Yoga Nidra Guided Meditation and Parkinson's Disease

Introduction - how I discovered Yoga Nidra

Subsequent to my recent hospitalization,

MY HOSPITALIZATION WITH PARKINSON'S DISEASE,

I had had the amount of the main l-dopa medicine I take cut in half. This has left me with much longer periods between doses. Some of these doses don't work at all, or might not last long if they do, so I was now faced with much more "off" time, in which the Parkinson's Disease symptoms are present. It can be terrifying for me when a dose of the drug wears off while there are still hours to go to the next one, with the added anxiety that even then that next dose may or may not work. I greatly fear being stuck in the freeze state, along with the chronic pain, disassociation, and mental and emotional impairment which comes with it. Indeed, it was my fear of not having any drugs in my system, without the psychological crutch of knowing that the clock is at least ticking down until the next "on" period, which led me into trouble with the drugs in the first place, and ended up with me in the hospital. Due to this fear, I would be compelled to take another dose as soon as one wore off. This overdosing actually made the drugs much less likely to work, with nasty side-effects when they did, so I got stuck in horrible vicious circle. It took my "drug holiday" in hospital to gather the evidence for myself that more is definitely not better with these things.

Nevertheless, I needed two things to psychologically sustain the much lower dosage I am now on: something to help reduce my anxieties and fears about being in the "off" state for prolonged periods; something to occupy me/my mind for the “off” periods when I can only really lie on the bed.

I recalled an article I wrote on the benefits of meditation I had written some time ago,

MEDITATION AND PARKINSON'S DISEASE,

about how it had helped with calming my anxiety, and moreover, how I had found that, if I could relax into the meditation, it seemed to not only help to ensure the next dose of medicine would actually work, but also that doses could kick in much sooner than when I just lay there waiting and begging silently for the medicine to work, full of mental anguish about being stuck in the "off" state itself.

However, my previous experiments with meditation don't appear to have lasted long, and it seems I didn't take my own advice from that article, perhaps due to the apathy and lack of motivation which is naturally part of dopamine deficiency conditions, or perhaps as I didn't feel safe enough to relax in the environment I was in at that time, or I had simply not reached the point in my own journey back then where I was ready to face some of the things the meditation sessions would throw at me.

However, after leaving hospital for my new home, where I now feel supported and much safer, it seemed that practising meditation might be an ideal answer to reducing my anxiety, and for learning how to relax, as well as a beneficial, constructive way of passing the time between "on" periods and doses of the medication working, especially if, indeed, there is an added bonus that it could enhance the likelihood of the next dose of medicine actually working.

So I asked around on facebook for recommendations for free resources/apps for meditation and "Insight Timer" was most recommended. This app has thousands of guided meditations available. I started by exploring different types of meditation with the app, looking initially under keywords such as "stress", "anxiety", "relaxation", and found some worked for me and some did not, both the voice and the content, together, matter. I did find examples of mindfulness meditations, re-assuring meditations, loving kindness and self-compassion meditations, which could all help, but I soon hit upon a couple of examples of "Yoga Nidra" guided meditations, which really seemed to provide the largest benefits.

The first example of this form of meditation I found on Insight Timer was "Yoga Nidra for Stress and Anxiety" by Shannon Ryan, although the visualization part of this one doesn't work for me. The next one I discovered, and am still using frequently, was "Yoga Nidra for Relaxation" by The StillPoint. Another one which I am currently using a lot is "iRest Yoga Nidra for Healing Trauma" by Molly Birkholm.

Supporting Studies

Boosting Dopamine

Before moving on to describe and explore the basic elements of Yoga Nidra practice, lets look first at a couple of science journal articles which underline the potential benefits for people with Parkinson’s Disease in particular. Perhaps most importantly is that it may possibly increase the natural production of Dopamine,

Increased dopamine tone during meditation-induced change of consciousness.

This paper reports that, during Yoga Nidra meditation, an increase of up to 65% in delivery of Dopamine to parts of the brain important in Parkinson’s Disease, can occur. Interestingly, the authors find that the increase of Dopamine occurs in a part of a brain called the Striatum. This is the very area which Dr Daniel Jeanmonod, Swiss Functional Neurologist, has discovered is part of the main circuit of the brain that goes awry when the Substantia Nigra stops delivering Dopamine, as he explains in the video below.

For more information on this perspective of Parkinson’s Disease, see Dr Jeanmonod’s article

Some unclassical considerations on the mechanisms and neurosurgical treatment of Parkinson’s disease.

However, the Swiss Clinic’s ideas are strongly backed by the real world results they have been getting with a unique focused ultrasound (non-invasive) procedure that cauterizes a very small, and very specific part of the brain, called a pallido-thalamic tractotomy (PTT) . First hand feedback from people with PD who have had the procedure done are excellent, both in terms of giving people their “lives back”, but also in there being very little side-effects, together with improvements that actually keep getting better over the course of years, post-procedure. Thus if practising Yoga Nidra does also help restore natural supply of Dopamine to the same circuits in the brain, it may have profound cumulative benefits if practised daily over the long term too.

I have now been practising Yoga Nidra guided meditations for around 3 months at the time of writing this, daily each morning. I definitely have seen cumulative benefits for progressive reduction of my Parkinson's Disease symptoms over that time, including much reduced anxiety, pain, really bad days. However, in particular, I’ve noted increased effectiveness of dopamine replacement drugs, longer "on" periods, as well as improved sleep. Indeed, I personally believe that the practice does boost my dopamine levels, because when I take a dose of my PD meds after or during a Yoga Nidra session, it is much more likely that that dose will actually work to turn my movement back on, and it can take as little as 15-20 minutes for the drug to kick in (this is very short time for me, about 50% less time needed than usual. I have also had a handful of profound experiences where the previous dose of the drugs had worn off and, even before another dose was due, while practising Yoga Nidra, my movement spontaneously came back and I stay “on” for around 20 minutes.

Increasing Resilience to Stress

According to studies such as

Yoga Nidra Relaxation Increases Heart Rate Variability and is Unaffected by a Prior Bout of Hatha Yoga,

Yoga Nidra has also been shown to help increase "Heart Rate Variability" , which is a quantitative measure of how well we respond to, and how resilient we are to, stress, how big our “window of tolerance” is to stressors before we are triggered to into a threat response, and also how quickly we bounce back to a relaxed state after a stressor has come and gone. It is an indirect of measure of how healthy and well our Ventral Vagus and other major Cranial Nerves are, so is a quantification of "Vagal Tone". An improved ability to cope with stress may be particularly pertinent to people with PD, for whom any stress tends to greatly amplify symptoms.

“These changes demonstrate a favorable shift in autonomic balance to the Parasympathetic branch of the ANS…, and that Yoga Nidra relaxation produces favorable changes in measures of HRV…”

Reducing Anxious Thoughts

According to

Yoga Nidra as a Stress Management Intervention Strategy,

Yoga Nidra induces a state of consciousness corresponding to alpha brainwave frequencies (internally directed attention with eyes closes, body and mind in relaxed state), and, with practice, theta brainwave frequency (creative meditation) states too, replacing beta brainwave frequencies (externally directed attention, mental activity, anxiety).

This may be profoundly important for people with PD, as we tend to be stuck in loops of busy, anxious thoughts, corresponding to high levels of abnormal beta brainwave activity, which actually worsens motor symptoms, see

BUSY, ANXIOUS THOUGHTS AND PARKINSON'S DISEASE.

Hence anything we can do to break out of the looping, anxious thoughts by entering non-beta states of consciousness for prolonged periods should have important impacts on progressive symptom reduction, and Yoga Nidra appears to be a good candidate solution for this when practised long term. I have certainly found my anxiety levels to have markedly decreased, and my ability to break out of looping, anxious thoughts improved, since taking up Yoga Nidra.

Basic Elements and Benefits

I've explored several forms of Yoga Nidra type guided meditations (I’m including here ones which are based on formal Yoga Nidra, but may not be strictly adherent to the ancient wisdom Yoga Nidra taught by Yogis, for example the modernized "iRest" flavour of Nidra) on the "Insight Timer" app, and there are some common themes which may be potentially helpful with Parkinson’s Disease in particular.

The first beneficial element is that during the meditation, we are meant to lie down perfectly flat on our back, prone, with legs apart, arms down by sides and palms facing upwards. This is a position of rest and relaxation. I have found it very surprising that with Yoga Nidra, I can remain in this position, without moving, for over an hour even though I am not asleep, when otherwise I would usually be unable to stay with my body flat for long at all, and I would have to constantly move limbs around, due to muscle the stiffness, rigidity and pain. Although I am aware and alert during the meditation, albeit tending to slip in and out of full consciousness, it as if my body is asleep for the duration. In fact, Yoga Nidra refers to a "Yogic Sleep".

The most important point here for myself of being able to lie still during Yoga Nidra is that it allows me to be in the "off" state for a period of over an hour, yet without feeling the pain and rigidity of my Parkinson's Disease at all. At worse, I am aware of the stiffness of my right shoulder/neck, which remains my place of greatest physical symptoms, but I don't need to do anything about it while practising Yoga Nidra. Thus the first very major advantage of the practice, therefore, is in-the-moment relief from suffering. I also believe there is also something important here in the idea of "going with the PD" for a while, i.e. purposefully immobilizing as much as possible. There is a significant difference between "immobilizing in fear" via a “freeze” stress response and "immobilizing without fear" for relaxation, in Dr Stephen Porges' Polyvagal model, and I believe Yoga Nidra switches the former into the latter. One caveat on my experience with this is that I need to start the session just as a dose of my drugs are wearing off, as if I leave it too long afterwards, I become too stiff and rigid and fearful to put myself comfortably into the prone Yoga Nidra pose and stay there long enough. Also, since I have rigidity dominant form of PD, I’m not sure how Yoga Nidra will interact with tremors, but I’d be interested from people with PD who practice it whether their tremors stop while doing so.

The second beneficial common theme of Yoga Nidra practices entails going on a guided tour of one's own body. The guide asks the listener to shift their attention quickly around different parts of the body, in a specific order, calling out each part in turn. I find it beneficial to also repeat in my head the name of the body part as I shift my awareness to it. This is the part of the practice where my body relaxes the most. The guide might say "right hand thumb, first finger, ..., palm of the hand, ..., right elbow, ... right armpit,...", "the whole right arm, the whole left arm, ..., ..., ..., the whole body" and so forth, until every part of the body has been "touched" this way, akin to a "psychic" whole body massage..

According to the guides, the point of doing this fast full body tour is that different parts of the body are connected to different parts of the brain, via different nerve pathways. Practising this "touring" of awareness of our body therefore helps clear these nerve pathways and activates all sorts of different parts of the brain. It may also help balance the left and right hemispheres of the brain, and the communication pathways between them, which is important in symptom reduction of Parkinson’s Disease, see

THE DIVIDED BRAIN AND PARKINSON'S DISEASE, PART 1,

THE DIVIDED BRAIN AND PARKINSON'S DISEASE, PART 2.

I believe the guided tour of the body is particularly beneficial for PD, because underdeveloped, atrophied or inhibited proprioception (sense of movement and position of the body) and interoception (sense of the physiological state of the body) are part and parcel of the condition. Going on the guided tour daily may therefore significantly help reconnect body and brain. Placing attention is put on the features of the face and head may be especially beneficial for PD, since the Parasympathetic Cranial Nerves, which move and sense these facial features, are often atrophied/inhibited as part of the condition, see

THE CRANIAL NERVES AND PARKINSON'S DISEASE,

SOCIAL ENGAGEMENT AND PARKINSON'S DISEASE,

LONELINESS, SOCIAL ISOLATION, ESTRANGEMENT AND PARKINSON'S DISEASE.

One thing in particular struck me when first going on such a guided tour of my own body. My right side seemed much larger in my awareness/imagination/mind's body map than the left side. My right side is the hypertonic side, where the muscle stiffness, rigidity and pain is much more noticeable. According to the Farias Technique for Dystonia, this means that my left side is actually the real problem, because it is the hypotonic side, where the pathways between the brain and muscles have become dormant. The brain has forgotten about muscles on that side, which become overly flaccid, making the muscles of the right side overcompensate by becoming overly tense. According to Dr Farias, the forgotten ones are the true source of the Dystonia. Through contralaterization, this means that my right brain, responsible for moving and sensing the left side of body, is where the problem is in the brain, and hence it is my right cortex which is in shock when the PD symptoms return. Therefore it makes sense to me that practising the body guided tour will help re-activate both sides of the brain and bring balance back. Indeed, it already seems to have helped me here, as now my mind's body map seems much more left-right balanced, and the right side does not appear so overlarge anymore.

I have also noted whilst following the body tour that, although my eyes are closed, they still move around smoothly underneath my eyelids, as my focus of attention shifts around my body following the instructions. This aspect of Yoga Nidra might therefore incorporate some important beneficial elements of Eye Movement Desensitization and Reprocessing methods for healing Post-Traumatic Stress Disorders.

A third common beneficial feature of "Yoga Nidra" style guided meditations is active awareness/sensing, in particular listening exercises. Typically, we are asked by the guide to become aware of noises around us, firstly outside the room/building, say listening out for birdsong or traffic sounds, then inside the building/room, then rotating attention quickly between all the different sounds available for us to tune in to. This type of listening is a form of "orienting" which helps to move our system out of stressful states. Hence practising such rotation of external awareness exercises daily can also be of assistance over time in regulating the Nervous System.

However, I believe the "listening" benefits of Yoga Nidra run much deeper. Dr Stephen Porges' work,

Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder: Preliminary Findings Evaluating the Listening Project Protocol

explains how the muscles of the middle ear, innervated via important Parasympathetic Cranial Nerves, have a switch-like setting for the frequencies of sound the ears are tuned in to. According to this, our hearing can either be optimized to listening out for low frequency predator sounds, or for listening to the higher frequencies of calm and relaxed human voices. Porges predicted that active listening to voices of the right type of frequencies can therefore help switch our ears, and hence our Nervous Systems, to the calm “Socially Engaged” state. Indeed, he created the "Safe & Sound Protocol” based on his predictions, and has shown this modality can be remarkably effective at regulating the Nervous System for some people. Importantly, the typical tones of voice used by the guides in Yoga Nidra also tend to have the requisite tonal qualities - prosodic (poetic), lullalby, hypnotic - which are optimal for tuning the middle ear muscles to the calm, relaxed state. Therefore, even of itself, just practising listening and really tuning in to the voice of the guide during Yoga Nidra may have profound anti-stress benefits. Listening via headphones, as per the Safe and Sound Protocol might enhance this further.