Every breath you take…

Breath is our initiator, our propeller and our oxygenator. The main job of our respiratory system is to take oxygen from atmosphere through nostril into our air sacs, the alveolar system. The air has to be pushed from the zero atmosphere pressure, so lungs have to generate negative air pressure to allow oxygen to flow from high pressure to low pressure, so inhalation effort is needed.

Journey to total wellness involves conscious control of breath. The coordination of inhalation and exhalation creates a wave-like motion in your nervous system, which makes you relaxed and make you feel energetic, both physically and mentally.

Inhalation is the art of receiving primeval energy into the body in the form of breath, while exhalation is removal of toxins from the system. The right breathing practices are must for optimum health. The more you breathe in, the more you breathe out. More breath per breath is a kriya which conserves your total energy, provides wellness and healthy longevity.

If you breathe in more per breath, you actually breathe in less number of breaths. For example, if you are breathing 500ml alveolar breath you need only ten breaths per minute. If you breathe in 250 ml you need only 20 breaths per minute. So people who breathe in small breaths they get fatigued faster because they have to breathe in more number of breaths at the end of the day.

During emotional stress our sympathetic nervous system is stimulated and affects a number of physical responses. When our heart rate rises, we perspire, our muscles tense and our breathing become rapid and shallow. If this process happens over a long period of time, the sympathetic nervous system becomes over stimulated leading to an imbalance that can affect the physical health, resulting in inflammation, high blood pressure, aches and pain and fatigability.

The breath can be used to directly influence stressful changes causing a direct stimulation of the parasympathetic nervous system resulting in relaxation and reversal of the changes seen with the stimulation of the sympathetic nervous system. Due to more shallow breathing, the chest does not expand as much as it would with slower deeper breaths and much of the air exchange occurs at the top of the lung tissue towards the head. This results in “chest” breathing. Chest breathing is inefficient because the greatest amount of blood flow occurs in the lower lobes of the lungs, areas that have limited air expansion in chest breathers. Rapid, shallow, chest breathing results in less oxygen transfer to the blood and subsequent poor delivery of nutrients to the tissues.

Abdominal breathing is also known as diaphragmatic breathing.When diaphragm contracts it is forced downward causing the abdomen to expand. This causes a negative pressure within the chest forcing air into the lungs. The negative pressure also pulls blood into the chest improving the venous return to the heart. This leads to improved stamina in both disease and athletic activity. Like blood, the flow of lymph, which is rich in immune cells, is also improved. By expanding the lung’s air pockets and improving the flow of blood and lymph, abdominal breathing also helps prevent infection of the lung and other tissues. But most of all it is an excellent tool to stimulate the relaxation response that results in less tension and an overall sense of well being.

Steps: 1. Focus your breath between lungs, the triangle area at level of stomach and epigastric point,

2. Resting one hand on chest and the other on abdomen, breathe slow and deep and inflate stomach.

3. Push back and breathe out slowly through lips like a purse lip,

4. Do this for 15 per minute.

5. Rest as a corpse pose, savanasana for a minute,

6. Do this exercise for 15 minutes in the morning.

The right breathing practices are must for optimum health and journey to total wellness. The more you breathe in, the more you breathe out.

Wellness: Relaxes spine; improves breathing

This is about a 62-year-old lady, a patient of chronic airflow limitation with progressive kyphoscoliosis (forward bending of spine), who was subjected to Bidalasana – Cat Pose Breathing.

The Cat Pose loosens your back and spine. It also stretches the front and back of your body and frees your neck and shoulders. Doing the Cat Tilt elongates your back muscles and makes your abdominal muscles contract. Doing the Cat Pose benefits your health by stimulating spinal fluid and the digestive tract, and by improving circulation through the spine and core. It is also beneficial in managing stress.

You breathe from lower brain called brain stem and breathe best when your spine, pelvis and diaphragm are in coordination with each other. A good spine posture with right breathing technique augments lung ventilation. If you nurture your spine and do regular spinal breathing it would expand lungs and improve ventilation. There are two types of breathing movement of rib cage.

The pump handle and bucket handle movement.

The pump handle movement increases the forward expansion of chest cage or horizontal expansion and bucket handle movement elongates the lung or expands the lung vertically. These movements involve simultaneous movement of intercostals cartilage, diaphragm and spine, clavicle, shoulder and pelvic movement.

A good breathing involves symmetrical expansion of chest both forwardly and vertically so that there is minimum dead space ventilation or wasted ventilation.

Bidaasana or cat pose breathing

Bidalasana – Cat Pose Breathing improves breathing and takes care of spine. Spine is the most important part of the human system. It is a pillar which allows respiratory system to function synchronously and effectively for optimum ventilation and wellness.

Benefits of this breathing are that it gently stretches lower back, hips, thighs, knees and ankle. Relaxes your spine, shoulders and neck. Massages your internal organs and calms the mind.

Step 1: Start on your hands and knees. Position your hands directly beneath your shoulders and your knees directly beneath the hips. Have your fingers fully spread with the middle fingers pointing straight ahead. Make your back horizontal and flat. Gaze at the floor. This is your “neutral” positioning. When your pelvis is in neutral, your spine will be at full extension, with both the front and back

Step 2: As you wait for the inner cue, do not sag into your shoulders. Instead, create a line of energy through each arm by pressing downward into your hands and lifting upward out of your shoulders. Go back and forth like this several times to make sure you understand the movement. As you exhale, sag into your shoulders and do the incorrect action; as you inhale, lengthen the arms, lift out of the shoulders and do the correct action.

Step 3: When you are ready to begin, breathe in deeply. As you exhale, turn your hips into Cat Tilt. Do this by gently pulling the abdominal muscles backward toward the spine, tucking the tailbone (coccyx) down and under, and gently contracting the buttocks. Press firmly downward with your hands in order to stay lifted out of the shoulders, and press the middle of your back toward the ceiling, rounding your spine upward. Curl your head inward. Gaze at the floor between your knees.

Cat pose breathing significantly improved this patient’s kyphoscoliosis and significantly improved breathing parameters as well as wellness.

Breathe better; fight flu

A vast majority of patients are asthmatic and suffer from related respiratory diseases. Swine flu has been making headlines for causing huge misery across the country.

Patients with asthma are more likely to develop lower respiratory infections, including pneumonia, morbidity and mortality. Remember the strain of HINI is the same as it was in 2009.

It means we all have developed innate immunity against it but still there are patients suffering from this disease.

When Suniti, a 37-year-old working professional developed symptoms of the H1N1 swine flu in December, her condition quickly deteriorated. She recalls, “I went to bed on a Tuesday night feeling fine. I woke up the next morning and felt terrible. I was dizzy, weak, feverish and simply in a fog.”

Taking a combination of antiviral and asthma medications  finally eased her symptoms, but not all asthmatic patients with H1N1 swine flu are so fortunate. In fact, research has found that asthma is the leading medical condition found among H1N1 patients requiring hospitalisation. Nearly 30 per cent of both child and adult patients hospitalised for swine flu have asthma. There are steps and methods to prevent swine flu. You have to see how best you breathe daily?

Just breathe more per breath and feel better, sleep better and avoid virus by taking a diet rich in protein, citrus rich fruits and engaging in outdoor physical activity can prevent major respiratory infections. Deep breathing exercises improve your oxygen delivery to tissues and help you to remove toxins.

Oxygen is, by far, the most vital component humans need to live. We can go weeks without food, days without water, but only a few minutes without air. To get the most out of oxygen, it’s imperative our lungs are functioning properly.

Every cell in the human body requires oxygen and although it seems like an autonomous function we may not give much thought to, deep breathing exercises can be done to help clear out toxins that may have built up in the lungs. This will help to improve lung performance and clear airways.

Deep breathing gets more nourishing oxygen into your body. Blood that is rich in oxygen will help you feel better and give you more energy.

Deep breathing also reaches the deepest depths of your lungs, and helps to expel and break up residue. Deep breathing exercises help in expanding the lungs maximally. Normally we all take small breaths and most of our efforts get wasted due to increase dead space ventilation.

By deep breathing exercises you breathe more per breath. If you breathe more per breath you expand your lungs more, you receive more oxygen. You will feel more energetic and also save your breaths. For example, if you breathe 250 ml per breath and your requirement is 5 litres then you need 20 breaths per minute.

If you breathe more breath say double i.e. 500ml then you will require only ten breaths. So by breathing deep you breathe less and you feel better and conserve energy.

STEPS

1. Find a relaxing and quiet place to sit down and feel your breath.
2. Close your eyes and begin by breathing in deeply through your nose from your belly up depths of your lungs to inflate all the alveoli and break up any toxins and pollutants that may have accumulated. Hold your breath for several seconds and then exhale over the course.
3. Now practise breathing out by tonic and clonic contraction of diaphragm. The diaphragmatic contraction will squeeze the lung and in turn increase the volume of breath in next breaths. Do sixty breath outs per minute.
4. Relax, close your eyes and watch your breath for the next one minute.
5. Repeat. Maybe, you could chant too.

Swine Flu Awreness

SWINE FLU

Dr Partho P Bose, MD, DTCD, DNB, FCCP, FISDA

Chest, Critical Care and Sleep Physician

Founder SAANS foundation

Chairman, SAKSHAM

Sr Consultant, National Heart Institute

Sr Consultant, Max Superspeciality Hospital

In 1918, an estimated forty million people died as a virus swept the world almost overnight. Even the young and healthy were affected, leaving children orphaned and families devastated. But perhaps the most frightening thing of all was that the killer was a strain of virus that comes around every year and that most people take for granted - FLU

What is Flu?

Flu is an acute respiratory illness caused by infection with influenza viruses.

What is Flu/influenza?

• The illness affects the upper and lower respiratory tract and is often accompanied by systemic signs and symptoms such as fever, headache, myalgia, and weakness.
• The disease usually spreads in certain periods of the year, especially winter or early spring.
• When healthy people catch influenza, the disease is self-limiting and usually disappears in about one week. In contrast, influenza can cause serious complications and even death in people at risk of complications.

Disease trend

The disease is more common in periods from January to March; and from July to August

Emergence of Antigenic Sub types of Influenza A virus associated with Pandemic or Epidemic disease

• The most extensive and severe outbreaks are caused by influenza A viruses, in part because of the remarkable propensity of the H and N antigens of these viruses to undergo periodic antigenic variations.
• Major antigenic variations called Antigenic Shift; may be associated with pandemics and are restricted to influenza A viruses.
• Minor variations are called Antigenic Drifts.

Influenza Pandemic

3 pre-requisites for the start of an Influenza Pandemic

• A novel influenza virus subtype emerges and humans in general have no immunity against it
• The new virus must be able to replicate in humans and cause serious illness
• The new virus must be efficiently transmitted from one human to another

How do influenza pandemics arise?

• Fowl are natural reservoirs of influenza and can spread the virus to other birds
• All human influenza viruses arise from avian viruses
• Avian influenza viruses evolve into new strains capable of infecting humans
• A new avian-derived flu virus that can reproduce and spread in humans leads to a pandemic

Influenza: Clinical features

• Incubation period is usually 2 days (range is 1-5 days)
• Severity of illness depends on prior influenza exposure
• Abrupt onset includes fever, muscle aches, sore throat, dry cough, and headache

Symptoms of influenza

The first indication of influenza activity in a community is an increase in the number of children with febrile respiratory illnesses who present for medical attention. This increase is followed by increases in rates of influenza like illnesses among adults and eventually by an increase in hospital admissions for patients with pneumonia; worsening of CCF; and exacerbations of COPD

Complications of influenza

Lungs

• Elderly people and chronic cardio-respiratory; diabetic; renal and immune compromised patients.
  Pneumonia
• Primary pneumonia
• Secondary pneumonia: Streptococcus pneumoniae, S aureus and H. influenzae.
• Exacerbation of chronic obstructive lung disease.
• The most life-threatening of these is pneumonia. If not resolved, death may result from obstruction of air flow to the lungs, arrhythmias of the heart, blood poisoning and shock.
• Rapid onset of high fever and the progression of cough to severe shortness of breath, and bluish discoloration of skin and lips are consistent with a diagnosis of severe

Complications of influenza

Extra Pulmonary complications

       Heart

• Myocarditis and pericarditis.
• ECG changes are caused by exacerbation of the underlying heart disease rather than by a direct effect of the influenza virus on the heart muscle

Complications of influenza

• Inflammation (myositis) and destruction of skeletal muscles
• Involvement of muscles has been reported most commonly after influenza B infection of children. Leg pains and muscle tenderness last for 1-5 days. Destruction of the skeletal muscles may result in acute renal failure. Specific treatment may be necessary.
• Central nervous system
• Inflammation of the spinal cord and brain rarely occurs (encephalitis). Mania and schizophrenia were associated with the 1918 influenza pandemic
• GB syndrome

Complications of influenza

Reyes syndrome

Reye’s syndrome causes fatty accumulation in the organs of the body, especially the liver. This is a rare liver and central nervous system complication seen after viral infections, in particular influenza B, almost exclusively occurring in children, and linked with use of salicylates (aspirin). Symptoms are a change in mental status, nausea and vomiting due to edema of the brain. It may be fatal in up to 40% of cases

Chronic fatigue syndrome

Fatigue and a lack of energy that persist after influenza symptoms are gone. People may take several weeks to fully recover, although no cause for the symptoms has been identified.

Lab Finding

• Tissue culture and chick embryo
• Virus may be isolated from throat swab, sputum within 48 – 72 hours after inoculation.
• Rapid viral test
• Detect viral nucleoprotein or neuraminidase by either immunofluorescence, CF or HI techniques. Four fold or greater titer rises by HI or CF or ELISA (60-90% sensitivity and specificity)

Treatment of influenza

• Specific Antiviral therapy
• Amantadine and Rimantadine for influenza A
• Start within 48 hours, and reduction of symptoms by 50%. Dose 200 mg/d for 3-7 days
• Zanamivir and Oseltamivir for both influenza A and B
• Zanamivir, inhaled orally, 10 mg twice a day for 5 days
• Oseltamivir, ingested orally 75 mg twice a day for 5 days. Reduction in duration of signs and symptoms by 1 – 1.5 days.
• Antibacterial therapy for complications

How to prevent Influenza?

‘Influenza pandemic’ Vs ‘Seasonal Influenza’

When compared to localized “seasonal” influenza epidemic, the influenza pandemic:

Spreads quicker and broader

Usually associates with higher severity of illness and a higher death toll

Has more serious consequences, greater social and economic impact

Preparedness Plan for Influenza Pandemic

The Government’s 3-tier response system for handling major infectious disease outbreaks

• Alert Response Level
• Serious Response Level
• Emergency Response Level

Actions from Public – Alert  Level

Maintain normal way of life

Pay attention to further announcements from the Government

Actions from Public – Serious Level

• Maintain normal way of life
• Prepare enough masks for possible exigencies
• Pay attention to and comply with  guidelines issued by the Government

Emergency Response Level

• Evidence of efficient human-to-human
• Influenza pandemic

Actions from Public – Emergency Level

• Use mask appropriately
• Pay attention to and comply with guidelines issued by the Government

How to Prevent

• Avoid touching live birds and poultry and their droppings
• After contact with live birds and poultry, wash hands thoroughly with liquid soap and water immediately
• Poultry and eggs should be thoroughly cooked before eating
• Travelers’ returning from areas with reported avian flu outbreaks should consult doctors promptly if they have symptoms of influenza after the trip. Let the doctors know the travel history and wear a mask to prevent spread of the disease
• Ensure good ventilation
• Avoid visiting crowded places with poor ventilation
• Prevent the trap of drainage pipe from drying and disinfect drain outlets. Pour half a litre of water into each drain outlet and add 1 easpoon of 1:99 diluted household bleach solution into the outlet once a week
• Keep your home clean, wipe furniture and toilet with 1:99 diluted household bleach solution once a week

8 Steps to Protect Yourself

• Individual preparedness
• Before the pandemic comes
• When the pandemic comes

Step 2 Keep hands Clean

When Should We Wash Our Hands?

Before touching eyes, mouth & nose

When hands are contaminated by

• respiratory secretion

e.g. after coughing / sneezing

• After touching public installations
• or equipment

e.g. escalator handrails, elevator control panels, door knobs

• Before handling food or eating
• After going to toilet

Six steps of Hand washing

Step 3 Get Vaccinated

• Seasonal peaks : Jan – Mar / Jul – Aug
• Influenza vaccination one of the effective means of preventing influenza complications

• Influenza vaccination is recommended to special groups

Step 2 : Get Vaccinated

People who should receive influenza vaccination:

• Elderly persons living in
• residential care homes
• Long-stay residents of
• institutions for the disabled
• Elderly persons aged 65 years
• or above
• Persons with chronic illnesses
• Health care workers
• Poultry workers
• Children aged 6 to 23 months
• Pregnant women in their second or third trimester

           Influenza vaccine can be given on the same day as other types of vaccines

Step 2 : Get Vaccinated

People not suitable to  receive influenza vaccination:

• Allergic to eggs, neomycin, etc
• Allergic to previous dose of influenza vaccine
• With bleeding disorders or on warfarin
• Suffer from acute febrile illness

2 Vaccination

• Two weeks after vaccination
• antibodies develop and provide protection
• Immunity declines over time

Step 4 : Use Mask Properly

People who should wear masks:

• Patients with respiratory infection symptoms
• Caregivers of patients with respiratory infection symptoms
• Visitors of clinics or hospitals

Step 4 : Use Mask Properly

Points to note about wearing a surgical mask :

• The mask should fit snugly over the face
• Try not to touch the mask once it is secured on your face. If you must do so, wash your hands before and after touching the mask
• When taking off the mask, avoid touching the outside of the mask

Step 5 : Know How Influenza Presents

Incubation period: about 1-3 days Signs and symptoms of influenza:

• Fever
• Headache
• Muscle ache
• Cough
• Sore throat
• Runny nose

Step 6 : Manage Fever Well

FEVER － Symptom of underlying illness  (we should be concerned about the specific illness that causes fever)

Normal body temperature

• 37℃ / 98.6℉
• can vary 1℃- 1.5℃ normally

Readings taken as reference under different methods of measurement:

• Rectal temperature (38℃)
• Oral or tympanic temperature (37.5 ℃)
• Axillary temperature (37.0 ℃, less reliable)

Step 7 : Practise Healthy Lifestyle

Is one of the most effective ways to prevent communicable diseases

To lead a healthy lifestyle:

• Eat a balanced diet
• Get regular exercise
• Do not smoke
• Have adequate rest

build up body resistance

Step 8 : Be Resourceful

www.saansfoundationindia.com

Influenza Vaccine – CDC guidelines

Types of vaccines

FLU SHOT

An inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

NASAL SPRAY FLU VACCINE

A vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV (FluMist®) is approved for use in healthy people 2-49 years of age* who are not pregnant.

Influenza Vaccine – CDC guidelines

Types of vaccines

• Each vaccine contains three influenza viruses-one A (H3N2) virus, one A (H1N1) virus, and one B virus. The viruses in the vaccine change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year.
• About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

Influenza Vaccine

Trivalent	Type A (2) and type B (1)
Efficacy	Varies depending on circulating strain, age, and underlying illness
Immunity	< 1 year
Schedule	One dose annually

Influenza Vaccine – CDC guidelines

When to get vaccinated

• October or November is the best time to get vaccinated, but you can still get vaccinated in December and later.
• Flu season can begin as early as October and last as late as May
• In general, anyone who wants to reduce their chances of getting the flu can get vaccinated.
• However, it is recommended by ACIP that certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications.

People at high risk from complications from the flu:

• Children aged 6 months until their 5th birthday
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long term care facilities

People who live with or care for those at high risk for complications from flu, including:

• Household contacts of persons at high risk for complications from the flu.
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
• Healthcare workers.
• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination in the past.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Influenza vaccine is not approved for use in children less than 6 months of age.
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

Vaccine effectiveness

• The ability of flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or “match” between the virus strains in the vaccine and those in circulation.
• Testing has shown that both the flu shot and the nasal-spray vaccine are effective at preventing the flu.

Vaccine Efficiency

70-90%	For persons < 65 years of age
30-40%	For the frail, elderly
50-60%	Preventing hospitalization
80% preventing death	Preventing death

Vaccine Side effects

• The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are

1. Soreness, redness, or swelling where the shot was given
2. Fever (low grade)
3. Aches

• If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it.

Happy thoughts, happy minds

Obesity is a state of mind body illness. As with all chronic medical conditions, effective management based on partnership between a highly motivated patient and a committed team of health proffesionals is the key to dealing with it. Obesity needs a strong mental wellness and behavioural control. This is about a 50-year-old sluggish lady suffering from weight gain, disturbed sleep and choking during sleep. To compound matters, her history of binge calorific eating caused rapid gain resulting in body mass index of 32. Obesity is pan endemic and responsible for all cardio respiratory, sleep and psychological disturbances. We create a positive mindset by cognitive behavioural therapy, a mental wellness by stimulus control techniques and non food rewards. Stimulus control involves changing the mindset towards food stimulus by positive thought insertion. Every thought has a stimulus, stimulus brings a perceptive change in mind and perception brings behavioural changes. Behavioural changes bring actions. Action involves sinful eating. We change the thought and we call it happy thoughts and happy mind. Normally it involves 12 sessions over a period of six weeks. Structured programme involves self monitoring of caloric intake and physical activity, goal setting, stimulus control, non food rewards and relapse prevention. Follow this structured protocol 1. Two glasses of water in the morning. 2. 30 minutes of brisk walking. 3. Ten minutes of breathing exercises. 4. Specific stretches using stretch bands. 5. Fifty abdominal crunches. 6. Rest and relaxation through the Corpus pose. 7. A cup of green tea. 8. Two atta roti, low carbohydrate high protein chapatti. The atta should have chana, millets, kuttu, bran, maize, fenugreek seeds. Green vegetable cooked in one tea spoon full oil (canola or olive oil) and one small bowl of homemade paneer. 9. Mid morning smoothie with tomato, amla, orange, gourd, guava, lemon, mint and ginger without water 10. One bowl bhuna chana pre lunch 11. Two diet fibre chapattis/ one bowl of parboiled rice, one small bowl of boiled mixed legumes, one small bowl yogurt and mint chutney 12. Evening, roasted snacks with green tea 13.15 minutes of chaotic breathing 14. Pre-dinner: vegetable soup 15. Dinner with baked beans/ fish/ lean meat/ soya chap with yogurt 16. Listen music and do OM chanting 17. Follow right pre-sleep habits 18. Sleep well. This lady lost ten kilograms in five months and became very alert and active in the day. Her sleep disordered breathing got corrected and in fact she lost 14 kgs with her motivation and self discipline.

Breathe well, sleep well

Total wellness is not possible without good sleep. Sleep is a de-learning process. It relaxes and rejuvenates the body and makes our body ready for a new day. We spend one third of our life in sleep and this one third decides the two third of our life. For every two hours of alertness we need one of sleep. Ever since society has become 24×7, our sleep quality has become poor. A healthy body needs a regular refreshing seven to eight hours of sleep.

Sleep debt creates a mortgaged mind. If we are sleeping one hour less per day then we have to pay back in the day. Sleeplessness is equivalent to drunken driving. Anger, agitation, personality disorders, road rage, substance abuse are indirectly related to poor sleep. Sleep disorders are rising in society and more over sedentary behaviour, obesity is responsible for the rising number of sleep apnoea and related sleep disorders.

There are two types of sleep disorders one primarily because of defects in sleep regulatory mechanisms and others are secondary due to lifestyle causing insomnia and sleep disordered breathing like sleep apnoea. A tired and spent person gets relief and is able to retrieve his liveliness and energy only after taking sound sleep. Sleep is a law of nature which is applicable not only to human beings but also to the botanical world.

A good night sleep is a good regular sleep practice. Always be happy while sleeping. Concentrate on your breathing and feel you are totally relaxed. Keep in mind that the pranayama practice is very important. Pranayama and yoga are the key to good activation of our biological clock.

Our hypothalamic area in the brain is our internal clock. If we do not nurture our biological clock we will face sleep delay and fragmented sleep.

A good sleep involves right pre-sleep practices. It’s like a right alap before a classical music performance. Yoga and Pranayama are an important measure to improve sleep and reduce work place negativity, tension, anxiety and so many other problems. Following yoga and pranayama – Bhastrika pranayam, Kapalbhati pranayam and Anulom Vilom pranayam – have been found to be beneficial.

Besides this, Shavasan and Yognidra are very much useful for sound sleep. Listening to light music like mantras before sleep is beneficial. Yoga increases blood circulation and stimulates the nervous system. Following few practices improves oxygenation to the brain and improves sleep quality and cures insomnia. Halasana and Sarvangasana are the asana to cure insomnia naturally by yoga.

Good pre-sleep habits are called sleep hygiene. A good sleep hygiene improves sleep quality by reducing the onset of sleep and maintenance of rhythm of sleep. We all enter sleep through NREM sleep it’s like slow uncoiling of a curtain wire. We enter sleep with high alfa waves and slowly go to delta or slow wave sleep.

Initial sleep is all NREM sleep and subsequently we enter REM sleep or rapid eye movement sleep. REM sleep constitutes one third of total sleep and in this time of sleep muscles reach to zero tone and it’s a dream sleep.

This is about a 50-year-old man, a heavy smoker with sedentary corporate life with disturbed sleep, snoring, day time sluggishness, irritability and poor corporate performance.

He was subjected to a quit tobacco programme, weight loss and good nutrition and lifestyle modification programme with following sleep rules.

He improved on all fronts and started enjoying wellness in his life.

Stick to your sleep time and get up exactly 7 to 8 hours after sleep. You will feel oven fresh.

Follow this sleep rules one hour before going to your sleep clock.

1. A relaxing warm shower an hour before sleep.
2. Anulom vilom for five minutes
3. Kapalbhati for five minutes, avoid doing if you had dinner an hour before.
4. Bhastrika for five minutes.
5. Eye exercises for five minutes in all quadrants
6. Cervical flexion, extension and rotation exercises for two minutes.
7. Sharvanasana or corpse pose for 5 minutes and focus on your breath.
8. Now listen to some slow music. Music induces Alfa activity and helps in sleep initiation for 10 minutes.
9. Do visual imagery. Make memorable twenty images on your iPad or phone or album and slowly brush though.

This helps in release of endorphins and gives feel good feeling for 5 minutes.

1. Take a hot cup of milk. Milk has serotonin and serotonin induces sleep. These steps will de-stress you and help you to get a sound sleep.

Avoid thinking too much while sleeping. Just relax while sleeping.

Always be happy while sleeping. Concentrate on your breathing and feel totally relaxed.

Keep in mind pranayama practice is very important, as important as pre-sleep habit.