Back when I was working on my doctoral degree at the Harvard Medical School Division of Sleep Medicine, in 2006, I was investigating the effects of sleep deprivation on neurocognitive performance. At the same time, I was also actively involved in anti-war activism, as well as caring for my father, who was suffering from an untreatable illness. I had been receiving aggressive phone calls and even some threats on my life due to my anti-war activism.
I was getting more and more emotionally drained, and then I lost any ability to fall asleep. I would lie awake in bed feeling frustrated, and then developed a phobia of going to bed even slightly hungry. Even if I would manage to fall asleep, the slightest noise would wake me. (And no, I was not using myself as a subject for my research.)
Over the next two years, I tried everything—healthy and unhealthy—to be able to sleep. I asked my thesis advisors for advice; I tried Tylenol PM, warm baths, yoga, walking and running. I went to psychotherapy sessions; drank wine; and basically tried to exhaust myself physically and mentally—and still nothing helped.
Finally, I discovered a soft-tissue manipulation method derived from Chinese tui na massage therapy. Each session was an amazing journey, as I literally discovered more of my own body. It was like watching a movie—but instead of looking outside myself, I was looking inside.
While I had been practicing various forms of movement arts for years, I realized I had very little familiarity with my own body. Through massage, I discovered my body was full of wondrous spots of which I had been absolutely ignorant. As the tui na therapist pressed on those spots and gently released their tightness, I experienced a multitude of wonderful sensations, calmness and a deep sense of relaxation.
After suffering from insomnia for more than two years, three weeks of massage sessions stabilized my sleep, reduced my anxiety and resolved my sleep-related hunger phobia. My massage therapist helped me understand that hunger was really expression of my anxiety, which I could resolve by massaging a particular spot under my ribs.
My story of insomnia is not unique. According to the National Sleep Foundation’s 2015 Sleep and Pain report, 36 percent of Americans report just fair sleep quality on a regular basis, while 13 percent report poor or very poor sleep quality. Thirteen percent of Americans also say they “rarely or never” get a good night’s sleep, according to the report.
Why Are We Awake?
Recent studies reviewed in the article, “Hyperarousal and insomnia: state of the science,” published in 2014 in Sleep Medicine Reviews, suggest that insomnia could occur due to physiological hyperarousal, whereby a person’s sympathetic system works in overdrive, raising body temperature and heart rate during waking and sleeping; increasing metabolic rate; making the brain work harder even while the person is asleep; and increasing levels of stress hormones such as adrenocorticotropic hormone, cortisol and norepinephrine.
The brain goes into hyperdrive, leading to a nonstop dialogue with oneself, excessive worrying and feeling anxious.
Myofascial tightness may contribute to and sustain this state of hyperarousal. We know that fascia is our largest sensory organ, and that it contains an abundance of receptors that act like sensors to detect the local environment. Thermoreceptors may respond to temperature changes, chemoreceptors to local chemical changes, nociceptors to tissue injury or trauma, and mechanoreceptors to mechanical forces such as compression during massage.
Once activated, the receptors send afferent signals toward the brain that pass through the dorsal horn of the spinal cord, brain stem and hypothalamus, which are the homeostatic centers of the body. These centers process information and send efferent—back to the body—nerve signals as instructions for how to respond to or correct an issue.
We can illustrate this by looking at what happens after you have worked on five clients consecutively. You might start feeling discomfort in your shoulders due to localized chemical changes or repetitive strain that activates the chemoreceptors and nociceptors, respectively. This sense of discomfort is a report generated by your brain that an action needs to be taken to correct the discomfort before injury occurs.
There could be multiple solutions—some are subconscious, including self-massaging the painful areas or adjusting your shoulder and arm positioning. Other solutions may require analytical processing, such as asking yourself to determine the causal factors with questions such as, “Am I simply overworking myself, or is this pain due to my chronic postural imbalances?”
Such processing facilitates the analytical part of the brain to extrapolate and interpret information from other sources in order to determine the underlying problem and find appropriate solutions. This information-gathering is necessary for maintaining health and wellness, and in this case, may prolong your career as a massage therapist.
However, we tend to use the analytical part of our brain differently from how we use the nonanalytical part. Instead of finding solutions, our analytical thinking can motivate us to choose to implement strategies that suppress the sensory, feeling part of the brain. Thus, we ignore the sensations as long as the signals are not too painful or intense. This is a useful strategy for survival in extreme situations or athletic competitions, but in the long term this represents a maladaptive strategy that diminishes our brain’s ability to self-regulate.
Moreover, the underlying afferent signals of discomfort are still being sent to the brain, causing overstimulation to the nervous system and maintaining hyperarousal, which may decrease sleep efficiency and potentially lead to a wide range of effects, including low-grade inflammation and increased risk of accidents.
Hyperarousal may also contribute to myofascial tightness by increasing tonus of the intrafascial smooth muscles. This sets off a cycle of injury, imbalanced posture and emotional stressors that adds to the physiological stress load on the body. Such cycles are often perceived by health care providers and the general public as aspects of normal aging, although I believe many of these factors are preventable.
Interrupt the Cycle
In my experience, massage therapy is an excellent way to interrupt the vicious, self-perpetuating cycle of sleep deprivation–inflammation–discomfort–hyperarousal–intrafascial muscle activation–myofascial tightness that I identified in myself and that I believe many people suffer from.
Massage seems to interrupt the cycle of hyperarousal affecting the nervous system via mechanoreceptors, while at the same time normalizing the local environment around peripheral receptors, thereby reducing hyperarousal signals and promoting relaxation and parasympathetic activity.
Recently, International Rolfing Instructor and International Fascial Anatomy Teacher Robert Schleip, Ph.D., posited that upon stimulation of fascial receptors with mechanical pressure, the afferent signals travel to the major homeostatic areas of the brain—brain stem, thalamus and hypothalamus. The resulting efferent signals from the brain to the body may cause dilation of arterioles and capillaries as well as minimize contraction of the intrafascial smooth muscles, which are activated by the sympathetic nervous system during times of stress and may contribute to sustaining the state of hyperarousal.
The increase in blood circulation and reduction in general muscle tone may explain the potentially quick and palpable changes in tissue pliability you can feel during a massage therapy treatment.
Research indicates massage is effective for improving sleep; however, massage-sleep studies have been conducted primarily on specific populations—infants, menopausal women, migraine sufferers, fibromyalgia patients, and children with autism among them—rather than the general population.
Still, research does show that chronic or acute pain contributes greatly to insomnia. The National Sleep Foundation’s 2015 Sleep in America Poll found that “ percent of [respondents] with no pain reported good or very good sleep quality, while only 45 percent of those with acute pain and 37 percent of those with chronic pain did the same.” The poll results also noted, “People with pain are also far more apt than others to report that lack of sleep interferes with their mood, activities, relationships and enjoyment of life overall.”
I think we can agree there may be an important role for massage therapy to play in addressing sleep concerns in the general and pain-challenged populations.
Massage’s Role in a Good Night’s Sleep
Many of the relaxation effects of massage therapy are likely to be mediated by the vagus nerve, according to Tiffany Field, Ph.D., director of the Touch Research Institute, at the University of Miami School of Medicine in Miami, Florida. Field told me, “The vagus nerve is a major parasympathetic nerve that sends efferent signals of relaxation to most vital organs.
“Stimulating pressure receptors in various parts of the body sends signals to the vagus nerve in the brain,” Field continued, “[and] activation of the vagus nerve lowers heart rate, reduces blood pressure, increases gastric motility and relaxes muscles of the face and voice.”
Numerous studies conducted by Field and colleagues show that massage reduces levels of stress hormones such as cortisol. TRI has not conducted research specifically on massage and sleep; however, cortisol can increase arousal and wakefulness, and interfere with deep sleep.
TRI has conducted research indicating that massage therapy has a positive effect on brain activity. “Experiments at my lab showed that moderate pressure massage decreases alpha and beta wave activity and increases theta wave activity, suggesting a relaxation response,” Field said. “Another experiment we conducted showed that one month of moderate-pressure massage therapy delivered to fibromyalgia patients increased deep sleep and reduced substance P. This is relevant to clinical practice, as substance P causes pain and less substance P is produced during deep sleep.”
Massage provides a unique entry point for breaking the slow-developing cycles we discussed earlier that many in our society call normal aging, but are actually abnormal and preventable.
The first major step to restoring our body’s ability to self-regulate is recognizing and acknowledging its decline in function. Massage therapists can facilitate this by simply asking clients to compare how good they feel in their bodies before and after sessions. This may launch clients onto a path of restoring self-regulation by guiding them on a journey through the various sensations elicited through their bodies. This occurs as issues, like insomnia, are helped by therapeutic massage.
On the other hand, massage therapy can also be used as a passive tool, like a painkiller that can remove clients’ discomfort or pain, but does not increase body awareness or restore their capacity for self-regulation. In this case, this continued lack of self-regulation can resurface and present, oftentimes, with more serious consequences.
A Growing Need
I am now grateful for the traumatic experiences that destroyed my sleep. Thanks to them, I discovered a form of massage therapy that healed my insomnia.
Since then, I have created a system of deep tissue self-bodywork that allowed me to derive similar benefits on my own, at home. I ended up quitting my job as a mathematical epidemiologist to dedicate myself to teaching this system to a wide range of health-and-fitness professionals.
More recently, I founded a nonprofit that creates and delivers trainings to war veterans on somatic methods for working through war shock trauma and post-traumatic stress disorder. All of this is thanks to the massage therapy I received.
Massage therapy has a tremendous potential to positively affect human health and well-being. There is a great need to disseminate knowledge about the efficacy of massage among the general public and health providers alike.
More research is also necessary to determine the exact mechanisms of action in order to optimize massage therapy treatments and offer a better understanding of how myofascial manipulation affects the brain, emotional processing and trauma healing.
Roman Torgovitsky, Ph.D., is the founder of Soma System and Wounded Warrior Ukraine. He is a Harvard-trained biomedical scientist, structural bodyworker and practitioner of internal martial arts. He has taught Soma System internationally at a variety of venues, including the IDEA Fit World Convention, Perform Better Functional Training Summits and yoga conferences.