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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 77-83 |
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Effect of pranayama as per trishikhbrahmana upanishad on sleep quality in adults: An experimental study
Prakhar Tyagi, Arpit Kumar Dubey, Rameswar Pal
Department of Teaching, Morarji Desai National Institute of Yoga, Ministry of Ayush, Government of India, New Delhi, India
| Date of Submission | 09-Sep-2022 |
| Date of Decision | 07-Feb-2023 |
| Date of Acceptance | 22-May-2023 |
| Date of Web Publication | 11-Aug-2023 |
Correspondence Address:
Arpit Kumar Dubey
Morarji Desai National Institute of Yoga, Ministry of Ayush, Government of India, 68 Ashoka Road, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijptr.ijptr_136_22
Context: The Upanishads are primary texts of Yoga philosophy and practices. Various Yoga Upanishads have given detailed description of various yogic practices along with their spiritual and physical benefits. This study aims to assess the effect of one Pranayama practice from Trishikhbrahmana Upanishad on sleep quality in adults.
Aim: The aim of the study was to assess the effect of a Pranayama technique (described in the Trishikhbrahmana Upanishad) on sleep quality in adults.
Settings and Design: An experimental study was conducted on volunteer participants from North India.
Subjects and Methods: A pretest–posttest control group study was designed where the participants (n = 30) were randomized into study (n = 15) and control (n = 15) groups. The study group was given the Pranayama intervention for 30 days whereas the control group was not given any intervention throughout the study. The sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI).
Statistical Analysis Used: GraphPad Instat Software was used to carry out independent t-test. The mean and standard deviation were also calculated.
Results: The results showed a significant improvement in the postglobal PSQI score in the study group (P < 0.001) whereas there was no significant change in the pre- and postglobal PSQI score in the control group (P = 0.941).
Conclusion: The results suggest that the Pranayama technique from the text and its effects are true in improving the sleep quality in adults but future studies with a larger sample size and some other physiological parameter assessments may further support the textual claim.
Keywords: Pranayama, Sleep quality, Upanishads, Yoga
How to cite this article:
Tyagi P, Dubey AK, Pal R. Effect of pranayama as per trishikhbrahmana upanishad on sleep quality in adults: An experimental study. Indian J Phys Ther Res 2023;5:77-83 |
How to cite this URL:
Tyagi P, Dubey AK, Pal R. Effect of pranayama as per trishikhbrahmana upanishad on sleep quality in adults: An experimental study. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Sep 27];5:77-83. Available from: https://www.ijptr.org/text.asp?2023/5/1/77/383669 |
| Introduction | |  |
Yoga is an ancient Indian, time-tested collection of practices for healthy body, happy mind, and harmonized surrounding. The Ashtanga Yoga of Maharshi Patanjali consists of eight limbs of Yoga which include Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana, and Samadhi. Each of these practices has its own role and benefit in the upliftment of human consciousness. Various practices of Yoga have physical, mental, social as well as spiritual benefits. Most of the problems of a modern man are due to bad lifestyle which can be improved with the help of Yoga, especially Pranayama.[1]
Pranayama is the essence of all the mind–body-centric practices and a very important practice of Yoga philosophy and practices. It acts as a bridge between external and internal existence and connects the two. Pranayama is such an integral part of Yoga that it can be found in almost all the yogic texts. It has been discussed thoroughly in various Hatha yogic texts such as Hathapradipika by Swami Swatmarama, Gheranda Samhita by Sage Gheranda, and many more which are more than 500 years old. It can be found in even older texts like the Yoga Upanishads, Shrimadbhagavad Gita, and the Yogasutra of Maharishi Patanjali where he describes it as  (tasminsati śvāsapraśvāsayorgativicchedaḥ prāṇāyāmaḥ)[2] which means Pranayama is the regulation of the incoming and outgoing flow of breath with retention.
In the second verse of the second chapter of the famous Hatha Yoga text, Hatha Pradipika, written by Swami Swatmarama, it has been mentioned:
(Cale vāte calaṁ cittaṁ niścale niścalaṁbhavet)
(Yogī sthāṇutvam āpnoti tato vāyuṁ nirodhayet) |:|:2.2|:|: Hathapradipika
Respiration being disturbed, the mind becomes disturbed. By restraining respiration, the Yogi gets steadiness of mind.[3] It explains the relation between the breath and the mind. When the breathing is disturbed, it directly affects the mind and the mind also gets disturbed, so in order to gain control over the mind one needs to get control over the breath. According to an ancient yogic text “Yoga Vasistha” the cause of physical illness (Vyadhi) is mental illness (Adhi).
Sleep is a basic physiological drive, similar to hunger or thirst, and it is extremely important for life and normal functioning.[4] Sleep is important to a number of brain functions such as nerve conduction. Sleep impacts the entire body, encompassing vital organs such as the brain, heart, and lungs, as well as affecting immune functions, metabolism, and more.[5]
According to a Fitbit study, Indians are the least active and second-most sleep deprived in the world.[6] According to another research, sleep plays an important role in various physiological functions, and disruptions in sleep can have adverse effects on healthy individuals as well as those with health conditions. In healthy individuals, short-term consequences of sleep disturbance include increased stress response, pain, depression, anxiety, as well as impaired cognition, memory, and performance. In children and adolescents, disrupted sleep can lead to poor school performance and behavioural issues. Decreased quality of life might be a momentary result of sleep interruption in any case sound people and those with a basic ailment. Long-term ramifications for in any case sound people incorporate hypertension, dyslipidemia, cardiovascular disease (CVD), weight gain, and metabolic conditions. There is also evidence that sleep disruption may increase the risk of certain cancers and death in males and suicidal adolescents. Long-term sleep disruption may also worsen the symptoms of a variety of gastrointestinal disorders.[7]
There are various causes of sleep disturbances such as cardio vascular diseases (congestive heart failure, coronary artery disease), endocrine disorders (diabetes, thyroid diseases), neurological disorders (Parkinson's disease, epilepsy, dementia, headaches) respiratory diseases (asthma, chronic obstructive pulmonary disease), mental illness (anxiety, depression, bipolar disorder), some other health problems such as gastroesophageal reflux disease, kidney disease, arthritis. It's worth noting that certain medications can also disrupt normal sleep such as alpha and beta blockers, diuretics, antiarrhythmic drugs used in cardio vascular diseases, some other drugs such as beta agonists, corticosteroids, nicotine patches, and stimulants hamper the sleep quality.[8] Environmental issues (for example, it is too bright or too noisy), genetics, night shift work, and aging can also distrust sleep. These causes can lead to loss of sleep quality which can increase the risk of developing various health conditions. A recent study shows a significant association of stress with poor quality of sleep.[9]
Pranayama stimulates the body parasympathetically that helps to reduce stress and eventually helps the body to relax and improves sleep quality. Various yogic practices, especially Pranayama, affect the mind and the body directly and various problems related to psychosomatic and stress-related physical, mental, and emotional disorders can be resolved with the help of these yogic practices which can help an individual regain health.[10]
The Upanishads are the primary texts of Yoga philosophy and practices and are considered the highest form of human knowledge. The Trishikhbrahmana Upanishad is one of the Yoga Upanishads that describes the practical aspect of Yoga. The Upanishad explains a detailed exclusive technique of Pranayama along with its benefits which includes mastery over breath and senses, decreased food, and sleep quota. This practice can be performed and even if one cannot attain the spiritual benefits of the technique due to lack of proper practice, one can certainly get some benefits on physical as well as mental levels.
A large population in India is sleep deprived, it is important to develop such techniques to improve the sleep quality effectively with no side effects. There has not been any such study till now that assesses the effect of this technique taken from Trishikhbrahmana Upanishad on sleep quality in adults. It would be a great contribution to humanity if this technique can be used effectively to improve the sleep quality of individuals. In order to meet the need of the study the objectives of the study include (I) to assess the effect of the Pranayama technique on sleep quality in adults and (II) to spread awareness about ancient yogic techniques in the contemporary world.
| Subjects and Methods | | |
The design of the study is pretest–posttest control group design. A 30-day study was designed to assess the impacts of the Pranayama practice on the participants. The participants were randomized into two groups – study group and control group. The study was conducted through online mode from February 20, 2022, to May 20, 2022.
Participants
The total sample size of the study was thirty (n = 30). The random allocation of the participants to study and control groups was done using an online statistical applet (simple random sample). A number between 1 and 30 was assigned to each participant. Then 15 numbers were randomly selected by the statistical applet. The individuals with selected numbers were included in the study group and the remaining participants were included in the control group, in this way 15 participants were included in each group (Study group = 15, Control group = 15). [Figure 1] shows the participant allocation. The sample included male and female participants with age ranging from 21 to 50 years, having different educational and working backgrounds (students and working professionals). [Table 1] shows the baseline characteristics of the participants. The participants were invited through a Google Forms which was promoted through various social media platforms (WhatsApp and Instagram). The selected participants registered themselves to participate in the study and all of them passed through the inclusion criteria which were (I) individuals (males and females) from India, (II) individuals who can read and write in English, and (III) mentally and physically fit individuals having no major physical or mental issues. The exclusion criteria included (I) individuals who were not in the 21–50 age range, (II) individuals indulged in any other activities such as Gym or Yoga, and (III) individuals on any kind of medications which may alter sleep. Five participants from the study group left before completing the study because of the inability to attend the sessions on time, and some other personal reasons. Hence, they were excluded and five participants from the control group denied to fill the questionnaire before postassessment and were excluded.
Ethical consideration
The research proposal was presented in front of the Institutional Research Board (IRB). IRB approved the study and study invitation was circulated through various social media platforms. The consent form was taken from the participants and the procedure, risk involved (if any), and other related information regarding the study was explained clearly to all the participants. The right to leave the study at any time during the course of the study was also given to all the participants. The participants were given assurance regarding the confidentiality of their given information.
Intervention
The Pranayama practice was performed for 20 min every day from 9:30 pm to 9:50 pm for 30 days (April 1, 2022–April 30, 2022). The intervention was divided into 3 parts: breath awareness, Pranayama practice, and mental observation. The practice started with 5 min of Breath awareness followed by the Pranayama practice (as described in Trishikhbrahmana Upanishad). Three rounds of Pranayama were performed. Each round consisted of 4 min of the Pranayama practice followed by 1 min of mental observation. [Figure 2] shows the structure of intervention.
Breath awareness
The participants were asked to sit comfortably in Sukhasana (crossed-legged position) with hands on the knees, keeping the head, neck, and spine straight with closed eyes. Participants were then instructed to direct their awareness to their breath, consciously shifting their attention away from external distractions and fully focusing on their breathing.
Pranayama practice (as per Trishikhbrahmana Upanishad)
The Trishikhbrahmana Upanishad explains the procedure of the practice in detail from the 95th to 97th mantra of the Upanishad.
(hastena dakṣiṇenaiva pīḍayennāsikāpuṭam) (95/2)
(śanaiḥ śanairatha bahiḥ prakṣipetpiṅgalānilam)
(iḍayā vāyumāpūrya brahmanṣoḍaśamātrayā)(96)
(pūritaṃ kumbhayetpaścāccatuḥṣaṣṭyā tu mātrayā)
(dvātriṃśanmātrayā samyagrecayetpiṅgalānilam)(97)
Press the left nostril with the right hand and exhale through Pingala (right nostril). After that inhale through Ida (left nostril) for 16 matras (one matra is the shortest period of time; around 1 s) and perform Kumbhaka (breath retention) for 64 matras (seconds) then exhale that air through Pingala for 32 matras (seconds).[11]
The practice starts with deep inhalation through both the nostrils, followed by exhalation from the right nostril while keeping the left nostril closed. After complete exhalation from the right nostril, inhalation is performed slowly through the left nostril while keeping the right nostril closed. After complete inhalation, Kumbhaka (internal breath retention) is performed by keeping both the nostrils closed. The right nostril is then released and complete exhalation is performed through the right nostril. The ratio of inhalation, Kumbhaka, and exhalation must be kept 1:4:2. This is one round.
Mental observation
The participants were asked to take normal breaths and to keep their focus on the breathing and the effects of the practice.
The rounds of the practice varied depending upon individual practice, but the time period remained same for everyone. The emphasis was more on the ratio of inhalation, exhalation, and breath hold (1:4:2) than the time taken in each round. In the 1st week, only those participants who could hold their breath comfortably were asked to perform Kumbhaka. The rest of the participants were instructed to avoid Kumbhaka and the ratio of inhalation and exhalation was kept 1:1. From the 2nd week onward, Kumbhaka was introduced and all the participants could perform it comfortably. The ratio of inhalation, breath hold, and exhalation was kept 1:1:1. From 3rd week onward, the ratio was gradually increased to 1:4:2 and was kept the same until the completion of the study.
The control group was kept idle throughout the study. No intervention or medications were given to the control group.
Data collection
The study outcome was determined with the help of a questionnaire, the Pittsburgh Sleep Quality Index (PSQI). PSQI is a self-rated questionnaire which assesses sleep quality and disturbances over a time interval of 1 month. The PSQI consists of 19 questions distributed across seven components to measure various aspects of sleep. The 7 components consist of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each item is scored from 0 to 3, and the total scores of the seven components are denoted as the global PSQI score, which ranges from 0 to 21. A global PSQI score over 5 indicates poor sleep relative to clinical and laboratory measures, and higher scores indicate poorer sleep quality.[12]
Statistical analysis
The data were expressed in mean ± standard deviation (SD), degree of freedom, and 95% confidence interval of mean difference. Statistical analysis, including mean, SD, and t-test, was done using GraphPad Instat software version 3.00 for windows (GraphPad Software, San Diego, CA, USA). The level of significance was set at P ≤ 0.05. Within-group analysis and between-group analysis were carried out using Student's t-test.
| Results | | |
The pre- and postdata (global PSQI) collected from the study and control groups were calculated in mean ± SD. The pre- and postintervention results of the study and control groups are given in [Table 2]. Between-group preanalysis showed no statistical difference in the global PSQI score between the study and control groups (P = 0.822), indicating that the two groups were similar in terms of sleep quality before the intervention. Within-group pre–post analysis showed a significant reduction in the global PSQI score (mean ± SD) of study group (P < 0.001) whereas there was no significant change in the within-group pre–post mean analysis of the control group (P = 0.941). Between-group postanalysis of the groups also showed a significant difference between the global PSQI score of the study and control groups (P = 0.05), indicating that there was a significant change in the sleep quality and the sleep quality of the study group had increased significantly. | Table 2: Within- and between-group analysis of effects of Pranayama on Pittsburgh Sleep Quality Index
Click here to view |
| Discussion | | |
The results showed significant improvement in the sleep quality of the participants. Thus, it is safe to assume that regular practice of the Pranayama can help in improving the sleep quality of the practitioner. Various studies have shown the positive impacts of yogic practices on various levels of human health.[13],[14],[15],[16],[17] The present study was an attempt to assess the impacts of an exclusive Pranayama technique taken from Trishikhbrahmana Upanishad on the sleep quality of the participants.
The practice majorly includes left nostril breathing which stimulates and enhances the Parasympathetic dominance in the body. This helps in providing a balance between the Sympathetic and parasympathetic systems of the Autonomic nervous system. An earlier study conducted on medical students also suggested that the left nostril breathing may alleviate stress and reduce cardiovascular risks.[18] In this way, various factors that reduce the sleep quality, especially stress, are controlled and a better, suitable internal environment is established which leads to overall improved quality of sleep.
The inhalation, breath retention, and exhalation ratio in the practice was kept 1:1:1 initially and then it was gradually increased to 1:4:2 to match the textual reference and gain the maximum benefits of the practice. The deep inhalation, breath retention, and exhalation for longer time help to enhance the respiratory and circulatory efficiency. Breath retention increases the oxygen demand in the body, CO2 in the blood is increased and a state of hypoxia occurs. In response to increased oxygen demand, the body triggers erythropoiesis (red blood cell production) and activates dormant lung areas. This is achieved through enhanced blood supply to the upper lobes of the lungs, resulting in improved gas exchange efficiency. Along with this hormonal balance is also achieved. Hormones such as estrogen, progesterone, testosterone, cortisol, and melatonin are regulated properly that help in managing an ideal sleep–wake cycle and improve sleep quality.[19],[20],[21]
Along with this when mental awareness is directed towards the breath, it helps to reduce the wandering nature of the mind. The mind finds a momentary respite from the constant stream of thoughts, and attains rest and tranquility. The Hatha yogic texts also promote breathing as a tool to get control over the wavering mind.[22] The mind and the breath have direct connection. When the breath is disturbed, the mind also gets disturbed and vice versa. So, in order to calm the mind, breathing is an efficient tool and the Pranayama practice does it very effectively. When the mind becomes calm it helps the body to relax and it becomes easier to fall asleep. The sleep quality also improves. It is possible to gain maximum benefits of sleep within minimum time provided that the sleep quality is excellent. But various factors, including poor dietary habits, inadequate sleep hygiene, and excessive screen time, negatively impact the quality of sleep.[23] So, one needs to focus on the quality and take measures that help in removing the sleep-depleting factors. Although this study had a small sample size and the sleep quality was assessed using a self-rated questionnaire, future studies may consider a larger sample size with different physiological parameters such as melatonin or cortisol level, to establish the effect of the Pranayama practice with stronger evidence.
| Conclusion | | |
The results obtained from the data analysis of the 30-day 20-min Pranayama intervention before sleeping show that the intervention may be helpful in enhancing the sleep quality of healthy adults and it may be used to enhance the overall sleep quality. Further research with larger sample size is recommended to strongly conclude the effects of the practice.
Acknowledgment
The authors would like to express their deepest gratitude firstly to Dr. I. V. Basavaraddi, Director, Morarji Desai National Institute of Yoga for the continuous support and encouragement throughout the study. The authors are also indebted to Dr. Khushboo Jain, Assistant Professor (Biochemistry), MDNIY, for her guidance in statistical analysis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]
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