Lisa Garvin: Welcome to Cancer Newsline, a Podcast Series from the University of Texas

Lisa Garvin: Welcome to Cancer Newsline, a Podcast series from the University of Texas MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin and today we're going to be talking about a practice called Yoga Nidra and it's possible applications with cancer and here today to talk about that is Smitha Mallaiah, she is a mind, body intervention specialist at MD Anderson's Integrative Medicine Program. Smitha let's talk about Yoga Nidra, it's something I've never heard of before. What type of yoga is this?

Smitha Mallaiah: Oh, when we talk about Yoga Nidra as a practice I would like to put Yoga Nidra as one of the tools of yoga because a lot of times we get lost with the type and the varieties of yoga that comes and mostly for the commercial purposes which is done, but Yoda Nidra is a traditional ancient practice that comes from the texts of yoga which is as old as 5000 years, so it comes from the tradition there directly and a lot of schools and teachers have used with slight modification over the years, so we have today the practice that is used as Yoga Nidra which is directly from the text and this practice of Yoga Nidra is something that we can look as the relaxation tools of yoga. So, we have tools where we do the physical postures, breathing, relaxation, meditation, so this is somewhere in between relaxation and meditation.

Lisa Garvin: And some people commonly call it sleep yoga because it purports to reach a very specific state in the mind.

Smitha Mallaiah: Correct.

Lisa Garvin: So what is that state, I mean some people say it's like being in the sleep state but still being aware, so can you explain it better?

Smitha Mallaiah: Yes. So, when we talk about Yoga Nidra, Yoga Nidra is not basically deep sleep where we are kind of like aware or dream or something, or not it is a awaken state of wakefulness, but it is a state of sleep with awareness, so yoga basically when we look at yoga, yoga is one pointed awareness and sleep is relaxation or deep sleep and Yoga Nidra is basically a practice with a tinge of awareness, so you are aware during the whole practice, but you are not awake to you know your external stimuli's.

Lisa Garvin: How does one get into that state? It sounds like it would be difficult, I mean, and it sounds like the approach to get to this state would be different than some other types of yoga.

Smitha Mallaiah: Correct. So, Yoga Nidra has some preparations that we do before we get into the actual practice, so we want a state or the atmosphere around in which we do this practice to be completely neutral or to be in a state of balance, so you don't want too much lights, or the temperature to be normal as you do the practices, and also you can prepare yourself by doing some yoga postures before you go into this practice, but once you lay down on the mat and get ready for the practice you would require either a recorded version of the practice to do or an instructor who can help you guide through the practice of Yoga Nidra as you do it.

Lisa Garvin: So you have to have an instructor kind of talk you into that state?

Smitha Mallaiah: Exactly. So you want a person who can help you guide you into the practice.

Smitha Mallaiah: So, what are the steps that people go through to achieve this state?

Smitha Mallaiah: To put the practice of Yoga Nidra in a natural, we have few steps that we can through. First, we prepare the person, you can do some of the yoga practices to warm up your body and stretch your body and you lay down comfortably on your back in the supine position on a mat or a mattress whatever is comfortable for you, of your patients who are bound to bed that's absolutely okay to lay down and rest on supine in which you were positioned comfortable. We begin with a Sankalpa or what we call as the resolved statement, so in this step we make a conscious effort to take a short positive statement that you want to work on to improve your overall health and well-being. It could be statements like, "I am healthy, I am cancer free, happiness is my nature." It could be any short, positive statement that you take and you repeat that for three times before the beginning of the practice, then we go for movement or the progress of relaxation off the body where you relax the body from head to toe or the directions can be different depending upon different schools of yoga. Then we bring in awareness and work on breath, so it's very important that you work on breath and slow down your breath and deepen your breath. The breath is the most important key that connects the mind and body in all the mind body practices. So you want to make your breath slower and longer, then you have the feelings and sensations, so you scan the body and try to feel the sensations that can be there and you also get instructions to just feel hot or cold or any of the sensations that are like opposites just by the instructions even though you don't physically feel it, you will feel that by the instructions and then you have visualization and the visualization can be different depending upon what is the goal of the practice of Yoga Nidra and once you complete the visualization, you will repeat the Sankalpa or the resolved statement that you took at the beginning. So, this is like one you begin with Sankalpa, you end the practice in Sankalpa and in between you're helping your mind body consciousness to provide to get that depress that is necessary, so you always end with the Sankalpa or the line and then you can lay down for a little more and then complete the practice. So, the whole practice should take anywhere about 20 to 40 minutes depending upon the goal and the teacher that you're working with.

Lisa Garvin: And so it sounds like this typical position for this would be supine or laying down.

Smitha Mallaiah: Exactly, what we call Savasana or laying down position would be the best. If patients are unable to do the practice laying down on their back, they're more than welcome to do it sitting position but with more support where you can kind of like relax in that sitting position, so either one of them can be used to do this.

Lisa Garvin: And even though the practice is thousands of years old, I guess the first scientific proof came in about 1971 when they attached electrodes to a Guru or Swami Rama what his name.

Lisa Garvin: Swami Rama.

Lisa Garvin: His brain and they said that he was able to get into that state like within 5 minutes just by thinking about clouds in a sky. Smitha Mallaiah: Yes. So, what is the secret behind the monks or the teachers going into these states is basically practice. So, any of the yoga techniques that we do and we want to get certain results basically, require some amount of practice to do or at MD Anderson in the Integrative Medicine Program we call what those effects, so how many times you practice to get the desired results, but Yoga Nidra has done as being used with different populations with different applications, so for school children various psychosomatic elements that they have been used to and some of the challenges in the psychology field that is the anxiety, depression, these have been also tested and extensive research also has been done to look at the changes in the brain or the brain activity while one does this practice. So, one thing that we have to learn from all these changes during the activities when you do the Yoga Nidra is Yoga Nidra promotes a state of relaxation response what we call as the [inaudible] stimulation which is very important to do stress management which is basically the cause for a lot of illnesses that we see today.

Lisa Garvin: Now we're not practicing Yoga Nidra quite yet, although MD Anderson's Integrative Medicine Program was kind of ahead of its time in introducing mind body interventions for cancer patients, so you're kind of researching it. What sort of path or research is taking for Yoga Nidra?

Smitha Mallaiah: For, Yoga Nidra has been used as one of the practices with the whole program that we use for many different cancer populations that we study here. So, for example one of the breast cancer studies that we are doing the research, all the practice is ended by the practice of Yoga Nidra which is the deep relaxation. So, in this world that is so busy today we are always on the go, go, go mode until in the night we crash into the bed so tired and we do still have problems falling asleep there, but the practice that we provide here in the research is that we have a model where the do of practice followed by deep breaths. They do another practice of yoga asana followed by deep breaths and the whole practice for an hour is followed by a variety of Yoga Nidra or deep relaxation what we call, which is basically retraining your system to achieve the deeper states of relaxation after every stressful period. So, we see patients who come back even though it is not like a published result, but patients individually where they come back and say, I've not been able to sleep for many years, but I slept like a baby just practicing Yoga Nidra, because the trained their system to do so. So, we have very promising results where patients are really using these relaxation techniques in their day-to-day live activities.

Lisa Garvin: Are you doing this in like a protocol setting, or?

Smitha Mallaiah: That's right. So, what we do in different studies is what idea of Yoga Nidra, so it's not Yoga Nidra by itself in deep and elaborate, but it is a quick format of Yoga Nidra which is for 10 to 15 minutes that is used by the end of these practices in the research protocols that we do with Dr. Lorenzo Cohen here at the Integrative Medicine Center.

Lisa Garvin: So, what are the physiological responses when somebody's in that Yoga Nidra state that state of I don't even know what to call it because it's not lucid dreaming, it's sleeping but aware, I don't know maybe we need to coin a new term, but what are the physical responses that the body is making?

Smitha Mallaiah: One, your body as such physically is not knowing at the body level when we do the practices, but at the physiological level when we are kind of like shutting down all the stimulus that all the sense organs can get basically seeing, hearing, or touch or any of these responses your body has an ability to kind of regenerate, so to look within and to kind of like regenerate, and another thing that happens when you're helping your body through this exercises of moving basically one of the things that we do as part of Yoga Nidra is like progressive muscle relaxation where you move the awareness within the body to relax, so that is an excellent technique again to promote the parasympathetic activity because there is no stress response, and because you are kind of reaffirming yourself to do this relaxation through the muscles of the body, it is good to provide that local deep rest within the system so it could be at the muscular level, musculoskeletal level that it happens.

Lisa Garvin: So, are we actually seeing a difference in the release of like hormones and other chemicals from the adrenal gland, or you know, are we seeing a difference in brainwave patterns in this state?

Smitha Mallaiah: Right here at MD Anderson we don't have that research that we are studying that. We are studying more stress hormones and other patterns that are associated with the sleep and the relaxation responses. We right now at least don't have the studies that involve the brain activity.

Lisa Garvin: But it sounds like this is something you will move to incorporate into your integrative medicine programs?

Smitha Mallaiah: We look forward to it. So, we have various programs at the Integrative Medicine Center and we have one of the yoga classes that is available for patients and their families and we do Yoga Nidra in every one of those sessions by the end which is not part of the clinic, but it is one of the services that we offer for patients and their families here.

Lisa Garvin: Do you find that most people are able to achieve this state?

Smitha Mallaiah: Every time after patients come out of the practice, this is like wow I'm so relaxed, I'm so ready and regenerate to do my other things in the day, so they have that sense of definitely energization which is a big thing for our cancer patients because fatigue is something that catch them throughout the treatment and even after the end of treatment, so patients do feel a lot of benefit while they go through these practices.

Lisa Garvin: Is this something that somebody can take home and do by themselves or do they need the guidance of an instructor?

Smitha Mallaiah: It is good if they at least have a recording. It could be on a CD or something that they can play and do it, the reason is because if you are trained to be aware and concentrate on the practice you might fall asleep trying to do the practice on the mat, so it's easy; always good to have a teacher or a recording with you.

Lisa Garvin: It must be very satisfying to find that you know practices that are thousands of years old have practical applications in cancer treatment.

Smitha Mallaiah: Absolutely true.

Lisa Garvin: As you approach patients with traditional medicines like this, how, is the reaction getting better? Are they more willing to accept it now than they might have been 5 or 10 years ago? Smitha Mallaiah: Absolutely. The response and openness of the patients and families continue to be in a very positive open way to try these practices for their own benefit, so we do have practices where we involve patients and families to come and take the sessions so they know the benefit of stress management and relaxation responses because they also have a lot of stress that they go through, and even for patients who are not so open if they try 1 or 2 sessions we see that they see tangible benefits right there and they're open to trying and getting the benefits out of these practices that are offered.

Lisa Garvin: So, the bit benefits are let's tick them off in a list; so the biggest benefits of Yoga Nidra are?

Smitha Mallaiah: Relaxation, it has a huge potentiality to improve your sleep. You can train many habits that are there within you so Yoga Nidra can be applied for retraining you sleep habit which is one of the biggest things, and sleep can be a biggest aid in helping patients get through treatment and the outcomes also. So, sleep is the biggest thing that I want to address today. Fatigue, your emotional and physical state which is basically a big thing in the quality of life for patients, these are some of the benefits that patients can achieve by Yoga Nidra.

Lisa Garvin: In closing, do you feel like this is going to be incorporated more into the programs we offer to cancer patients here at MD Anderson?

Smitha Mallaiah: Definitely. Relaxation is something that we always look as a big thing to give patients and their families and Yoga Nidra has a huge potentiality to become part of many or all of the mind body practices that we offer here at the Integrative Medicine Center.

Lisa Garvin: Great, thank you very much. Very interesting.

Smitha Mallaiah: Thank you.

Lisa Garvin: If you have questions about anything you've heard today on Cancer Newsline, contact Ask MD Anderson at 1-877-MDA-6789 or online at mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in for the next Podcast in our series.