Insomnia (Anidra)- Nidan, Lakshan and Effect of Panchkarma Chikitsa

Aetiopathogenesis

Aharaj Nidan (Food habits): Excessive consumption of Aahar like Rukshanna Ratriprabhutashana Upavasa Visamashana Adhyashana Alpashana Viruddhashana Ati-madhyapana Direct drug effects (Including Alcohol) Drug withdrawal effects (including Alcohol) can cause the Nidranasha [8]. Viharaj Nidan: Excessive Dhumpana Sewan (Adhika Dhumpana), Ratri Jagarana, Adhika Sharirika, Shrama, Diwaswapna, Ativyavaya, uncomfortable sleeping enivironment (Asukha Shayya), Vegavidharna are responsible factors for Anidra. Mansik Nidan: The Satvaudirya and Tamojaya are said to be the causes for Nidranasha and Manasantapa. All the psychic conditions: like worry, anger, mania etc. cause Anidra [9]. Improper Chikitsa: Excessive effect of Purgation, emesis, smoking, physical exercise (excessive), blood-letting (excessive) caused vitiation of Vata [10].

Other Factors

• Karya: When an individual is deeply involved in a work, either mental or physical, his mind would be divorced from the sleep or he would not get the sleep. This happens in persons who are having a heavy load of mental work.
• Kala: It is another factor which plays an important role in the Nidra and Anidra both. Everyone experiences in day to day life, that as soon as the night comes he feels the desire for sleep. This type of feeling, under normal circumstance is never seen during the day time except in the summer. It indicates that the sleep has got a relationship with the time factor.
• Vikara: There are various diseases in which sleep is disturbed or they may be causative factors for sleeplessness.
• Prakriti: The Vata Prakriti persons have been described as Jagaruka i.e., those who sleep very less. The Satvika persons also sleep less time. The individuals of the Tamasika Manasa Prakriti are having excessive sleep.
• Vata: Vata Dosha is considered mainly as sleep dispeller. Vata is having Chala Guna and by virtue of this Guna, it does not allow the Mann to take rest and therefore, it doesn’t allow the individual to sleep well and soundly. Hence, we can consider all Vata Prakopaka Hetus as the causative factors for Anidra [11].

According to Modern Aspect

Insomnia is due to many factors like stress and anxiety, life style factors, some mental health conditions, some physical health conditions (COPD, Alzheimer’s disease, Parkinson disease, over active thyroid, Arthritis)

On the basis of Cause

• Primary Insomnia: Not directly associated with any other health condition or problem.
• Secondary Insomnia: Because of something else, such as a health condition (like asthma, depression, arthritis, cancer or heart burn) pain, medication they are taking, or a substance they are using (like alcohol) [12].

On the basis of Duration

• Transient insomnia: Lasting from a night to a week and is usually caused by events that alter normal sleep pattern, such as travelling or sleeping in an unusual environment.
• Short term insomnia: Lasts about two to three weeks and is usually attributed to emotional factors such as worry or stress.
• Chronic insomnia: Occurs most of the night and lasts a month or more [12].

Purvarupa: Purvarupa of Anidra is not mentioned in any Ayurvedic classics. This is Vata predominant Vyadhi, so Avyakt is Purvarupa. Rupa: Cardinal feature of Insomnia is Loss of Sleep. Due to lack of sleep symptoms usually appears are [13, 14] (Table 1):

Samprapti

• Anidra is considered as Vata Nanatamaj Rog. If an individual falls asleep when his mind including the sensory and motor organs get exhausted, and they dissociate themselves from their objects.

• Mansik dosh raja plays an important role in pathogenesis. Vata vitiation occurs due to both kind of etiological factors i.e. Sharirik and Mansik.
• Impairment of psychosomatic functions of mind restrict detachment of Mann from Gyanendriya and karmendriya [15].
• This ultimately results into the pathological stage of Anidra.

Management of Anidra

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 treatments which are described for Anidra in Ayurvedic Samhitas are mostly same. It is described in form of Ahara, Vihara, Aushadh and Panchakarma as follows [15, 16, 17, 18].

Nidan Parivarjan: Before starting treatment for insomnia any other pathological condition (psychiatric, neurological, chronic illness) may be ruled out first and if present it should be treated accordingly.

Dietary form

• Mamsa of Anoop Deshiya animals and birds, Shali rice, curd, milk, wheat these food articles are responsible for Kapha Vriddhi.
• Use of Ikshu, Pishta, Draksh, Mishri.
• Incompatible, indigestible, hot spicy food article and excessive consumption of coffee, tea, soft drink, alcohol and smoking should be avoided.

Life style Management

• Comfortable bed, comfortable room should be required.
• Patient may be advised to do some light physical activities before going to bed.
• Regular sleep time pattern should be followed. Day time sleeping should be avoided.
• Living active life both mentally and physically, practicing yoga and meditation like pranayama Surya namaskar, Tadasana, Shavasan, Padamasana relive stress and calm mind.

Compound formulations:

Panchkarma form

• Nasya
• Abhyang (Abhyanga with medicated Vathara oil. This pacifies Vata Dosha and makes the body strong, grow well, healthy and induce sound sleep)
• Padabhyang (practice of Padabhyang before sleeping can improve eye sight and induce good sleep)
• Utsadan
• Chakshu Tarpana
• Shiro Lepa
• Vadana Lepa
• Murdha Taila (Pouring oil over the head and massaging oil result in calm sleep)
• Karna Purana
• Shiro Basti
• Shirodhara Ayurvedic treatment of Kerala has advised the Tailadhara, Takradhara, and Kshiradhara.

Medication form

• Single drugs
• Sarpagandha churna: It is a powerful tranquilizer and induces sleep [19, 20, 21].
• Ashvagandha churna: 3 gm Churna is used two times in a day with sugar and Ghrita before meal. It vitalizes our mind and improves memory. It refreshes our nerves and relaxes them.
• Jatamansi churna: Its dose is 500 mg to 1 gm two times in a day with milk after meal. It is a sedative herb, used to tranquilize a patient. It relaxes the nervous system. It has been found to increase levels of neurotransmitters like serotonin and is good for memory too.
• Vacha churna: Dose is 30-50 mg BD. It is an efficient mind calming herb which cures tension, emotional stress and depression.
• Brahmi churna/svarasa: Dose is 1-2 gm BD/10 ml BD with milk and sugar.
• Mandukparni churna/Svarasa: Dose is 1-2 gm BD/10 ml BD with milk and sugar.
• Shankhapushpi churna/Svarasa: Dose is 1-2 gm BD/10 ml BD with milk and sugar.

Brahmi, Mandukparni, Shankhapushpi are calming and tranquilizing herbs used widely as brain tonic.