Physiotherapy in the treatment of insomnia

Physiotherapy in the treatment of insomnia

Physiotherapy means to improve sleep are exercises that make it possible to calm the over-excited body and mind. In addition, psychoeducation can be applied in physiotherapy and discussions with clients about sleep hygiene, sleep ergonomics, rhythm of life and everyday content.

Physiological, emotional, or cognitive hyperresponsiveness is a significant factor in the formation and chronicity of insomnia. Therefore, the goal of non-drug therapies is to find ways to calm the over-excited body and mind. CBT-I methods utilize a variety of relaxation techniques, such as progressive muscle relaxation and breathing exercises. These methods are bodily and are also used in psychophysical physiotherapy. Nevertheless, physiotherapy is often not mentioned when talking about non-pharmacological treatments for insomnia, although physiotherapists, especially those specializing in psychophysical physiotherapy, have a great deal of knowledge about bodily approaches to treating insomnia. Physiotherapy should be part of a multi-professional collaboration in the treatment of insomnia, involving at least a doctor and a nurse and, if necessary, a psychiatrist, psychologist, social worker and occupational therapist.

What is psychophysical physiotherapy?

Psychophysical physiotherapy is a specialty of physiotherapy that aims to promote a person’s holistic functioning. The starting point is both the therapist’s and the client’s understanding of the connection and interaction between body and mind. The goal is to find ways for the client to survive and find solutions to their own lives through experiential learning. The methods used are breathing and body awareness exercises, movement exercises, relaxation methods, soft tissue treatments and interaction-strengthening exercises. Through training, the client learns to relax, to find a better connection with themselves and their body, stress management and mental balance. For example, people with mental health problems, insomnia, stress symptoms, tension, or anxiety benefit from psychophysical physiotherapy.

Overexcitation due to excessive activation of the sympathetic nervous system, usually due to excessive perceived stress or threat, is the most significant cause of insomnia from a physiotherapy perspective. The physiological changes during a fight or flight reaction triggered by a threatened situation are bodily and can be alleviated and learned to control through exercises in physiotherapy. The goal of psychophysical physiotherapy is to find ways for the client to calm themselves down, learn compassion for themselves, find their own boundaries, and learn to regulate and structure their own experiences so that he or she can be reconciled to himself or herself again. Physiotherapeutic methods have the potential to calm the sympathetic nervous system and activate the parasympathetic nervous system. The parasympathetic nervous system is an antagonist of the sympathetic nervous system. It makes it possible to resist the activity of the sympathetic nervous system and, for example, to slow down the heart rate. Ways to activate the parasympathetic nervous system include various relaxation exercises.

Physiotherapy in the treatment of insomnia

Physiological relaxation reaction

When calming an over-excited body, it is desired to elicit a physiological relaxation response. It is a reaction that activates the hypothalamus of the brain and causes calm of the sympathetic nervous system as well as activation of the parasympathetic nervous system.

During the physiological relaxation reaction, in addition to the hypothalamus, amygdala, cerebellar vermis, dorsolateral part of the prefrontal cortex, orbital cortex, anterior cingulum fold, Insula region, thalamus, and Globus pallidus are also activated in the brain. The functions of these brain regions include the regulation of the autonomic nervous system and the formation of neurotransmitters such as serotonin, oxytocin, and dopamine. As a result of the physiological relaxation reaction, the body’s oxygen consumption decreases, the amount of nitric oxide in the body increases, anxiety is relieved and the heart rate decreases. Nitric oxide calms the sympathetic nervous system by blocking the action of stress-inducing noradrenaline and balancing the metabolism of stressed tissues. Voluntary muscles also relax, blood pressure and respiration rate decrease, and pupils become smaller. These reactions are the opposite of the stress-induced reactions that activate the sympathetic nervous system. The physiological relaxation reaction can be activated voluntarily through meditation, progressive muscle relaxation, breathing exercises, yoga, or chin, guided imagination training, Qi Gong training, or biofeedback training. Although a physiological relaxation reaction has been observed and its effects could be measured as early as the 1970s, its exact mechanism of action is still unknown.

In psychophysical physiotherapy, it is possible to apply all of the above exercises. In addition, psychophysical physiotherapy uses its own methods in which a similar physiological relaxation reaction occurs. According to one study, relaxation training lasting about 8 weeks can significantly change stress-altered genetic activity back to normal. However, if the training is intended to change the changed structure of the brain, the training should be continued for a longer period of time, probably even years.

Physiotherapy in the treatment of insomnia

Breathing in psychophysical physiotherapy

Activation of the sympathetic nervous system intensifies respiration and intensified respiration excites the sympathetic nervous system. The thoracic and diaphragmatic movement that accompanies respiration is directly connected to the autonomic nervous system through the circulatory nerve entering the lungs, i.e., the anterior ligament of the vagus nerve and the sympathetic nerve nodes in the thorax. A vicious circle is easily created that gets the whole body into an over-tuned and anxious state. When you are aware of your own breathing, it is possible to calm your over-tuned body. Calming is possible with activation of the anterior ligament of the vagus nerve during deep breathing. Especially calm exhalation is important for calming the body. During a balanced exhalation, the respiratory muscles need to relax. Calming the breath also reduces muscle tension in the middle body area.

It is possible to relieve stress and psychosomatic symptoms by actively breathing through the diaphragm. The researchers emphasize that during relaxing breathing exercises, the diaphragm should be activated at the pace of breathing. In this case, during exhalation, the diaphragm contracts and retracts upwards, during inhalation the abdomen expands and the diaphragm protrudes downwards. At the same time, inhalation and exhalation deepen, respiration rate decreases and the amount of respiratory gases (oxygen and carbon dioxide) in the blood is maximized. During diaphragmatic respiration, the above-mentioned sedation of the sympathetic nervous system due to the activation of the anterior ligament of the vagus nerve occurs. Well-defined breathing exercises can worsen the symptoms of a person who is already stressed and tired. Mindfulness exercises do not seek to change breathing, but only to observe. The key is to do things yourself, that is, to be self-aware, to recognize yourself in relation to space and time, and to focus and perceive your own breathing so that it is possible to begin to relax. The client is encouraged to let the breath take place, to surrender to the body and its rhythm. Later in one’s own doing, one seeks to observe the meaning of rhythm, movement along with breathing, sound along with breathing, and the use of one’s own power. The goal of psychophysical respiratory therapy is to relieve anxiety by recognizing, saying, and working out tensions, and to strengthen self-confidence and experience of oneself.

Physiotherapy in the treatment of insomnia

Quality of movement in psychophysical physiotherapy

Physiotherapy has traditionally focused on movement as well as taking into account and correcting possible movement disorders. Today, especially in psychophysical physiotherapy, more attention is paid to the quality of movement. The method of psychophysical physiotherapy that focuses on the quality of movement is, for example, Basic Body Awareness Therapy, or BBAT, in which movement plays a central role in relation to place, time and energy. It is possible to look at the quality of movement from a biomechanical, physiological, existentialist, and psycho-socio-cultural perspective. Physiotherapists who have utilized this method have found that multi-symptomatic clients often suffer from basically losing contact with themselves, their bodies, their emotions, their limits, their environment, and other people. Loss of connection is reflected in movements, daily activities, habits, and health.

From a biomechanical point of view, the starting point for the quality of motion is the relationship to one’s own vertical axis. Perception of the vertical axis emphasizes the body’s relationship to its own center, the perception of its own center, the relationship of the center to the limbs, the contact with the base, and the relationship to the surrounding space. From a physiological point of view, the quality of movement emphasizes freedom of breathing, digestibility of movement, rhythm, flexibility and its own center. The movements are desired to leave the center of the body and the goal is for the movement and breathing to run seamlessly together. Thus, it is possible to achieve digestibility, flexibility and a steady rhythm. From a psycho-socio-cultural perspective, the quality of movement is based on awareness and presence. In addition, the quality of movement consists of the emotional, cognitive, and appropriate factors that a person mirrors in his or her environment. Thus, the environment also affects the quality of movement. From an existentialist perspective, emphasis is placed on self-awareness, presence in movement, and the ability to perceive oneself during movement. In addition, attention is paid to the individual way of moving and the purpose of the movement. Eventually, it is possible to achieve a connection between body and mind. When looking at the quality of a patient’s movement, it is possible to see a lot about the person and his or her current well-being. When looking at the quality of movement, the factors that emerge are similar to, for example, breathing exercises, meditation, or yoga produced by a physiological relaxation reaction. It is possible to increase well-being, health, balance and more functional movement of the body when you learn to perceive yourself, release your breath and be more aware of your own body and state of being.

Physiotherapy in the treatment of insomnia

Awareness in psychophysical physiotherapy

Awareness of one’s own body and connection to one’s own body are the goals of psychophysical physiotherapy. Consciousness is combined with the aforementioned breathing and quality of movement. Psychophysical physiotherapy seeks to increase body awareness and a sense of control over one’s own body so that it is possible to learn to understand one’s own reaction to other people and things. When the goal of rehabilitation is to increase body awareness, through the practice of identifying and expressing emotions, the connection to one’s own body is improved at the same time. Emotions often manifest through the body. For example, anger may manifest as increased breathing and the need to kick or punch. BBAT is a good method for raising awareness. BBAT training utilizes movements, breathing, massage, and awareness during exercise to restore balance, freedom, and connection between body and mind, utilizing the body’s own resources. Awareness should always be present when doing BBAT exercises. In practice, you can do it yourself and you can do the exercises independently. With BBAT training, your body’s balance, posture, cradle awareness, and understanding of your body’s messages will improve. Moving gets easier. In addition, it is possible to learn to deal with muscle tension because tension relaxation through exercises learns to distinguish between when the muscles are relaxed and when they are tense. It is possible to achieve a feeling of control over your own body and well-being to look better on the outside as well.

During BBAT exercises, the physiotherapist encourages the client to move in a balanced way and breathe freely, as well as to listen to and accept the feelings and sensations that emerge during the exercises. It is possible to utilize the method for both physical and mental symptoms. Awareness exercises can include, for example, pounding the feet against the floor or rocking the soles of the feet forward and back to allow the client to find any lost connection to the base. During the exercise, the client trains to be aware of their own soles and to recognize how the pressure under the soles changes. Another exercise can be, for example, observing your own breathing while lying on your back. Later, breathing can be observed in other positions. The goal of BBAT exercises is initially to accept your current state of being and find a connection to your own body. After that, you want to become more aware of your own breathing and combine breathing with movements. Breathing is like a bridge between body and emotions. The goal can be to reduce body tension or pain, increase the feeling of freedom, or release breathing.

Physiotherapy in the treatment of insomnia

Touch in psychophysical physiotherapy

A safe and gentle touch soothes the stress state of the body. As a result of safe contact, the pituitary gland produces the hormone oxytocin, also called pleasure and sedation hormone. Oxytocin activates the parasympathetic nervous system, lowers heart rate and blood pressure, calms the breath, relaxes the muscles and calms the internal organs. In psychophysical physiotherapy, it is possible to take advantage of manual contact. For example, during a BBAT workout, a physiotherapist can perform a manual soft tissue treatment that helps the client relax their breathing, identify the limits of their own body, and reduce muscle tension. The therapist should always remember that prior to contact, the client must be asked for permission to touch. If the client is involved in an uncomfortable and even traumatic experience, the calming effect will be reversed.

Relaxation in psychophysical physiotherapy

Active relaxation has similar effects on the body as sleep. Upon relaxation, the parasympathetic nervous system is activated and the sympathetic nervous system calms down. The metabolism of stressed tissues normalizes and the function of neurotransmitters returns to normal. There are numerous different relaxation methods and methods suitable for the patient can be found by experimenting. Active relaxation exercises include breathing exercises, autogenic relaxation, progressive relaxation, mindfulness, and meditation. Of these, progressive relaxation is the most widely used method and is also utilized in CBT-I therapy. Progressive relaxation is a gradual relaxation technique that progresses throughout the body. Under the guidance of a therapist, muscle groups are alternately tense and relaxed. The goal is to get to know the difference between tense and relaxed muscles. The effectiveness of the method is based on the effect of the muscular senses, ie the sensory and sensory receptors of muscles are taught the difference between tension and relaxation. When stressed, the neck and shoulder area is usually very tense. When the muscles of the neck and shoulder are relaxed, it is almost impossible for people to maintain a state of hypersensitivity. This is most obviously an evolutionary remnant that works in two directions. It is good to learn progressive relaxation exercise in a guided way at first, but later you can move on to doing the exercise independently. Once the relaxation is successful you can skip the tensioning phase and move directly to muscle relaxation. For everyone, this exercise is not suitable before going to bed, because muscle tension can increase the state of alertness.

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