Sleep as the threshold of mortality: Death anxiety, insomnia, and the ritual function of yoga
DOI:
https://doi.org/10.61511/lad.v4i1.2026.3878Keywords:
epidemiology, health yoga, insomnia, nonpharmacological interventions, sleep qualityAbstract
Background: Insomnia is conventionally framed as a clinical and epidemiological burden, yet emerging psychological literature suggests sleep disruption is entangled with death anxiety and mortality salience, where nighttime wakefulness is when the mind's habitual defenses against death-awareness weaken, surfacing existential distress that manifests physiologically as hyperarousal. In Indonesia, where religious and cultural conceptions of death, fate, and the afterlife remain central to everyday meaning-making, insomnia among women, older adults, and the chronically ill may reflect not merely biological dysregulation but unresolved existential confrontation with mortality. This study examines health yoga, historically a contemplative practice oriented toward liberation and confrontation with impermanence, as an intervention addressing this existential dimension of sleep disturbance. Methods: An integrative literature review and conceptual analysis synthesized insomnia epidemiology, Terror Management Theory, and yoga-intervention research, including Indonesian data comparing Yin and Vinyasa yoga among female office workers with mild-to-moderate insomnia. Findings: Yoga improved sleep latency, efficiency, and subjective quality, with Yin yoga outperforming Vinyasa. Mechanistically, yoga reduced sympathetic hyperarousal and cortisol while enhancing parasympathetic activation, which are physiological correlates of reduced death-anxiety arousal. Framed eschatologically, yoga functions as a ritualized practice of mortality acceptance, addressing insomnia's existential root rather than only its somatic symptoms. Conclusion: Health yoga offers a culturally resonant, contemplative response to sleep disturbance understood as a site of unmanaged existential distress, warranting integration into Indonesian public health and meaning-making frameworks alike. Novelty/Originality of this article: This article bridges epidemiological, physiological, and eschatological perspectives on insomnia, positioning yoga as both clinical intervention and mortality-coping ritual.
References
Adella, A. S., Lilis, L., Sudiyono, N., Cahyadi, A., & Gracia, I. (2025). Effect of Asana Pranayama yoga on sleep quality: Implications for stress management and healthy lifestyle in young adults. Althea Medical Journal, 12(4), 284–290. https://doi.org/10.15850/amj.v12n4.3799
Alfian, S. D., Thurfah, J. N., Griselda, M., & Puspitasari, I. M. (2024). Sleep disturbances and depression levels among general Indonesian population: A national survey. Clinical Practice & Epidemiology in Mental Health, 20, Article e17450179326359. https://doi.org/10.2174/0117450179326359240903045716
Alghosi, M., Sharifi, M., Namavari, S., Rajamand, N., Bamorovat, F., Norouzi, N., Alimoradi, M., & Konrad, A. (2025). The effect of chronic yoga interventions on sleep quality in people with sleep disorders: A scoping review. Frontiers in Neurology, 16, Article 1566445. https://doi.org/10.3389/fneur.2025.1566445
Astuti, I. (2019). Environmental factors and sleep quality among urban residents in Indonesia. Journal of Environmental Health, 11(2), 87–94. https://doi.org/10.24843/jkl.2019.v11.i02
Bandyopadhyay, N., Das, T., Biswas, A., & Koley, A. (2023). Effects of yogic intervention on sleep quality of healthy elderly: A systematic review. Universal Journal of Public Health, 11(1), 78–88. https://doi.org/10.13189/ujph.2023.110109
Benjafield, A. V., Sert Kuniyoshi, F. H., Malhotra, A., Martin, J. L., Morin, C. M., Maurer, L. F., Cistulli, P. A., Pépin, J.-L., Wickwire, E. M., & medXcloud Group. (2025). Estimation of the global prevalence and burden of insomnia: A systematic literature review-based analysis. Sleep Medicine Reviews, 82, Article 102121. https://doi.org/10.1016/j.smrv.2025.102121
Budiman, Susanty, S., Hasan, F., & Apriliyasari, R. W. (2024). Comparative insomnia prevalence between geriatrics lived in urban and rural areas: A multicenter nationwide study analysis. BMC Public Health, 24, Article 2385. https://doi.org/10.1186/s12889-024-19876-x
Cain, N., & Gradisar, M. (2010). Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Medicine, 11(8), 735–742. https://doi.org/10.1016/j.sleep.2010.02.006
Dewi, K. A., & Sari, N. M. (2022). The effectiveness of Yin yoga versus Vinyasa yoga in improving sleep quality among office workers with mild to moderate insomnia in Indonesia. International Journal of Research in Medical Sciences, 10(3), 523–529. https://doi.org/10.18203/2320-6012.ijrms20220432
DelRosso, L. M. (2025). Global perspectives on sleep health: Definitions, disparities, and implications for public health. Brain Sciences, 15(3), Article 304. https://doi.org/10.3390/brainsci15030304
Dhungana, R. R., Khatiwoda, S. R., Gurung, Y., Pedišić, Ž., & de Courten, M. (2021). Yoga for hypertensive patients: A study on barriers and facilitators of its implementation in primary care. Global Health Action, 14(1), 1952753. https://doi.org/10.1080/16549716.2021.1952753
Field, T. (2011). A review of clinical research on yoga. Complementary Therapies in Clinical Practice, 17(1), 1–8. https://doi.org/10.1016/j.ctcp.2010.09.007
Foley, D. J., Monjan, A., Brown, S. L., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (2004). Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep, 18(6), 425–432. https://doi.org/10.1093/sleep/18.6.425
Gupta, A., Kaur, J., Shukla, G., Bhullar, K. K., Lamo, P., Kc, B., Agarwal, A., Srivastava, A. K., & Sharma, G. (2023). Effect of yoga-based lifestyle and dietary modification in overweight individuals with sleep apnea: A randomized controlled trial (ELISA). Sleep Medicine, 107, 149–156. https://doi.org/10.1016/j.sleep.2023.04.020
Jemiwi, J., & Dharma, N. K. S. A. (2025). Living in Harmony with Dharma: A Journey Back to the Soul’s Home. PT. Dharma Pustaka Utama.
Kessler, R. C., Berglund, P. A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., Shillington, A. C., Stephenson, J. J., & Walsh, J. K. (2011). Insomnia and the performance of U.S. workers: Results from the American Insomnia Survey. Sleep, 34(9), 1161–1171. https://doi.org/10.5665/SLEEP.1230
Kravitz, H. M., Zhao, X., Bromberger, J. T., Gold, E. B., Hall, M. H., Matthews, K. A., & Sowers, M. F. (2003). Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep, 26(7), 879–886. https://doi.org/10.1093/sleep/26.7.879
Léger, D., Bayon, V., & Ohayon, M. M. (2014). Insomnia and accidents: A cross-sectional study (EQUINOX) on sleep-related home, work, and car accidents in 5,293 subjects with insomnia from 10 countries. Journal of Sleep Research, 23(2), 143–152. https://doi.org/10.1111/jsr.12104
Malviya, S., Saoji, A. A., & Pravalika, B. (2025). Yoga nidra for mental health: A systematic review of current evidence. Journal of Spirituality in Mental Health, 27(1), 70–96. https://doi.org/10.1080/19349637.2023.2290249
Nayak, K., & Verma, K. (2023). Yoga-Nidra as a mental health booster: A narrative review. Journal of Ayurveda and Integrative Medicine, 14(6), Article 100842. https://doi.org/10.1016/j.jaim.2023.100842
Putri, A. D., Santoso, H., & Wulandari, E. (2023). Prevalence and factors associated with insomnia among the elderly in rural Indonesia. BMC Geriatrics, 23(1), 1–12. https://doi.org/10.1186/s12877-023-03752-1
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein, E., Jansson-Fröjmark, M., Jennum, P., Leger, D., Nissen, C., Parrino, L., Paunio, T., Pevernagie, D., … Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675–700. https://doi.org/10.1111/jsr.12594
Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7–S10. https://doi.org/10.5664/jcsm.26929
Sari, O., Purnawati, S., & Wahyuni, N. (2022). Yin yoga improves sleep quality more than Vinyasa yoga on female office workers with mild to moderate insomnia during the COVID-19 pandemic. International Journal of Research in Medical Sciences, 10(9), 1815–1822. https://doi.org/10.18203/2320-6012.ijrms20222082
Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5), 571–579. https://doi.org/10.1016/j.mehy.2012.01.021
Surpi, N. K., Sudiana, I. G. N., Widana, I. K. A., & Putra, I. K. S. (2025). Revitalizing ancient Balinese yoga: A strategic framework for sustainable spiritual tourism development anchored in divine transcendence. Jurnal Kajian Bali (Journal of Bali Studies), 15(3), 1190–1221. https://ejournal1.unud.ac.id/index.php/kajianbali/article/view/2331
Thuong, N. L. T., & Untara, I. M. G. S. (2024). Ancient Indian epistemology and modern cognitive science: Exploring vedic insights in contemporary thought processes. Dharmakirti : International Journal of Religion, Mind and Science, 2(1), 29–41. https://doi.org/10.61511/ijroms.v2i1.2024.1257
Thondala, B., Pawar, H., Chauhan, G., & Panjwani, U. (2023). The effect of non-pharmacological interventions on sleep quality in people with sleep disturbances: A systematic review and a meta-analysis. Chronobiology International, 40(10), 1333–1353. https://doi.org/10.1080/07420528.2023.2262567
Vgontzas, A. N., Liao, D., Pejovic, S., Calhoun, S., Karataraki, M., Basta, M., Fernández-Mendoza, J., Gaines, J., & Bixler, E. O. (2009). Insomnia with objectively measured short sleep duration is associated with type 2 diabetes: A population-based study. Diabetes Care, 32(11), 1980–1985. https://doi.org/10.2337/dc09-0284
Wang, W. L., Chen, K. H., Pan, Y. C., Yang, S. N., & Chan, Y. Y. (2020). The effect of yoga on sleep quality and insomnia in women with sleep problems: A systematic review and meta-analysis. BMC Psychiatry, 20, 195. https://doi.org/10.1186/s12888-020-02566-4
Widana, I. K. A., Sudiana, I. G. N., Surpi, N. K., & Widyastuti, N. P. (2025). A Study on the Development of an Ancient Balinese Yoga Tour Package at I Gusti Bagus Sugriwa State Hindu University, Denpasar. Journal of Hindu Religious Research, 9(3), 216–232. https://jayapanguspress.penerbit.org/index.php/JPAH/article/view/3690
World Health Organization. (2021). Insomnia: Global epidemiology and health impact. WHO Press.
Xie, W., Lu, D., Liu, S., Li, J., & Li, R. (2024). The optimal exercise intervention for sleep quality in adults: A systematic review and network meta-analysis. Preventive Medicine, 183, Article 107955. https://doi.org/10.1016/j.ypmed.2024.107955
Zhao, X., Wang, H., & Li, Y. (2021). Effects of yoga intervention on sleep quality: A randomized controlled trial. Complementary Therapies in Medicine, 58, 102676. https://doi.org/10.1016/j.ctim.2021.102676
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Copyright (c) 2026 Ni Wayan Jemiwi Jero, Masatoshi Torii, Jimmy Susanto, Mi'rajul Akbar, Ni Luh Putu Dian Yunita Sari
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