarding our diabetes care. But how many of those decisions are honestly in the best interest of diabetes?
It is nearly impossible to put diabetes first 100% of the time. The skill is figuring out how to increase your time in range while enjoying your life.
The problem is when we're driven by impulses, strong emotions, and negative thought loops. We cannot create a separation between the Self and diabetes.
Over the last several weeks, we've put mental health with diabetes in the spotlight, looking at transformation on the level of thought and mood. Now, let's look at behavior and learn how to glean wisdom from yoga psychology.
Let Me Remind You
This is not a conversation about diabetes perfectionism. It is about narrowing the gap between your impulses and conscious choices. To achieve lasting physical and mental health with diabetes, we must develop willpower over dysfunctional habits and replace them with positive ones.
We've all heard that challenges are growth opportunities. However, most people are actually entirely unaware of their potential to change.
Many of us, through yoga practice, awaken to new possibilities but lack the methods and means to sustain real behavioral change. Or we change one thing only to find that there is something else underneath that is harder to eradicate.
So we may give up or rationalize true transformation because the pull of the "comfortable know" is stronger than the freedom of uncertainty.
5-Steps to Behavioral Transformation
According to a behavioral psychology theory proposed by James Prochaska, people who have made lasting behavioral changes in their lives go through five distinct stages: pre-contemplation, contemplation, preparation, action, and maintenance.
These stages have been successfully tested on many behavioral management changes, including diabetes. You'll find that the steps are non-linear, a dynamic and ever-evolving process.
When implementing behavioral changes, it's easy to get overwhelmed by the big picture that we lose sight of the small steps forward. Over ten years ago, I was frustrated with my A1c, lingering at 7.2. I was doing everything I was "supposed" to be doing. Eating right, exercising, meditating, but I still couldn't bring my numbers any lower. The path to a lower A1c seemed impossible until my doctor said this to me, "all you need is numbers in range an extra two hours a day".
I realized at that moment how doable it was. Looking at my daily patterns, I saw that my biggest BG challenges were after meals and overnight. I began paying more attention to pre-bolusing and eating dinner earlier, which helped my post-prandial and overnight numbers. Pretty soon, without much effort, I had achieved my desired A1c goal.
Ultimately it is not enough to want to change behavior. We have to develop the means to believe we are the change and sustain it. There are many yoga methods to help us build our willpower, one of which is reducing stress.
Another is an active process of selective renunciation called TYAGA.
Tyaga means renunciation. It is a practice of tapas - discipline - to let go of anything you are attached to because that attachment is a cause of bondage and suffering. When we're attached to something, there is a thought and physical sensation bound to an action. For instance, if you're addicted to cigarettes and are trying to quit, you'll feel a craving in the body and obsessive thoughts about it.
With tyaga, we learn to witness the lure of desire while remaining steadfast in our determination. Think of it like this; after you've treated a low blood sugar and waiting for 15 minutes in the discomfort without eating more.
The Starting Point to Renunciation
What's so cool about tyaga is that small steps can lead to significant gains.
Pick one thing easy thing you're attached to and renounce it for 40 days. It could be food - like apples, or a habit - like watching to go to bed. The key is to start easy! Don't go straight for the most challenging thing like chocolate, coffee, or getting rid of social media.
Once you've mastered that, pick something a little more challenging.
Over time you'll develop greater self-discipline over the things you are attached to, so when you have to say no to what's easy and yes to what's hard, you'll have the willpower.
Remember, the process of transformation is a spiral. It is not linear. Just when you master one thing, you'll find there'll be something else even more challenging to master.
But you'll know that your efforts are working when you are less triggered by diabetes and less attached to perfection. You can say no, and there is zero internal conflict. Practicing tyaga is a simple strategy to build your self-confidence and improve your health.
The way we feel at any time dictates how well or unwell we perceive ourselves and our reality to be. For instance, if you are running at a high blood glucose level, your energy will be different from normal levels or low levels. Within the blood glucose spectrum, there is a difference between 200mg/dL and 400 mg/dL, or 65 mg/dL to 45 mg/dL. You are going to feel different.
Just as there is a difference between when we feel capable with diabetes versus hopeless. There is a thought, but also a feeling in the body.
Our energetic condition governs our mood and emotions. How we feel determines how we see the world and live in relationship to it. Essentially the better we feel, the more vibrant and engaged we will be in our lives and, in turn, our diabetes management. But if we're in a funk, numbers awry, plagued by stress and digestive distress, we're less likely to view the glass as half full.
Our mood is a feeling; it is not a thought. It connects with thought, but mood shows up as a sensation in our body. The problem is that when we feel an uncomfortable mood, we identify with it just as we would identify with a core belief like "I will never control my diabetes."
We feel it, so it must be real.
By learning to link with our feeling/energy body, we can de-link from uncomfortable sensations and link with sources of happiness and devotion, transforming discomfort into ease.
In yoga, this is the energy of bhava shakti - the feeler. We can bring a positive bhav - or feeling into our yoga practice - and then into our diabetes practice. To transform mood is one part mind (intellect) and one part body (nervous system). The most potent and practical tools for transforming mood are self-reflection, intention (sankalpa), breath, and sound.
A Meditation to Transform Mood
1) To begin your practice, any practice take several breaths and reflect on your feeling state - what is your energy like? How does this manifest as emotions and sensations in your body? Where do you feel these sensations? As you reflect, keep the breath smooth and even.
2) Remember a pleasant experience, a time in your life where you felt the freest and effortless. Observe the sensations in the body and where they are most concentrated.
3) Alternate nostril breathing. Lift your right hand, inhale left nostril, breathing into the space of concentrated sensation, hold your inhale for 5-10 seconds in that space. Exhale right nostril. Inhale right nostril, breathing into the same space, hold the inhale for another 5-10 seconds. Exhale left. Repeat 5x.
4) Bring attention to the fact of your natural, effortless breath at the heart center. The feeling of your breath when it is effortless is the feeling of PURE JOY and LIGHT. As the body inhales, experience the joy and light radiating at your heart. When the body exhales, the light is absorbed.
5) Mantra - remaining with the same awareness from #4, mentally chant the mantra SO on inhale and HUM on the exhale. Remain in this effortless space for several minutes. So hum = I AM THAT.
6) Eventually, the mantra will occur spontaneously. Experience the breath, light, and the mantra occurring at the heart center, recognize that the feeling of you is the feeling of THAT - the essential SELF - beyond sorrow, beyond darkness.
7) Before you return, recall that moment of peace, the feeling of real, lasting peace in your body. Recognize that there is no separation between you and lasting peace.
May is mental health awareness month, and it is no secret that mental health + diabetes are intimately connected. Mental and emotional health is essential for overall health with and beyond diabetes. But people with diabetes are up to 50% more likely to develop mental health conditions like anxiety and depression due to immense self-care requirements and physiological changes(blood glucose dysregulation, digestive distress, sleep disruption).
This month, I'm offering yoga psychology tools for transforming thought, mood, and behavior with diabetes.
To start, we're looking at thought and cognition. The ancients described the energy of intelligence and knowledge as jñana shakti. Jñana is to know and possess insight, essential skills for managing diabetes. When the mind and body are disturbed by illness, worry, or obsession, our innate intelligence cannot shine through and inform our decisions.
According to yogic philosophy, we are constantly incurring new impressions from our experiences. Every experience that we have, whether positive or negative, leaves an imprint in our mind, through which we see the world. So, let's consider diabetes, a disease we do not receive a manual for and one that we have to learn through trial and error.
Our minds will hold onto negative experiences more readily than positive ones, forming deep grooves in our subconscious. It is estimated that it takes about five positive experiences to counteract one negative one. Considering this, it is no wonder that we can hold negative perceptions, biases, and thoughts regarding diabetes and our competency in taking care of it.
The thoughts we have about diabetes, expectations of treatment requirements, and our perceptions of how well we can handle the task will influence our attitudes about diabetes and, ultimately, our engagement in management (1)
There is a positive correlation between improved A1c outcomes, reduced anxiety and depression, and increased quality of life with T1DM and T2DM patients who feel effective at management, even when they make mistakes (2).
But this is not for everyone. The nature of the mind is to grip onto the negative. The ancients knew this, so they devised practices to help us rewire our thoughts, release and transform negative experiences into our strengths.
In both T1DM and T2DM, patients who believed they were worse off because of diabetes reported poorer physical functioning. Lower beliefs in treatment effectiveness yielded the weakest perceptions of health (4).
The silver lining is that beliefs, thoughts, and perceptions are changeable, implying that altering thought patterns could enhance self-management effectiveness and glycemic control.
How to Flip the Switch
To transform thought, we must go deeper than the constant chatter and look at what underlies our thoughts; and these are our core beliefs. Core beliefs are automatic, formed by past experiences, and activated by internal and external triggers. It is essential to recognize that core beliefs are not true; they are learned patterns from past experiences. We perceive them to be accurate, so they become our reality.
A common core belief in diabetes is: "I will never get my diabetes in control".
This core belief could be triggered by an suprise high or low, an undesirable A1c, or a person's comment, "should you really be eating that?"
Having a Conversation with Yourself, About Yourself
We can transform core beliefs through self-inquiry by asking ourselves questions and testing them against reality.
The first step is to identify the core belief - Look for a consistent thought pattern that repeats itself. A common core belief with diabetes is:"I will never get my diabetes in control."
The second step is to test whether the belief is helpful or harmful to your goal. Ask yourself questions like:
The third step is to transform an irrational thought into a helpful one - this is a process in yoga called praktipasha bhavana - or "cultivating the opposite".
Yoga Sutra 2.33 says when we have a conflicted view, we contemplate the situation from another perspective. In psychology, this process is called "benefit-finding." Studies show that teens with type 1 diabetes who can find a lesson in their diabetes management mistakes are more likely to have a better A1c (6).
It is not as simple as saying "serenity now" every time we notice an undesirable thought surfacing. Instead, it becomes an active meditation where we reflect on our thoughts without reactivity—when we see a harmful thought surfacing, we test its validity and then alter it with awareness.
Praktipaksha bhavana does not mean we deny the negative; diabetes is not all skittles and rainbows after all, and life would certainly be a lot easier without diabetes. But it suggests that we hold both the negative and positive together. If it were not for these challenges, I would not be half the person I am today. Because of diabetes, I have a greater understanding of myself and my body. I have more compassion for others and understand what self-discipline means.
(1)Snoek, Frank J., and T. Chas Skinner, editors. Psychology in Diabetes Care. 2nd ed, John Wiley & Sons, 2005, pp 215.
(2) McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015, pp 203.
(3)McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015, pp 202, Harvey, J. N., and V. L. Lawson. “The Importance of Health Belief Models in Determining Self-Care Behaviour in Diabetes.” Diabetic Medicine, vol. 26, no. 1, 2009, pp. 5–13. Wiley Online Library, doi:https://doi.org/10.1111/j.1464-5491.2008.02628.x.
(4) Harvey, J. N., and V. L. Lawson. “The Importance of Health Belief Models in Determining Self-Care Behaviour in Diabetes.” Diabetic Medicine, vol. 26, no. 1, 2009, pp. 5–13. Wiley Online Library, doi:https://doi.org/10.1111/j.1464-5491.2008.02628.x.
(5) Snoek, Frank J., and T. Chas Skinner, editors. Psychology in Diabetes Care. 2nd ed, John Wiley & Sons, 2005, pp 215.
(6) McGonigal, Kelly. The Upside of Stress. 1st ed, Avery, 2015 203
mental health yoga therapy diabetes
One of the most challenging side-effects of hypoglycemia is energetic depletion. The more severe the low, the larger the energetic deficit, often rendering us physically exhausted, mentally foggy, and less capable of being as present as we would like.
Breathing is not a cure, but it will help you feel better. When you know that you have tools to help you recover faster and feel better after any blood sugar swing, you experience diabetes and life differently.
Studies show that people who feel more confident in managing diabetes, even when they make mistakes, have better outcomes.
What if that shift started with one breathing practice?
In this quick breathing tutorial, I'll walk you through my go-to technique for self-inducing balance, a perfect go-to to recover from any hypoglycemia episode (obviously after you've treated it with glucose).
If you missed last week's video for developing hypoglycemia willpower, check it out here.
Next Thursday, join me for a free masterclass on managing hypoglycemia with yoga therapy techniques.
We'll go over:
-What happens to a T1D during hypoglycemia?
-The #1 reason why we get low.
-How to preserve your body's natural counterregulatory responses.
-3 simples ways to design a yoga practice for hypoglycemia.
When you're low, you lose your natural willpower instinct. All too often, overtreating and subsequently ending up high later, perpetuating a vicious cycle.
We've all been there. 3am with a severe low, and suddenly all dietary rules are thrown out the window. I'm low, so I deserve this whole pint of ice cream! Then we wake up at 300 mg/dL, and our entire day is ruined.
Regardless of whether you've mastered these moments or not, being low is scary and uncomfortable. In fact, the tighter control you have over your blood sugars, the higher the likelihood of experiencing lows.
The old 15/15 rule holds true today, but it is not always realistic, especially when hypoglycemia sensations are so intense. It's easy to overreact and overtreat our lows.
In this video, I'll walk you through a yoga therapy practice to develop willpower amid hypoglycemia. I have adapted this practice from the work of Dr. Kelly McGonnigal and her book the Willpower Instinct.
The Steps of Hypoglycemia Willpower are:
1. Notice the thought, feeling or craving.
2. Accept and attend to the inner experience.
3. Breathe and give your brain and body a chance to pause and plan.
4. Broaden your attention and look for an action that will help you achieve your goal.
5. Treat the low.
6. Sit or lie down and repeat steps 1-4, consciously shaping the breath for up to 15 minutes. At which, retest and treat again if numbers have not resolved to normal levels.
I recommend practicing this first when you're not low and then applying it when you are. See how it helps you recognize your cravings, attend to the experience, plan appropriately, and remain centered during one of the most challenging side-effects of diabetes.
You've got this!
Last week, I offered a masterclass on rewiring the stress response.
Rewatch it here.
We talked a lot about how the breath is the one thing we can do to consciously train the nervous system and stress response to be more adaptive and resilient against stress.
I wanted to share an additional technique we did not have time to cover fully; Swara Yoga, the ancient tantric science of studying the breath.
In this guided breath-awareness and meditation, we'll create a balance between the left nostril (ida) and right nostril (pingala) to prepare the body and mind for a meditation at the third eye.
Every 90-minutes, nasal predominance changes side to side, mainly shaping your energetic condition.
When the right is predominant, you are active; you are more receptive when the left dominant. There are times when you need to be proactive and other times when it is necessary to open. Think leading a lecture vs. receiving a lecture.
Our ability to influence these energetic paradigms is the key to health and wellbeing and one of the most remarkable yogic accomplishments.
Not all stress is equal. In fact, stress can help us live happier, more meaningful lives. Part of the process of rewiring stress lies in our perception of it as good or bad, and the strength of our adaptive responses.
Learn more about the science of stress and how yoga therapy can help you train your nervous system to be more resilient against stressors, improving health, happiness and joy.
We'll learn about:
✖️History of stress and its negative connotation
✖️Neuroscience of stress - anatomy and systems involved
✖️Transforming negative stress into positive stress
✖️Yoga psychology's view on the mind
➕Breathing practices to train your stress responses.
For yoga students, yoga teachers, and yoga therapists.
Please leave you comments below! How did this shift your mindset of stress?
Evan Rachel Soroka