Management of Anidra (Insomnia)

through Ayurveda

1

Department of Dravyaguna

Shri VM Mehta Institute of Ayurveda,

Gardi Vidyapith, Anandpar,

Rajkot, Gujarat.

Vd. Krutika J. JoshiMD (Ayu.), PhD

Lecturer/Assi. Professor

Cause of Sleep Problem

awareness of patients and doctors

Hectic pace of modern life and the rising prevalence of obesity

Lawrence Epstein, Steven Mardon. The Harvard Medical School

Guide To A Good Night’s sleep. McGraw-Hill eBooks; 2007.

Prevalence

An estimated 30 to 40% of the U.S. population suffers

occasionally from insomnia, with 10 to 15% having

chronic problem.(Lawrence Epstein, Steven Mardon. The Harvard Medical

School Guide to A Good Night’s sleep. McGraw-Hill eBooks; 2007.

p.4.)

WHO health survey of 2003 reveal that about 35% of

respondents in India have reported mild to extreme

difficulty associated with sleeping.(Health system performance assessment, world health survey

2003, India, International Institute for Population Sciences (IIPS) .

Mumbai & WHO-India- New Delhi, 2006. P.153.)

Why Insomnia?

The modern medical science is still not having a definitetreatment for insomnia.

Although hypnotics, sedative, anxiolytic, psychotropics arethere but they have got their own limitations because of itshazardous adverse effects and their role in curing the diseaseis very limited. Therefore, such agents cannot be safe to begiven for a long period.

Hence, it becomes imperative to search out for drugs whichare safe and effective from natural systems of medicine likeAyurveda which can help patients with insomnia.

Bina H Vansh (2008), Mansika Bhavas in Anidra (stress induced insomnia)-Tagaradi Kwatha & Mahishi Dugdha Shirodhara, IPGT & RA, Jamnagar

HEALTH

Ahara

NidraBrahma-

Charya

UPASTAMBHA

NERVOUSSYSTEM

FUNCTIONALSYSTEM

Proper sleep plays an important role in maintaining

health, proficiency and state emotional well-being.

“ For the living beings Nidra is an

essential phenomena for the

maintenance and restoration of both

body and mind. ”

IMPORTANCE OF NIDRA

Ahara, Nidra and Brahmacharya are the three factors which play an

important role in the maintenance of a living organism. In the Ayurvedic

literature, these factors have been compared with the three legs of sub-

support and termed as the three Upastambhas (Sub-pillars).

(Ch. Su. 11/35)

The inclusion of Nidra in three Upastambha proves its importance.

While discussing about Nidra it is stated that happiness & sorrow,

growth & wasting, strength & weakness, virility & impotence and the

knowledge & ignorance as well as the existence of life and its cessation

depend on the sleep.

(Ch. Su. 21/36)

Getting good sleep at a proper time, is one of the

characteristic of a healthy man according to Kashyapa.

(Ka. Sa. Khi.5/7)

Asvapna – categorized in to 80 Nanatmaja Vata diseases (Ch-20/11)

Causative factors Associated symptoms

• Kala

• Shila

• Dhatukshaya

• Vyadhivriddhi

• Anila-pittavriddhi

• Jrumbha (yawning),

• Angamarda (body ache),

• Tandra (drowsiness),

• Shirogaurava (heaviness of the head),

• Jadya (heaviness),

• Glani (uneasiness),

• Bhrama (giddiness) and

• Apakti (Indigestion).

Anidra

NIDANA(ETIOLOGY)

AHARAJA

• Rukshanna

• Ratriprabhutashana

• Upavasa

• Visamashana

• Adhyashana

• Alpashana

• Viruddhashana

• Ati-madhyapana

• Direct drug effects (Including Alcohol)

• Drug withdrawal effects (including Alcohol)

VIHARAJA

• PanchakarmaVyapada

• Adhika Dhumpana

• Ratri Jagarana

• Adhika Sharirika Shrama

• Diwaswapna

• Ativyavaya

• Asukha Shayya

• Vegavidharna

MANASIKA

• Chinta

• Shoka

• Bhaya

• Udvega

• Krodha

• Atiharsha

• Manastapa – includes all psychic disorders

• Manobhighata

• Tamojaya

• Satvaudarya

Purvarupa

Purvarupa of Anidra is not mentioned in any

Ayurvedic classics .

RupaIn Ayurvedic classic, some symptoms are

mentioned due to the holding up of Nidra.

Ch. Su. A.H. A.S.

Jrumbha

Angamarda

Tandra

Shiroroga - - -

Shirogaurava -

Akshigaurava - -

Jadya - -

Glani - -

Bhrama - -

Apakti - -

Vataroga - -

Nidana Sevana

Sharirika Manasika

Shodhana Atiyoga Vyayama Upavasa

VP Prakopaka Ahara-Vihara

Chinta Krodha Bhaya Shoka

Vata Prakopa

Manas (Rajah)

Keeps mind active Constant perception of Vishaya by the sense organs

Increased activity

GnanendriyaKarmendriya

Manah Klanta VishayebhyonivartanteKarmatmanah Klamanvitaha

Absence of Manonivritti

Anindra

Absence of

SAMPRAPTI

Raja & Tama

Dhee, Dhrit, Smriti

Vibhransha

Pragyaparadha

Dosha Prakopa

Disease manifestation

Relation between Manasa and Sharira roga

Role of Manasa Bhava In The Pathogenesis of Insomnia

Bhaya, Krodha (Threatened Condition)

Insomnia

Awakeness For

Extended period

Reduces Serotonin

Dopamine

&

N.E.

Adrenaline

Secretion of

Reduced GABA, Opiod N.T. (in Brain)

Anxiety

Negative

Feedback

Insomnia

Insomnia is difficulty in initiating or maintaining sleep. It may be

transient or persistent.

A brief period of Insomnia is most often associated with anxiety

either as a sequel of an anxious experience or in anticipation of an

anxiety provoking experience.

In some persons transient insomnia may be related to grief, loss or

almost any life change. Specific treatment for the condition is usually

not require, if required that is of small duration.

Persistent insomnia consists of a group of a condition in which the

problem is most often difficulty in falling asleep, rather than in

remaining asleep. The patients often have no clear complaint other

than insomnia.

Insomnia – Classification And Diagnosis

1) Psychophysiological

a) Transient and situational : A brief period of sleep disturbance usually

provoked by an acute emotional arousal or conflict caused by a loss or

perceived threat.

b) Persistent : Develops as a result of the mutually reinforcing factors of

chronic, somatized tension – anxiety and negative conditioning to sleep.

2) Associated with psychiatric disorders

a) Symptom and personality disorder : Related to the psychological and

behavioral symptoms of the clinically well known and classified, non-

effective and non-psychotic psychiatric disorders.

b) Other functional psychosis : Consists usually of a severe sleep onset

insomnia and often sleep continuity difficulties.

3) Associated with use of drugs and alcohol

a) Tolerance to or withdrawal from CNS depressants is associated with

tolerance to or withdrawal from CNS depressant. Tolerance increases and the

depressant lose their sleep inducing effects often leading to an increase in

dosage.

b) Sustained use of CNS stimulants – caused by wake inducing agents taken in

excessive quantities and too late in the day.

c) Chronic alcoholism : It is characterized during episodes by progressive

disintegration of the sleep architecture : persistent sleep interruptions leading

to low total sleep time, fragmented REM sleep periods, reduced REM sleep.

Insomnia – Classification And Diagnosis

4) Associated with sleep related myoclonus and restless legs

a) Sleep related myoclonus : It is a condition in which insomnia is

associated with the occurrence during sleep of periodic episodes of

repetitive and highly stereo typed leg muscle jerks.

b) Restless legs : An individual feels extremely disagreeable, deep sensations

of creeping inside the calves, whenever sitting or lying down.

5) Associated with other medical, toxic and environmental

conditions

Almost any medical, toxic or environmental conditions associated with

pain and discomfort can produce insomnia. CNS conditions like neoplasms,

vascular regions, infections, degenerative conditions and traumatic conditions.

Non-CNS conditions especially endocrine and metabolic diseases.

CHIKITSA

In the treatment of Anidra, one should depend upon the measures

having Vatashamaka, Vedanashamaka and Roga Nivaraka effects as

well as pacifying effects on mental activities.

The treatment which are described for Anidra in Ayurvedic Samhitas

are mostly similar. It is described in form of Ahara, Vihara,

medicine and Panchkarma.

Life style modifications to manage Anidra

Ahara Ch. Su. A.H. A.S. B.P.

Meat of Bil and Vishikara - + - - -

Meat of Anupadesiya

animals & birds

- - - + -

Draksha - + - - -

Mishri - + - - -

Wine - - + + +

Sidhu - - + - -

Peya by sugar, Amalaki, Sunthi - - + - -

Masha - - - + -

Kilata - - - + -

Ghrita - - - - +

Yusha - - - - +

Tila - - - - +

Fish - - - - +

Ahara Ch. Su. A.H. A.S. B.P.

Shali Rice + + - - -

Curd - - + - +

Milk + + + + +

Wheat - + - - +

Ikshu - + - + -

Pishta - + - + -

Mamsa rasa - + + - +

Sweet - + - - -

Vihara Ch. Su. A.H. A.S.

Comfortable beds + + - -

Comfortable room + - - -

Proper time + - - -

To wear clean cloth - + - -

To live in safe & dim light place - + - -

To speak slowly - + - -

To take bath - - + -

To observe celibacy - - + -

To lay down in fragrant and airy place - - - +

Life style modifications to manage Anidra

MEDICATION FORM

External:

To tie Kakajangha root on head. (chakradatta –jwarachikitsa)

To tie Upodika root or whole on head. (vaidhyamanorama)

Paste of Bhanga powder with milk of goat, apply on sole

Rubbing of sole with mastu (curd water)

Internal:

Decoction of Jeevaniya Gana with milk (A. S.)

Loknath Rasa (Sha. Sam.)

Ashwagandha Churna with Sharkara & Ghee (Vangasena)

Pippali Moola Churna with Jaggery (B.P.)

Bijapoora patra churna with honey.(B.P,Y.R)

RoastedVijaya powder with honey (B.P.)

Cont.

PSYCHIC MANAGEMENT (ADRAVYA CHIKITSA)

Pleasant smell, sound, touch

Psychic pleasure

Sense of satisfaction

Thinking of things pleasant to mind and fulfillment of desire

Follow the Brahmacharya

To embrace with beautiful lady

Comfortable bed and home and proper time

Tips For Getting Good Sleep

Avoid Naps.

Avoid illuminated bedroom

clocks.

Quiet ears

Avoid caffeine, alcohol and

tobacco.

Keep regular bed time hours.

Get a massage.

Get some physical exercises

during the day.

Take a warm bath.

Listen to music.

Toe wiggling

Stomach rub

Deep breathing

PANCHKARMA FORM

Abhyanga

Shiro Basti

Shirodhara

Shiro Lepa

Vadana Lepa

Murdha Taila

Utsadana

Chakshu Tarpana

Karna Purana

data, it has been observed

etc., and dietary

psychosomatic disease i.e.

Best herbal sedative

Ashwagandha

Pippalimula

Jatamansi

Shankhapushpi

Reported classical herbs having sedative activity

Jatamansi- Nardostachys jatamansi DC.

Tagara- Valeriana Jatamansi Jones

Aswagandha- Withania somnifera (Linn.) Dunal

Ahiphena- Papaver somniferum Linn.

Jatiphala- Myristica fragrans Houtt.

Bhanga- Cannabis sativa Linn.

Mandookaparni- Centella asiatica Linn.

Vacha- Acorus calamus Linn.

Priyangu- Aglaia diepenhorstii Miq.

Saptaparna- Alstonia scholaris Linn. R.Br.

Kajutaka- Anacardium occidentale Linn.

Nimba- Azadirachta indica A. Juss

Brahmi- Bacopa monnieri Linn.

Jyotismati-Celastrus paniculatus Willd.

Shankhpushpi- Convolvulus prostratus Forssk.

Aparajita- Clitoria ternatea Linn.

Reported non-classical herbs

having sedative activity

Artabotrys hexapetalus R.Br.

Artemisia capillaries Thumb.

Canscora decussata Roxb.

Carvia callosa (Nees) Bremek.

Cissus repens Lamk.

Catharanthus roseus Linn.

Diploknema butyracea (Roxb.)