By better aligning his sleep routine to the natural cycle of dosha aggravation, my client should feel more rested and have better energy during the day. Focus is on Kapha dosha aggravation from 6:00pm - 10:00pm.

Have client complete a constitutional assessment, and introduce the concept of the doshas. Encourage client to consider not only the impact of the doshas on his constitution, but also the influence of the doshas on daily rhythms. Encourage client to implement a routine beginning in the evening Kapha aggravation window to support restful sleep.

Age 54. Injured February 2010, now manages/battles chronic pain, PTSD (anxiety and depression), some cognitive impairments. Poor sleep quality, has gained 20 pounds in the past year, which is aggravating acid reflux issues and increasingly frequent nausea. Struggling to feel productive and purposeful. Has also been experiencing positional vertigo and vision-related issues that have increased anxiety about driving.

In December the client underwent neuropsychological testing, which revealed a diagnosis of pseudodementia, highlighting current challenges in attention and short-term memory. His VA provider recommended incorporating more intentional movement into his day, so I planned to begin the session with adapted asana. The client had completed a constitutional assessment for me and shared his daily activities, allowing me to prepare some suggestions to better work with him to craft a simple sleep routine he could perform during the evening Kapha aggravation window. I planned to end our time with the pranayama practice of extended exhalation, performed in various positions.

I utilized Hatha yoga, focusing on gentle asana and pranayama. Keeping the client’s balance challenges in mind, we practiced wall-assisted sun salutations to energize body and mind, as well as encourage breath awareness. As a beginning pranayama practice, the client performed extended exhalation standing in tadasana, seated in sukhasana, and reclining in viparita karani. The client self-reported feeling more calm and at ease in each pose after the pranayama practice, and could see benefit in practicing extended exhalation after getting in bed to prepare for sleep.

The client put forth a genuine effort to remain engaged and attentive. I encouraged him to write down notes and thoughts in order to better retain what will be most helpful to him. Several times during our session I also invited him to explain back to me, in his own words, his understanding of our sharing. This allowed me to better assess his comprehension and retention, and highlight ideas I should revisit or explain more clearly.

I encouraged the client to keep his planner on his bedside table, and upon waking, pause to notice how he felt. Next he might evaluate the quality of that night’s sleep by asking: Does he feel rested? Was his sleep interrupted? On a scale of 1-10, how would he rate it? Lastly, to the best of his ability, I encouraged him to write down a few thoughts or words. If he is able to do this consistently for a few weeks, we could evaluate the impact of his new sleep routine.

I also encouraged him to practice the wall-assisted sun salutations prior to drinking his morning coffee, as a way to energize naturally himself and continue to strengthen his mind-body connection.

I encouraged him to continue the practice of extended exhalation in all of the positions we utilized as it was an easily portable way to both deepen breath awareness and reduce a stress response in his body and mind.

Yes, and yes. The client performed four rounds of wall-assisted salutations, and self-reported feeling more alert and energized. I shared a very basic introduction to the doshas, highlighting both their role in our constitutions and the rhythm of each day. I had considered discussing the seasons, but felt that would be overwhelming for him at this time. I then asked if he would share with me what he understood so far, and I was impressed with his comprehension. We took a five minute “bio break,” which also provided a mental break for him. We together established a sleep routine which the client felt was doable for him to implement beginning that evening. We ended our session with the extended exhalation pranayama practice.

This will be the only client interaction where I did not have to adapt the plan, due to my relationship with the client: I am both his wife and primary caregiver, trained through the Caregiver Support Program of the DVA. The past twelve years has been an ongoing education in learning to slow down my communication with him, to ask for real-time feedback to better understand his comprehension, to adjust time commitments and activities his body's management of energy post-injury, and to look for ways to support his ongoing healing. While there are other yoga therapy goals where it would be too complicated to work with him as a client, we were both comfortable with this scenario.

I learned that my time invested in becoming a supportive caregiver has cultivated deeper compassion towards those with similar cognitive challenges, and I will be better able to support future clients from it.

From the standpoint of working with a client with short-term memory and attention issues, I would offer a similar approach, including adapted asana and simple pranayama in the session, as well as including short breaks as needed for the client. The specific interventions selected as well as the frequency and duration of breaks would be client specific.

From the standpoint of incorporating basic ayurvedic interventions to compliment the yogic, it was extremely helpful to have the client complete the constitutional assessment ahead of our scheduled meeting, so I could plan dosha-targeted adjustments to suggest.

Regardless of any self-disclosed cognitive impairments, I realized the benefit of having a client periodically share with me during the session what they've understood. It provided such helpful real-time feedback as a therapist, signaling the need to pause and find a new way to present an idea, or confirmation of understanding, or the potential need to shift and take the session in a different direction. I also would make sure to include some measurable way for the client to track the effectiveness of the intervention, with a set time to check back and evaluate.