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.)