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Management of Anidra with Nidra caps - a placebo comparative study, Kamalaxi. M. Angadi, 2005-2008, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
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“Management of Anidra with Nidra caps - a placebo comparative study”
By
Kamalaxi. M. Angadi
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D. In
Kayachikitsa Under the Guidance of
Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish)
Department of Kayachikitsa Post Graduate Studies & Research Center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2005-2008
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
This is to certify that the dissertation “Management of Anidra with Nidra caps - a
placebo comparative study” is a bonafide research work done by Kamalaxi. M. Angadi in
partial fulfillment of the requirement for the post graduation degree of “Ayurveda
Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,
Bangalore, Karnataka.
Guide
Prof. Dr. Shiva Rama Prasad Kethamakka
M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)
Professor in Kayachikitsa
DGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
Endorsement by the H.O.D, principal/ head of the institution
This is to certify that the dissertation entitled “Management of Anidra with Nidra caps
- a placebo comparative study” is a bonafide research work done by Kamalaxi. M. Angadi
under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm),
C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa in partial fulfillment of the
requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)”
Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place: Gadag
(Dr. V. Varadacharyulu) Professor & HOD
Dept. of Kayachikitsa PGS&RC
Date: Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Management of Anidra with
Nidra caps - a placebo comparative study” is a bonafide and genuine research work carried
out by me under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu)
(Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place Gadag
Kamalaxi. M. Angadi
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date
Place Gadag
Kamalaxi. M. Angadi
© Rajiv Gandhi University of Health Sciences, Karnataka
Abstract of “Management of Anidra with Nidra
caps - A placebo comparative study” Key words: Anidra, Nidranasha, Insomnia, Nidra cap, Placebo, sleep efficiency, Tamas in
terms of RATR, Somnus Rasayana
Anidra vis-à-vis Primary insomnia is one of the important diseases pertaining to
the Vata disorder affects the people of all age groups. The study objective is – to evaluate
a Nidrajanaka prabhava (sedation) with Nidra caps in comparison to placebo compared.
Simple random sampling technique with comparative clinical trial is adopted here under
two groups to test the significance. Induction of sleep it is said that when the mind gets
exhausted or becomes inactive, the sensory and motor organs become inactive then the
individual gets sleep. Onset of sleep is related to the increases of Tamas always. Here,
tamo-abhava is reticular activity transmission and tamobhava is RATR. When Vata along
with rajas gets increased the above told phenomena will not takes place leading to
Anidra. Here the rational combination Nidra cap is with bhutaghna manasa doshahara
Jatamamsi, vatahara and mastishka shamaka prabhava Tagara, adaptogen and immuno
modulator Ashwagandha and Vata hara and deepaniya Pippali moola are able to act
against the symptoms of Anidra and induces the good sleep. . The parameters show High
significance with Nidra caps as good sedative. Among the subjective and objective
parameters the Nidra cap group shows more High significance than the placebo group
and said to effective. Thus it is fair to conclude the Nidra cap has putative Nidra janaka
prabhava.
Acknowledgement Any research is not an individual effort. It is a contributory effort of many hearts,
hands and heads. I am very much thankful to the subjects of this study.
I am extremely happy to express my deepest sense of gratitude to my beloved and
respected guide Prof. Dr. K.Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.],
for his guidance and timely help.
I express my gratitude to Dr. V. V. Varadacharyulu Professor and H.O.D for his
advice and encouragement in every step of this work.
I am sincerely grateful to Dr. G. B. Patil, Principal, for his encouragement and
providing all necessary facilities for this research work.
I extend my gratitude to Dr. R. V. Shettar, Dr. G. Purushottamacharyulu, Dr. P.
Shivaramudu, Dr. M. C. Patil, and Late. Dr. Dilip Dr. G. S. Hiremath. Dr. G.
Danappagoudar. Dr. S. H. Doddamani. Dr. Rajashekhar. Dr. S. N. Belawadi. Dr.
Nedugundi, Dr. Samudri, Dr. Kubersankh. Dr. Mulgund. Dr. J. Mitti. Dr. Mulki Patil. Dr.
Yasmin A.P. Dr. B. G .Swami all my U.G. Lecturers for time-to-time help offered.
I express my immense gratitude to my statistician Nandakumar, Tippanagoudar
(Lab), V.B. Mundinamani (librarian) and Shyavi and Kerur for facilitating me in
collection and production of my thesis.
My deep senses of gratification to my inspirations of this study are my husband
Shivanand. B. Manvi and my parents Mallappa. S. Angadi and Neelamma. M. Angadi
who are architects of my career. I am extremely happy to express my deepest sense of
gratitude to my mother-in-law Sharanamma.B.Manvi and my beloved son Bhuvan.
Last but not least I express my deepest thankfulness whose names are not taken
here but helped me a lot along with my kith and kilns to my family members and Dr.
Sanjeevkumar and all my senior and junior friends.
(Dr. Kamalaxi M. Angadi)
- 1 -
Contents of
“Management of Anidra with Nidra caps - a placebo comparative study”
by
Kamalaxi. M. Angadi
Chapter Content Pages
1 Introduction 1 to 7
2 Objectives 8 to 10
3 Literary Review 11 to 59
4 Methods 60 to 71
5 Results 72 to 95
6 Discussion 96 to 108
7 Conclusion 109 to 111
8 Summary 112 to 114
9 Bibliographic References i to vi
10 Annex 1 – Master Charts Data of trial 1 to 8
11 Annex 2 – Case sheet 1 to 6
- 2 -
Tables of
“Management of Anidra with Nidra caps - a placebo comparative study”
SN TITLE OF TABLE PAGE 1 Stages of sleep in the NREM 30 2 Synonyms of Anidra 38 3 Anidra Ahara Nidana 41 4 Anidra Vihara Nidana 41 5 Chikitsa atiyogajanya Nidana of Anidra 41 6 Anidra Manasika Nidana 41 7 Symptoms of Anidra 42 8 Anidra – Samprapti ghataka 45 9 Bahya Upacharas for Nidranasha 47 10 Aahara Upacharas for Nidranasha 48 11 Manasika Upacharas for Nidranasha 48 12 Anya upachara for Nidranasha 49 13 Single drugs useful for Nidranasha 50 14 Distribution of Patients by Age- Gender in Group A & B 73 15 Gender wise Results in Group – A (Placebo cap) 75 16 Gender wise Results in Group –B (Nidra cap) 75 17 Religion wise Results in Group – A (Placebo cap) 76 18 Religion wise Results in Group – B (Nidra cap) 76 19 Occupation wise Results in Group – A (Placebo cap) 77 20 Occupation wise Results in Group – B (Nidra cap) 78 21 Economical status wise Results in Group – A (Placebo cap) 79 22 Economical status wise Results in Group – B (Nidra cap) 79 23 Diet wise Results in Group – A (Placebo cap) 80 24 Diet wise Results in Group –B (Nidra cap) 81 25 Showing chief complaints of Anidra 82 26 Showing Associated complaints of Anidra 83
- 3 -
27 Showing Mode of onset in Anidra 84 28 Showing Anidra course in study 84 29 Showing Anidra frequency in study 85 30 Showing Anidra duration in study 85 31 Showing Anidra preceding factors in study 86 32 Showing Anidra change of regularities in study 87 33 Showing Anidra Nidana in study 87 34 Showing Anidra Nidra (sleep) Examination in study 88 35 Showing Anidra Results of the Group A (Placebo caps) in study 89 36 Showing Anidra Results of the Group B (Nidra caps) in study 91 37 Subjective Statistical assessment Group-A 92 38 Objective Statistical assessment Group-A 92 39 Subjective Statistical assessment Group- B 92 40 Objective Statistical assessment Group-B 92 41 Comparative Statistical assessment of Both Groups 93 42 Comparative Statistical assessment of Both Groups in % of
comparison 94
Figures and Photos of
“Management of Anidra with Nidra caps - a placebo comparative study”
SN TITLE OF FIGURES AND PHOTOS PAGE
1 Schematic diagram of Anidra Samprapti 43 2 Ingredients of Trial drug Nidra cap 57 3 Distribution of Patients by Age- Gender in Group A & B 73 4 Gender wise Results in Group – A (Placebo cap) 75 5 Gender wise Results in Group –B (Nidra cap) 76 6 Combined Religion wise Results 77 7 Occupation wise Data of Both Groups 78 8 Economical status wise Data of Both Groups 80 9 Combined Diet data of Group A & B 81 10 Associated compliant in the study 83 11 Results of the Group A (Placebo caps) 90 12 Results of the Group B (Nidra caps) 91
Management of Anidra with Nidra caps – Introduction 1
Chapter – 1
Introduction
Barenked Ladies sung “Who needs sleep?” as -
“Now I lay me down not to sleep
I just get tangled in the sheets,
I swim in sweat three inches deep,
I just lay back and claim defeat…
Lids down, I count sheep,
I count heartbeats,
The only thing that counts is that
I won’t sleep…. My mind is racing,
Filled with lists of things to do
And things I’ve done.
Another sleepless night’s began….”
How the food, water and air are essential for life, like the same sleep i.e. Nidra is also
very much essential. ‘The best bridge between despair and hope is good night’s sleep. Sound
restorative sleep is the foundation of a healthy life. Hence, the Ayurveda explains Nidra as
one among the “Trayo-Upasthambha” i.e. primary tripod of life.
In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a
winding up of the vital clock, a recharging of life’s battery or “Chief nourisher at life’s feast”.
Three sub-pillars are diet, sleep and celibacy. If these three are fulfilled properly, the body is
supported well by these pillars, it continues well endowed with strength, complexion and
developments till the complexion of life span provided one abstains from harmful practices
which will be explained here itself 1.
Management of Anidra with Nidra caps – Introduction 2
Ahara
Ahara, partaking food confers satisfaction and immediate strength supports the
body, increases span of life, radiance, enthusiasm, memory, valiance and digestive
capacity 2. It is a fact that the empty stomach doesn’t give sleep.
Brahmacharya
The end product of ahara rasa is said as the shukra dhatu. Loss of shukra
causes death on the other hand conservation of sukra promotes life. Thus it is said as
the shukra is the bala (strength) for purusha (human) ultimately 3.
Nidra
Sleep enjoyed at the proper time bestows nourishment, good color
(Complexion), and strength, enthusiasm, keenness of digestive power, wakefulness
and maintains normalcy of tissues 4.
Hence, these three trayopasthmbha exhibits their importance in the life and necessity
of the induction or regulation of the Nidra effect to add flavor to the life. As we know that
satisfaction alone is sufficient to have better life thus the satisfaction of the Nidra gives raise
every positive effect to live happy and healthy.
The importance of sleep is well accepted by modern science also, because of its
restorative, recuperative and resting actions to the living organisms. We spend at least 1/3rd of
our lives asleep. Yet little understand why our body requires it or for what reasons nature
often chooses to transform the soothing slumbers of youth into the restless tossing of
maturity. Only for the last half century has this universal subject of human concern or distress
stimulated seriousness and physiologists and neurological physicians to examine its mysteries
and mechanisms.
Management of Anidra with Nidra caps – Introduction 3
Now a day due to altered lifestyles busy schedule and stressful living conditions,
struggle for existence etc, the (sleeplessness) Anidra (Insomnia) became a major problem.
Incidences / Prevalence of Anidra
According to American Association 5 of sleep medicine, Insomnia is “the inability to
fall asleep or to stay asleep; A broader definition of insomnia is difficulty initiating sleep,
difficulty maintaining sleep, early-morning awakening with difficulty resuming sleep or un
refreshing sleep. The subject must also suffer some degree of impairment in social
occupational, or other important areas of daytime functioning.
Now a days about 40% women and 30% men and about 25% of elderly people and
15% of the general population suffer from this altered sleep i.e. insomnia 6.
Nidranasha/Anidra is not discussed as a disease anywhere in the classical texts,
mentioned as vataja nanatmaja vikara 7 bears much weight in this regard. The merits and
demerits, classification and the management of insomnia are also dealt along with the concept
of sleep in every Ayurvedic treatise.
Recent researches on Anidra
So far the problem of Nidra, Anidra and the management of Anidra are concerned, it is
surprising, and that research work carried out on this topic is very less 8:
• Dr. Kala Kasliwal (1984), in N.I.A. Jaipur, has carried out the study on Nidra and tried
some Nidra janana drugs to assess their efficacy in inducting the sleep.
• In P.G.T and R.A Jamanagar- Dr.U.D.Joshi (1987) has carried out a study on Anidra,
an etiopathological and manage mental approach.
• Dr. Kavitha Trivedi (1995) has carried out the comparative study of shirodhara and
shirobasti in the management of Anidra.
Management of Anidra with Nidra caps – Introduction 4
• Dr. Prakash. B.(2000) has carried out the management of asvapna (sleep disorders)
with certain indigenous drugs and ashwagandha taila dhara,
• Dr. Muralidhar Pujar carried out a comparative study on Nidranasha/Anidra
Mention of lacunae in current knowledge
The management of Nidranasha/Anidra in contemporary sciences mainly depends on
most commonly available antidepressant drugs, sedatives, tranquillizers and hypnotic drugs.
The drawback with this approach is drug dependence, tolerance towards the drugs and
reoccurrence of the symptoms on withdrawal of the drug. Apart from these internal
medications, counseling, cognitive therapy, physiotherapy and meditation have also been
advised. Still we find no satisfactory and safe measures for Nidranasha/Anidra.
Purpose of the Study
In comparison to the therapeutic procedure of different systems of medicine,
Ayurveda has a very good approach towards the treatment of Nidranasha/Anidra by both
internal and external medications.
The main purpose of the study is to evaluate a medication which doesn’t give any drug
dependence along with tolerance. Chiefly the purpose relays on two areas viz. 1) control of
Vata and 2) correction of Manasa vyakula Bhavas which cause the Anidra. Such medicament
under the principles of Ayurveda based upon the theories and concepts are erected as “Nidra
caps”.
Charaka has mentioned that the controller and stimulant of the mind is Vata. The
Vatahara herbs are said to be the best medicines to induce sleep as they are the Kapha
promoters. The Kapha is of “Tamo” guna, thus the dravyas which are of Kapha in nature offer
better relaxation and induction of sleep.
Management of Anidra with Nidra caps – Introduction 5
Chinta, Shoka, Bhaya, Krodha and other disturbed Manasa bhava, are stressors plays
an important role in causing Anidra. The Nidra cap is designed as cost effective and corrects
the disturbed mental faculties and provoked Vata. Thus pacify all kinds of stressors to achieve
the state of tranquility leading to deep relaxation which helps in the normalization and
stabilization of manasa bhava to make patient healthy and happy.
As the internal medication is concerned a number of herbal preparations and plant
extracts have been used with varying degree of success in the management of
Nidranasha/Anidra. Among them –
1. Tagara 9 (Valerian walichi),
2. Jatamamsi 10 (Nordostachys jatamamsi),
3. Ashwagandha 11 (Withania somnifera),
4. Pippalimoola 12 (piper longum) –
When made as a rational combination induces sleep in a better way making the Dosha
samyata in the body. The rationality of the combination is justified by the rasa, guna, veerya,
vipaka and karma prabhava attributed to the individual drugs with Nidrajanakatwa prabhava
embedded in them.
Hypothesis and Research questions
According Ayurveda sleep is induced by the increase of the inert universal attribute
called Tamas. The term Tamas literally means darkness. Satva, Rajas and Tamas are the three
major or universal attributes that pervade the universe. These three attributes play an
important role in the functioning of the mind, of them rajas and Tamas are the vitiators of
mind (manodosha) because there predominance affects mental diseases.
Management of Anidra with Nidra caps – Introduction 6
Sleep is a periodic functional state of man and higher animals, characterized by
specific changes in vegetative and motor systems by the absence of purposeful activity and
sensory interaction with the environment. Sleep is characterized by the inhibition of conscious
mental activity.
Onset of sleep is related to the increase of Tamas and Kapha. Both these principles
effect inertia, sleep usually occurs at night as the surroundings are dark and are predominated
by Tamas. This dark environment naturally increases the Tamas in human beings according to
the theory of generality.
During night the biological channels are blocked by Kapha. The sensory and motor
faculties are fatigued by day’s work. The fatigued faculties become sluggish in their work and
will loose their activity. Considering the physical plane, the humor Kapha i.e. responsible for
conservation of energy has a role in inducing sleep, Kapha is stable and sluggish. Increase of
satva is conducive to mental health, rajas represents action.
They gradually withdraw from their objects. The functions of the mind also are
blocked by the increase of Tamas. Mind gets detached from the faculties and its action of
enjoying the faculties ceases. This stage is called sleep, even in sleep mind maintains its
connection with the soul.
The hypothesis is made on the basis of Vata shamaka in terms of controlling the mind
through its functions. The present medicine acts as Vata shamaka in terms of regulating the
mind thus sleep is induced by initiating the Tamas. The important factor responsible for
reduction of sleep has been shown to be the fatigue of neuromuscular function which in turn
unable to pass on proprioceptive impulses may be the Tamas. The action of the trial drug is
Management of Anidra with Nidra caps – Introduction 7
compared to the placebo, to rule out the psyche involvement in induction of sleep. At this
juncture many questions are raised such as -
1. What is the Tamas which induces the Nidra in living beings?
2. How Rajas and Tamas disturb the mind to induce Anidra?
3. How Vata is responsible for disturbing the inhibition of conscious mental activity i.e.
sleep
4. What is the role of Kapha in sleep?
The search for the answers are made at this study named as – “MANAGEMENT OF
ANIDRA WITH NIDRA CAPS - A PLACEBO COMPARATIVE STUDY”, under the
headings of Introduction, Objectives, Literary study, Methodology, Results, Discussion and
Conclusion along with necessary documents and appendices attached.
Management of Anidra with Nidra caps – Objectives 8
Chapter – 2
Objectives
Today’s man has become a tired and chronically sleep-deprived generation.
Technology and the industrial revolution is one of the biggest factors. People live in a fast-
paced, high-tech world that operates 24 hours a day. Working fields like a myriad of
businesses and services are accessible around the clock. Television, radio and movie channels
broadcast day and night. To cope up such conditions occurring around the clock, people work
long hours and something must be sacrificed. Unfortunately sleep is a very common thing to
sacrifice. Consequently, insomnia has spread up very widely like other harassing diseases.
Insomnia has a great impact on social, occupational and other functioning areas of the
individual. The modern medical science is still not having a definite treatment for this disease.
Although, hypnotics and sedatives are there in all the prescriptions of psychiatrists and in
maximum prescriptions of general practitioners their role in curing the disease is very limited
rather the patients will be addicted for the particular drug.
There comes the relevancy of our Ayurvedic principles for the treatment, which
reveals that the medicine or treatment that cures one disease and creates some other is not a
good therapy, but the therapy which cures one disease and does not create any other, is the
right treatment 13. Hence, here a humble attempt had been done to give an effective
management process for the disease Anidra.
Management of Anidra with Nidra caps – Objectives 9
Aims & Objectives
1) To evaluate the Nidrajanaka prabhava (sedation) of Nidra cap in Anidra
Dosha involvement in Anidra is Tridosha with predominance of Kapha. But
the deviations from the normalcy of Dosha are to be considered with due importance.
Vata and Pitta are in increased state, while in case of Kapha, the diminished is
observed usually. As in Anidra, mainly Vata Prakopa occurs due to its Chala and
Laghu Guna vitiate, thus keeps the mind active, causing Anidra.
The ingredients of the Nidra capsules are with Vata Dosha hara action having
snigdha guna, ushna veerya, with the sedative and hypnotic action, otherwise
understood as the Tamas initiation. By observing all these characteristics of medicine,
Nidra caps, it seems to be very much beneficial in the management of Anidra for
obtaining the requisite results, viz. induction of Tamas, initiation of sedation, relaxing
the body mind, etc.
2) To evaluate the Nidrajanaka prabhava (sedation) of placebo in Anidra
Anidra is one of the pshyco-somatic disease condition, many a times, the
anxious or phobic or even depressive patients, respond to the placebo. Thus the
placebo is responsible for many temporary successes in therapy acting on the mind. As
we know that many times placebo is used to understand the differentiate phenomenon
of the psyche physical disturbances, with good success of specifying the relief of the
problem, for a comparison to understand the Nidra cap efficacy, the placebo sedation
effect is undertaken as one of the objective. Hence, taken comparative study to
evaluate the effect of Nidra cap is justifiable.
Management of Anidra with Nidra caps – Objectives 10
3) To compare the Nidrajanaka prabhava (sedation) of placebo and Nidra cap in
Anidra
The study is incomplete if a comparative clinical Trial of sleep inductive effect
of the Nidra caps internally to pacify the Dosha in Anidra and placebo to overcome the
psychosomatic origin of the disease Anidra is not compared. Thus the trial is
compared at the clinical efficacy with respect to the subjective and objective
parameters chosen. At this attempt the group-A and group-B designated with
respective medicaments of Placebo and Nidra caps, are observed for the efficacy of
nidrajanaka prabhava (sedation) effect drawn in the comparative statement.
Management of Anidra with Nidra caps – Literary Review 11
Chapter – 3
Literary Review
In fact, Nidra looks like a glimpse of Pralaya, which carries peace but in darkness.
After this glimpse of Pralaya – man awakens fresh like Srujana. For the living beings in the
world, it is an essential phenomenon for maintenance and restoration of both – body and
mind.
Since the dawn of the civilization the thinkers of the world tried to study the sleep, its
nature and causes. In India, from the Vedic and Upanishad period, the Yogis have studied the
Yogic phenomena pertaining to various stages associated with Atma. They have termed these
stages as Jagritavastha (waking state), Svapnavastha (dream state), Sushuptavastha (sleep
state) and Samadhi Avastha (the conscious sleep phase having Detachment from the external
world in different degrees).
IMPORTANCE OF SLEEP
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 i.e. Ahara,
Nidra and Brahmacharya have been compared with the three legs of sub-support and have
been termed as the three Upastambhas 14.
The inclusion of Nidra in the three Upastambha proves its importance. While
discussing about Nidra, the ancient Acharyas have stated that happiness and sorrow, growth
and wasting, strength and weakness, virility and impotence and the knowledge and ignorance
as well as the existence of life and its cessation depend on the sleep 15.
According to Kashyapa, getting good sleep at a proper time is one of the
characteristics of a healthy man 16. The importance of sleep for health and recovery from
diseases has been recognized intuitively if not scientifically in the modern texts; nearly all
Management of Anidra with Nidra caps – Literary Review 12
doctors recommended that their patients should get plenty of rest and their advice is followed
because that is just what patients want to do whether such sleep does have any adoptive value
is, however, unknown. Many disorders are associated with abnormal patterns of sleep. Some
important findings of sleep are listed below: Sleep is one of the factor upon which the pattern
of GH secretion is dependant. (Factors are stage of development, nutritional state, sleep stage,
stress and exercise.) Secretion is enhanced by sleep with levels highest during slow-wave
sleep and lowest during REM sleep. Oxygen consumption is lower during sleep, facilitating
an anabolic process. Physiological activities (e.g. exercise) and pathological disorders (e.g.
hyperthyroidism), which lead to increased catabolism are associated with increased slow-
wave sleep. Reduced activity and metabolic turnover (e.g. paraplegia and hypothyroidism) are
associated with decreased slow-wave sleep. Hormones that inhibit anabolic processes (e.g.
corticosteroids, adrenaline and noradrenaline) are inhibited during sleep.
Etymological derivation of Nidra
The word Nidra is feminine formed by the prefix ni+dra+rak+ta. This is a state of
nature which causes encapsulation to the consciousness of a person 17.
Definition
Ever since modern people are unable to define it accurately from the time it is a
question in every mind that what is sleep, how it occurs and what is its role in health. But the
great sages of India had the perfect knowledge regarding the sleep. The definitions are as
follows -
1. Sleep is the mental operation having the absence of cognition for its grasp. Vyas while
commenting Patanjali Yoga darshana made a statement as – “sleep is a state of
unconsciousness, but the consciousness remains about his own unconsciousness 18.
Management of Anidra with Nidra caps – Literary Review 13
2. According to Mandukya Upanishad Nidra is a condition in which ‘Atma’ does not
have any dream or desire for anything and that state is called ‘susupti” 19.
3. Chhandogya upanaishad states that “the state in which the mind is unaware about
surroundings or will not have any dream is termed as sputa or Nidra 20.
4. Nidra is defined as the temporary loss of contact with Jnanendriya and Karmendriya to
the manas 21.
5. Charaka affirmed that when the mind (as well as soul) gets exhausted or becomes
inactive and the sensory and motor organs become inactive then the individual gets
sleep 22.
6. Susruta described the sleep occurs when the Hridaya the seat of chetana is covered by
Tamas 23.
7. Dalhana the commentator of Susruta states that Nidra is the state of combination of
mind and intellectual in which the person feels happy 24.
8. Astanga sangraha Vagbhata stated that - the manovaha srotas become accumulated
with sleshma and mind is devoid of sense organs because of fatigue, when individual
fell asleep 25.
9. Sharangadhara mentions that Nidra is a state where predominance of Kapha and
Tamas is witnessed 26.
10. Adhamalla defines that the Nidra is a state in which the tamoguna combines with
Kapha where mohavastha of indriya and mana is observed 27.
Phenomena of Nidra
There is a natural relation of sleeping and waking during 24 hrs. The sleep comes
naturally during the night but it is not necessary consequence of darkness, as is proved by
Management of Anidra with Nidra caps – Literary Review 14
those persons who have to work in night sleeps in the day and readily adopt themselves to this
condition.
Authors of ancient Hindu literature made crystal clear explanations regarding the
physiology of sleep. They explained it in different ways according to their working field and
conceptualized. These explanations regarding the phenomena of Nidra may be summed and
classified under four groups -
1. Theories of Upanishad
2. Theories of Yoga
3. Theories of Ayurveda
4. Contemporary concepts developed
1) Theories of Upanishad
a) Ancient seers of Chandyogyopanishad 28 stated that the Atma moves from
Hridaya through the nadis and gets lodged inside the membranous sac
around the Hridaya, then the sleep is induced.
b) Brihadaranyakopanishad 29 explains that the Nidra occurs when Atma goes
into rest in space in side the Hridaya
2) Theories of Yoga
The yogic philosophers have made a clear explanation regarding sleep resembles as
Samadhi state which is entirely different from it. They studied ‘Yoga Nidra’ pertaining to
various states associated with Atma.
They have termed these states as
Jagratavastha – waking consciousness
Svapnavastha – dreaming
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Susuptavastha – dreamless sleep
Turiyavastha – conscious dreamless sleep
Maharshi Patanjali 30 states that the Sleep is a state in which all activities of thought
and feeling come to an end. In sleep the senses of perception rest in the mind, the mind in the
consciousness and unconsciousness in the being. In deep sleep, the senses of perception cease
to function, because their king, the mind, is at rest.
3) Theories of Ayurveda
a) Tamo prabhava theory
According Susruta 31, the sleep is induced by the increase of the inert universal
attribute called Tamas. The term Tamas literally means darkness. Satva, Rajas and
Tamas are the three major or universal attributes that pervade the universe. These
three attributes or dimensions play an important role in the functioning of the mind
and even body, of them rajas and Tamas are capable to vitiate mind (Manas). Because
of their predominance’s affects and afflicts the mind the mental diseases are resultant.
On the other hand the satva increase can cause the conductive to mental health and
Rajas which represents in action.
Onset of sleep is related to the increases of Tamas always. These said
principles affect inertia on general. Sleep usually occurs at night as the surroundings
are dark and are predominated by Tamas. This dark environment naturally increases
the Tamas in human beings according to the theory of generality 32. Apart from this
the bioelectrical cells, which are in the body, sustain the energy for activity in the day
light by getting charged through Sun light. At the night the Human is the only capable
to generate Bioelectricity through the activity of digestion (Jatharagni). At the
Management of Anidra with Nidra caps – Literary Review 16
darkness the person reserves the energy and wish to retire as the activities are
restricted and energy levels are inhibited.
b) Theory of Klama (Fatigue)
The sensory and motor faculties are fatigued by day’s work. The fatigued
faculties become sluggish in their work and will loose their activity. They gradually
withdraw from their objects. The mind functions are also blocked by the increase and
influence of Tamas. Mind gets detached from the faculties and its action of enjoying
the faculties ceases. This stage is entitled as sleep. But even in the sleep also mind
maintains its connection with the soul, as it is “Ubhayendriya” – dualistic organ 33.
c) Theory of Swabhava Nidra
Sleep is a natural function of Tamas where in both satva and rajas acts against
the sleep induction. Apart from sleep Tamas causes of fear, ignorance, depression and
laziness also. Satva represents cognition and enlightenment. It is the cause of
awakening: Nevertheless sleep is included among any natural diseases. Hence, the
Satva is against the ignorant and inert sleep. Rajas on par with satva represent action
and hence, it is also a factor against to sleep induction, where the physical and mental
activities are subdued or restrained 34.
d) Kapha Dosha theory
Kapha is said as the strength of the living being. Such Kapha when obliterates
the channels because of the over activity of the body the mind withdraws from the
sensory activities and induces the sleep as physical rest to the body. Such Nidra also
associates with the Tamas to fulfill the sound sleep 35.
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4) Contemporary Concepts of Sleep
Sleep remains one of the great mysteries of modern neuroscience. We spend nearly
one-third of our lives asleep, but the function of sleep still is not known. Fortunately, over the
last few years’ researchers have made great headway in understanding some of the brain
circuitry that controls wake-sleep states, but no single explanation can accepted as the final
word for the understanding of physiology of sleep 36. The views regarding the phenomenon of
the sleep throw light upon the phenomenon occurring during the rest and refreshing effect.
1) Vascular Theory:
Probably the oldest theory is that sleep is induced by a reduction
in the blood supply to the brain or at least to the conscious centers. This
is the so-called ischemic theory.
2) Pavlov’s Theory:
As a result of his study of conditioned reflexes in dogs, Pavlov
proposed a theory for sleep, base upon the cortical inhibition caused by
the repeated elicitation of a conditioned response without
reinforcement. The condition inhibition slowly spreads the entire cortex
that causes sleep.
3) Chemical Theory:
Some have favored the chemical theory. According to this
concept some chemicals, like lactic acid, acetylcholine, bromide or
specific fatigue toxins were supposed to accumulate during the waking
hours which irritates the nerve cells of brain and causes sleep as a
result.
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4) Kleitman’s Theory:
Sleep is caused due to reduction of the muscle tone and
discharge of less afferent impulses, thereby, keeping the cerebral cortex
inactive.
5) Oxygen Theory:
Explains sleep depends upon the utilization of oxygen.
Whenever brain utilizes less oxygen, at that time sleep is taking place.
6) Hypothalamus Theory:
This theory states that there is a sleep center in the
hypothalamus. The stimulation of which is responsible for sleep. To
explain this some experiments were carried out.
7) Parasympathetic Theory (Acetylcholine Theory – Dixit):
The depression of the sympathetic center is stated to be
responsible to inducing the sleep and as such sleep is regarded as a
parasympathetic function.
8) Lactic Acid Theory:
Sleep is supposed to be caused due to accumulation of lactic
acid in the nervous tissues.
9) Serotonin Theory:
The most conspicuous stimulation area for causing almost
natural sleep is the raphe nuclei in the lower half of pons and in the
medulla. Nerve fibers from these nuclei spread widely in the reticular
formation and upward into the thalamus, neocortex, hypothalamus and
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most areas of the limbic system. Ending of these nerve fibers secrete
serotonin. It has been assumed by the experiment that serotonin is a
major transmitter substance associated with production of sleep 37.
10) Neuronal Centers theory 38
Stimulation of some areas in the nucleus of tractus solitarius
(the sensory region of the medulla and pons) – also promotes sleep.
These regions perhaps act by exciting the raphe nuclei and serotonin
system. Stimulation of several regions in the diencephalon can also
help promote sleep, including –
a) The rostrum part of the hypothalamus, mainly in suprachiasmal area
and
b) An occasional area in the diffuse nuclei of the thalamus.
Types of Nidra
Ayurveda has different opinions regarding the types of sleep. Basically Nidra can be
classified into type’s viz. Svabhavika (natural) and Asvabhavika (abnormal). Out of the
former Svabhavika Nidra is regularly every night, which offers beneficial effects for the
living beings, whereas the later Asvabhavika is one can be due to different causes of
pathological in origin.
1) Charaka classification of Nidra 39
Charaka classifies the sleep condition into seven folds. He agrees with the ancient
authors who considered the sleep is Bhutadhatri. Sleep comes at night, spontaneously and
regularly as a natural instinct and that the other categories were either due to sin or the
disease. The seven types described by Charaka run as under -
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1. Tamobhava Nidra
2. Sleshma Samudbhava Nidra
3. Manah Shrama Sambhava Nidra
4. Sharira Shrama Sambhava Nidra
5. Agantuki Nidra
6. Vyadhyanuvartini Nidra
7. Ratri Svabhava Prabhava Nidra
Brief descriptions of said Charaka types of Nidra are elaborated is as follows -
a) Tamobhava Nidra:
Generally the sleep is due to the effect of Tamas, but the Tamobhava Nidra as
particularly due to the excessive Tamas causing sleep. When Satva and Rajasa are
diminished in excess and the seat of Atma and Mana i.e. Hridaya is covered by the
vitiated Tamas, then the organization become inert or inactive.
According to some scholars, the Tamodbhava Nidra resembles with Sanyasa
condition described by Charaka, which is the comatose state. The sleep caused by
Tamas is also the root cause for all sinful acts.
Tamas always causes excessive sleep. Thus, the individual is unable to perform
the virtuous files and so he subjects himself to sinful behavior.
b) Sleshma Samudbhava Nidra:
Sleshma is the material state of Tamas and as such the Sleshma and the Tamas
are having identical properties. When the Sleshma increases in the body the sleep
ensues. Therefore, it is called Sleshma Samudbhava Nidra.
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c) Manah Shrama Sambhava Nidra:
The person also gets the sleep as the result of exertion. Due to excessive
mental stress and strain, the mind gets tired and unable to perform its activities; as a
result the animal gets sleep.
d) Sharira Shrama Sambhava Nidra:
The person also gets the sleep due to physical exertion. When a person
indulges in excess physical activities he feels too much tired. The body and mind
desire to take rest and agitate to work further and the person gets sleep.
e) Agantuki Nidra:
Sometimes the cause of sleep remains obscure and the cause is not explainable.
However, the sleep is followed by the death and as such Chakrapani has termed this
sleep as a death signal (Arishta) 40.
f) Vyadhyanuvartini Nidra:
There are some diseases like Sannipata Jwara where severe weakness of the
patient and follows the condition just similar to coma. This type of sleep is termed as
Vyadhyanuvartini Nidra.
g) Ratri Svabhava Prabhava Nidra:
As has been stated earlier the sleep is a natural phenomenon and it comes at a
particular time cyclically in the night. There is no specific or particular reason for this
kind sleep and it is termed as Bhutadhatri 41. It has been observed that even the
individual who has slept during the daytime would also feel sleepiness in the night,
which is quite a natural phenomenon.
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2) Susruta classification of Nidra
Susruta 42 described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi
and Vaikariki Nidra. The detailed description is as follows.
a) Vaishnavi or Svabhaviki Nidra:
Svabhaviki Nidra is caused due to the Maaya or illusionary effect
attached to the power of Vishnu Maaya. Here, Maaya is a desire of the Manasa
to get detached from the worldly sensory objects on account of the tiredness of
Manasa; and the seat of Manasa and the Sleshma and Tamas cover Atman.
This mostly happens in the night and individual gets sleep. The Tamoguna
dominant persons may go to sleep at any time i.e. day or night. But a person
having Rajoguna in excess may get sleep sometimes in the day or in the night,
because of Chalatva of Rajasa. The person having qualities dominated by
Satva Guna sleeps at the midnight, because, at this time Tamas is excess and
Satva will be decreased (Dalhana). The term Papma has been used to describe
the Tamobhava of Nidra and also to mention the sinful activities.
b) Tamasi Nidra:
It is the lack of consciousness preceding the death. Tama dominant
Kapha induces this due to the blockage of Sanjnavaha Srotasa, and this Nidra
cannot awaken individual.
c) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha
and increase of Vata and also due to mental and physical pain, distress etc. the
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person doesn’t enjoy the sufficient and sound sleep in quantity and quality 2,3.
Disturbed sleep is also a type or Vaikarika Nidra.
3) Vagbhata classification of Nidra
Astanga Sangraha 43 Vagbhata followed the Charaka’s view with a slight change in
the names. He also mentioned seven types. The commentator Indu opined that the Tamobhva
is Antya i.e. comes at the time of death and Agantuka means Shastra Praharadina (due to
injury) and considered these are due to Vyadhis.
Astanga Hridaya 44 Vagbhata considered only four types of Nidra and included the
all seven types in this viz. Akala sevitha, Ati prasangath sevitha, Nacha sevitha and
Nishevitha. The commentator Hemadri considered them as – The properly taken sleep brings
happiness, nourishment, strength, virility, knowledge and life to the individual. The
improperly taken other three types may kill the individual like the Kalaratri, who killed all
demons.
Instead of above seven fold classification we can make three types of classifications in
terms of Tamas. As we seen that sleep is due to manodosha Tamas, but here Tamas means not
alone, the other manasika doshas are there i.e. according to Charaka 45 vimansthana Dosha
anubhandhya anubhandha concept the Nidra can be made into mainly three types.
Tamasika nidra
Rajayukta tamasika nidra
Satvayukta tamasika Nidra
According to Susruta 46 another sets of Nidra viz. Tamasika Nidra is sleeps
both day & night, Rajayukta tamasika Nidra get sleeps either in the day or night and
Satvayukta tamasika nidra sleep at midnight.
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Sleep and immunity
There is much evidence to support the theory that sleep is a period of growth and
anabolic activity but little about the role of sleep in recovery from illness. Excessive sleep,
sleepiness fatigue and fever are symptoms of nearly all infections diseases and chronic
inflammatory disorders. Fever probably protects during illness, but the effects of sleep are m
ore difficult to measure.
Many processes could contribute to the link be in sleep and immune response. For
example the circadian release of melanotonin during the night is thought to counteract the
immuno-suppression association with glucocentricoids, melatonin is known to regulate both
the release of uptokines and cell mediated immunity.
Several molecules play a part in the regulation of sleep and immune processes
muranyl peptides that are produced by macrophages from phagocytosed bacterial cell walls
and certain viral products also increase the length of sleep and the production of modifiers of
the immune response, one class of that is called cytokines. Cytokines are concerned with the
amplification, coordination and regulation of the immune response. Specific ccytokines
known to effect sleep include interleukin L-alpha, interleukin l-beta, tunor necrasis factor and
interferon – alpha.
Though the studies regarding the close association between sleep and immune
regulation are carried out, further elucidation is required to prove this any how rest is part of
the host’s defense against infection 47.
Nidra as Rasayana
In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a
winding up of the vital clock, a recharging of life’s battery and “Chief nourisher at life’s
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feast”. Rasayana 48 (Achara) gives rise regularized sound sleep and vice versa the regularized
sleep patterns induce Rasayana effect. Health is a first muse and sleep is the condition to
produce it. The goal of the Ayurvedic approach is to create more potent individuals through
increased Ojas (immunity), which is the finest end product of digestion & metabolism that
provides energy, enthusiasm, happiness, clarity of thinking, better coordination between the
body and mind 49. Only the sound most restful (stage IV) sleep generates Ojas. A sound
quality sleep provides ultimate rest to the mind and senses, with enhanced capacities of
mental and physical work ability for the next day. On the other hand, lack of sleep vitiates &
initiates Vata, Ama (endo toxins), etc in the body.
Total Body Restoration:
The hypothesis is that sleep is a process by which the whole body may be restored.
This theory is based on an accumulation of evidences. The consumption of oxygen is lowest
during slow wave sleep. Though the process of catabolism and anabolism are continuous, the
relative rates vary according to whether the subject is awake or asleep, and it has been shown
that the rate of anabolism is at its peak during sleep.
Growth hormone is released mainly at night, also in association with slow wave sleep
and also treatment of short stature by growth hormone is more effective if given at night.
Further more, cell mitosis is at a peak during sleep 50.
It has been postulated that slow wave sleep being more important for macromolecular
synthesis and REM sleep for removing the synthetic products of slow wave sleep to maintain
synaptic connections which is necessary to maintain cognitive function (ABC of Sleep
Disorders) 51.
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Brain Restoration: 52
Some research workers have postulated that it is the brain not the body that
recuperates during sleep and that sleep counteracts the effects of the metabolism of the brain
during the day. They also claim that the exercise included increases in slow wave sleep can be
explained by an increase in brain temperature and metabolism and alter sleep deprivation it is
psychological rather than physiological deficits that are most apparent. This emphasizes that
restorative function is central rather than general.
No one hypothesis completely explains the complexities and vagaries of sleep, but
taken together may form the foundation of the explanation for the indisputable need for sleep.
Nidra and prakriti
Individuals vary sleep with the prakriti i.e. personality and vayah (age factor). The
sleep requirement differs with relation to either psychological or somatic personalities. The
sleep according to prakriti is classified into two groups’ -
a) According to Deha prakriti and
b) According to manasa prakriti.
a) Nidra - Deha prakriti
The sleep is produced by tamoguna and sleshma so according to the prakriti of a
person the quality and quantity of sleep varies. An individual of Kapha prakriti gets more
sleep which is sound also, while a person of Vata prakriti gets less sleep is related to the age
or vayah. In balyavastha, Kapha is predominant, so child sleeps more time than the youth. In
vriddhavastha, Vata is predominant, so the old aged gets very less sleep. Apart from the deha
prakriti some naturally get less sleep 53.
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b) Nidra - Manasa prakriti:
Susruta 54 described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi
and Vaikariki Nidra.
1) Svabhaviki Nidra:
Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the
power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached from the
worldly sensory objects on account of the tiredness of Manasa; and the seat of Manasa and the
Sleshma and Tamas cover Atman. This mostly happens in the night and individual gets sleep.
The Tamoguna dominant persons may go to sleep at any time i.e. day or night. But a person
having Rajoguna in excess may get sleep sometimes in the day or in the night, because of
Chalatva of Rajasa. The person having qualities dominated by Satva Guna sleeps at the
midnight. Because, at this time Tamas is excess and Satva will be decreased (Dalhana)
The term Papma has been used to describe the Tamobhava of Nidra and also to
mention the sinful activities.
2) Tamasi Nidra:
It is the lack of consciousness preceding the death. Tama dominant Kapha induces this
due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individual.
3) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of
Vayu and also due to mental and physical pain, distress etc. the person doesn’t enjoy the
sufficient and sound sleep in quantity and quality 2,3. Disturbed sleep is also a type or
Vaikarika Nidra.
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Nidra and kala
Manu 55 the great law maker has described the divisions of time, and then has
remarked that the thirty muhurta period (24hours) is divided by the sun into day and night, the
day being intended for the activities and the night designed for the rest and repose.
Naturally the night is described as a proper time for sleep. The person should not
awake at night and should not sleep in day time because both are Dosha prakopaka. It is
advised to take sleep avoiding at the first and last parts of night. As the sleep is one among
five varjyas of sandhya kala, if taken the person becomes needy or sparse 56. As it is well
known concept that early morning awakjening is good for health and also to get Bramhajnana.
Relationship between the Nidra and Dosha – Dhatu – Malas
By the previous descriptions regarding sleep it is very clear that sleep is having
important role in the maintenance of equilibrium of body. As Nidra is said to be Kapha
dominant process, it also maintains the equilibrium between three humors. In Ayurvedic
classics, it is mentioned that in the kaphaja vikaras, Nidra and tandra are commonly seen and
in vataja vikaras sleeplessness occurs and in pittaja vikaras lack of sleep is one of the
symptoms 57.
The equilibrium of the dhatus also depends upon the sleep. Charaka 58 and Susruta59
have stated that by means of proper sleep the dhatusamya, the nourishment of the body, the
increase of strength and the stability of life are achieved. When the decrease of Rasa Dhatu
occurs, the sleep is diminished and the dhatus get proper nourishment again only when the
proper sleep is enjoyed. By the proper sleep the digestion power is properly mentioned and
the Agni functions remain normal. The evacuation of the bowel and the emptying of the
urinary bladder take place properly, if a person has slept well.
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The bad habits of waking at night and sleeping at day time have been stated to
provoke all the three doshas.
Karma of Nidra at different dhatu level
• Rasa – pushti and varnaprada
• Rakta –varna, agnidipti
• Mamsa –pushti and bala
• Meda –attractiveness (shriman)
• Asthi –bala
• Majja –varna, utsaha
• Ojas –jivana
• Manasa – gyana, and sukha
STAGES OF SLEEP
During each night, a person goes through stages of two types of sleep that alternate
with each other. The EEG (Electro encephalogram), EOG (Electro occulogram), EMG
(Electro myogram) can be conveniently record during the sleep by fixing small silver
electrodes to the scalp and to the face before the subject goes to sleep. EOG reveals the
eyeball movements while EMG indicates the tension of the muscles. Based on these records
two kinds of sleep classified are -
1) Non Rapid Eye Movement Sleep (NREM)
2) Rapid Eye Movement Sleep (REM)
NREM Sleep:
In NREM type of sleep the brain waves are very slow, so it is also called slow-wave
sleep. This sleep is exceedingly restful and is associated with decrease in peripheral vascular
tone and many other vegetative functions of the body.
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Characteristics of NREM Sleep:
Most sleep during each night is of slow-wave variety and it is deep, restful type of
sleep. NREM sleep is composed of four stages. (75 percent in young)
Table – 1
Stages of sleep in the NREM
Stage I Stage II Stage III Stage IV
5% 45% 12% 13%
NREM sleep is a peaceful state relative to waking. Because the decrease of pulse rate,
respiratory rate, blood pressure, basal metabolic rate is seen in this state.
The deepest portion of NREM sleep (stage III & IV) is sometimes associated with
unusual arousal characteristics. The organization during arousal during stage III or IV
may result in specific problems including enuresis, somnambulism and stage IV
nightmares or night terrors.
NREM sleep is frequently called ‘dreamless sleep’, but dreams do occur during it.
These dreams are not usually remembered whereas those of REM sleep are likely to
be remembered 60.
REM sleep (Paradoxical Sleep, Desynchronized Sleep): 61
REM sleep is a qualitatively different kind of sleep characterized by a high level of
brain activity and physiological activity levels similar to those in wakefulness. In a normal
night of sleep, bouts of REM sleep lasting 5 to 30 minutes usually appear on the average
every 90 minutes, the first such period occurring 80 to 100 minutes after the person falls
asleep. When the person is extremely sleepy, the duration of each bout of REM sleep is short
and even may be absent.
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Characteristics of REM Sleep
It is usually associated with active dreaming.
The person is even more difficult to arouse by sensory stimuli than during deep slow-
wave sleep and yet people usually awaken in the morning during an episode of REM
sleep, not from slow-wave sleep.
The muscle tone throughout the body is exceedingly depressed, indicating strong
inhibition of the spinal projections from the excitatory areas of the brain stem.
Probably the most distinctive feature of REM sleep is dreaming. The heart rate and the
respiratory rate usually become irregular, which is characteristic of the dream state.
Despite the extreme inhibition of peripheral muscles, a few irregular muscle
movements occur. These include, in particular, rapid movements of the eyes.
The brain is highly active in REM sleep and the overall brain metabolism may be
increased as much as 20%. This type of sleep is also called paradoxical sleep because
it is a paradox that a person can still be asleep despite marked activity in the brain.
However, the brain activity is not channeled in the proper direction for people to be
fully aware of their surroundings and therefore to be awake.
EEG Changes in Different Stages of Wakefulness & Sleep:
Alert wakefulness is characterized by high frequency β waves, whereas quiet
wakefulness is usually associated with α waves. Slow-wave sleep is divided into four stages.
In the first stage of slow-wave sleep, the voltage of the EEG waves becomes very low; this is
broken by “sleep spindles”, that is, short spindle-shaped bursts of α waves that occur
periodically. In stages II, III and IV of slow-wave sleep, the frequency of the EEG becomes
Management of Anidra with Nidra caps – Literary Review 32
progressive slower until it reaches a frequency of only 1 to 3 waves per second in stage IV,
these are typical δ waves 62.
It is often difficult to a difference between REM sleep brain wave pattern and that of
alert awake person. The waves are irregular high frequency β waves which are suggestive of
excess but desynchronized nervous activity as found in the awaken state. Therefore, REM
sleep is frequently called desynchronized sleep.
PHYSIOLOGY OF SLEEP
When Manas is exhausted then sleep occurs this phenomenon can be understood in
this manner. According to Howell, sleep is due to cerebral ischaemia. Cerebral cortex is the
seat of higher centers like pre and post central gyrus, association area etc., which have the
correlation with mental activities described in Ayurveda. So due to the reduction in cerebral
blood supply Manas becomes Klanta that causes sleep 63-64.
Further, during sleep, Indriyas (both Jnanendriya and Karmendriya) become inactive
by the detachment from their sense organs or from their work. Kleitman explains that due to
reduction of muscle tone and discharge of less afferent impulses, the cerebral cortex remains
inactive. This can be interpreted in the terms of ‘Guru’ and ‘Varanaka’ properties (according
to Sankhya theory) of Tamas. Fatigue of the muscles with consequent reduction of
transmission of afferent impulses to the cerebral cortex and thereby keeping it inactive seems
to be a possible factor in the production of sleep 65-66.
HOW SLEEP IS REGULATED
During wakefulness, the brain is kept in an alert state by the interactions of two major
systems of nerve cells, in the upper part of the pons and in the midbrain, which makes
acetylcholine as their neurotransmitter, sends inputs to the thalamus, to activate it. It in turn
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activates the cerebral cortex, and produces a waking EEG pattern. However, during REM
sleep the cholinergic nerve cells and the thalamus and the cortex are in a condition similar to
wakefulness but the brain is in REM sleep. The difference is supplied by three sets of nerve
cells in the upper part of the brain stem: nerve cells that contain the neurotransmitter a)
norepinephrine b) serotonin and c) histamine. These monoamine neurons fire most rapidly
during wakefulness, but they slow down during slow wave sleep, and they stop during REM
sleep.
The brain stem cell groups that control arousal are in turn regulated by two groups of
nerve cells in the hypothalamus. One group of nerve cells, in the ventrolateral preoptic
nucleus, contains inhibitory NT (neurotransmitter), galanin and GABA. When the
venterolateral pre-optic neurons fire, they are thought to turn off the arousal system, causing
sleep, damage to the ventrolateral preoptic nucleus produces irreversible insomnia (Anidra). A
second group in the lateral hypothalamus acts as an activating switch. They contain the NT
orexin and dynorphin, which provide an excitatory signal to the arousal system, particularly to
the monoamine neurons. Recent studies show that in humans with narcolepsy, the orexin
levels in the brain and spinal fluids are abnormally low. Two main signals control this
circuitry. First, there is homeostasis. There is an intrinsic need for a certain amount of sleep
each day. Some people think that a chemical called adenosine may accumulate in the brain
during prolonged wakefulness, and that it may drive sleep homeostasis. The other major
influence on sleep cycle is the body’s circadian clock, the suprachiasmatic nucleus. These
nerve cells in the hypothalamus contain clock genes, which go through a biochemical cycle of
almost exactly 24 hours, sleep, hormones and other bodily functions. The suprachiasmatic
Management of Anidra with Nidra caps – Literary Review 34
nucleus provides a signal to the ventrolateral preoptic nucleus and probably the orexin
neurons 67.
The Depth of Sleep:
The depth of sleep is not constant throughout the sleeping period, but varies from hour
to hour. Experiments upon man in which auditory stimuli were employed to arouse the subject
at different time or in the movements of the sleeper were recorded indicate that the depth of
sleep follows a characteristic curve. In most adults sleep deepens rapidly to the end of the first
hour, after which it lessens sharply for a time, and then more slowly till the time of waking.
Generally, sleep taken during the daytime is lighter than that during the night. Deep sleep is
dreamless, dreams occur only during light sleep and chiefly in the period, which just precede
waking. In sleep, unconsciousness is not uniform for all senses; the depth of sleep is greatest
for the sensations of smell and least for those of pain, hearing and touch. The sleep
requirement of different persons varies widely; it also alters with age. The following are
average figures for the hours of sleep required at different periods of life:
• Newborn (infant) 18 – 20 hours
• Growing children 12 – 24 hours
• Adults 7 – 9 hours
• Aged (old) persons 5 – 7 hours
Physiological Changes Accompanying Sleep: 68
During sleep most bodily functions are reduced their basal levels.
The blood pressure is lower, the systolic pressure showing a decline of from 10 to 30
mmHg. If the sleep is disturbed by exciting dreams the blood pressure might be
elevated well about the normal waking level.
Management of Anidra with Nidra caps – Literary Review 35
The pulse rate is slowed by from10 to 30 beats.
The metabolic rate is reduced by from 10 to 15% below the basal level and the rectal
temperature by a fraction of a degree Fahrenheit.
The heat regulating mechanisms are depressed.
The respirations are slowed as a rule they also tend to become irregular or periodic.
Muscle tone is minimal, the knee jerk is abolished and a positive Bebinski may be
present.
The thresholds for most somatic reflexes are definitely raised.
Vasomotor reflexes, however, are more active. The pupils are usually constricted, the
light reflect is retained. The eyeballs are turned upwards and outwards.
Urine volume is reduced and the specific gravity is raised.
The secretion of sweat gland is considerably increased.
Gastric secretion is increased or little altered during sleep.
Lacrimal and salivary secretions are reduced.
PHYSIOLOGICAL EFFECTS OF SLEEP
Charaka explains that in the night, the Hridaya (heart) gets contracted and the Srotasa
(the channels of circulation) as well as the Koshtha (the gastro-intestinal tract) are contracted,
the body elements get softened 69.
According to modern view, sleep causes two major types of physiological effects.
1) Effects on the Nervous System itself.
2) Effects on the other structures of the body
Management of Anidra with Nidra caps – Literary Review 36
The first one seems more important because lack of sleep wakefulness cycle in the
nervous system at any point below the brain cause neither harms to the body organs nor any
deranged function.
On the other hand, lack of sleep certainly does affect the functions of the central
nervous system. Prolonged wakefulness is often associated with progressive malfunction of
the mind and sometimes even causes abnormal behavioral activities of the nervous system.
So, in the absence of any definitely demonstrated functional value of sleep, we might
postulate that the principle value of sleep is to restore the natural balance among the neuronal
centers 70.
Sleep does have moderate physiological effects on the peripheral body. For instance,
during wakefulness, there is enhanced sympathetic activity and hence increases the muscle
tone. Conversely, during slow-wave sleep, sympathetic activity decreases while
parasympathetic activity increases. Therefore, a ‘restful’ sleep ensues – fall in blood pressure,
respiratory rate and pulse rate, and skin vessels dilate, activity of GIT sometimes increases,
muscles fall into a mainly relaxed state, and the overall basal metabolic rate of the body falls
by 10 to 30 percent.
FUNCTIONS OF SLEEP – 71-72
Sleep at the nighttime makes for the balance of the body constituents (Dhatusamya),
alertness, good vision, and good complexion and fired digestive power.
Susruta described that, those who takes proper sleep in proper time will not suffer
from disease, the mind of them will be peaceful, they gain strength and good complexion,
good virility, their body will be attractive, they won’t be lean or fatty and they live good
hundred years 73.
Management of Anidra with Nidra caps – Literary Review 37
Despite the wealth of information that is accumulating about the biochemistry and
physiology of sleep, its precise nature and functions are not exactly known to the modern
physiology. A number of theories have been proposed, which include the hypothesis that
sleep is needed; for consolidation of memory, for binocular vision, or as part of
thermoregulatory evolution, for conservation of energy. The most widely held theory about
the function of sleep is that its senses as a period of recuperation or restoration. There are two
ways in which this hypothesis is interpreted; total body restoration and neurological
restoration.
Disease review
By going through the previous description, it is quite evident that Nidra is not only an
important but an essential phenomenon of life, which affects the body and mind equally in a
favorable way when it is enjoyed in a rightful manner. Otherwise the inadequate Nidra
(Anidra) leads to various problems like dukha, karshya, abala, klibata, ajnana at last leads to
death also 74.
Charaka 75 explains Nidra and Nidranasha in context of ninditi purusha at sutra sthana
which is included in 80 nanatmaja Vata vikaras 76. But has no explanation of management at
either in Chikitsa sthana or else where.
Susruta 77 describes it under the chapter of garbha vyakarana shariram might be – of
Nidra plays a role in nutrition and development of the body. He also describes vaikarika Nidra
(sleep disorders) in the same chapter along with Chikitsa.
Vruddha Vagbhata 78 of Astanga sangraha mentions Nidra and Nidra vikara along with
Chikitsa in viruddha annavijnaniya adhyaya and in Vagbhata 79 of Astanga hridaya dicuss the
same in annaraksha adhyaya, while affirming trayopastambha.
Management of Anidra with Nidra caps – Literary Review 38
Sarangadhara 80 resolute the Anidra in vataja nanatmaj vikara, alpa Nidra in pittaja
nanatmaja vikara and atinidra under kaphaja nanatmaja vikara.
Deprivation of Anidra
It is composed of two words ‘A’+’Nidra’. The suffix ‘A’ provides negative meaning
to the act of Nidra 81. Anidra means less or no sleep. Ayurveda Vishwakosha part I 82 explains
Anidra as Nidranasha. In Ayurvedic texts the term ‘Anidra’ is used indicating a pathological
condition in which A+ is devoid of sleep.
Synonyms of Anidra
Table – 2 Synonyms of Anidra
Sno Synonyms CS SS AH AS YR MN HS BS DN RN
1 Anidra + + + + + + + +
2 Alpa Nidra + + +
3 Aswapna + + + +
4 Jagarana + + +
5 Nidranasha + + + + + +
6 Nidra vighata + +
7 Nasta Nidra + + + + + +
8 Nidra dourbalya +
9 Nidra bhramsha +
10 Nidra kshaya + +
11 Nidra bhanga +
12 Nidra vinasha +
13 Nidra cheda +
14 Nishi jagarana + +
15 Nidra viparyaya +
16 Prajagarana + + + +
17 Veatanidra + +
Management of Anidra with Nidra caps – Literary Review 39
Alpa Nidra:
Alpa means small minute 83 which refers to reduction in sleep time.
Jagarana:
Jagarana means awake or waking 84 Nidra rahita, Nidra abhava 85 which refers to the
loss of sleep or no sleep.
Nidra kshaya:
Kshaya means harsa, adarshana, bhanga 86 so, this term refers to disturbances in sleep
reduction in sleep time.
Nidra bhanga;
The word bhanga 87 means breaking splitting, dividing, this shows disturbances of
sleep.
Nidra chheda:
Chheda 88 means cutting off, a section, apiece which shows disturbances during sleep,
Nidra bhramsha:
The term ‘bhramsha’ 89 means to drop, fall down, cessation, loss which refers to
reduction in sleep time.
Vigata Nidra:
The term ‘vigata’ 90 means gone, disappear, ceased which can be correlated with loss
of sleep or reduction in sleep time.
Nasta Nidra:
Nasta 91 means lost, disappeared deprived which convey the meaning of loss of sleep.
By seeing all these synonyms Nidranasha can be considered as difficulty in initiation of sleep
reduction in sleep time and disturbances during sleep either one or more (icd-10) 92.
Management of Anidra with Nidra caps – Literary Review 40
Nidana Panchaka
Nidana
Charaka mentions the causes for Anidra as – eva eva cha vigneyo nidranashasya
hetavaha 93 the factors are Atiyoga of vamana, Atiyoga of virechana, Atiyoga of nasyakarma,
Atiyoga of rakta mokshana and Atiyoga of dhoomapana. Due to the excess use of these
factors makes the Vata vitiation and Anidra is inducted. Ati vyayama, Ati upavasa and
Asukha shayaa are the causatives of Vata vitiation, thus the Anidra is induced.
Ati chinta, Ati krodha and Ati bhaya are the manasika karana leading to tama kshaya
and rajo vruddi induces the Anidra.
Along with these, some others Chikitsa procedures of Atinidra advised by Charaka can
also are considered as causative factors for Anidra, which are as follows.
Satva audarya (increased satwa), Tamojayee (conqueror of tama), Karya (engaged in
work), Kala (old age), Vikara (disease), Prakriti (personalities such as Vata) and Vayu (Vata
Dosha) are the causes of Anidra 94-95.
Further Susruta has mentioned some extra Nidana factors which may cause Anidra;
these factors are Vata vridhi, Pita vridhi, Manastapa, Kshaya and Abhighata 96.
Bhavamishra considers atiyoga of nasya, upavasa, vyayama, chinta, dukha, bhaya,
Kapha kshaya as the causative factors of Anidra /Nidranasha 97.
Astanga sangraha Vagbhata mentions Nidana which may cause the Anidra are as
follows. Lobha, Harsha, Vyatha, Atimaithuna, Ati kshudha, Rukshanna sevana, Yavanna
sevana and Anjana are said to cause Anidra with their individualized qualities embedded 98.
At consideration of all these Nidana factors, the sharirika doshas such as Vata, Pitta,
and manasika Dosha raja are the principal causative factors for Anidra /Nidranasha.
Management of Anidra with Nidra caps – Literary Review 41
Table – 3 Anidra Ahara Nidana
Ahara CS SS AS AH BS HS BP Rookshanna - - + - - - - Yavaanna - - - - + - -
Table – 4 Anidra Vihara Nidana
Vihara CS SS AS AH BS HS BP Vyayama + - - + + - + Upavasa + - - + - + - Asukhasaiyya + - + - - - - Kshudha - - + - - - - Atimaithuna - - + - - - -
Table -5 Chikitsa Atiyogajanya Nidana of Anidra
Chikitsa Atiyogajanya
CS SS AS AH BS HS BP
Vamana + - + + - - - Virechana + - + - + - - Nasya + - + - + - - Rakta mokshana + - + - - - - Dhoomapana + - + + + - - Sveda - - - + - - - Anjana - - - + - - - Langhana - - - + + - -
Table -6 Anidra Manasika Nidana
Manasika CS SS AS AH BS HS BP Bhaya + - - - - + + Chinta + - + + - + + Krodha + - - + - - + Manastapa - + - - - - - Shoka - - + + - - + Vyatha - - + - - - - Harsha - - + - - - - Lobha - - - - - + -
Management of Anidra with Nidra caps – Literary Review 42
In addition to above discussed causative factors, Susruta has mentioned abhighata and
kshaya as Nidana of Anidra 99.
Purvarupa
Purvarupa is not mentioned for Anidra in any Ayurvedic classics.
Rupa
In Ayurvedic classics some symptoms are mentioned due to holding up of sleep
schedule. They are in the following table.
Table – 7
Symptoms of Anidra
Rupa CS 100 SS 101 AH 102 AS 103
Jrumbha + + + +
Angamarda + + + +
Tandra + + + +
Shiroroga + - - -
Shirogourava - + + +
Akshigaurava + + - -
Jadya - - + +
Glani - - + +
Bhrama - - + +
Apakti - - + +
Vataroga - - + +
Charaka has described the symptoms are suppression of sleep; yawning, body ache,
drowsiness, head disorders and heaviness in eyes are caused. Susruta has described following
symptoms due to restraint of sleep. Yawning, body aches, stiffness in the body, head and eyes
drowsiness are the symptoms caused by restraint of sleep. Vagbhata has mentioned that due to
Anidra – malaise, heaviness in head, yawning, laziness, languor, giddiness, indigestion, stupor
and vatajanya rogas will be manifested.
Management of Anidra with Nidra caps – Literary Review 43
Anidra Samprapti
Anidra is not explained as a separate disease in Ayurveda, thus no where the
Samprapti is available. Depending upon the Dosha, dushya involvement Anidra is
emphasized. Anidra is mentioned as Vata vikara with pita vriddhi associated with some other
disease states or symptoms which is common in aged people.
Figure – 1
Schematic diagram of Anidra Samprapti
At the description of Nidra it is mentioned that Kapha, Tamas, Hridaya and sanjavaha
srotas are responsible for it 104. But yogic concept defines Nidra as - when Atma having
Nidana
Ahara , Vihara & Anya Manasika
Vata Vruddhi (Chala, Rooksha & Laghu) Pitta Vruddhi (Ushna & Teekshna) Kapha Kshaya (Snigdha, Guru & Manda)
Leads to Kapha kshaya
Rajo Vruddhi (Chala, Rooksha & Laghu) Tama Kshaya (Snigdha, Guru & Manda)
Leads to Tama kshaya
kshaya Kapha & Tama avarana to the chetana Hrudaya / Sanjnavaha srotas
Anidra
Management of Anidra with Nidra caps – Literary Review 44
contact with manomaya kosha then susupti avastha (sleep) occurs. Consequently, when there
is any changes appear in this physiological process or path it causes the Anidra 105. Hence it is
evidential that the Vata Pitta, raja, Hridaya and sanjnavaha srotas play an important role in the
Samprapti of Anidra. Thus it is concluded that the vitiation of involved factors leads to the
condition of Anidra/ Nidranasha.
Types of Samprapti
Sankhya: According to Ayurveda, Asvapna/ Anidra is of two types viz., either due to
Vataprakopa or Pittaprakopa 106.
Vikalpa: In Anidra, mainly Vata Prakopa occurs and it’s Chala and Laghu Guna vitiates,
which keeps the mind active, causing Anidra. Thus the Dosha amshamsha kalpana is
essential.
Pradhanya: In Pradhanya Samprapti of Anidra, the predominance of morbid humors are
described in terms of the comparative and superlative degrees. As Anidra is of Vataja
Nanatmaja Vyadhi, vitiation of Vata takes place, and Pitta dominance is not ruled out. Thus
the validation of the Dosha pradhanyata is essential.
Bala: Bala of Anidra i.e. Vyadhi can be distinguished by the strength of manifestation of
symptoms, severity, duration etc, which will help as a prognostic tool.
Kala: Kala is an important factor, while considering Nidra as well Anidra. Charaka107
mentioned the Nishi Kala cause Nidra naturally. Sleeping at day time is contra indicated. Not
sleeping at night indicates that Kala interferences to cause the Anidra – thus the time factor
have an influential effect on Anidra / Nidra.
Management of Anidra with Nidra caps – Literary Review 45
SAMPRAPTI GHATAKA
Table - 8
Anidra – Samprapti ghataka
Dosha Vata & Pitta (Vriddhi), Kapha (Kshaya)
Dushya Rasa
Srotas Manovaha, Rasavaha
Srotodushti Prakara Atipravritti (Over indulgence)
Adhisthana Hridaya
Agni Jatharagn
Dosha: Dosha involvement in Anidra is said as Vata, Pitta and Kapha. But the deviation from
the normalcy is to be considered with due importance. Vata and Pitta are in Vruddhi state,
while in case of Kapha, the Kshaya is usually observed.
Dushya: As the Anidra is a psycho-somatic condition, initially no dushya is involved. Later
in due course the Dhatu involvement occurs to give rise associated symptoms and conditions
of Anidra viz. Glani, Aruchi, Apakti etc, which are the symptoms of Annavaha srotas and
Rasa Dhatu, do has their role in Samprapti of Anidra, as they provide Tushti, Preenana for the
entire body.
Srotas: The role of Manovaha Srotasa is understood without any controversy in Anidra as the
mind psychologically and body physically takes rest voiding the external stimuli. In this
context, Rasavaha Srotas too have a pivotal role in the pathogenesis of Anidra. Seat of
Manovaha and Rasavaha is Hridaya where the functions of different levels originate from the
same. Moreover, the etiological factors responsible for Rasa Dushti are said to be psycho
disturbing, such as Chintyanam Chatichintanat, where the chetana and stawa are disturbed.
Management of Anidra with Nidra caps – Literary Review 46
Srotodushti Prakara: Over indulgence of Manas is a common feature of Anidra, attributed
to the Manovaha sroto Atipravritti. But the sanga of Rasavaha srotas can not be ruled out, as
the symptoms of Rasavaha sroto dusti is witnessed.
Adhisthana: Hridaya is the abode for Rasa and Mana. It is the platform where the whole
Samprapti process is supposed to be observed. As earlier stated, Hridaya is the bed rock for
Mana and its role in Anidra is well defined.
Agni: Here, vitiation of Jatharagni takes place, because proper Nidra is said to enhance the
Agni 108. Apakti and Aruchi are the symptoms of Anidra, indicates the vitiation of Agni.
UPADRAVA
In Ashtanga Sangraha, it is mentioned that increased Vata is due to Anidra produces
Kapha kshaya. The decreased and dried Kapha sticks in Dhamanis walls and cause
Srotorodha. This, results in so much exhaustion that eyes of the patient remain wide open and
watery secretion from eyes. This dangerous exhaustion is Sadhya up to three days then
becomes Asadhya 109.
Upashaya and Anupashaya
As upashaya and anupashaya are not available in texts, they can be evolved. Mamsa
sevana, madya, ksheera and ksheera vikaras, abhyanga, utsadana, tarpana and sneha sevana
etc., can be considered as upashaya of Anidra, whereas rukshanna, yavanna, dhoomapana,
krodha, shoka etc., can be considered as its anupashaya.
Management of Anidra with Nidra caps – Literary Review 47
Chikitsa in general
There is no specific line of treatment mentioned for Anidra in our texts. Depending
upon the Chikitsa mentioned is in different contexts, for Anidra can be broadly divided into 2
types 1. Bahya Chikitsa 2. Abhyantara Chikitsa. Abhyantara Chikitsa can be again sub
divided into (a) ahara pradhana Chikitsa (b) aushadha pradhana Chikitsa.
Our acharyas have given more importance to bahya upacharas such as moordhni taila,
abhyanga etc. and manasika upacharas such as manonukula vatavarana manonukula vishaya
grahana etc., along with these therapeutic measures are also described along with some
specific aharas for patients of Anidra. All these therapeutic measures in the different contexts
may be classified into the following groups’ viz. Bahya upachara, Manasika upachara,
Ausadha upachara and Ahara upachara.
Table – 9 Bahya Upacharas for Nidranasha
Bahya Upachara
CS SS AH AS YR BP KS HS BS BR
Abhyanga + + + + + + - - + -
Utsadana + - - - - - - - - -
Samvahana + + - + + + - - - +
shitarpana + - + + - + - - - -
Moordhni Taila + + - - - - - - - -
Udvartana - + + + - + + - - -
Shirobasti - - + + - - - - - -
Shirastarpana - - + - - - - - - -
Karnapoorana - - - + - - - - - -
Padabhyanga - - - + + - - - - -
Angamardhana - - - - - - - - - -
Mardana - - - - - - - + - -
Shirolepa + - - - - - - - - -
Vadana lepa + - - - - - - - - -
Management of Anidra with Nidra caps – Literary Review 48
Table No. - 10 Aahara Upacharas for Nidranasha
Ahara Upacharas CS SS AH YR BP KS HS BR RV DN RN Gramya mamsa rasa + - - - - - - - - - - Anupa mamsa rasa + - - - - - - - - - - Jaleeya mamsa rasa + - - - - - - - - - - Mahisha ksheera + - + + - - + + + + + Peeyusha + - + + - - - - - - - Morata + - - + - - - - - - - Goodhooma - + - - + + - - - - - Varahamamsa - - - - - - - - - + + Guda - - - - - + - + - - - Matsya - - - - + + - + - - - Dadhi - - - - - + - - - - - Koorchika - - - + - - - - - - - Masha - - - - + - - + - - - Sita - + - - - - - - - - - Yoosha - - - - + - - - - - - Sneha - - - - + - - - - - - Kilata + - + + - - - - - + + Madhya - - + - - - - - - - -
Table No. - 11 Manasika Upacharas for Nidranasha
Manasika Upachara CS SS AH AS HS BP Manonukula Vishaya grahana + - - - - - Manonukula Sabda grahana + - - - - - Manonukula Gandha grahana + - - - - + Mrudu shayya - + - - - - Sukha shayya - - - + - - Sukha sparsh - - - + - - Nischinta - - + - - - Nityatrupti - - + - - - Bhaya tyaga - - - - + - Chintatyaga - - - - + - Lobha tyaga - - - - + - Swasteerna Sayana + - - - - - Sukhavartalapa - - - - + - Santosha - - - - - +
Management of Anidra with Nidra caps – Literary Review 49
Table No. - 12 Anya upachara for Nidranasha
Anya Upacharas CS AH
AS BP KS HS YR
Snana + + + - - - - Shirolepa + + + - - - - Varsa sevana in Varsa Ritu - - - + - - - Lehana karma - - - - + - - Vastra kruta vayu sevana - - - - - + - Kamsya patrakruta vayu sevana - - - - - + - Talapatra kruta vayu sevana - - - - - + - Kadali patrakruta vayu sevana - - - - - + - Viewing dance and hearing humorous voice - - - - - + -
Some other measures, which can be advised to the patient of Anidra/ Nidranasha,
though are not mentioned in Ayurvedic texts, are as follows:
• Maintaining regular time for going to bed.
• Avoid seeing excited pictures at night.
• Avoid smoking, tea, coffee or alcohol at night before going to sleep.
• Not indulge in any type of work or reading till late night.
• Should devoid of thoughts tensions before going to bed.
• Hearing soft music or favorite songs also induces sleep.
• 5-10 minutes mediation before going for sleep
• Offering prayer before sleep.
• Washing of hand, feet and face before goes to sleep
• Avoid of excess coitus
• Avoid of day sleep
• Proper evacuation of stool and urine
• Avoid mosquito bites
• Maintenance of adequate privacy and free from disturbances
Management of Anidra with Nidra caps – Literary Review 50
Aushadha Chikitsa (Upachara):
a) Single drug therapy: A good number of single drugs are described in Ayurvedic
literatures which gives relief from Nidranasha. These single drugs are:
Table No. - 13
Single drugs useful for Nidranasha
Ekamoolika BP KS HS DN RN BR
Palandu + - - + + -
Ikshurasa + - - - - -
Potaki + - - - - +
Tila + - - - - -
Trikatu - + - + - -
Ketaki - - + - - -
Vartaka - - + - - -
Kakamachi - - + - - -
Asuri - - - + + -
Some other single drugs are as follows :
• Brahmi
• Aswagandha
• Drakshya
• Bhanga
• Shankapuspi
• Jatamamsi
• Ahiphena
• Kusmanda
• Yamini
• Pippali moola
• Sarpagandha
• Punarnava
• Karpura
• Parasika yavani
• Katu tumbi
• Jatiphala
• Apamarga moola
• Khas khas
• Kupilu
• Tagara
• Raja sarshapa, etc.
Management of Anidra with Nidra caps – Literary Review 51
b) Compound drugs
o Sarasvata choorna
o Nidrakara choorna
o Ashvagandharista
o Shankhapushpyarista
o Chandravaleha
o Chintamani Chaturmukha Rasa
o Vatakulantaka rasa
o Nidrodaya rasa
o Sarpagandha ghana vati
o Agasti Sutaraja Vati
o Indumarichadi vati 110
o Swarna Makshika Bhasma 111
o Yashada Bhasma 112
o Tungadrumadi Taila 113
o Dhanyamla
o Kantakaryadi kwatha 114
o Kakajanghadi Kwatha 115
o Ghrita Bharjita Nagara 116
o Mukta Bhasma – mainly for Pittavridhi
Janya Nidranasha.
c) Amayika Prayoga
1. Ghrita Bharjita Bhanga + Madhu 117
2. Pippalimoola + Guda 118
3. Aswagandha Choorna + Pippalimoola Choorna + Parasika Yavani Choorna with milk.
4. Sarpagandha powder – 1gm + Rasasindura ¼gm with milk
5. Sarpagandha powder (50gm) + Jaharamohara Pisti 6 gms + Pravala Pisti (6 gm) +
Amrita Satva (6 gms)
Dose – ½ - 1 gm BID or TID with Gulab Arka (mainly for Insomnia due to HTN)
6. Amalaki – 2 parts + Pippalimoola – 1 part + Jatamansi – 1 part
Dose – 1 tsf twice daily.
7. Aswagandha Choorna + Pippalimoola Choorna with milk
8. Kakajangha Twak Kwatha + Madhu 119
9. Shalmali Niryasa + Kiratatikta 120
10. Ghrita + Taila Yamaka Yusha 121
11. Mahisha Ksheera + Khas Khas
12. Rohitamatsya Kambalika + Kutajaveeja Choorna + Guda 122
Management of Anidra with Nidra caps – Literary Review 52
Contemporary concepts of Anidra vis-à-vis Insomnia 123
Interests on sleep disorders started in the early 1970’s when obstructive sleep apnea
becomes established as a common and often life threatening condition. A number of survey’s
carried out in different countries indicates that sleep related complaints are most commonly
encountered in modern medicine. The disturbances of sleep are also very common complaints
in psychiatry. Sleep is disturbed in several ways in its pattern, quality and duration. As age
advances the average sleeping time decreases which is normal phenomenon. In some
pathological problems like mania, insomnia may be total. Delay in falling asleep (early
insomnia) occurs in anxiety, depression is characterized by early waking up (late insomnia)
and the sleep is usually non-refreshing. The sleep wake pattern is disturbed in certain organic
conditions like delirium and dementia. As sleep is interrupted in several conditions, it has
vital interest in proper appreciation and understanding of sleep related symptoms.
Classification of Sleep Disorders:
A. The classification of sleep disorders introduced in 1979 by the Association of Sleep
Disorders Centers (ASDC) which has been widely accepted. It consists of 4 major types
of sleep disorders.
1. DIMS (Disorders of initiating and maintaining sleep)
2. DOES (Disorder of Excessive somnolence)
3. DOSWS (Disorder of sleep wake schedule)
4. Parasomnias
B. Sleep disorders according to ICSD (International Classification of Sleep Disorders)
1. Dyssomnias
2. Sleep disorders associated with medical or psychiatric illness
3. Parasomnias
4. Proposed sleep disorders (Sleep related laryngeal spasm)
Management of Anidra with Nidra caps – Literary Review 53
C. Sleep disorders according to DSM-IV
1. Dyssomnias
2. Parasomnias
3. Sleep disorders related to another mental disorders
4. Others sleep disorders
Dyssomnias:
Dyssomnias are described under headings, viz. Hypersomnia (DOES), Disorders of
Sleep-wake schedule (DOSWS) and Insomnia (DIMS). Out of insomnia (DIMS) are
discussed here elaborately.
Insomnia (DIMS) –
During classification of sleep disorders Insomnia is mentioned under Dyssomnia. A
synonym also gives for insomnia which shows its clinical features i.e. DIMS (Disorders of
Initiation and Maintenance of Sleep).
Causative factors of Insomnia:
Symptoms Medical conditions Psychiatric / environmental conditions
1. For falling
asleep
(Difficulty in
initiation of
sleep)
• Any painful or
uncomfortable conditions
• CNS lesion
• Anxiety
• Pre psychotic tension (stress)
• Environmental changes
• Sleep-wake cycle disorders
2. For remaining
asleep (difficulty
in maintaining of
sleep)
• Sleep apnoea syndrome
• Nocturnal myoclonus
• Parasomnias
• Alcohol withdrawal
• CNS/ Painful diseases
• Drug effects
• Depression
• Sleep-wake disorders
• Dream interruption
• Environmental changes
• Mania
• Dementia, etc.
Management of Anidra with Nidra caps – Literary Review 54
Two unique disorders, which produce DIMS, include periodic leg movements and
restless leg syndrome
Diagnosis of Insomnia:
People are varying in their amount of sleep they require and some of those who
complain of insomnia may be having enough sleep without realizing it.
Usually the diagnosis of Insomnia can be based on the account given by the patient.
EEG recordings are occasionally helpful whether there is continuing doubt about the extent
and nature of the insomnia. So diagnosis of insomnia made on the basis of following points:
• The sleep disturbances like –
- Difficulty in initiation of sleep
- Difficulty in maintaining of sleep (may be frequent awakening or early morning
awakening)
- Non restorative sleep (i.e. despite adequate duration of sleep, feeling of not having
proper sleep) (Poor quality of sleep)
• It causes either marked distress or interferes with social and occupational functioning.
Above sleep disturbances (either one or more) if occurs at least 3 times in a week for
at least one month can be diagnosed as Insomnia.
Types of Insomnia:
Mainly Insomnia is of 2 types
I) Primary – No discernible cause for insomnia
II) Secondary – It is caused by one of several medical conditions that affect
sleep.
Management of Anidra with Nidra caps – Literary Review 55
I) Primary Insomnia:
About 15% of all the insomnia is primary origin. They are rare in childhood and
adolescences but become more prevalent as age advances. Females are more affected.
Symptoms of primary insomnia are
- Difficulty in initiating of sleep (more common in younger adults)
- Difficulty in maintaining of sleep (common in elderly)
- Not related to any mental disorders or physical conditions
- Individual shows excessive worry during the day about not being able to fall
asleep.
- In evening the person shows intense efforts to fall asleep but becomes
unsuccessful.
- Person complaining of lethargy, fatigue, lack of concentration, easily irritable.
- He may resort to hypnotics or alcohol to reduce tension or cups of coffee or other
stimulants to overcome the tired feelings.
II) Secondary Insomnia
- Secondary to other disorders
- Several psychiatric disorders are associated with insomnia
- Also occur secondary to substance abuse like alcohol, amphetamine, steroids and
several others
- After a course of progressive worsening a chronic stable stage is reached which
continue for several years
- Sometimes the course is episodic with short periods of improvement and
worsening.
Management of Anidra with Nidra caps – Literary Review 56
Investigative tools 124
The investigations are not only for Insomnia but also can be applied for other sleep
disorders. These are as follows:
1. Clinical evaluation:
A detailed sleep history is the most informative diagnostic tool. A thorough sleep
history can help for deciding whether the sleepiness or sleeplessness is normal or
pathological.
2. Multiple Sleep Latency Test (MSLT):
Objective conformation of hypersomnolence and determining its severity are
mandatory in a patient before using long term treatment with CNS stimulants initiated. MSLT
is widely used for evaluation of hyper somnolence.
3. Polysomnography:
Most patients with sleep-wake disorder require monitoring of various physiologic
parameters during sleep (polysomnography). The basic parameters in polysomnography are:
- Several changes of EEG to distinguish wakefulness from sleep and for sleep
staging.
- Eye movements
- Electro cardiogram
- Electro myogram of chin muscles, tibialis anterior muscle.
- Oral and nasal air flow by thermistor or a mask.
- Respiratory effort of the chest and abdomen by impedance pneumography.
- Oxygen saturation by ear oximeter.
Management of Anidra with Nidra caps – Literary Review 57
Drug review
Management of Anidra is divided in to three modalities viz. general sleep measures,
behaviour treatment and pharmacological treatment. General sleep measures include some
activities like regular exercise, avoidance of nicotine, alcohol and heavy meals close to
bedtime, etc. behaviour therapy includes relaxation, sleep restriction, stimulus control and
cognitive therapy. Pharmacological treatment includes several hypnotics and sedative drugs.
All these modalities of management are not capable enough to meet the challenges of Anidra.
Vata plays the most important role in the pathogenesis of the Anidra. Thus, the main aim
behind the management of the Anidra is directed towards pacification of Vata. In the present
study Nidra cap, mentioned below is a rational combination.
Each 500 mg Nidra cap consists of –
The above Rational combination has been formulated based on the pharmacological
properties and pharmacokinetics of individual drugs included in Nidra cap are individually
scrutinised for its Nidra janakatwam and Nidra prabhava from the classical texts. To check the
suitableness of this combination through information of these herbs which are included in
Nidra cap are discussed on the basis of Rasa, guna, veerya, vipaka is as under.
Drugs Botanical Names Quantity
Tagar Valeriana wallichii 125mg
Jatamanshi Nordostachys jatamamshi 125mg
Ashwaganda Withania somnifera 125mg
Pippalimoola Piper longum 125mg
Management of Anidra with Nidra caps – Literary Review 58
Tagar - Valeriana wallichii 125 to 128
Prayojyanga Moola
Rasa Madhura, Tikta, Katu
Guna Ushna
Veerya Ushna
Vipaka Katu
Prabhava Sedative, Hypnotic
Doshagnata Kapha Vata shamana
Rogaghnata Agnimandya, Unmada, Apasmara
Chemical consttiuents Volatile oil of Estates, Valerianic acid
Prepared Medicines useful at
Manovaha Srotas
Vataraja vati-2
Jatamanshi - Nordostachys jatamamshi 129 to 132
Prayojyanga Moola
Rasa Tikta, Kashaya
Guna Laghu, Snigdha
Veerya Sheeta
Vipaka Katu
Prabhava Bhootaghna, sedative
Doshagnata Tridosha shamaka
Rogaghnata Shira shoola, Anidra
Chemical consttiuents Oleum Jatamamsi, Resin, Sugar, Starch
Prepared Medicines useful at
Manovaha Srotas
Vatarajavati -2
Management of Anidra with Nidra caps – Literary Review 59
Ashwaganda - Withania somnifera 133 to 136
Prayojyanga Mooola
Rasa Tikta, Kashaya
Guna Ushna, Snigdha,Laghu
Veerya Ushna
Vipaka Katu
Prabhava Sedative, Hypnotic
Doshagnata Kapha vata shamaka
Rogaghnata Bhrma, Moorcha, Anidra
Chemical consttiuents Somniferen,
Prepared Medicines useful at
Manovaha Srotas
Ashwagandhavalehyam
Pippalimoola - Piper longum 137 to 140
Prayojyanga Moola
Rasa Katu
Guna Laghu, Snigdha, Teekshna
Veerya Sheeta
Vipaka Madhura
Prabhava Rasayana, Yogavahi, srotoshodhaka
Doshagnata Kapha vata shamaka
Rogaghnata Aruchi, Ajeerna, Dourbalya
Chemical consttiuents Piperine, Piplartine, Piperlongumirin, Steroids,
Glycosoids
Prepared Medicines useful at
Manovaha Srotas
Sudarshana choorna
Management of Anidra with Nidra caps – Methods 60
Chapter – 4
Methods
Human is the superior out of all the living creatures has always been trying to find
new things, which will, helpful for his better living, since time immemorial. Now-a-days
many varieties of diseases are coming up, out of which some are challenging to medical
sciences and some affects the health and longevity of human life. One of such symptom and
disease is insomnia, which is a challenge to the physician as well as adversely, affects the
patients in all the sphere of their life. Cause and diagnosis of Insomnia is difficult, because the
kind of sleep patterns and degree of daytime fatigue differs to that of people considering the
indications of insomnia for other people is normal. Ayurveda considers Anidra (Aswapna) is
one out of 80 Nanatmaja Vata Vikaras described by Charaka 141. However its detail
description is not available may be due to low prevalence of the disease in the society at that
time. Now days due to fast mechanical sleep patterns style makes prevalence to increase.
METHOD OF COLLECTION OF DATA
A) Study Design:
A comparative placebo control single blind clinical study
B) Sample:
A minimum of 30 patients with Anidra/Nidranasha are scrutinized with preset
inclusion/ exclusion criteria. Selected patients are distributed randomly and equally in two
groups, viz. Nidra caps and placebo. 15 patients are treated in each group for the stipulated
period.
C) Grouping:
Group A: Control group of 15 patients with placebo
Group B: Trial group of 15 patients with Nidra cap
Management of Anidra with Nidra caps – Methods 61
D) Study duration:
21 days of study with every 7th day drug distribution where patients under went
periodical checkups.
E) Follow up:
21 days after the study period completion with drug withdrawal
F) Exclusive criteria:
1. Nidranasha due to Madatyaya - is excluded because, the intoxication induced
Mada and Nidra are very difficult to differentiate
2. Nidranasha due to Abhighata are excluded because, it is a condition where the
pain dominates to induce sleep disturbances
3. Pregnant women are excluded because - even though the drug composition is
herbal and safe still may be placental barrier and affect the foetus.
4. Lactating mothers are excluded because - even though the drug composition is
herbal and safe still may have effect over food (milk) of infant.
5. Associated with any other systemic and metabolic disorders are excluded
because, they may alter the results of observation
G) Inclusive criteria:
1) Any of below or all are included
a) Patients complaining of reduction in sleep time are included because they are the
prime objective parameters of assessment.
b) Difficulties in initiating sleep are included because they are the prime objective
parameters of assessment.
Management of Anidra with Nidra caps – Methods 62
c) Wakefulness during normal sleep is included because they are the prime objective
parameters of assessment.
2) Along with Nidranasha patients complaining of angamarda, shirogourava, jrumbha, jadya
glani, bhrama and apakti will be included because they are the prime subjective parameters
of assessment.
3) Patients already diagnosed for primary insomnia with the duration of 1 month to 5 years
will be included because, the disease said as kasta sadhya from the Ayurvedic classics
4) Patients those who are in between 18 to 70 years of the age are included
H) Posology:
2 caps of 500mg or 15mg /kg body weight/24 hours, 1 hour before to retiring with
buffalo milk as Anupana. Charka mentioned that the buffalo milk is the best for inducing
sleep, thus the Buffalo milk is selected as Anupana to enhance the effect of the medicament.
I) Examination of an Anidra Patient vis-à-vis Insomnia
For diagnosis, a detailed medical history is taken and physical examination also
undertaken in detail according to Ayurvedic and contemporary clinical methods. Patients are
diagnosed according to diagnostic criteria given for insomnia in DSM – IV 142. A special case
sheet is prepared incorporating all Anidra aspects is placed as annexure.
Patient may be asked to complete a questionnaire to determine wake-sleep pattern and
level of daytime sleepiness. If the problem is grave patient may be suggested to spend a night
at a sleep disorders center for evaluation. A team of people at the center can monitor and
record a variety of body activities during the night, including brain waves, breathing,
heartbeat, eye movements and body movements. But for most people whose main complaint
is insomnia, polysomnography does not provide useful information.
Management of Anidra with Nidra caps – Methods 63
Screening and diagnosis of Anidra patient
Doctor may ask patient many questions about sleep patterns; such as 143–
How long the patient is experienced with symptoms
Whether symptoms occur every night or not
Whether patient snore
How well patient function during the day
Whether patient take any medications
Whether patient have any other health disorders
1) Demographic data
The patient identity is prime in diagnosing the disease as Ayurveda specifies the
Sadhya and Asadhya based on age and relative factors such as desha, Kala etc. thus Name,
Age, Gender, Occupation, Economical status, Birth place and Food habits are recorded in the
demographic data of the case sheet along with the consent signed.
2) Chief complaints and associated complaints
The symptoms of presenting complaints enumerated in the classical textbooks and
contemporary systems are detailed for the studies are noticed with chronological order and
duration is as follows. The chief complaints of the possible are tabulated and rest are added to
the main list in the clinical trial to understand the complaints of an Anidra patient. The listed
complaints and associated complaints are as under -
Management of Anidra with Nidra caps – Methods 64
Chief Complaints
1) Difficulty in initiating sleep –
Difficulty in initiating sleep is a gradual process which changes from person to person.
For proper assessment of the sleep quality and to measure the quantity, the following
gradations are put forth.
Grade 0 = No difficulty in getting sleep after going to bed
Grade 1 = Getting sleep 1hr after going to bed
Grade 2 = Getting sleep 2 hrs after going to bed
Grade 3 = Getting sleep > 3 hrs after going to bed
2) Reduction in sleep time
Since the sleeping state and the waking state are both integral components of a 24 hour
continuum. The quality of the patients waking state is equally relevant. How does the patient
feel upon awakening in the morning? How does the person function during the day? Does the
patient feel tired and / or involuntarily fall asleep during the day? A few patients awaken
refreshed and function perfectly well despite sleeping much less than expected. Except for
brevity their sleeping appears to be normal. These so called short sleepers regularly have a
daily sleep total that is less than 75% of that usually expected for their age. Hence it is
necessary to measure the reduction of sleep time in hours with respect to the patients
complained of Anidra. The units of measurements here are hours and minutes.
3) Wakefulness during sleep
In the proper context sleep disturbance may constitute strong evidence for diagnosis of
uni-polar depression. How patient is sleeping? A frequent response is not good. In what way
Management of Anidra with Nidra caps – Methods 65
the sleep is not good? Commonly the reply is that the patient awakens and has difficulty in
getting back to sleep. The number of awakens are recorded here.
4) Body ache (Angamarda)
Body ache is common symptom of the Anidra patients as they are subjected for
increased muscle tone with enhanced sympathetic activity. Thus the compliant of Angamarda
is observed in the study with the grades of following.
Grade 0 = Getting of body ache never
Grade 1 = Getting of body ache Occasional
Grade 2 = Getting of body ache periodically
Grade 3 = Getting of body ache Always
5) Yawning (Jrumba)
Yawning is the expression of the sleep and lack of sleep, seen in Anidra. It may or
may not be present in all patients. The intensity of the yawning is necessary to measure to
evaluate the sleep patterns. Thus the following grades are inducted.
Grade 0 = Getting of Yawning never
Grade 1 = Getting of Yawning Occasional
Grade 2 = Getting of Yawning Periodically
Grade 3 = Getting of Yawning Always
Associated Complaints
Associated complaints are the symptoms associated with the main complaint or
seldom may lead to Anidra. The listings of the Anidra associated symptoms observed in the
study are put forth here under with explanations.
Management of Anidra with Nidra caps – Methods 66
Tandra (Stupor) is a condition characterized by reduced activity of perception or
helplessly amazed state with dazed where the intense urge for the sleep is noticed. It is caused
by the increase of the Tamas, Vata and Kapha. This is observed as present or absent with
duration.
Klama (Fatigue), Shirogourava (Head Heaviness), Shirasoola (Headache), Akshi
Jadya (heaviness in eyes), Deha Jadya (Body heaviness), Glani, Bhrama (Giddiness), Apakti
(Indigestion) and Aruchi (Anorexia) are associative symptoms of Anidra are commonly seen
in sleeplessness observed as present or absent with duration.
3) History of present illness
At the history of present illness, Mode of onset, Course of Anidra, Frequency of
Anidra, Duration of Anidra, and Preceded by what factors & Change of Regularities are
discussed as listed in the annex-1 (Case sheet).
4) History of sleep
Taking history of the patient with due importance of the bed habits as the questioner is
the technique followed here. The answer obtained from the patient is in the form of yes/no to
rule out the bias in the research. The questioner is of St. Joseph Hospital Sleep Disorders
Center, 1310 West Stewart Drive (Suite 403), Orange, CA 92868, is followed as under 144.
Hearing soft Music before going to bed Yes/ No
Perfume applications before going to bed Yes /No
Having Bath Before going to Bed Yes /No
Massage of feet etc before going to bed Yes /No
Passing Urine before going to bed Yes /No
Passing Stools before going to bed Yes /No
Management of Anidra with Nidra caps – Methods 67
Masturbation before going to bed Yes /No
Prayers before going to bed Yes /No
Reading before going to bed Yes /No
Consuming alcohol before going to bed Yes /No
Sexual Intercourse before going to bed Yes /No
5) Personal history
The personal history is discussed as - Food habits with reference to taste, Taste
preferred, Agni, Kosta, Nidra, Addictions, Bowel habits, Menstrual History, Family history –
Specify if any has the same disease, Treatment history and History of past illness, along with
the vital (BP, PR, RR, t °F) examination.
6) Sleep examination
Patient is examined for the sleep with sleep questionnaires having the following
grades set for the respective answers. The questioner is from St. Joseph Hospital Sleep
Disorders Center, 1310 West Stewart Drive (Suite 403), Orange, CA 92868, is followed as
under.
Examination of sleep (Sleep questionnaires)
As sleep is the basis of our day to day activity to determine the sleep questioner is
inquired from patient to get absolute information of his sleep patterns. The detailed questioner
is shown here under with the marks awarded for each possible answer.
0 = Never,
1=. Slight Chance
2 = Moderate Chance
3 = High Chance
Management of Anidra with Nidra caps – Methods 68
1. Do you wake frequently during the night and feel un-refreshed in the morning?
2. Do you have difficulty staying awake during the day?
3. Do you have diabetes, hypertension or another health problem that affects your sleep?
4. Are you overweight? Do you find it difficult to lose weight?
5. Do you wake up with a dry mouth, sore throat or headache in the morning?
6. Do you have difficulty concentrating during the day?
7. Do you need to take naps during the day?
8. Does your snoring bother you or your spouse enough for you to consider treatment?
9. Doze off or fall asleep in Sitting and reading position
10. Doze off or fall asleep while Watching TV
11. Doze off or fall asleep in sitting inactive in a public place
12. Doze off or fall asleep as a passenger for 1 hour without a break
13. Doze off or fall asleep in Lying down to rest in the afternoon
14. Doze off or fall asleep in Sitting & talking to someone
15. Doze off or fall asleep while sitting quietly after lunch without alcohol
16. Doze off or fall asleep while stopping for a few minutes in traffic
7) Ayurvedic examination
In Ayurvedic examination Dosha Vruddhi, Kshaya lakshanas are examined with
reference to the symptoms affirmed in Ayurvedic texts. The Dasha vidha pareeksha and
Astastana pareeksha were also included to understand the pathogenesis under the lime light of
Ayurvedic pathology. The special emphasis of the Agni is made as the Chikitsa is to regulate
the Agni in Ayurveda.
Management of Anidra with Nidra caps – Methods 69
8) Observation of Pancha Lakshana Nidana
The pancha lakshana Nidana i.e. Nidana, Lakshana along with the Upashaya and
anupashaya are examined according to the classical references as detailed in the annex-1.
Subjective parameters
Apart from the mentioned chief complaints the following are taken as the subjective
parameter described along with the gradations of evaluation is as under.
Vitality after morning awakening
Grade 0 = Awakening with freshness
Grade 1 = Awakening with feeling of UN freshness
Grade 2 = Heaviness over forehead & irritation during work with Family & work
Grade 3 = Disturbing routine work
Performance of daily activities
Grade 0 = No any change
Grade 1 = Slight disturbed
Grade 2 = Moderately disturbed
Grade 3 = Highly disturbed
Objective parameters
The objectivity of the sleep is difficult to establish but as the researchers have
evaluated sleep measurements in mathematical way through a tabulator work sheet shown
below. The objective parameters evaluated are -
1. Total sleep time (hrs)
2. Sleep onset latency (min)
3. Number of awakenings
4. Efficiency of sleep (TST/TTSR * 100)
5. Sleep Fragmental Time (TST/ # Awk)
Management of Anidra with Nidra caps – Methods 70
Sleep worksheet
S.No
Goi
ng to
Bed
Falli
ng
asle
ep
Slee
p La
tenc
y
Slee
p C
ompl
etio
n
Num
ber o
f A
wak
enin
g
Dur
atio
n of
A
wak
enin
gs
TTSR
TST
= TT
SR
– (D
aw +
SL)
1
2
befo
re
3
1
2
Afte
r
3
1
2
Follo
w u
p
3
The above shown work table is used to calculate the objective parameters in the study.
9) Investigations
The following routine investigations are undertaken to estimate the patient general
health condition but has no significance with Anidra.
Haemoglobin %
Differential count
Erythrocytes sedimentation rate
10) Assessment of Result and declaration
Subjective and objective parameters of base line data (subjective and objective
parameters) to the after treatment data comparison are done for the assessment of results.
Management of Anidra with Nidra caps – Methods 71
Result declaration is made upon the cumulative assessment of the parameters used in
the study. Out of Subjective parameters, Difficulty in initiating sleep, Body ache
(Angamarda), Yawning (Jrumba), Vitality after morning awakening and Performance of daily
activities were considered. At the objective parameters Total sleep time (hrs), Sleep onset
latency (min) Number of awakens, Efficiency of sleep (TST/TTSR * 100) and Sleep
Fragmental Time (TST/ # Awk) are considered. The Result is declared as Well Responded,
Moderately Responded, Poorly Responded and Not Responded categories. The discontinued
patients were not considered for the result declaration.
J) Statistical analysis:
The parameters going to be compared are subjective parameters and objective
parameters. The paired T – test is used for the objective parameter assessment and non
parametric tests are used for the testing subjective parameters. If the test hypothesis p value is
< 0.05, the test is highly significant.
Management of Anidra with Nidra caps – Results 72
Chapter – 5
Results
Present study registers 30 patients, out of 42 approached patients. Out of this, 7
patients were discontinued and 5 patients not fulfilled the inclusion criteria hence their data
has not been included in the assessment. The remaining 30 patients of Anidra viz. Insomnia
defined as a psycho-somatic disturbance in an individual due to the presence of an agent to
which patient is reactive. Patients fulfilling the criteria of diagnosis and inclusive criteria were
included in the study, fewer than two groups as discussed in the Methodology, distributed
patients in Group-A are 15 (Placebo) and Group-B (Nidra caps) are 15.
All the patients were examined before and after the trial, according to the case sheet
format given in the annex. Both the subjective and objective criteria were recorded. The data
recorded are presented under the following headings.
A. Demographic data
B. Evaluating disease Data and
C. Result of the Nidra caps in comparison with placebo
D. Statistical assessment
Management of Anidra with Nidra caps – Results 73
E. A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 15 patients in each
group are as follows.
A1) Age & Gender relation
Table- 14
Distribution of Patients by Age- Gender in Group A & B
Group-A (Placebo cap) Group –B (Nidra cap) Total PatientsAge
Mal
e
%
Fem
ale
%
Mal
e
%
Fem
ale
%
Num
ber
%
20-30 3 20 2 13.3 1 6.66 2 13.3 8 26.7
30-40 3 20 1 6.66 0 0 0 0 4 13.3
40-50 1 6.66 1 6.66 2 13.3 3 20 7 23.3
50-60 3 20 1 6.66 2 13.3 2 13.3 8 26.7
60-70 0 0 0 0 3 20 0 0 3 10
Total 10 66.6 5 33.4 8 53.4 7 46.6 30 100
Figure – 3
Distribution of Patients by Age- Gender in Group A & B
00.5
11.5
22.5
3
20-30 30-40 40-50 50-60 60-70
Distribution of Patients by Age- Gender in Group A & B
Group A Maleroup A FemaleGroup B MaleGroup B Female
Management of Anidra with Nidra caps – Results 74
Age relation with the gender is identified here in the above table. The study reveals
that the Anidra is much identified at the ages progressing from the 40 years till to the upper
age limit of the study as 70 years. This is an evidence for the Vata implications with Anidra
induction. Apart from this observation an alarming 26.7% of the youngsters of 20 to 30 years
of age group are in the study with Anidra. This strongly suggests that the present trends of
environmental and social disturbances.
In the Group A (placebo), out of 15 patients, the over all results declared are 1 well
responded, 7 each in Poor responded and not responded. The patient who is well responded is
of 30-40 age group. On the other hand the result in the group –B declared as 4 well responded
And 11 moderately responded. No poor or not responded patients recorded. Out of the well-
responded 4 patients 2 patients are of 50-60 age groups and 1 in 40-50 years of age and 1 in
20-30 age groups.
A2) Gender
The gender distribution in the trial with the result is tabulated as under. This trial
reveals that the distribution of the male community is more. The ratio in the group A is 1:3 of
the female to male and in the group B it is as almost 1:1. The results declared in the group A
(placebo) suggests that the 1 male as well responded and 4 poorly responded. The percentage
of the not responded in the male group are 33.33% i.e. 5 patients. The females has poor
response at the treatment are 3 and not responded as 2. In the group B (Nidra caps) out of 8
males 3 well responded and 5 moderately responded. Out of 7 females 1 well responded and 6
moderately responded. The reasons of obtaining these results are discussed in the next
chapter. The tabular forms and pictorial forms are shown below.
Management of Anidra with Nidra caps – Results 75
Table- 15
Gender wise Results in Group – A (Placebo cap)
Gender
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Male 10 66.6 1 13.3 0 0 4 26.6 5 33.3
Female 5 33.4 0 0 0 0 3 20 2 13.3
Total 15 100 1 13.3 0 0 7 46.6 7 46.6
Figure - 4
Table- 16
Gender wise Results in Group –B (Nidra cap)
Gender
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Male 8 53.4 3 20 5 33.34 0 0 0 0
Female 7 46.6 1 6.66 6 40 0 0 0 0
Total 15 100 4 26.66 11 73.34 0 0 0 0
10
10
45 5
0 0
32
0
2
4
6
8
10
Male Female
Gender wise Results in Group – A (Placebo cap)
Total patients
Well responded
ModeratelyrespondedPoor Responded
Not responded
Management of Anidra with Nidra caps – Results 76
Figure - 5 A3) Religion
Table- 17 Religion wise Results in Group – A (Placebo cap)
Religion
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Hindu 12 80 1 6.66 0 0 5 33.34 6 40
Muslim 2 13.34 0 0 0 0 1 6.66 1 6.66
Christian 0 0 0 0 0 0 0 0 0 0
Others 1 6.66 0 0 0 0 1 6.66 0 0
Total 15 100 1 6.66 0 0 7 46.6 7 46.6
Table- 18 Religion wise Results in Group – B (Nidra cap)
Religion
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Hindu 9 60 4 26.6 5 33.3 0 0 0 0
Muslim 5 33.3 0 0 5 33.3 0 0 0 0
Christian 1 6.66 0 0 1 6.66 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0
Total 15 100 4 26.6 11 73.33 0 0 0 0
8
3
5
0 0
7
1
6
0 0012345678
Male Female
Gender wise Results in Group –B (Nidra cap)
Total patients
Well responded
ModeratelyrespondedPoor Responded
Not responded
Management of Anidra with Nidra caps – Results 77
The religion wise looking at a limited geographical area doesn’t give any specificities
of the condition related exploration. But as a routine the data is collected here and presented
in tabular form for the Group A and B separately with results obtained. The over all
expression of the religion census is represented in the pie diagram.
Figure -6
A4) Occupation Table-19
Occupation wise Results in Group – A (Placebo cap) Occupation
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Sedentary 1 6.66 0 0 0 0 1 6.66 0 0
Active 11 73.3 0 0 0 0 4 26.6 7 46.6
Labor 3 20 1 6.6 0 0 2 13.3 0 0
Total 15 100 1 6.66 0 0 7 46.66 7 46.66
Combined Religion wise Results
Christian , 1 Others , 1Muslim , 7
Hindu, 21
Management of Anidra with Nidra caps – Results 78
Table- 20
Occupation wise Results in Group – B (Nidra cap) Occupation
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Sedentary 1 6.66 0 0 1 6.66 0 0 0 0
Active 12 80 4 16.66 8 53.33 0 0 0 0
Labor 2 13.33 0 0 2 13.33 0 0 0 0
Total 15 100 4 16.66 11 73.33 0 0 0 0
The occupation level of this study refers with three groups’ viz. sedentary, active and
labor. The study reveals that the active group people are prone to get the problem of
sleeplessness i.e. Anidra. In the study 73.3% of group A and 80% of group B are active
workgroup people. The rest are very small in number.
Figure - 7
The sedentary group patient in group A poorly responded and where in group B
moderately responded. The labor group patients in group A poorly responded and in B
1 1
1112
32
0
2
4
6
8
10
12
Sedentary Active Labor
Occupation wise Data of Both Groups
Group AGroup B
Management of Anidra with Nidra caps – Results 79
moderately responded. The effect of the Nidra caps over active group is good as the 4 well
responded and 8 moderately responded are recorded. The graphical representation is as above.
A5) Economical Status Table- 21
Economical status wise Results in Group – A (Placebo cap) Economical
Status
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Poor 4 26.66 1 6.66 0 0 3 20 0 0
Middle 10 66.66 0 0 0 0 4 26.6 6 40 Higher Middle
1 6.66 0 0 0 0 0 0 1 6.66
Higher 0 0 0 0 0 0 0 0 0 0 Total 15 100 1 6.66 0 0 7 46.66 7 46.66
Table- 22 Economical status wise Results in Group – B (Nidra cap)
Economical Status
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Poor 3 20 0 0 3 20 0 0 0 0
Middle 8 53.33 3 20 5 33.33 0 0 0 0 Higher Middle
4 26.66 1 6.66 3 20 0 0 0 0
Higher 0 0 0 0 0 0 0 0 0 0 Total 15 100 4 26.66 11 73.33 0 0 0 0
The class mass to differentiae is difficult in this small study. But certainly a target of
middle class is observed in the study with Anidra. The percentages of the cumulative groups
are expressed here as 18 (60%) patients of middle 7 (23.33%) of poor and 5 (16.66%) of
higher middle are recorded. The tabulations above with graphical representations below are
shown.
Management of Anidra with Nidra caps – Results 80
Figure - 8
A6) Diet Table- 23
Diet wise Results in Group – A (Placebo cap) Diet
Tota
l no
of
patie
nts
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Vegetarian 11 73.33 0 0 0 0 5 33.33 6 40
Mixed
Diet
4 26.6 1 6.66 0 0 2 13.33 1 6.66
Total 15 100 1 6.66 0 0 7 46.66 7 46.66
The food has always influence over the Tridosha and also on mano bhava. The
vegetarian food consumers are supposed to be comfortable always but in the study it is found
that much of the patients are of vegetarians as 11 and 10 patients respectively in group A & B.
on the other hand the mixed diet practitioners are only 4 and 5 in group A & B. well response
43
10
8
1
4
0 00
2
4
6
8
10
Poor Middle HigherMiddle
Higher
Economical status wise Data of Both Groups
Group AGroup B
Management of Anidra with Nidra caps – Results 81
to Nidra caps is found with vegetarians but not with mixed diet practitioners. The summed up
distributions are shown in pie diagram as below along with group B distributions.
Table- 24 Diet wise Results in Group –B (Nidra cap)
Diet To
tal n
o of
pa
tient
s
%
Wel
l re
spon
ded
%
Mod
erat
ely
resp
onde
d
%
Poor
R
espo
nded
%
Not
re
spon
ded
%
Vegetarian 10 66.66 4 26.66 6 40 0 0 0 0
Mixed Diet
5 33.33 0 0 5 33.33 0 0 0 0
Total 15 100 4 26.66 11 73.33 0 0 0 0
Figure - 9
Combined Diet data of Group A & B
Vegetarian , 21
Mixed Diet , 9
Management of Anidra with Nidra caps – Results 82
B) Evaluating disease Data B1) Chief complaints
Table – 25
Showing chief complaints of Anidra
SN Chief complaint Group –A (Placebo)
Group –B (Nidra cap)
Total
Patients
% Patients
% Patients
%
1 Difficulty in initiating sleep
15 100 14 93.33 29 96.66
2 Reduction in sleep time 15 100 14 93.33 29 96.66
3 Wakefulness during sleep 11 73.33 13 86.66 24 80
4 Body ache (Angamarda) 7 46.66 9 60 16 53.33
5 Yawning (Jrumba) 4 26.66 4 6.66 8 26.66
The study includes with the 30 patients in two groups. The prime complaint Difficulty
in initiating sleep and Reduction in sleep time is observed with 96.66% of patients. The
second common presenting complaint is Wakefulness during sleep with 80% of patients
involved. Body ache with 16 (53.33%) patients and yawing with 8 (26.66%) patients are
observed in the study.
B2) Associated Complaints
The trial observes 70% of patients with the shirogourava, Shirasoola and Deha jadya.
Out of 30 patients 66.66% of patients reported withAkshi jadya. The rest of the features of the
associated complaints are minimal and expressed in the tabulation and also in graph below.
Management of Anidra with Nidra caps – Results 83
Table - 26
Showing Associated complaints of Anidra
SN Associated complaint Group –A (Placebo)
Group –B (Nidra cap)
Total
Pts % Pts % Pts % 1 Tandra (Stupor) 3 20 6 40 9 30
2 Klama (Fatigue) 8 53.33 9 60 17 56.66
3 Shirogourava (Head
Heaviness)
12 80 9 60 21 70
4 Shirasoola (Headache) 12 80 9 60 21 70
5 Akshi Jadya (heaviness in
eyes)
11 73.33 9 60 20 66.66
6 Deha Jadya (Body heaviness) 12 80 9 60 21 70
7 Glani 0 0 5 33.33 5 16.66
8 Bhrama (Giddiness) 5 33.33 4 26.66 9 30
9 Apakti (Indigestion) 4 26.66 4 26.66 8 26.66
10 Aruchi (Anorexia) 4 26.66 3 20 7 23.33
Figure 10
Associated compliant in the study
Associated Complaints in the studyAruchi
(Anorexia), 7Apakti (Indigestion), 8
Bhrama (Giddiness), 9
Glani , 5
Deha Jadya (Body
heaviness), 21Akshi Jadya (heaviness in
eyes), 20
Shirasoola (Headache), 21
Shirogourava (Head
Heaviness), 21
Tandra (Stupor), 9 Klama (Fatigue),
17
Management of Anidra with Nidra caps – Results 84
B3) History of Mode of onset
Table -27
Showing Mode of onset in Anidra
SN Group –A (Placebo) Group –B (Nidra
cap)
Total
Mode of onset Patients Number
% Patients Number
% Patients Number
%
1 Sudden 2 13.33 2 13.33 4 13.33
2 Gradual 11 73.34 8 53.33 19 63.33
3 Insidious 2 13.33 5 33.34 7 23.34
Total 15 100 15 100 30 100
The mode of onset observed in the study revels that the Anidra is a gradual in onset for
a population of 63.33% and 7 patients are of insidious. Very few of 4 patients went in to
sudden mode of onset in the study.
B4) History of Anidra course
Table – 28
Showing Anidra course in study
SN Group –A
(Placebo)
Group –B (Nidra
cap)
Total
Course of Anidra
Patients Number
% Patients Number
% Patients Number
%
1 Transient 5 33.34 8 53.34 13 43.34
2 Continuous 10 66.66 7 46.66 17 56.66
Total 15 100 15 100 30 100
Management of Anidra with Nidra caps – Results 85
The course of the Anidra was observed in the study expresses that the continuous
course is for 17 (56.66%) and the rest of patients i.e. 13 (43.33%) are at the transient course of
Anidra.
B5) History of Anidra frequency
Table -29
Showing Anidra frequency in study
SN Group –A (Placebo) Group –B (Nidra
cap)
Total
Frequency of Anidra
Patients Number
% Patients Number
% Patients Number
%
1 Few days 9 60 4 26.66 13 43.34
2 Few weeks 6 40 11 73.34 17 56.66
Total 15 100 15 100 30 100
Anidra frequency is calculated in days and weeks. Few weeks of frequency is shown
by 56.66% of patients and rest 43.34% of the patients show the few days’ frequency. More or
less the distribution is 1:1.
B6) History of Anidra duration
Table -30
Showing Anidra duration in study
SN Group –A (Placebo) Group –B (Nidra
cap)
Total
Duration of Anidra
Patients Number
% Patients Number
% Patients Number
%
1 Continuous 8 53.34 6 40 14 46.66
2 Intermittent 7 46.66 6 40 13 43.34
3 Sleeps with medication
0 0 3 20 3 10
Total 15 100 15 100 30 100
Management of Anidra with Nidra caps – Results 86
The duration of the Anidra makes the results to understand in a better manner. Here in
the study 46.66% of the patients’ exhibit the continuous patterns and 43.33% show
intermittent duration. Very few of 10% patients are reported with medication usage for
achieving sleep.
B7) Anidra preceding factors
Table 31
Showing Anidra preceding factors in study
SN Group –A (Placebo) Group –B (Nidra cap)
Total
Preceding factors
Patients Number
% Patients Number
% Patients Number
%
1 Anxiety 11 73.33 9 60 20 66.66
2 Anger 1 6.66 7 46.66 8 26.66
3 Fear 9 60 4 26.66 13 43.33
4 Restlessness 6 40 4 26.66 10 33.33
5 Pain 4 26.66 7 46.66 11 36.66
Sleep and psychology are hand in hand to give rise sleep. Here an attempt is made to
understand the sleep in relation with psychological factors. To disturb sleep anxiety has major
role i.e. 66.66%. Later to it 43.33% express fear. 36.66% of patients expressed pain either
physical or psychological. In the present study along with the above said psychological
factors Restlessness (33.33%) and anger (26.66%) are associated.
B8) Anidra causes – change of regularities
In the study 56.66% of patients were observed with Anidra due to change of place and
40% with bed. 26.66% of patients expressed that the environmental changes cause Anidra.
Management of Anidra with Nidra caps – Results 87
Table -32
Showing Anidra change of regularities in study
SN Group –A (Placebo)
Group –B (Nidra cap)
Total
Change of regularities
Patients Number
% Patients Number
% Patients Number
%
1 Place 8 53.33 9 60 17 56.66
2 Bed 4 26.66 8 53.33 12 40
3 Environmental 2 13.33 6 40 8 26.66
B9) Nidana of Anidra
Table -33
Showing Anidra Nidana in study
Group –A (Placebo) Group –B (Nidra cap)
Total
Pts % Pts % Pts % Yavanna 0 0 0 0 0 0
Aha
ra
Rookshanna 2 13.33 3 20 5 16.66 Dhooma 0 0 0 0 0 0 Vyayama 0 0 0 0 0 0 Upavasa 0 0 2 13.33 2 6.66 Asukhashayya 2 13.33 0 0 2 6.66 Kshudha 3 20 1 6.66 4 13.33
Vih
ara
Mithuna 0 0 0 0 0 0 Bhaya 11 73.33 10 66.66 21 70 Chinta 13 86.66 11 73.33 24 80 Krodha 6 40 8 53.33 14 46.66 Manastapa 4 26.66 6 40 10 33.33 Vyatha 8 53.33 7 46.66 15 50 M
anas
ika
Harsha 0 0 0 0 0 0 Virechana 0 0 0 0 0 0 Vamana 0 0 0 0 0 0 Shirovirechana 0 0 0 0 0 0 Raktamokshana 0 0 0 0 0 0 Kshaya 0 0 0 0 0 0
Any
a
Abhighata 0 0 0 0 0 0
In the present study manasika Nidana are major factors for Anidra showing
89%patients of chinta, 70% patients of bhaya, 50% patients of vyatha and 46.66% patients of
Management of Anidra with Nidra caps – Results 88
krodha are recorded. Where as aharaja, viharaja & anya nidanas are not that much
contributory.
B10) Nidra (sleep) Examination
The examination of the Anidra patient is a Herculean task. Here the help of questioner
is taken to understand the patient before and after. The sum of the patients in both groups
suggests that inclination to the susceptibility of Anidra has reduced in later study of
questioner. The tabulation is as follows. The group A initially shows the 8 points mean later
reduced to 3.33. The group B mean initially is 7.53 which reduced to the 1.2 at later stage.
The mean difference observed at both groups suggests that the efficiency of the Nidra caps
(Group B) is more than that of group A.
Table – 34
Showing Anidra Nidra (sleep) Examination in study
Group –A (Placebo) Group –B (Nidra cap) Total Questioner Points obtained
Mean Points obtained
Mean Points obtained
Mean
Before 120 8 113 7.53 233 7.76
After 50 3.33 18 1.2 68 2.66
Difference 70 4.66 95 6.33 165 5.55
C) Result of the Nidra caps (Group B) and placebo (Group A)
As it is described in the methods the baseline data to the after trial final data was
compared to get the results of the trial. Here all the parameters are individually compared to
get percentage of the result in terms of individual. The percentages are cumulated and mean
percentage is drawn. Above 75% of cumulative percentage achieved patients are considered
as the well responded in the study. The patients between 50 to 75% recognized as moderately
responded for the study and less than 50 and above 25 percentages are considered as poorly
Management of Anidra with Nidra caps – Results 89
responded. Below 25% of cumulative result patients are pronounced as not responded. The
result cumulated table is shown in Annex.
C1) Results of the Group A (Placebo caps)
The results as discussed in the methods were classified under 4 groups viz. well
responded, moderately responded, poorly responded and not responded. The group A placebo
study doesn’t show any well and moderate response except one patient of well responded in
general. The result is mainly poor responded with 7 patients and 7 patients of not responded.
Thus it is a clear and evidential that the placebo doesn’t induce sleep. The placebo
psychological effect of inducting sleep is mere chance i.e., One in 15 patients of the study.
The detailed tabulation along with pictorial presentation is as follows.
Table 35
Showing Anidra Results of the Group A (Placebo caps) in study
Result Number of patients Percentage
Well Responded` 1 6.66
Moderately Responded 0 0
Poorly responded 7 46.67
Not Responded 7 46.67
Total 15 100
Management of Anidra with Nidra caps – Results 90
Figure - 11
C2) Results of the Group B (Nidra caps)
The results as discussed in the methods were classified under 4 groups viz. well
responded, moderately responded, poorly responded and not responded. The group B Nidra
caps study show well and moderate response only but not of either poor or no response
categories. The result is mainly moderate responded with 11 (73.33%) patients and 4
(26.66%) patients of well responded. Thus it is a clear and evidential that the Nidra caps has
induced sleep. The Nidra caps effect is not only psychological but also has drug effect in
inducting sleep is not mere a chance. The detailed tabulation along with pictorial presentation
is as follows.
Results of Group A (Placebo caps)
Not Responded
46.67%
Moderately Responded
0.00%
Well Responded`
6.67%
Poorly responded
46.67%
Management of Anidra with Nidra caps – Results 91
Table 36
Showing Anidra Results of the Group B (Nidra caps) in study
Result Number of patients Percentage
Well Responded` 4 26.66
Moderately Responded 11 73.34
Poorly responded 0 0
Not Responded 0 0
Total 15 100
Figure - 12
Results of Group B (Nidra caps)Not
Responded0.00%
Moderately Responded
73.33%
Well Responded`
26.67%
Poorly responded
0.00%
Management of Anidra with Nidra caps – Results 92
D) Statistical assessment
Table -37 : Subjective Statistical assessment Group-A Parameter Mean SD SE t value P value Remark Difficulty in initiating sleep
0.733 0.961 0.248 2.955 <0.02 HS
Body ache (Angamarda) 0.266 0.593 0.153 1.7385 >0.05 NS Yawning (Jrumba) 0.2 0.5606 0.144 1.388 >0.05 NS Vitality after morning awkng
0.4 0.736 0.19 2.105 >0.05 NS
Performance of daily activities
0.4 0.736 0.19 2.105 >0.05 NS
Table -38 : Objective Statistical assessment Group-A Parameter Mean SD SE t value P value Remark Total sleep time (hrs) 0.8166 0.893 0.230 3.55 <0.01 HS Sleep onset latency (min)
35.33 40.85 10.54 3.55 <0.01 HS
Number of awakens 0.6 0.92 0.235 2.55 <0.05 HS Efficiency of sleep (TST/TTSR * 100)
10.272 12.18 3.144 3.267 <0.01 HS
Sleep Fragmental Time (TST/ # Awk)
1.495 2.2 0.569 2.67 <0.05 HS
Table -39 : Subjective Statistical assessment Group-B Parameter Mean SD SE t value P value Remark Difficulty in initiating sleep
1.8 0.5606 0.114 12.5 <0.001 HS
Body ache (Angamarda)
1.0 0.654 0.169 5.917 <0.001 HS
Yawning (Jrumba) 1.0 0.534 0.138 7.246 <0.001 HS Vitality after morning awkng
1.266 0.457 0.118 10.728 <0.001 HS
Performance of daily activities
1.2 0.414 0.1069 11.225 <0.001 HS
Table -40 : Objective Statistical assessment Group-B Parameter Mean SD SE t value P value Remark Total sleep time (hrs) 1.833 0.523 0.135 13.577 <0.001 HS Sleep onset latency (min)
90.0 32.07 8.28 10.86 <0.001 HS
Number of awakens 1.866 0.915 0.236 7.906 <0.001 HS Efficiency of sleep (TST/TTSR * 100)
23.46 7.608 1.964 11.94 <0.001 HS
Sleep Fragmental Time (TST/ # Awk)
3.468 1.487 0.384 9.031 <0.001 HS
Management of Anidra with Nidra caps – Results 93
Table -41 Comparative Statistical assessment of Both Groups
Parameter Gr Mean SD SE PSE T value P value Remark
A 1.2 0.9411 0.242 0.274 2.919 <0.01 HS Difficulty in
initiating sleep B 0.4 0.507 0.130
A 0.8 0.774 0.2 0.226 2.65 <0.02 HS Body ache
(Angamarda) B 0.2 0.414 0.106
A 0.933 0.457 0.118 0.171 3.508 <0.02 HS Yawning
(Jrumba) B 0.333 0.487 0.125
A 0.6 0.507 0.1309 0.1588 2.94 <0.01 HS Vitality after
morning awkng B 0.133 0.351 0.090
A 0.6 0.507 0.1309 0.1588 2.94 <0.02 HS Performance of
daily activities B 0.133 0.351 0.090
A 5.9 0.976 0.252 0.401 1.246 >0.05 NS Total sleep time
(hrs) B 6.4 1.213 0.313
A 74.0 40.67 10.501 11.903 2.016 >0.05 NS Sleep onset
latency (min) B 50.0 21.71 5.606
A 1.8 0.861 0.222 0.298 2.013 >0.05 NS Number of
awakens B 1.2 0.774 0.2
A 78.382 11.154 2.88 4.438 0.025 >0.05 NS Efficiency of
sleep
(TST/TTSR *
100)
B 78.494 13.08 3.377
A 3.7433 1.903 0.491 0.662 1.948 >0.05 NS Sleep Fragmental
Time (TST/ #
Awk)
B 5.033 1.723 0.445
Management of Anidra with Nidra caps – Results 94
Table -42 Comparative Statistical assessment of Both Groups in % of comparison
Group –A (Placebo) Group –B (Nidra cap)
Parameter Mean % Mean %
Difficulty in initiating
sleep
1.933 37.92 2.2 81.8
Body ache (Angamarda) 1.066 24.95 1.2 83.33
Yawning (Jrumba) 1.133 17.65 1.333 75.1
Vitality after morning
awakening
1.0 40 1.4 81.92
Performance of daily
activities
1.0 40 1.333 78.44
Total sleep time (hrs) 5.01 17.76 4.566 40.16
Sleep onset latency (min) 110 32.72 140 64.28
Number of awakens 2.4 25.1 3.066 60.86
Efficiency of sleep
(TST/TTSR * 100)
67.44 16.22 55.03 42.638
Sleep Fragmental Time
(TST/ # Awk)
2.248 66.516 1.565 221.59
To compare the effectiveness of drugs in two different groups, here statistical analysis
is done by using un-paired t-test, the conclusion is done as highly significant if P <0.05 by
assuming that the mean effect of two if among subjective parameters all groups is same. The
parameters show High Significant in both the groups. There is High Significant in body ache,
yawning, and performance of daily activities but in the parameter difficulty in initiating sleep
and vitality after morning awakening is less highly significant.
Among the objective parameters all the parameters shows non significant is both the
groups, (i.e. the mean effect of the two groups is not same groups). To know the effectiveness
of drug on individual group the Statistical analysis is done by using paired t test by assuming
Management of Anidra with Nidra caps – Results 95
that drug is not responsible for changes in grading before and after the therapy. The
conclusion is drawn as High Significant if P<0.05. Among the subjective parameters the
Nidra cap group shows High Significant, than the placebo group in all the parameters (by
comparing P values) in the placebo group except the parameter difficulty is initiating sleep all
parameters shows not significant by comparing P value.
Among the objective parameters the Nidra cap group shows High Significant than the
placebo group is all the parameters by comparing the t-values.
The parameter efficiency of sleep is more High Significant in Nidra cap group than
placebo group with more mean effect and less variation, (by comparing t-value, mean and
S.D). The % improvement in subjective parameter in group placebo is 17.65% is yawning and
40% is vitality after morning awakening and performance of daily activities.
In group Nidra, caps less % improvement in yawning (75.1%) and more %
improvement in body ache (83.33%). Among objective parameters is group placebo the least
% improvement is efficiency of sleep (16.22%) and most % improvement is sleep fragmental
time (66.51%)
In the group B the least % improvement in total sleep time (40.16%) and more than
100% improvement in sleep fragmental time.
Management of Anidra with Nidra caps – Discussion 96
Chapter – 6
Discussion
In introduction Barenked Ladies song say –
I won’t sleep . . . . . . . Another sleepless night began . . . .
From birth to death almost half of the lives we spend for sleep. Insomnia became a
major problem now-a-days, by stress, anxiety etc., which play a key role in causing the
Anidra. It is for all religions and economical people who are under the sky. But it is more with
middle class people.
Adequate sleep is critical to good health, yet many adults have sleep related problems
that prevent them from getting adequate sleep. Many Foundations working for sleep disorders
say that at least 1/3rd people of the world suffer from sleep disorders. Additionally,
sleeplessness has been associated with a broad range of complications, including depression,
heart disease, lost productivity and an increased risk of high-way and work related accidents.
In majority of the people, various mental factors causing insomnia cause numerous mental
disorders too. The present study intended to evaluate the Anidra with Nidra cap a rational
combination made from the various Nidra janaka, pravartaka prabhava herbs cited at the
Ayurvedic treasure. The comparison of the test drug Nidra cap is compared with the placebo
to rule out the psychoneural involvement in the study. The discussion is made under the
following heads to facilitate discussion.
I) Discussion on demographic data
II) Discussion on disease aspects
III) Discussion on probable mode of action of Nidra cap
IV) Statistical discussion of parameters
V) Limitations of the study and suggestions
Management of Anidra with Nidra caps – Discussion 97
I) Discussion on demographic data
a) Age relation discussion in Anidra
Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.
sleep often becomes less restful as age progresses. But, a lack of restful sleep is not normal
consequence of aging. With age, people’s bio clock often alters, that means, they get tired
early than normal and seek rest and consequently wakeup early in the morning. It is
physiological; often it results as Anidra with reduction in sleep time and associated
symptoms of Anidra.
Here in the study, out of the 30 patients of Anidra studied exhibits each 26.7%
patients belong to 50 to 60 and 20 to 30 years age group. 50 to 60 age group data denotes
the age stage of Vata. On the contrary the early ages of 20 to 30 years suggests that the
psychological and insecurities of life style mainly related to Rajas which ultimately
influence the Vata. This observation strongly suggests that the present trends of
environmental and social disturbances influences over the causative factors of Anidra and
plays an active role in the pathogenesis of Anidra.
In placebo group one male patient of 32 years responded well, where as all others
show either not responded or poor responded. At the counseling it is reveled that the patient
is unmarried and workaholic not consuming the food at proper time. The patient is at the
early insomnia responded well with placebo up to 70% of symptom variance. In this patient
added stress led to have Anidra with associations of deleterious effect on day time
functioning. Increased efforts to obtain sleep can it self induce sleep with timely
suggestions and placebo. Thus the patient achieved result apart from others in the same
group of study.
Management of Anidra with Nidra caps – Discussion 98
Vata and Manas are interdependently dependent and when one vitiated the other
vitiates excessively. In this disorder Anidra, both of the above are seems to be vitiated.
Consequently, Charaka gave importance to Vata in the management of Anidra. Treating a
psychic disorder is a difficult task. Proper counseling, relaxation techniques applied along
with other oral or methodical managements is considerable in the management of Anidra.
Thus the Manaha Sukham, Manonukula Vishaya etc. of pleasing techniques of mind is
mentioned in sleeplessness, which is indicative of psychic management. Here a treatment
module consisting herbal formulation by name Nidra caps is planned for the study. The
result of the Nidra caps on the ages strata are discussed here under.
b) Gender relation discussion in Anidra
Generally insomnia is seen on higher side in females than males. It is said in texts as
sukrabahulya (Soma) in male and rajo (Agni) bahulya in females is usual physiologically.
Thus the reason behind influence of the drug could be understood as the Agni predominance
in females helps to assimilate the drug faster and safer. In this study maximum number of 60
% male patients and 40% female patients were observed. This observation is at this
geographical area not to be considered as standard due to variances. The result of the Nidra
cap on this part of the study show more inclination over the male community.
c) Religion relation discussion in Anidra
Religion is not a marker of the sleep disturbances. The Anidra at communal riots are
may be claimed to insecurity, but the area of study is free of any disturbances the religion
relation is not existing. Thus the Maximum patients of 70% Hindus are recorded in Hindu
dominated area of the study.
Management of Anidra with Nidra caps – Discussion 99
d) Economic Status relation discussion in Anidra
Economics of a person influence health. The insufficiency of money makes insecurity
and leads ultimately to Anidra. Here in the study middle class people are found more. The
results as already told that the placebo doesn’t have any better effect and Nidra caps exhibited
its excellence.
e) Occupation relation discussion in Anidra
Occupation has a good role in the induction of sleep naturally. People who are well
tired gets sleep well. Even the same is observed with the mentally active too. But when it
crosses the threshold level the same induce the Anidra. Thus the study has a many either
mentally tired or physically people as 23 patients out of 30. Businessmen, labor or service
persons suffer from excessive mental tension and worry, which may lead to Anidra. The
Nidra cap result implication over these exhibited 80% success. The reason behind could be
that Nidra cap is Vata and Rajodosha pacifier to release the neuron chemical action at the time
of either stress or strain.
f) Diet Pattern relation discussion in Anidra
In the Ahara Nidana and of people food consumption methods as observed that the
vegetarian food takers are usually less unctuous and non vegetarians with more unctuous food
intake. The former makes the Vata vitiation and the later to Kapha. Even though Kapha
involvement is not justified at the installation of Anidra, the other factors suggesting
influential over the Vata is a marker here. The Vata and Kapha predominant food takers are
not away from the involvement of Rajas, thus the Maximum 70% patients of Niramisha
(vegetarian) food are observed with Anidra along with 30% patients Samisha. The result of
Nidra cap has nodding effect over the Niramisha takers with 66%.
Management of Anidra with Nidra caps – Discussion 100
II) Discussion on disease aspects
Anger and intolerance are the twin enemies of correct understanding – Mahatma
Gandhi; with increasing industrialization and a faster pace of life developing countries like
India are also following the pattern set by western nations. A stressful life style resulting from
day to day problems of finance, education, family and inter personal relationships; as also the
demands of work, travel, insecurity of job and business; and an urge to exceed and
accomplish more than what already a person possess. All these lead to a degree of stress,
which results in slow but progressive damage to the sleep pattern.
Mans best escape from the stress of life is provided by sleep and rest, recuperation
which it affords. Sleep occupies 1/3 of our lives and turns out to involve the basic biological
states of the brain and body. But sleep and getting enough of it is not a simple problem.
Insomnia is the most common of sleep related symptoms.
Chief Complaints:
All the patients (100%) have complained of sleeplessness, followed by 96.66%
patients having Difficulty in initiating sleep and Reduction in sleep time. Out of 80% were
having Wakefulness during sleep as complaint. As sleeplessness (Anidra) is due to vitiation
of Vata and Rajo Dosha – sleeplessness/ disturbed sleep might be seen due to their Chala
and Pravartaka Guna respectively.
Associated Complaints:
These associated complaints are due to Vata, Pitta and Rajo guna. Though some of
the symptoms like Akshi Gaurava, Shiro Gaurava etc. are seen as in Kapha Prakopa, even in
Nidranasha also they are witnessed, is due to Vata alone. It is observed that the Anidra
Management of Anidra with Nidra caps – Discussion 101
symptoms they are included with angamarda, shirogourava, jrumba, jadyata, glani, bhrama,
apakti, tandra and other Vata rogas, which may fall under different areas.
We have seen that proper sleep does have moderate physiological effects on the
peripheral body, for instance during wakefulness, there is enhanced sympathetic activity and
hence increases the muscle tone, conversely, during slow wave sleep sympathetic activity
decreases while parasympathetic activity increases. Therefore a restful sleep ensues fall in
blood pressure, respiratory rate and pulse rate and skin vessels dilate, activity of GIT
sometimes increases, muscles fall into a mainly relaxed state, and the over all basal metabolic
rate of the body falls by 10 to 30%.
On the other hand, lack of sleep certainly does affect the functions of the central
nervous system. Prolonged wakefulness is often associated with progressive malfunction of
the mind causing the above said symptoms. It is not necessary to have all symptoms in Anidra
patient, sometimes without these symptoms only there is disturbed sleep or sleeplessness.
Nidana observed at trial
A sound mind in a sound body has been recognized as a social ideal for many
centuries. In present study both the physical and psychological etiology are noticed. Majority
of patients are having the psychological implications are declared at results are of 89% of
Chinta, 70% of Bhaya, 50% of Vyatha, 46.66% of the Krodha.
Stress
Concerns about work, school, health or family can keep many patients mind too
active, making them unable to relax. Excessive boredom, such as after retirement or
during a long illness, may occur and also can create stress and keep patient awake.
Management of Anidra with Nidra caps – Discussion 102
Anxiety
Everyday anxieties as well as severe anxiety disorders may keep patients mind too
alert to fall asleep.
Depression
Patients may either sleep too much or have trouble sleeping if they're depressed. This
may be due to chemical imbalances in their brain or because worries that accompany
depression may keep them from relaxing enough to fall asleep.
Stimulants
Prescription drugs, including some antidepressants, high blood pressure and
corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC)
medications, including some pain medication combinations, decongestants and
weight-loss products, contain caffeine and other stimulants. Antihistamines may
initially make the patients groggy, but they can worsen urinary problems, causing
them to get up more during the night.
Change in their environment or work schedule
Travel or working a late or early shift can disrupt patients’ body's circadian rhythms,
making them unable to get to sleep when they want to. The word "circadian" comes
from two Latin words: "circa" for "about" and "dia" for "day." Their circadian
rhythms act as internal clocks, guiding such things as there wake-sleep cycle,
metabolism and body temperature.
Behavioral insomnia
This may occur when patients worry excessively about not being able to sleep well
and try too hard to fall asleep. Most people with this condition sleep better when
Management of Anidra with Nidra caps – Discussion 103
they're away from their usual sleep environment or when they don't try to sleep, such
as when they're watching TV or reading.
Eating too much too late in the evening
Having a light snack before bedtime is OK, but eating too much may cause patients
to feel physically uncomfortable while lying down, making it difficult to get to sleep.
Many people also experience heartburn, a backflow of acid and food from the
stomach to the esophagus after eating. This uncomfortable feeling may keep them
awake.
A change in activity
Patients may be less physically or socially active. Activity helps promote a good
night's sleep. Some patients may also have more free time and, because of this, drink
more caffeine or alcohol or take a daily nap. These things can also interfere with
sleep at night.
A change in health
The chronic pain of conditions such as arthritis or back problems as well as
depression, anxiety and stress can interfere with sleep. Older men often develop
noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which
can cause the need to urinate frequently, interrupting sleep. In women, hot flashes
that accompany menopause can be equally disruptive.
Ayurveda lays down the hypothesis that physical life depends largely on the psychic
life. The development of all the limbs of human body merely follow the mind which under the
control of Vata. Charaka say’s that “Sarvaangnaam hi asya hrudayam moolam” (Ch.Sa 6/30).
Management of Anidra with Nidra caps – Discussion 104
Hrudayam means here the mind. The importance of the mind is brought forward to make
limbs to rest physically at sleep. Sleep occurs during the sensory and motor faculties are
fatigued by day work. The fatigue faculties become sluggish in their work and will lose their
objects and the functions of the mind also blocked by the increase of Tamas. Mind gets
detached from the faculties and its action of engaging the faculties ceases. When there is over
indulgence of engaging of Manas it will not cease causing Anidra.
Now to discuss how Vata and Tamas are involved in causing Anidra. Jean Martin
Charcot says that – disease is very old and nothing about it has changed, it is we who change,
as we learn to recognize what was formerly imperceptible. There are many theories are
explained to understand the induction of sleep which are mentioned in the earlier while
explaining the contemporary concepts. By observing all these the conclusion can be drawn
that, there are some centers in the brain which are responsible for causing induction of sleep.
The theories are going on changing as the science and technologies advances. There is
no end for the science which is like flowing river stagnant water goes and new water comes.
Here, I tried my level best to record all the up date knowledge in my dissertation. According
to Ayurveda Vata vriddhi is the main cause for the Anidra, after proper analyzing we see that
mastishka and vatavahasrotases (brain and nervous system) are the important seats of Vata in
respect to its two functions viz., gati and gandhana i.e., motor and sensory functions.
Even though the mastishka is the main seat of Vata, to execute the two main functions
viz., gati and gandhana, the Vata has to move through the vatavaha srotasses to reach the
target organs throughout the body. These vatavaha srotases can be divided into two varieties
according to the function viz. 1) Chestravaha srotases – to conduct motor function and 2)
Sanjnavaha srotases – to conduct sensory function.
Management of Anidra with Nidra caps – Discussion 105
Manas, is sarvendriyapara, therefore both two varieties of srotases relay in the Manas.
So Manas is stated as ubhayatmaka. While describing the Anidra Samprapti, we have seen
that both daihika and manasika nidanas leads to Vata vriddhi and tama kshaya i.e., kshaya of
Kapha and tama avarana to the chetana hrudaya/sanjnavaha srotas. Vatavriddhi indicates the
involvement of mashtishka. Even the modern theories say the involvement of sleep centers at
brain.
When we go through Sensory functions of Vata as Vata stimulates all sensations. The
information about the artha from sense organ is carried to the Manas and Buddhi (cortical
centers) for nischayatmikajnana. The receptive impression of the artha on the sense organs is
transformed into the nerve impulse in the organ and carried through the sanjnavaha srotas via
the manas to the indriya Buddhi (receptive cortical centers).
In Charaka Samhita for induction of sleep it is said that when the mind gets exhausted
or becomes inactive, the sensory and motor organs become inactive then the individual gets
sleep. When Vata gets increased the above told phenomena will not takes place leading to
Anidra.
Somnus Rasayana
Previously it was believed that reticular activating system (RAS) located in upper
brain stem is the main area responsible for sleep. When the person remains active the area
within RAS remains excited and long continued excitation produces fatigability in that area,
when the RAS becomes fatigued, at the same time it becomes inactive and sleep manifests.
But it has been proved that an active inhibitory process causes sleep and stimulation of some
specific areas of brain can produce sleep with characteristics near to those of natural sleep.
These areas are -
Management of Anidra with Nidra caps – Discussion 106
a) Raphe nucleus in the lower half of the pons and medulla
b) Nucleus of tractus solitorious
c) Rastral part of hypothalamus and
d) An area in the diffuse neclei of thalamus.
Among the neurohormonal substances, serotonin plays an important role in the
mechanism of sleep and catecholamines are considered to be responsible for wakefulness. The
blood concentration of serotonin becomes lower during sleep than awakefullness cholinergic
neurotrasmitters also play an important role in REM sleep generation. A variety of sleeps
promoting substances have been identified. They are prostaglandin D2 delta sleep inducing
peptide, maramyl dipeptide interleukin -1, fatty and primary amides and melatonin. The
peptide increases the REM sleep, the prostaglandin D2 and interlukin -1 acts immunologically
to induce sleep. This fact suggests a link between immune function and sleep wake state.
Evaluation of Tamas in terms of RATR
The ancient Greeks endorsed the sleep to God Hypnos (sleep), the child of darkness
and night and the brother of death, whose power as he swept across humanity was so great
that even the gods succumbed to him. Even in our mythology we found the “Nidra Devata” as
sister of “Yama” who is simulating the death.
As we understand, the Sleep is a periodic functional state of man and higher animals,
characterized by specific changes in vegetative and motor systems by the absence of
purposeful activity and sensory interaction with the environment and the Sleep is
characterized by the inhibition of conscious mental activity.
Satva, Rajas and Tamas are the three major or universal attributes that pervade the
universe. Onset of sleep is related to the increases of Tamas always. These said principles
Management of Anidra with Nidra caps – Discussion 107
affect inertia on general. Sleep usually occurs at night as the surroundings are dark and are
predominated by Tamas. This dark environment naturally increases the Tamas in human
beings according to the theory of generality.
Sleep is a physiologic state of relative unconsciousness and inaction of the voluntary
muscles, the need for which recurs periodically. The stages of sleep have been variously
defined in terms of depth (light, deep), EEG characteristics (delta waves, synchronization),
physiological characteristics (REM, NREM), and presumed anatomical level (pontine,
mesencephalic, rhombencephalic, Rolandic, etc.).
Here, tamo-abhava is reticular activity transmission and tamobhava is RATR. We see
that, the satvika purusha with less tamas, who wants achievement in life, thinks that “If I
sleep, the world will move front, leaving me behind”. But dear, friends to maintain both
physical and mental health sleep in time for required period.
III) Discussion on probable mode of action of Nidra cap
For extreme diseases, extreme staidness of treatment is most efficacious. A normal
person spends approximately 1/3 of his life in sleep. Adequate sleep is a necessity of life. A
significant number of individuals complain of lack of sleep, insomnia; and the use of
hypnotics and sedatives is therefore, on the increase often indiscriminately as evidenced by
the availability of large number of such preparations in the market and the high incidence of
addiction and acute poisoning due to hypnotic drugs.
To discuss about Chikitsa, as Anidra is a pscycosomatic disease, the ubhayatmaka
Chikitsa i.e., which acts over both mind and body such a medicament has to be involved. Both
abhyantara and bahya Chikitsa and the manasika upacharas play an important role.
Management of Anidra with Nidra caps – Discussion 108
Here the drugs the Jatamamsi having bhutaghna prabhava (manasadoshahara) and
nidrajanana quality, Tagara which is vtahara and mastishkashamaka. Ashwagandha, a tonic
or adaptogen is also mastishkashamaka and acts as Rasayana. Compound known as
withanolides are believed to account for the multiple medicinal applications, stimulates the
immune system and also been shown to inhibit inflammation and to improve memory.
Pippalimoola is a Vata hara and deepaniya. Thus the four rational drugs made combination
(Nidra cap) is able to subside the symptoms of Anidra and induces the good sleep.
IV) Statistical discussion of parameters
The parameters show High Significance in both the groups. Among the subjective
parameters the Nidra cap group shows more High Significance than the placebo group.
Among the objective parameters the Nidra cap group shows High Significance than the
placebo group in all the parameters by comparing the t-values. The parameter efficiency of
sleep is High Significant in Nidra cap group than placebo group with more mean effect and
less variation, by comparing t-value, mean and S.D.
V) Limitations of the study and suggestions
The polysomography studies are not with in reach.
The study sample is minimal.
Ayurvedic herbal alkaloid extractions require Animal experiments for sleep patterns
This combination has to evaluate in different combinations and permutations for
isolating the active herb of sleep induction
The same combination may be tried over a large sample.
Management of Anidra with Nidra caps – Conclusion 109
Chapter – 7
Conclusion
On the basis of the study “Management of Anidra with Nidra caps - a placebo
comparative study”, the conclusions can be drawn as follows:
I won’t sleep . . . . . . . Another sleepless night began . . . .
Nidra is an essential phenomenon for maintenance and restoration of the life, which is
considered under Trayopastambha. Adequate sleep is critical to good health, yet many adults
have sleep related problems that prevent them from getting adequate sleep. Many Foundations
working for sleep disorders say that at least 1/3rd people of the world suffer from sleep
disorders. Insomnia is the most common of sleep related symptoms.
Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.
sleep often becomes less restful as age progresses. But, a lack of restful sleep is not normal
consequence of aging. It is physiological; often it results as Anidra with reduction in sleep
time and associated symptoms of Anidra. Some simple changes in your daily routine and
habits may result in better sleep.
How much sleep is enough varies from person to person. Although 7 1/2 hours of
sleep is about average, some people do well on four to five hours of sleep. Other people need
nine to 10 hours of sleep each night. Nearly everyone has occasional sleepless nights, perhaps
due to stress, heartburn, or drinking too much caffeine or alcohol.
Patients may either sleep too much or have trouble sleeping if they're depressed.
Prescription drugs, including some antidepressants, high blood pressure and corticosteroid
medications, can interfere with sleep. Most people with this condition sleep better when
Management of Anidra with Nidra caps – Conclusion 110
they're away from their usual sleep environment or when they don't try to sleep, such as
when they're watching TV or reading.
Activity helps to promote a good night's sleep. Sleep occurs during the sensory and
motor faculties are fatigued by day work. Even the modern theories say the involvement of
sleep centers at brain. Proper sleep provides balance of the body constituents, alertness, good
vision, good complexion, fired digestive power as well as happiness, vigor, virility, nutrition
and long life. According to modern science, sleep is said to nourish and repair the damages to
the tissues caused by various catabolic activities of the body.
When we go through Sensory functions of Vata as Vata stimulates all sensations. The
blood concentration of serotonin becomes lower during sleep than wakefulness’ cholinergic
neuron-transmitters also play an important role in REM sleep generation. A variety of sleep
promoting substances has been identified. The peptide increases the REM sleep, the
prostaglandin D2 and interlukin -1 acts immunologically to induce sleep. This fact suggests a
link between immune function and sleep wake state.
Insomnia can affect not only patients’ energy level and mood, but also patient’s health
as well because sleep helps bolster patient’s immune system. Fatigue, at any age, leads to
diminished mental alertness and concentration.
Here in the study, out of the 30 patients of Anidra studied exhibits each 26.7%
patients belong to 50 to 60 and 20 to 30 years age group. 50 to 60 age group data denotes
the age stage of Vata. Increased efforts to obtain sleep can it self induce sleep with timely
suggestions and placebo. Consequently, Charaka gave importance to Vata in the
management of Anidra. Religion is not a marker of the sleep disturbances. Occupation has a
good role in the induction of sleep naturally. People who are well tired gets sleep well. The
Management of Anidra with Nidra caps – Conclusion 111
Nidra cap result implication over these exhibited 80% success. Vata and Rajasa play a key
role in the pathogenesis of Anidra. Manasika Nidanas as well as Psychic stress are the main
causative factors of the disease.
All the patients (100%) have complained of sleeplessness, followed by 96.66%
patients having Difficulty in initiating sleep and Reduction in sleep time. Out of 80% were
having Wakefulness during sleep as complaint. It is not necessary to have all associated
symptoms in Anidra patient, sometimes without these symptoms only there is disturbed
sleep or sleeplessness.
Study observes that the administration of Ayurvedic herbal formulation containing
the drugs having tranquilo-sedative and muscle relaxant effects provided added beneficial
results to get good sleep.
Onset of sleep is related to the increases of Tamas always. A normal person spends
approximately 1/3 of his life in sleep. Adequate sleep is a necessity of life. Among the
subjective parameters the Nidra cap group shows High Significance than the placebo group.
Management of Anidra with Nidra caps – Summary 112
Chapter – 8
Summary
The present study is entitled “Management of Anidra with Nidra caps - a placebo
comparative study” is summarized as under.
Who needs sleep?” every body! I won’t sleep is a complaint of many patients at
clinics. Adequate sleep is a necessity of life. Sound restorative sleep is the foundation of a
healthy life among three sub-pillars diet, sleep and celibacy. According Ayurveda sleep is
induced by the increase of the inert universal attribute called Tamas. Sleep is characterized by
the inhibition of conscious mental activity. Onset of sleep is related to the increase of Tamas
and Kapha. This stage is called sleep, even in sleep mind maintains its connection with the
soul. Achara Rasayana gives rise regularized sound sleep and vice versa the regularized sleep
patterns induce Rasayana effect.
Naturally the night is described as a proper time for sleep. During sleep most bodily
functions are reduced their basal levels. Sleep does have moderate physiological effects on the
peripheral body. Gastric secretion is increased or little altered during sleep. Many disorders
are associated with abnormal patterns of sleep. Sleep depends upon the utilization of oxygen.
Theories state that there is a sleep center in the hypothalamus, the stimulation of which is
responsible for sleep. According to Howell, sleep is due to cerebral ischemia. NREM sleep is
a peaceful state relative to waking state. In NREM type of sleep the brain waves are very
slow, so it is also called slow-wave sleep. Most sleep during each night is of slow-wave
variety and it is deep, restful type of sleep. Deep sleep is dreamless, dreams occur only during
light sleep and chiefly in the period, which just precede waking. The consumption of oxygen
is lowest during slow wave sleep. It has been postulated that slow wave sleep being more
Management of Anidra with Nidra caps – Summary 113
important for macromolecular synthesis and REM sleep for removing the synthetic products
of slow wave sleep to maintain synaptic connections which is necessary to maintain cognitive
function. Conversely, during slow-wave sleep, sympathetic activity decreases while
parasympathetic activity increases. Probably the most distinctive feature of REM sleep is
dreaming. The depth of sleep is not constant throughout the sleeping period, but varies from
hour to hour.
Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.
sleep often becomes less restful as age progresses. Although 7 1/2 hours of sleep is about
average, some people do well on four to five hours of sleep. Patients may either sleep too
much or have trouble sleeping if they're depressed. Activity helps to promote a good night's
sleep. The peptide increases the REM sleep, the prostaglandin D2 and interlukin -1 acts
immunologically to induce sleep.
Any derangement of above can cause Anidra. Present study Anidra compared to
insomnia is difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening
with difficulty resuming sleep or un-refreshing sleep. The study is incomplete if a
comparative clinical Trial of sleep inductive effect of the Nidra caps (trial drug) internally to
pacify the Dosha in Anidra and placebo to overcome the psychosomatic origin of the disease
Anidra is not compared. Anidra means less or no sleep.
All the patients (100%) have complained of sleeplessness, followed by 96.66%
patients having Difficulty in initiating sleep and Reduction in sleep time.
The results in group A placebo study doesn’t show any well and moderate response
except one patient of well responded in general. The result is mainly poor responded with 7
(46.66%) patients and 7 (46.66%) patients of not responded. Increased efforts to obtain sleep
Management of Anidra with Nidra caps – Summary 114
can it self induce sleep with timely suggestions and placebo. Thus it is a clear and evidential
that the placebo doesn’t induce sleep. The placebo psychological effect of inducting sleep is
mere chance i.e., One in 15 patients of the study.
The group B Nidra caps study results are well and moderate response only but not of
either poor or no response categories. The result is mainly moderate responded with 11
(73.33%) patients and 4 (26.66%) patients of well responded. Thus it is a clear and evidential
that the Nidra caps has induced sleep. The Nidra caps effect is not only psychological but also
has drug effect in inducting sleep is not mere a chance.
To compare the effectiveness of drugs in two different groups, with statistical analysis
is highly significant as P value <0.05. In the placebo group except the parameter difficulty is
initiating sleep all parameters are not significant. The parameter efficiency of sleep is highly
significant in Nidra cap group than placebo group with more mean effect and less variation.
All subjective parameters of the Nidra cap group shows high significance than the placebo
group in all the parameters. All objective parameters of Nidra cap group show highly
significance than the placebo group in all the parameters by comparing the t-values.
Management of Anidra with Nidra caps – Bibliographic References i
Bibliographic References
1) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 11/35, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 160
2) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/68, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 235
3) Kashinatha Sastri ed, Charaka Samhita, vol-1, Nidana 6/9, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 652
4) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 234
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sig=QaxNvyEgrDQMVssbgb 7) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 399 8) Vaidya Baghel MS, Researches in Ayurveda, 2005, Mridu Ayurvedic Publication and
Sales, Jamnagar, pp 117, 20, 46, 43 9) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-64 10) Ibid, pp 31 11) Ibid pp 763 12) Ibid, pp 275 13) Kashinatha Sastri ed, Charaka Samhita, vol-1, Nidana 8/23, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 541 14) Ibid, Sutra, 11/35, pp 160 15) Ibid, 21/36, pp 283 16) Satyapal Bhishagacharya, Kashyapa Samhita Khila, 5/7, 2nd ed. 1976, Choukhambha
Sanskrit Samsthan, Varanasi, pp 256 17) Bhanoji Dikshit ed, Amarakosha, 1/7/36, 1st ed. Reprint, 2006, Choukhambha Sanskrit
Samsthan, Varanasi, pp 110 18) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003,
Choukhambha Sanskrit Samsthan, Varanasi, pp 40 19) Srirama Sharma ed, 108 Upanishad, jnanakhanda, Mandukyopanishat, 5, 4th ed.
2005, Parimala Publication, New Delhi, pp 362 20) Ibid, Chandyogyopanishad, 8/6/3, pp 188 21) Srikantha Murthy KR ed, Susruta Samhita, vol -1, shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 22) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/35, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283 23) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 24) Yadavji Trikamji Acharya ed, Susruta Samhita, Dalhana Nibandha Sangraha, Sutra,
1/25, 4th ed, 1980, Chaukhambha Orientalia, Varanasi, pp 7
Management of Anidra with Nidra caps – Bibliographic References ii
25) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/39, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 197
26) Srikanta Murthy KR ed, Sharangadhara Samhita, Poorva, 6/24, 1st ed. 1984, Chaukhambha Orientalia, Varanasi, pp-30
27) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 6/24, 3rd ed. 1983, Chaukhambha Orientalia, Varanasi, pp-74-75
28) Srirama Sharma ed, 108 Upanishad, jnanakhanda, Chandyogyopanishad, 6/8/1, 7th ed. Parimala Publication, New Delhi, pp 162
29) Ibid, Bruhadaranyakopanishad, 2/1/17, pp 268 30) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003,
Choukhambha Sanskrit Samsthan, Varanasi, pp 40 31) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34-5, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 32) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/65 3rd ed. 1996, Chaukhambha
Krishnadas Academy, Varanasi, pp-121 33) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/36, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283 34) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 35) Ibid, pp 63 36) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68 37) Arthur C gyton & John E Hall, Medical Physiology, 10th ed. 2001, Harcourt Asia PTE
Ltd, Singapore, pp 690 38) Ibid, pp 690 39) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/58, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 287 40) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/58, 1st ed. Reprint, 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp 119
41) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/37, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 284
42) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 63
43) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/68, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 201
44) Harishastri Paradkar ed, astanga Hrudayam, Sutra, 7/54, 7th ed, 1982, Choukhambha Orientalia, Varanasi, pp 141
45) Kashinatha Sastri ed, Charaka Samhita, vol-1, Vimana 6/11, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 602
46) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 63
47) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930 Baghel), pp 35
Management of Anidra with Nidra caps – Bibliographic References iii
48) Satyanarayana Sastri, Charaka Samhita, Part II, Chikitsa 1-4/32, 1st ed. Reprint, 2001, Chaukhambha Bharati Academy, Varanasi, pp- 58
49) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 19/37, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 370
50) AS Fauci, Harison principles of internal medicine, Vol-1, 14th ed. 1998 India: Mcgraw Hill co, Singapore, pp 151
51) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930 Baghel), pp 33
52) Ibid, pp 34 53) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/57, 1st ed. Reprint 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp 119
54) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 63
55) Gopala Sastri Nene ed, Manusmruti, 1/65, 7th ed. 2003, Chaukhambha Sanskrit Samsthan, Varanasi, pp 21-22
56) Indradev Tripathi & Dayashankar tripathi ed, Yoga Ratnakara, Poorva, Nitya Pravrutti Parkaran, 259, 1st ed. 1998, Krishnadas Academy, Varanasi, pp-66
57) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 7/112, 3rd ed. 1983, Chaukhambha Orientalia, Varanasi, pp-103
58) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/36, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283
59) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 234
60) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd, New Delhi, pp737
61) Arthur C gyton & John E Hall, Medical Physiology, 10th ed. 2001, Harcourt Asia PTE Ltd, Singapore, pp 689
62) Ibid, pp 693 63) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/35, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283 64) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68 65) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 66) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68 67) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain
Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930 Baghel), pp 29
68) Ibid, pp 30 69) Satyanarayana Sastri, Charaka Samhita, Part II, 1st ed. Reprint 2001, Chikitsa
15/241, 2001, Chaukhambha Bharati Academy, Varanasi, pp- 485 70) AS Fauci, Harison principles of internal medicine, Vol-1, 14th ed. 1998 India:
Mcgraw Hill co, Singapore, pp 151
Management of Anidra with Nidra caps – Bibliographic References iv
71) Indradev Tripathi & Dayashankar tripathi ed, Yoga Ratnakara, Poorva, Nitya Pravrutti Parkaran, 191, 1st ed. 1998, Krishnadas Academy, Varanasi, pp-61
72) Brahma Sankara Misra ed, Bhavaprakasha, Poorva khanda, 5/315, 5th ed, 1969, Chaukshambha Sanskrit series office, Varanasi, pp-146
73) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 234
74) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/36, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 418
75) Ibid, pp 416 76) Ibid, 20/11, pp 399 77) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63 78) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/39, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 197 79) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/65 3rd ed. 1996, Chaukhambha
Krishnadas Academy, Varanasi, pp-121 80) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 7/112, 3rd ed.
1983, Chaukhambha Orientalia, Varanasi, pp-103 81) Raja Radhakanta dev Bahadur, Shabdakalpadruma, vol-1, 3rd ed, 1967,
Chaukhambha Sanskrit series, Varanasi, pp-1 82) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary
insomnia, 2000, GAMC, Mysore, pp 11 83) Monier Williams, Sanskrit English dictionary, 1st ed reprint, 1993, Oxford university
press, Delhi, pp-95 84) Ibid, pp 417 85) Ibid, pp 60 86) Ibid, pp 327 87) Ibid, pp 744 88) Ibid, pp 407 89) Ibid, pp 769 90) Ibid, pp 957 91) Ibid, pp 532 92) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737 93) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/55-57, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 421 94) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/57, 1st ed. Reprint 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp 119
95) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/57, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 421
96) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/42, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 65
97) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/324, 5th ed, 1988, Chaukshambha Sanskrit sansthan, Varanasi, pp-74
Management of Anidra with Nidra caps – Bibliographic References v
98) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/53-54, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 199
99) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/42, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 65
100) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 7/23, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 157
101) Srikantha Murthy KR ed, Susruta Samhita, vol -3, Uttara 55/17, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 364
102) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/56, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 200
103) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/64 3rd ed. 1996, Chaukhambha Krishnadas Academy, Varanasi, pp-121
104) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 399
105) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003, Choukhambha Sanskrit Samsthan, Varanasi, pp 40
106) K. R Shrikanta Murthy ed, Sharangdhara samhita, 7/112-119, 1st ed, Chaukambha Orientalia ,Varanasi, 1984, pp 40-1
107) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/59, Vidyotini Hindi commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 422-3
108) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005, Choukhambha Orientalia, Varanasi, pp 234
109) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/56, 1st ed. Reprint 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 200
110) Brahma Shankar Mishra ed, Bhaisajya Ratnavali, 15/162-66, 18th ed, 2005, Chaukhambha Sanskrit Bhavan, Varanasi, pp-455
111) Ayurvedic formulary of India, part-1, 1st ed. 1978, 18/21, Govt. of India, controller of publications Delhi, pp 193
112) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary insomnia, 2000, GAMC, Mysore, pp 28
113) Ayurvedic formulary of India, part-1, 1st ed. 1978, 819, Govt. of India, controller of publications Delhi, pp 107
114) Ramavalamba Sastri, Harita Samhita, Truteeya, 15/5, 1st ed, 1985, Prachya Prakashan, Varanasi, pp 297-8
115) Ibid, 15/6, pp297-8 116) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary
insomnia, 2000, GAMC, Mysore, pp 28 117) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/325, 5th ed, 1988,
Chaukshambha Sanskrit sansthan, Varanasi, pp-74 118) Brahma Shankar Mishra ed, Bhaisajya Ratnavali, 21/9, 18th ed, 2005, Chaukhambha
Sanskrit Bhavan, Varanasi, pp-498 119) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/327, 5th ed, 1988,
Chaukshambha Sanskrit sansthan, Varanasi, pp-74 120) Ramavalamba Sastri, Harita Samhita, Truteeya, 15/4, 1st ed, 1985, Prachya
Prakashan, Varanasi, pp 297-8
Management of Anidra with Nidra caps – Bibliographic References vi
121) Tiwari PV ed, Kashyapa Samhita Khila, 4/30-31, 1st ed. Reprint 2002, Chaukhambha Vishwa Bharati, Varanasi, pp-472
122) Ibid, 4/56, pp 476 123) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737 124) Sainani GS ed, API textbook of medicine, 6th ed, 1999, Association of Physicians of
India, Mumbai, pp 745 125) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-64 126) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 199-200 127) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 1260 128) Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, 1985, Chaukambha Bharati
Academy, Varanasi, pp 374 129) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-31 130) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 840 131) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 240 132) Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, 1985, Chaukambha Bharati
Academy, Varanasi, pp 731 133) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-763 134) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 240 135) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 1292 136) Bapalal .G. Vaidya, Nighantu Adarsha, volume 2, 1st ed , Chaukambha Bharati
Academy, Varanasi, 1985, page no. 134 137) Ibid, pp 345 138) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-275 139) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 965 140) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 16 141) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 142) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737 143) http://www.mayoclinic.com/health/sleep/SL99999 144) http://www.sjo.org/MainServices.aspx?pageId=114 145) Ibid
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
1
Demographic Data of Group – Placebo SNo OPD
No Gender Religion Occupation Economical
Condition Result
M F Age
Food
V
/Mx
H M C O S A L P Md Hg Hc 1 2534 + 28 V + + + NR 2 2656 + 30 V + + + PR 3 2676 + 52 V + + + PR 4 2757 + 23 MX + + + PR 5 2821 + 58 V + + + PR 6 2869 + 32 MX + + + WR 7 2874 + 22 V + + + PR 8 3933 + 43 MX + + + PR 9 3842 + 27 MX + + + NR 10 3866 + 59 V + + + NR 11 3865 + 34 V + + + NR 12 3863 + 33 V + + + NR 13 5038 + 50 V + + + PR 14 2509 + 29 V + + + NR 15 2812 + 45 V + + + NR Total 10 5 V=11
MX=4 12 2 0 1 1 11 3 4 10 1 0 NR=7
PR=7 WR=1
Demographic Data of Group – Nidra cap
SNo OPD No
Gender Religion Occupation Economical Condition
Result
M F Age
Food
V
/Mx
H M C O S A L P Md Hg Hc 1 2210 + 69 V + + + MR 2 2515 + 65 V + + + MR 3 2368 + 55 V + + + MR 4 2472 + 40 MX + + + MR 5 2843 + 43 V + + + MR 6 3125 + 62 MX + + + MR 7 3001 + 28 MX + + + MR 8 2568 + 40 V + + + MR 9 3864 + 28 MX + + + MR 10 3882 + 50 MX + + + MR 11 4624 + 58 V + + + WR 12 4812 + 56 V + + + WR 13 5027 + 45 V + + + WR 14 2618 + 40 V + + + MR 15 2853 + 28 V + + + WR Total 8 7 V=10
MX=5 9 5 1 0 1 12 2 3 8 4 0 MR=11
WR=4
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
2
Subjective Statistical Assessment Data of Group – Placebo S.No OPD Difficulty in
initiating sleep Body ache
(Angamarda) Yawning (Jrumba)
Vitality after morning
awakening
Performance of daily activities
B A B A B A B A B A 1 2534 2 2 1 1 2 2 0 0 0 0 2 2656 1 0 3 3 1 1 1 1 1 1 3 2676 2 0 2 0 1 1 1 1 1 1 4 2757 2 1 1 1 1 1 1 0 1 0 5 2821 2 0 1 1 1 1 2 1 2 1 6 2869 3 0 1 0 2 0 2 0 2 0 7 2874 1 0 0 0 0 0 2 0 2 0 8 3933 3 2 2 1 2 1 1 1 1 1 9 3842 2 2 1 1 1 1 1 1 1 1 10 3866 1 1 1 1 1 1 1 1 1 1 11 3865 2 2 0 0 1 1 0 0 0 0 12 3863 2 2 1 1 1 1 0 0 0 0 13 5038 2 2 1 1 1 1 1 1 1 1 14 2509 2 2 1 1 1 1 1 1 1 1 15 2812 2 2 0 0 1 1 1 1 1 1 Total 29 18 16 12 17 14 15 9 15 9
Subjective Statistical Assessment Data of Group – Nidra caps S.No OPD Difficulty in
initiating sleep Body ache
(Angamarda) Yawning (Jrumba)
Vitality after morning
awakening
Performance of daily activities
B A B A B A B A B A 1 2210 3 1 1 0 2 1 3 1 2 1 2 2515 2 1 1 0 1 0 1 0 1 0 3 2368 2 1 2 1 2 1 1 0 1 0 4 2472 2 0 3 1 3 1 3 1 3 1 5 2843 2 1 0 0 1 0 1 0 1 0 6 3125 3 0 1 1 1 1 2 0 2 0 7 3001 2 0 2 0 1 0 2 0 2 0 8 2568 2 1 0 0 1 1 1 0 1 0 9 3864 2 0 1 0 1 0 1 0 1 0 10 3882 2 0 2 0 2 0 1 0 1 0 11 4624 2 0 1 0 1 0 1 0 1 0 12 4812 2 0 1 0 1 0 1 0 1 0 13 5027 2 0 1 0 1 0 1 0 1 0 14 2618 3 1 1 0 1 0 1 0 1 0 15 2853 2 0 1 0 1 0 1 0 1 0 Total 33 6 18 3 20 5 21 2 20 2
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
3
Objective Statistical Assessment Data of Group – Placebo S.No OPD Total sleep
time (hrs) Sleep onset latency (min)
Number of awakens
Efficiency of sleep (TST/TTSR * 100)
Sleep Fragmental
Time (TST/ # Awk)
B A B A B A B A B A 1 2534 6.5 6.5 120 120 2 2 70.2 70.2 3.25 3.25 2 2656 6 7.5 60 30 2 2 75 93.75 3 3.75 3 2676 3.75 5.5 120 30 3 1 62.5 91.66 1.25 5.5 4 2757 4 6 120 30 3 1 50 75 1.33 6 5 2821 4.25 6 120 60 3 1 60.71 85.71 1.41 6 6 2869 5.5 8 150 30 3 1 64.7 94.11 1.83 8 7 2874 5.75 6.5 60 30 3 2 82.14 92.85 1.91 3.25 8 3933 5.25 6.25 180 120 3 3 61.76 73.52 1.75 2.08 9 3842 5 5 120 120 2 2 62.5 62.5 2.5 2.5 10 3866 4.75 4.75 60 60 2 2 79.16 79.16 2.37 2.37 11 3865 5.25 5.25 120 120 3 3 65.62 65.62 1.75 1.75 12 3863 5 5 120 120 0 0 71.42 71.42 5 5 13 5038 4.5 5.5 120 60 3 3 64.28 78.57 1.5 1.83 14 2509 5 5 120 120 2 2 62.5 62.5 2.5 2.5 15 2812 4.75 4.75 60 60 2 2 79.16 79.16 2.37 2.37 Total 75.25 87.5 1650 1110 36 27 1011.65 1175.73 33.72 56.15
Objective Statistical Assessment Data of Group – Nidra caps S.No OPD Total sleep
time (hrs) Sleep onset latency (min)
Number of awakens
Efficiency of sleep (TST/TTSR * 100)
Sleep Fragmental
Time (TST/ # Awk)
B A B A B A B A B A 1 2210 0.5 3 60 30 3 0 7.1 42.85 0.1 3 2 2515 5 6 180 60 3 2 55.55 66.66 1.6 3 3 2368 5.75 7 120 60 3 1 71.87 87.5 1.9 7 4 2472 5.25 7 180 30 3 0 65.62 87.5 1.75 7 5 2843 5 6.5 120 60 3 2 62.5 81.25 1.6 3.25 6 3125 4 5.5 150 30 2 0 50 68.75 2 5.5 7 3001 5.5 8 180 90 5 2 55 80 1.1 4 8 2568 5 7 120 60 4 1 52.5 87.5 1.25 7 9 3864 5 6 180 60 3 2 55.55 66.66 1.66 3 10 3882 5.5 8 180 90 5 2 55 80 1.1 4 11 4624 3.75 5.5 120 30 2 1 62.5 91.66 1.87 5.5 12 4812 5 7 150 30 2 1 66.66 93.33 2.5 7 13 5027 4 6 120 30 2 1 50 75 2 6 14 2618 4 6.5 120 60 3 2 50 81.25 1.3 3.25 15 2853 5.25 7 120 30 3 1 65.62 87.5 1.75 7 Total 68.5 96 2100 750 46 18 825.47 1177.41 23.48 75.5
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
4
Chief & Associated complaints of Placebo Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 T
1 Difficulty in initiating sleep + + + + + + + + + + + + + + + 2 Reduction in sleep time + + + + + + + + + + + + + + + 3 Wakefulness during sleep + + + + + + + + + + + 4 Body ache (Angamarda) + + + + + + + 5 Yawning (Jrumba) + + + + Associated Complaints 1 Tandra (Stupor) + + + 2 Klama (Fatigue) + + + + + + + + 3 Shirogourava (Head
Heaviness) + + + + + + + + + + + +
4 Shirasoola (Headache) + + + + + + + + + + + + 5 Akshi Jadya (heaviness in
eyes) + + + + + + + + + + +
6 Deha Jadya (Body heaviness) + + + + + + + + + + + + 7 Glani 8 Bhrama (Giddiness) + + + + + 9 Apakti (Indigestion) + + + + 10 Aruchi (Anorexia) + + + +
Chief & Associated complaints of Nidra cap
Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 T
1 Difficulty in initiating sleep + + + + + + + + + + + + + + 2 Reduction in sleep time + + + + + + + + + + + + + + + 3 Wakefulness during sleep + + + + + + + + + + + + + 4 Body ache (Angamarda) + + + + + + + + + 5 Yawning (Jrumba) + + + + Associated Complaints 1 Tandra (Stupor) + + + + + + 2 Klama (Fatigue) + + + + + + + + + 3 Shirogourava (Head
Heaviness) + + + + + + + + +
4 Shirasoola (Headache) + + + + + + + + + 5 Akshi Jadya (heaviness in
eyes) + + + + + + + + +
6 Deha Jadya (Body heaviness) + + + + + + + + + 7 Glani + + + + + 8 Bhrama (Giddiness) + + + + 9 Apakti (Indigestion) + + + + 10 Aruchi (Anorexia) + + +
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
5
Examination of Sleep Data of Group – Placebo caps S.No OPD History of sleep
points (11) Sleep
Examination points (48)
Bahya Karana (Ahara-Vihara)
Manasika karana Upashaya
B A B A B A B A B A 1 2534 1 1 5 0 5 1 2 2 0 2 2 2656 1 1 14 6 3 1 2 2 0 2 3 2676 1 1 5 0 5 1 2 2 0 2 4 2757 2 2 8 3 0 0 4 1 0 2 5 2821 1 1 3 0 0 0 3 1 0 2 6 2869 1 1 11 0 4 0 1 0 0 4 7 2874 1 1 22 0 0 0 5 2 0 2 8 3933 1 1 13 10 0 0 4 2 0 3 9 3842 1 1 4 4 0 0 4 4 0 2 10 3866 2 2 7 5 0 0 2 2 0 5 11 3865 2 2 4 4 1 1 3 3 0 3 12 3863 2 2 3 3 3 1 3 1 0 2 13 5038 2 2 5 5 0 0 3 3 0 2 14 2509 2 2 13 10 0 0 4 2 0 1 15 2812 1 1 3 0 0 0 3 1 0 2 Total 21 21 120 50 21 5 45 28 0 36
Examination of Sleep Data of Group – Nidra caps S.No OPD History of sleep
points (11) Sleep
Examination points (48)
Bahya Karana (Ahara-Vihara)
Manasika karana Upashaya
B A B A B A B A B A 1 2210 2 2 15 2 1 0 5 3 0 5 2 2515 2 2 8 2 0 0 6 3 0 3 3 2368 1 1 6 0 0 0 3 1 0 1 4 2472 2 2 8 0 2 0 5 2 2 1 5 2843 1 1 10 3 0 0 5 4 0 1 6 3125 1 1 6 0 0 0 5 1 0 2 7 3001 1 1 7 2 0 0 5 2 0 2 8 2568 1 1 4 0 0 0 6 2 2 2 9 3864 2 2 2 0 0 0 3 1 0 2 10 3882 1 1 18 4 0 0 2 0 0 4 11 4624 1 1 10 3 0 0 3 1 0 2 12 4812 1 1 3 0 0 0 0 0 0 2 13 5027 2 1 10 2 0 0 2 0 0 2 14 2618 2 2 2 0 0 0 3 1 0 2 15 2853 1 1 4 0 0 0 6 2 2 2 Total 21 20 113 18 3 0 59 23 6 33
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
6
History of present Illness of placebo cap S.No OPD Mode of
onset Course
of Anidra
Frequency of Anidra
Duration of
Anidra
Preceded by Change of Regulariti
es 1 2 3 1 2 1 2 1 2 3 1 2 3 4 5 1 2 3 1 2534 + + + + + + + 2 2656 + + + + + + + + 3 2676 + + + + + + + + + 4 2757 + + + + + + 5 2821 + + + + + + + + 6 2869 + + + + + 7 2874 + + + + + 8 3933 + + + + + + + 9 3842 + + + + + + 10 3866 + + + + + + + 11 3865 + + + + + + + 12 3863 + + + + + + + 13 5038 + + + + + + + 14 2509 + + + + + + + + 15 2812 + + + + + + + + Total 2 11 2 5 10 9 6 8 7 0 11 1 9 6 4 8 4 2 *
History of present Illness of Nidra cap S.No OPD Mode of
onset Course
of Anidra
Frequency of Anidra
Duration of Anidra
Preceded by Change of Regulariti
es 1 2 3 1 2 1 2 1 2 3 1 2 3 4 5 1 2 3 1 2210 + + + + + + + + + 2 2515 + + + + + + + + 3 2368 + + + + + 4 2472 + + + + + + + + + + + 5 2843 + + + + + + + + + + 6 3125 + + + + + + + + + + + 7 3001 + + + + + + + + + + 8 2568 + + + + + + + + + 9 3864 + + + + + 10 3882 + + + + + + + 11 4624 + + + + + + + 12 4812 + + + + 13 5027 + + + + + + + + 14 2618 + + + + 15 2853 + + + + + + + + + Total 2 8 5 8 7 4 11 6 6 5 9 7 4 4 7 9 8 6
Mode of onset = 1-sudden /2- Gradual / 3- Insidious; Course of Anidra = 1-Transient / 2-continuous/; Frequency of Anidra = 1-few days / 2- few weeks; Duration of Anidra = 1-continuous / 2- intermittent / 3- sleeps with medication; Preceded by= 1-Anxiety / 2-Anger / 3-Fear /4- restlessness / 5-pain / ; Change of Regularities = 1-Place / 2-Bed / 3-Environmental
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
7
Group –A (Placebo caps) SN OPD.No Difficulty
in initiating sleep %
Body ache (Angamarda)
%
Yawning (Jrumba)
%
Vitality after
morning awakening
%
Performance of daily
activities %
Total sleep time (hrs %)
Sleep onset
latency (min %)
Number of
awakens %
Efficiency of sleep
(TST/TTSR * 100) %
Sleep Fragmental Time (TST/ # Awk) %
Total mean %
1 2534 0 0 0 0 0 0 0 0 0 0 0 2 2656 100 0 0 0 0 20 50 0 10.8 21.5 21.05 3 2676 100 100 0 0 0 31.9 75 66.7 29.2 77.3 48 4 2757 50 0 0 100 100 33.4 75 66.7 25 76.7 40.2 5 2821 100 0 0 50 50 29.2 50 66.7 25 76.5 44.8 6 2869 100 100 100 100 100 31.3 80 66.7 29.5 77.5 78.5 7 2874 100 0 0 100 100 11.6 50 33.4 10.8 41.2 44.7 8 3933 33.4 50 50 0 0 16 33.4 0 11.8 14.3 20.9 9 3842 0 0 0 0 0 0 0 0 0 0 0 10 3866 0 0 0 0 0 0 0 0 0 0 0 11 3865 0 0 0 0 0 0 0 0 0 0 0 12 3863 0 0 0 0 0 0 0 0 0 0 0 13 5038 0 0 0 0 0 18.2 50 0 14.3 18 19.2 14 2509 0 0 0 0 0 0 0 0 0 0 0 15 2812 0 0 0 0 0 0 0 0 0 0 0 Total 583.4 250 150 350 350 191.
6 463.4 300.2 156.4 403 317.35
Mean 38.89333 16.66667 10 23.33333 23.33333
12.77333
30.89333
20.01333 10.42667 26.86667 21.15667
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
8
Group –B (Nidra caps) SN OPD.No Difficulty
in initiating sleep %
Body ache (Angamarda)
%
Yawning (Jrumba)
%
Vitality after
morning awakening
%
Performance of daily
activities %
Total sleep time (hrs %)
Sleep onset
latency (min %)
Number of
awakens %
Efficiency of sleep
(TST/TTSR * 100) %
Sleep Fragmental Time (TST/ # Awk) %
Total mean %
1 2210 66.7 100 50 66.7 50 83.4 50 100 35.8 96.7 67.95 2 2515 50 100 100 100 100 16.7 66.7 33.4 11.1 46.7 62.5 3 2368 50 50 50 100 100 17.8 50 66.7 15.7 72.9 57.35 4 2472 100 66.7 66.7 66.7 66.7 25 83.4 100 21.9 75 67.25 5 2843 50 0 100 100 100 23 50 33.4 18.8 50.8 52.6 6 3125 100 0 0 100 100 27.3 80 100 18.8 63.7 59.3 7 3001 100 100 100 100 100 31.3 50 60 25 72.5 73.9 8 2568 50 0 0 100 100 28.6 50 75 25 82.1 51.05 9 3864 100 100 100 100 100 16.7 66.7 33.4 11.1 44.7 67.3 10 3882 100 100 100 100 100 31.2 50 60 25 72.5 73.9 11 4624 100 100 100 100 100 31.9 75 50 29.2 66 75.25 12 4812 100 100 100 100 100 28.6 80 50 26.7 64.3 74.55 13 5027 100 100 100 100 100 33.4 75 50 25 66.7 75 14 2618 100 100 100 100 100 38.5 50 33.4 31.2 60 71.35 15 2853 100 100 100 100 100 25 75 66.7 21.9 75 76.4
“Management of Anidra with Nidra caps- a placebo comparative study” 1
Special case sheet for “Management of Anidra with Nidra caps - a placebo comparative study”
POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG
Guide: Dr. K. Shiva Rama Prasad
Scholar: Kamalaxi. M. Angadi
1) Name of the Patient Sl.No
2) Gender Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
5) Occupation Sedentary Active Labor
6) Economical status Poor Middle Higher middle Higher class
7) Address
Pin
8) Birth data Place of Birth
AM Date Month Year Time
Hours Minutes PM
9) Selection Included Excluded
10) Schedule dates Initiation completion
11) Result Well
Responded
Moderately
Responded
Not
responded
Discontinued
INFORMED CONSENT I Son/Daughter/Wife of
am exercising my free will, to participate in above study as a subject. I have been informed to
my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of
the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any
time during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ
PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ
0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.
gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature
“Management of Anidra with Nidra caps- a placebo comparative study” 2
12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration Remarks
1 Difficulty in initiating sleep 2 Reduction in sleep time 3 Wakefulness during sleep 4 Body ache (Angamarda) 5 Yawning (Jrumba) 13) ASSOCIATED COMPLAINTS Associated Complaints Duration Remarks
1 Tandra (Stupor)
2 Klama (Fatigue)
3 Shirogourava (Head Heaviness) 4 Shirasoola (Headache)
5 Akshi Jadya (heaviness in eyes) 6 Deha Jadya (Body heaviness) 7 Glani 8 Bhrama (Giddiness) 9 Apakti (Indigestion) 10 Aruchi (Anorexia) 14) HISTORY OF PRESENT ILLNESS Mode of onset sudden / Gradual / Insidious Course of Anidra Transient / continuous/ Frequency of Anidra few days / few weeks Duration of Anidra continuous / intermittent / sleeps with medication Preceded by Anxiety / Anger / Fear / restlessness / pain / Change of Regularities Place / Bed / Environmental
History of sleep
Hearing soft Music before going to bed Yes No Perfume applications before going to bed Yes No Having Bath Before going to Bed Yes No Massage of feet etc before going to bed Yes No Passing Urine before going to bed Yes No Passing Stools before going to bed Yes No Masturbation before going to bed Yes No Prayers before going to bed Yes No Reading before going to bed Yes No Consuming alcohol before going to bed Yes No Sexual Intercourse before going to bed Yes No
15) Occupational History if any
“Management of Anidra with Nidra caps- a placebo comparative study” 3
16) PERSONAL HISTORY
Food habits Vegetarian Mixed diet
Taste preferred Sweet Sour Salty Pungent Bitter Astringent
Agni Sama Vishama Manda Teekshna
Kosta Mrudu Madhyama Krura
Nidra Day Night Sound Disturbed
Addictions Tobacco Alcohol Drugs
Bowel habits Normal Loose Constipated
Menstrual History Regular Irregular Amenorrhea Menopause
Family history – Specify if any has the same disease
Other system medications (Anti depressants) Since how long Treatment history Tranquillisers Hypnotics Sedatives
History of past illness corresponding to sleep disturbances
17) EXAMINATION a) Vitals
Temperature ºF Pulse / min Respiration rate / min
Height Cms Weight Kg Blood pressure mmHg
b) Examination of sleep B A 1. Do you wake frequently during the night and feel un-refreshed in the morning? 2. Do you have difficulty staying awake during the day? 3. Do you have diabetes, hypertension or another health problem that affects your sleep? 4. Are you overweight? Do you find it difficult to lose weight? 5. Do you wake up with a dry mouth, sore throat or headache in the morning? 6. Do you have difficulty concentrating during the day? 7. Do you need to take naps during the day? 8. Does your snoring bother you or your spouse enough for you to consider treatment? 9. Doze off or fall asleep in Sitting and reading position 10. Doze off or fall asleep while Watching TV 11. Doze off or fall asleep in Sitting inactive in a public place 12. Doze off or fall asleep as a passenger for 1 hour without a break 13. Doze off or fall asleep in Lying down to rest in the afternoon 14. Doze off or fall asleep in Sitting & talking to someone 15. Doze off or fall asleep while Sitting quietly after lunch without alcohol 16. Doze off or fall asleep while stopping for a few minutes in traffic
0 = Never, 1= .Slight Chance 2 = Moderate Chance 3 = High Chance
“Management of Anidra with Nidra caps- a placebo comparative study” 4
c) Dosha Examination (Ayurvedic)
Desham (Deha) Bhumi Jangala Anupa Sadharana Vata B A Pitta B A Kapha B A
Karshya Peeta mootrata Agni sadana
Karshnya Peetanetra Praseka
Ushna kamitwa Peetavit A lasya
Kampa Peetatwak Swetangata
Anaha Adhikshudha Sheetangata
Shakrudgraha Adhidaha Gowrava
Balabhrmsha Slathangata
Nidrabhramsha Swasa
Pralapa Kasa
(a) Dosha Vruddhi
Bhrama At inidra
Vata B A Pitta B A Kapha B A
Angasada Mandagni Bhrama Alpabhashite
ahitam Shareera sheetatwam Urah
shoonyata
Chesta heenata Prabha hani Shira soonyata
Vyamoha Hridrava
(b) Dosha Kshaya
Sleshma vruddhi Sandhi saidhi lya
Nadi V P K VP VK PK VPK
Prakruti V P K VP VK PK VPK
Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya
Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna
Ast
asth
ana
Drik Akruti
“Management of Anidra with Nidra caps- a placebo comparative study” 5
d) Examination of Sleeplessness effect on systems
System (Srotas) Observations Remarks Gastrointestinal (Anna) Respiratory (Prana) Cardiovascular (Rasa) Hemopoietic (Rakta) Musculoskeletal (Mamsa / Asti) Neurological (Majja) Genital (Sukra) Urinary (Mootra) Lower GIT (Pureesha)
18) Anidra Nidana Ahara Vihara Manasika Anya
Yavanna Dhooma Bhaya Virechana
Rookshanna Vyayama Chinta Vamana
Upavasa Krodha Shirovirechana
Asukhashayya Manastapa Raktamokshana
Kshudha Vyatha Kshaya
Mithuna Harsha Abhighata
19) Upashaya and Anupashaya in Anidra
Abhyanga Tarpana
Utsadana Sneha sevana
Upashaya
Ksheera panam Mamsarasa sevana
Anupashaya Rooksha ahara Manasika vikara
20) Investigations in routine Haemoglobin % Erythrocyte sedimentation Rate
Lymphocytes Neutrophils Eosinophils Basophils
Differential count
Monocytes 21) Assessment a) Subjective parameters Before After Follow-up Comment
1 Difficulty in initiating sleep
2 Body ache (Angamarda)
3 Yawning (Jrumba)
4 Vitality after morning awakening
5 Performance of daily activities
“Management of Anidra with Nidra caps- a placebo comparative study” 6
b) Objective parameters Before After Follow-up
1 Total sleep time (hrs)
2 Sleep onset latency (min)
3 Number of awakens
4 Efficiency of sleep (TST/TTSR * 100)
5 Sleep Fragmental Time (TST/ # Awk)
22) Treatment schedule of NIDRA CAPS / PLACEBO Schedule Investigator’s observation
Day 1
Day 7
Day 14
Day 21
Day 28 1st Follow up
Day 42 (Final Follow up)
Sleep worksheet S.No
Goi
ng to
Be
d
Falli
ng
asle
ep
Slee
p La
tenc
y
Slee
p C
ompl
eatio
n
Num
ber o
f Aw
aken
ing
Dur
atio
n of
Aw
aken
ings
TTSR
TST
= TT
SR
– (D
aw +
SL
)
1
2
befo
re
3
1
2
Afte
r
3
1
2
Follo
w u
p
3
Investigators Note:
Signature of Guide
(Dr. K. Shiva Rama Prasad)
Signature of Scholar
(Kamalaxi. M. Angadi)
Group –A (Placebo caps) SN OPD.No Difficulty
in initiating sleep %
Body ache (Angamarda)
%
Yawning (Jrumba)
%
Vitality after
morning awakening
%
Performance of daily
activities %
Total sleep time (hrs %)
Sleep onset
latency (min %)
Number of
awakens %
Efficiency of sleep
(TST/TTSR * 100) %
Sleep Fragmental Time (TST/ # Awk) %
Total mean %
1 2534 0 0 0 0 0 0 0 0 0 0 0 2 2656 100 0 0 0 0 20 50 0 10.8 21.5 21.05 3 2676 100 100 0 0 0 31.9 75 66.7 29.2 77.3 48 4 2757 50 0 0 100 100 33.4 75 66.7 25 76.7 40.2 5 2821 100 0 0 50 50 29.2 50 66.7 25 76.5 44.8 6 2869 100 100 100 100 100 31.3 80 66.7 29.5 77.5 78.5 7 2874 100 0 0 100 100 11.6 50 33.4 10.8 41.2 44.7 8 3933 33.4 50 50 0 0 16 33.4 0 11.8 14.3 20.9 9 3842 0 0 0 0 0 0 0 0 0 0 0 10 3866 0 0 0 0 0 0 0 0 0 0 0 11 3865 0 0 0 0 0 0 0 0 0 0 0 12 3863 0 0 0 0 0 0 0 0 0 0 0 13 5038 0 0 0 0 0 18.2 50 0 14.3 18 19.2 14 2509 0 0 0 0 0 0 0 0 0 0 0 15 2812 0 0 0 0 0 0 0 0 0 0 0 Total 583.4 250 150 350 350 191.
6 463.4 300.2 156.4 403 317.35
Mean 38.89333 16.66667 10 23.33333 23.33333
12.77333
30.89333
20.01333 10.42667 26.86667 21.15667
Group –B (Nidra caps) SN OPD.No Difficulty
in initiating sleep %
Body ache (Angamarda)
%
Yawning (Jrumba)
%
Vitality after
morning awakening
%
Performance of daily
activities %
Total sleep time (hrs %)
Sleep onset
latency (min %)
Number of
awakens %
Efficiency of sleep
(TST/TTSR * 100) %
Sleep Fragmental Time (TST/ # Awk) %
Total mean %
1 2210 66.7 100 50 66.7 50 83.4 50 100 35.8 96.7 67.95 2 2515 50 100 100 100 100 16.7 66.7 33.4 11.1 46.7 62.5 3 2368 50 50 50 100 100 17.8 50 66.7 15.7 72.9 57.35 4 2472 100 66.7 66.7 66.7 66.7 25 83.4 100 21.9 75 67.25 5 2843 50 0 100 100 100 23 50 33.4 18.8 50.8 52.6 6 3125 100 0 0 100 100 27.3 80 100 18.8 63.7 59.3 7 3001 100 100 100 100 100 31.3 50 60 25 72.5 73.9 8 2568 50 0 0 100 100 28.6 50 75 25 82.1 51.05 9 3864 100 100 100 100 100 16.7 66.7 33.4 11.1 44.7 67.3 10 3882 100 100 100 100 100 31.2 50 60 25 72.5 73.9 11 4624 100 100 100 100 100 31.9 75 50 29.2 66 75.25 12 4812 100 100 100 100 100 28.6 80 50 26.7 64.3 74.55 13 5027 100 100 100 100 100 33.4 75 50 25 66.7 75 14 2618 100 100 100 100 100 38.5 50 33.4 31.2 60 71.35 15 2853 100 100 100 100 100 25 75 66.7 21.9 75 76.4
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DESERTAION
0.1 NAME OF THE CANDIDATE : KAMALAXI. M. ANGADI.
ADDRESS(in block letters) : D/o. MALLAPPA. S. ANGADI.
OPP. J. T. KALLYANAMANTAPA,
GADAG.
DIST: GADAG. – 582 101
0.2 NAME OF THE INSTITUTION : SRI. D. G. MELAMALGI AYURVEDIC
MEDICAL COLLEGE, GADAG.
0.3 COURSE OF STUDY & SUBJECT : AYURVEDA VACHASPATHI(MD)
KAYACHIKITSA
0.4 DATE OF ADMISSION : APRIL – 2005.
0.5 TITTLE OF THE TOPIC :
“MANAGEMENT OF ANIDRA WITH NIDRA CAPS
- A PLACEBO COMPARATIVE STUDY”
0.6 RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY:
How the food, water and air are essential for life, like that Nidra is also very much
essential. Sound restorative sleep is the foundation of a healthy life. A good night’s sleep is
undoubtedly one of the most precious gifts we can enjoy. It provides rest our needs. Rest is
the basis of activity. Hence, the Ayurvedic Acharya’s explained Nidra one of the
trayopasthambhas1. As health is the first muse and sleep is the condition to produce it.
Improper sleep leads to disease both physical and mental.
2
Insomnia is ‘The inability to fall asleep or to stay asleep’. The onset of primary
insomnia is usually in young adulthood and middle age. It tends to increase with age and
affects about 40% of women and30% men 2 and about 25% of elderly people and 15 % of
the general population suffer from this complaint 3. This Nidranasha became a major
problem nowadays, due to altered life styles, busy schedule and stressful living conditions,
struggle for existence etc.
The management of Nidranasha in contemporary sciences mainly depends on most
commonly available antidepressant drugs, sedatives, tranquillisers and hypnotic drugs. The
drawback with this approach is drug dependence, tolerance towards the drugs and
reoccurrence of the symptoms on withdrawal of the drug. Apart from these internal
medication, counselling, cognitive therapy, physiotherapy and meditation have also been
advised. Still we find no satisfactory and safe measures for Nidranasha in contemporary
medical science.
So, it is forbidden moral responsibility of Ayurveda scholar to search for effective
and ideal remedy from Ayurvedic treasure of therapeutics. A several herbs have been
described in Ayurvedic literature which have beneficial effect in the management of
Nidranasha, among them Tagar (Valerian wallichii), Jatamamshi (Nordostachys
jatamamshi), Ashwaganda (Withania somnifera), and Pippali (Piper longum). At present
study an attempt will be made to evaluate the efficacy of this drug preparation in Nidranasha
with a view to find out a therapeutically efficacious, safer, cost effective and easily available
drug 16,17,18.19,20.
3
6.2Review of literature
Sleep is defined as unconsciousness from which the person can be aroused by
sensory or other stimuli 4. Nidranasha is not discussed as a disease anywhere in the
classical texts, only referred as one among the 80 types of vatavyadhi, 5,6 and mentioned as
a symptom in many diseases7. They have mentioned the relation of the doshas to Nidra. .
Nidra it is swabhavaj or swabhavik.8 Nidra is induced due to Kapha and tamobhav.9,10
. Classical text mentioned the symptoms angamarda, shirogourava, jrumbha, jadya, glani,
bhrama and apakti11,12.
While telling about merits and demerits of Nidra carak has mentioned, Happiness
and misery, obesity and leanness, strength and weakness, sexual vigour and impotence,
consciousness and loss of sensory activity, even life and death depend on the quantity of
sleep13. Nidranasha or insomnia may be defined as a condition of inadequate quantity and
quality of sleep, difficulty in getting sound sleep and early awakening14.
Primary insomnia is difficulty in initiating or maintaining sleep for at least 1 month
to 5 years and is characterised by difficulty in initiating sleep, wakefulness, during normal
sleep, daytime fatigue etc15.
A number of herbal preparations and plant extracts have been used with varying
degree of success in the management of Nidranasha. Among them Tagar (Valerian
wallichii), Jatamamshi (Nordostachys jatamamshi) Ashwaganda (Withania somnifera)
Pippalimoola (Piper longum), when taken in combination induces sleep. Which are taken on
basis of rasa, guna, veerya, and vipak, and karma and their Nidrajanakatwa prabhav16,
17,18,19,20. Vangasen has mentioned to give pippalimoola in Nidranasha due to jwara21.
4
6.2 Objectives of the study
a) To evaluate the Nidrajanaka prabhava (sedation) of Nidracap in Anidra
b) To evaluate the Nidrajanaka prabhava (sedation) of placebo in Anidra
c) To compare the Nidrajanaka prabhava (sedation) of placebo and Nidra cap in Anidra
Materials and methods
7.1 Source of data .
a. Patients : Patients suffering from Nidranasha are selected from P.G.S and R.C
O.P.D of Shri D.G.M.A.M.C and Hospital, Gadag.
b. Literary : Literary aspects of the study will be collected from classical Ayurvedic
and modern texts, medical journals and information regarding the study will be
updated from internet search along with above said.
c. Trial drug: the trial drugs will be collected from the area where it is available
abundantly and identification will be confirmed by botanist
Rational combination has been formulated based on the pharmacological
properties and pharmacokinetics of individual drugs included in Nidracap are
individually scrutinised for its Nidrajanakatwam , Nidraprabhav from the essential
texts. To check the appropriativeness of rational combination limited no. of herbs are
included in Nidracap. Based on rasa, guna, veerya, vipak the rational combination is
formed16,17,18,19,20,21.
Each 500 mg Nidra cap consists of -
Drugs Botanical Names Quantity Tagar Valeriana wallichii 125mg Jatamanshi Nordostachys jatamamshi 125mg Ashwaganda Withania somnifera 125mg Pippalimoola Piper longum 125mg
5
7.2 METHOD OF COLLECTION OF DATA
a) Study Design: A comparative placebo control single blind clinical study
b) Sample: A minimum of 60 patients with Nidranasha disease will be selected
30 patients will be treated in each group
c) Grouping: Group A: Control 30 patients with placebo
Group B: Trial 30 patients with Nidracap.
d) Study duration: 21 days
e) Follow up: 21 days
f) Exclusive criteria:
1. Nidranasha due to other conditions like madatyaya,
2. Nidranasha due to abhighata
3. Pregnant women
4. Lactating mothers
5. Associated with any other systemic and metabolic disorders
g) Inclusive criteria:
1. Patients complaining of reduction in sleep time any of these or all of these
will be included
2. Difficulty in initiating sleep.
3. Wakefulness during normal sleep
4. Any of above or all of the above will be included
5. Along with Nidranasha patients complaining of angamarda, shirogourava,
jrumbha, jadya glani, bhrama and apakti will be included.
6. Patients already diagnosed for primary insomnia with the duration of 1
month to 5 years will be included.
h) Posology:
2 caps of 500mg or 15mg /kg body weight/24 hours, 1 hour before to retiring
6
i) Assessment of results:
Subjective and objective parameters of base line data to the after treatment data
comparison are done for the assessment of results.
j) Subjective parameters:
1. Angamarda
2. Shirogourava
3. Jrumbha
4. Jadya
5. Glani
6. Bhrama
7. Apakti
k) Objective parameters
1. Total sleep time (hrs)
2. Sleep onset latency (min)
3. Quality of sleep (mm)
4. Vitality after morning awakening (mm)
5. Performance of daily activities (mm)
6. Sleep quality evaluation (mm)
l) Statistical analysis:
The parameters going to be compared are (subjective parameters) and (objective
parameters). The paired and unpaired T – test and non parametric test used for the
testing of hypothesis if p < 0.05, the test is highly significant.
7.2 Ethical clearance: Obtained and certificate attached
8. References:
1. Satyanarayan shastri ed, carak samhita, volume 1 sutra 11/35, vidyotini hindi commentary, 22nd ed, Choukamba Bharati Academy, Varanasi, 1996, page no.227.
2. http://www.printgoogle.co.in/print%3Fq%3Dprimary%2Binsomnia%260i%3DprintGsig=QaxNvyEgrDQMVssbgb
3. http://www.holistic-online.com/Remedies/Sleep/Sleep insomnia-herbs.htm
7
4. Guyton, Human physiology and mechanism of disease, 5th ed, W. B. Saunders Company, Tokyo, 1992,page no.453.
5. Satyapal Bhishagacharya, ed, Kashyap samhita, sutra 27/28, Chaukambha Sanskrit Samsthan , Varanasi, page no. 42.
6. Prof. K. R Shrikanta Murthy etd,Sharangdhara samhita, 7/112, 1st ed, Chaukambha Orientalia ,Varanasi, 1984, page no. 40.
7. Kavivar Shri Shali Gramoji Vaishya ed, Vangasen hindi tika samhita 1/718, Khenraj Krishnaadas prakashan, Bombay, 1996, page no. 64
8. Vaidya Jadavaji Trikamji Acharya ed, Susruta samhita ,sutra 1/25, 4th ed, Chaukambha Orientalia, Varanasi,1980, page no.
9. Kaviraja Ambikadutta shastri, ed, Susruta samhita, sharira 4/32, part 1, 11th ed , Chaukamba Sanskrit Samsthan,Varanasi, 1996, pag no.34.
10. Prof. K.R Shrikanta Murthy ed,Sharangdhara samhita, 6/24, , 1st ed, Chaukambha Orientalia ,Varanasi, 1984, page no. 30
11. P.V. Sharma ed, Astanghridayam, sutra 7/52, Sarvangsundara commentaryand Vidyotini hindi commentary, 1st ed, Chaukambha Orientalia, Varanasi,1978 page no. 116
12. Ravidutta Tripathi ed, Astang sangraha sutra 9/56, Saroj hindi commentary, 6th ed, Chaukambha Bharati Academy, Varanasi, 2001 page no.200
13. Satyanarayan shastri ed, carak samhita, sutra 21/36, vidyotini hindi commentary 22nd ed, Choukamba Bharati Academy, Varanasi, 1996, page no. 418
14. Christopher Haslett ed, Davidson’s Principles and Practice of Medicine 18th ed, Livingstone International, page no. 1093.
15. htpp//www.google.com/primary insomnia. 16. Dr. G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary,
Chaukambha Bharati Academy, Varanasi 2004 page no. 200, 240, 393, 16. 17. Dr. K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, Popular Prakashan,
Bombay, 1982, page no. 1260, 840, 1292, 965. 18. Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, Chaukambha Bharati
Academy, Varanasi, 1985, page no. 737, 731. 19. Bapalal .G. Vaidya, Nighantu Adarsha, volume 2, 1st ed , Chaukambha Bharati
Academy, Varanasi, 1985, page no. 134, 345. 20. P.V Sharma, Dravyaguna Vijnana. Volume 2, 16th ed, Chaukambha Vishvabharati,
1995, page no.31,64,275,763. 21. Kavivar Shri Shali Gramoji Vaishya ed, Vangasen hindi tika samhita, 1/718, Shri
Khenraj Krishnadasa Prakashan, Bombay,1996, page no. 64. 22. Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi,page no.737 for sleep and its disorders.`
1
External application : Kushtha, being exhibited through the skin, external application are also advocated. For the external application drug should be applied after elimination of the Doshas from the body by Shodhana Karma and Raktamokshana. Various forms of local application are prescribed like Udvartana, Pralepa, Parisheka, Abhyanga, etc. Kshara Karma and Agada Karma are also prescribed in special condition of Kushtha.
1. SOMNUS RASAYANA
(NIDRA EFFECT IN INDUCTING THE RASAYANA EFFECT)
Author: Dr. K. Shiva Rama Prasad, M.D.(Ay), C.O.P.(German), M.A, Ph.D (Jyotish) 1
Co-Author & Presentation: Dr. Kamalaxi. M. Angadi2
Rasayana (Achara) gives rise regularized sound sleep and vice versa the regularized
sleep patterns induce Rasayana effect. Health is a first muse and sleep is the condition to
produce it. The goal of the Ayurvedic approach is to create more potent individuals through
increased Ojas (immunity), which is the finest end product of digestion & metabolism that
provides energy, enthusiasm, happiness, clarity of thinking, better coordination between the
body and mind. Only the sound most restful (stage IV) sleep generates Ojas. A sound quality
sleep provides ultimate rest to the mind and senses, with enhanced capacities of mental and
physical work ability forthe next day. On the other hand, lack of sleep vitiates & initiates Vata,
Ama (endo toxins), etc in the body.
Human requires the three fundamental objective fulfillments in his entire lifetime, “Trayo
Upasthambha” (Trayo upasthambha iti swapnoahara brahmacharyamiti) viz. Ahara (Food),
Brahmacharya (regularized sex act) and Nidra (Sleep) (cha.su11/35). Sleep is function of all
living beings. It is definite to say that “The best bridge between despair and hope is a good night’s sleep”. As like the all essentials of life it is evidential that the Nidra is also very much
needed to attain the fulfillments of the individuals. Sound restorative sleep is the foundation for
healthy living, there by to construct a progressive society. A good night’s sleep is undoubtedly
one of the most precious gifts of the nature ever we are enjoying to give rise next days energy
boosted levels. Sleep is the basis of our day-to-day activity, hence, the Ayurveda explains
physiological and pathological Nidra in detail.
1 Professor, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic Medical College, Gadag, BOS member, Calicut University, Kerala (+91-9448746450), doctorksrprasad@gmail.com 2 Final PG scholar, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic Medical College, Gadag
2
In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a
winding up of the vital clock, a recharging of life’s battery and “Chief nourisher at life’s feast”.
Three sub-pillars are diet, sleep and celibacy. If these three are fulfilled properly, the body is
supported well by these pillars, it continues well endowed with strength, complexion and
developments till the complexion of life span provided one abstains from harmful practices
which will be explained here itself (Cha. Su. 11/35)
Ahara Ahara, partaking food confers satisfaction and immediate strength supports the body,
increases span of life, radiance, enthusiasm, memory, valiance and digestive capacity. (Su.Chi
24/38)
Nidra Sleep enjoyed at the proper time bestows nourishment, good color (Complexion), and
strength, enthusiasm, keenness of digestive power, wakefulness and maintains normalcy of
tissues (Su.Chi 24/88).
Brahmacharya The end product of ahara rasa is said as the shukra dhatu. Loss of shukra cause
marana i.e. death on the other hand dharana of sukra gives life. So the shukra is the bala
(strength) for purusha (human) (Su.Chi 24).
Hence, these three trayopasthmbha exhibits the importance of life and necessity of the
induction of the Rasayana effect in to the life. As we know that satisfaction alone is the cause of
Rasayana and the satisfaction of the Nidra gives raise the Rasayana effect.
Rasayana Rasayana is the food, medicine or therapy, which nourishes Rasa and other Dhatu or
the medicine with the effect of its taste, potency or special properties bestows long life, strength
and retards ageing.
Charaka has opined the ‘Nidra’ (Ch. Su. 11/35) along with Chakrapani as ‘Upastambha’
as sub-post, which promotes the Rasayana. Posts mainly support a house, but sub posts add to
the supporting strength of such posts. In the same way, body is mainly supported by the acts
performed in the previous life, which determined the intake of food, sleep and Bramhacharya.
So they are known as secondary supports of life. It is observed that all the living creatures must
enjoy the sleep in quality and quantity to keep them fit. From the very birth the amount in hours
of sleep of newborn is maximum, it is because at sleep the baby grows. Bhavamishra has
mentioned that during the pregnancy, when the mother sleeps, the baby in womb enjoys better
rest and comfort - (B. P. 1st part, S.No. 317).
3
Susruta commenter Dalhana classifies Rasayana is as follows. Mainly Rasayana into
two folds as –
1. Kutipravesika Rasayana – residing in a specially built house and undergoing therapy.
2. Vatatapika Rasayana - undergoing therapy while moving about in wind and sunlight.
Further it is again of three kinds as-
1.Kamya Rasayana – desiring benefits such as long life, great intelligence, wealth etc
2.Naimittika Rasayana – consequent to diseases (either for treatment or for resuscitation)
Such as, use of recipes of Shilajatu, Bhalltaka, Tuvaraka etc in diseases like diabetes piles,
leprosy etc
3.Ajasrika Rasayana – habitual to be consumed daily such as milk, ghee etc.
Again it is of two kinds- Samshodhana (purification)-producing vomiting, purgation etc and
Samsamana- mitigates/alleviating the aggravated doshas or diseases.
NIDRA In fact, Nidra looks like a glimpse of Pralaya, which carries peace but in darkness. After
this glimpse of Pralaya – man awakens fresh like Srujana. For the living beings in the world, it is
an essential phenomenon for maintenance and restoration of both – body and mind.
Since the dawn of the civilization the thinker of various countries in the world have tried
to study the sleep, its nature and causes. In India, from the Vedic and Upanishad period, the
Yogis have studied the Yogic phenomena pertaining to various stages associated with Atma.
They have termed these stages as Jagritavastha (waking state), Svapnavastha (dream state),
Sushuptavastha (sleep state) and Samadhi Avastha (the conscious sleep phase having
Detachment from the external world in different degrees).
In the Patanjali Yoga Sutra, the physiology of Nidra has been described as: Sleep is the
non-deliberate absence of thought waves or knowledge. Dreamless sleep is an inert state of
consciousness in which the sense of existence is not felt. In sleep, the senses of perception rest
in the mind, the mind in the consciousness and the consciousness in the being in the deep
sleep, the senses of perception cease of function because their king, the mind, is at the rest.
This is Abhava, a state of void, a feeling of emptiness (Samadhi Pada – 10 Yogasutras of
Patanjali).
The onset and progress of sleep as described in Brahmanopanishad, pertaining to Yoga
sutra runs as under: when the Chitta becomes exhausted, it goes inward the sense impulses
from worldly objects; hence the sleep is a resting phase of mind. At that time, there is absence
of the knowledge about the orientation of time and place. In this condition, it is believed that the
Chitta resides in the Medhya Nadi. When a person awakens from the deep sleep, it is the sense
4
of pleasure and sense of satisfaction. In Mandala Brahmanopanishad, the sleep is considered
as one of the five unwanted activities (Ma.Br.Up.pp274).
According to Lord Swaminarayana, Nidra is made for the rest of physical and mental
bodies, which get tired after the whole day’s work. Lord Shri Krishna have explained the
importance of proper sleep for a Dhyana Yogi in Bhagwadgita. According to him, excessive
sleep and ceaselessly awakening are also not good. (Shrimad Bhagvadgita).
Sleeping for six hours in the middle of the night and keeping awake during the first and
last quarters as well as during daytime, are generally considered as regulated sleep and
wakefulness. In the Ayurvedic classics and the later literature, the usefulness of sleep and its
role in the maintenance of health is elaborately discussed.
Similarly the botanists have observed that not only animals but plants also enjoy
recreation in the night by attracting the petals and leaves and flowers etc., at the time of sunset
and in the next morning relaxing and reopening (Sa. Ni. Page1142). The sleep is an indicator of
good health because it brings the normalcy in body tissue and relaxes the person. (B. P. Pu.
5/315; Y.R. Pu. 88). Untoward effects of various pathogenic conditions do not harass persons
residing in unhygienic locality but obeying the rules of diet, sleep and exercises. (Ka. Sam. Khi.
5/7).
Generally, the sleep comes during the night and at about the same time for a particular
duration everyday and as such in Ayurveda Nidra has been said to be Ratrisvabhava Prabhava
(Ch. Su. 21/58). According to Susruta, Nidra is provoked due to nature and considered as
Svabhavika Roga (Su. Su.24/8). Therefore, Ayurvedic authors have advised that a man should
not suppress this natural urge (Ch. Su. 7/4).
According to Charaka, the sleep occurring at night, as a natural phenomenon is a
nourishing phenomenon so it is termed as Bhutadhatri – that nurses all the living beings (Ch.
Su. 21/59). It is also called the ‘Vaishnavi Maya’ in a metaphoric language, which means that
Nidra provides the nutrition to the living body and maintains the health like Lord Vishnu, who is
the nourisher and maintainer of the world (Su. Sha. 4/32).
Though, the role and importance of sleep are very wider accepted even then if the sleep
is not taken appropriately and in appropriate quantity and irregularly, it may have adverse
effects on the body. Therefore, sleep should be watchfully enjoyed because the excessive sleep
causes various sins (Papma).
The control over sleep and wakening for the meditation is useful for the uplift of Atma.
The saints always prefer to keep awake at night for meditation, conversely person having
5
antisocial attachment do sleep during the daytime, which considered as one of the root causes
of many evils (Su. Sha.4/32).
Natural Instincts of life In Shaligram Nighantu, four natural instincts of the living organisms are mentioned,
which are as under –
1) Desire to take the food
2) Desire to take the water
3) Desire to take the sleep and
4) Desire to take the sexual contact for pleasure.
These four are considered as the pioneers of the health (Bri.Ni.Ra.pp2&164).
Independently but an all-round rest for the entire organism is possible only when it goes to
sleep. The ancient seers of India have not only recognized the natural constructive power of
sleep, but have also attributed to it, a super natural power which beneficial for the health,
happiness and longevity. The modern science also confirming the function and physiology etc.
told by our ancient sages but still not come for any conclusion as sleep is concerned.
Finally, Manu, the great lawmaker of the world has ever produced, after describing the
small divisions of time, remarks that 30 Muhurta period (24 hours), are divided by the sun into
day and night; the day time is intended the activities and the night time is designed for the rest
and repose. The daily (Bio) rhythm of the life is thus a natural instinct related to the rhythm of
night and day existing in nature (Manu Smriti). By all above explanation it is said that proper
sleep induces the effect of Rasayana.
Proper sleep
Proper agni
Proper nourishment
Proper dhatu sequence
Ojus
Hence, here it shows the effect of Nidra in inducting the effect of the Rasayana. In this
paper an attempt is made to evaluate the effect of Nidra in inducting the effect of Rasayana.
6
Many researchers claim that the sleep is psychosomatic in origin, thus a simple randomized
placebo clinical trial is studied. The results are as follows-
Rasayana effect assessment by Dhatu karma Lakshana Dhatu karma Lakshana as told by Charaka emphasises the effect any drug involvement
over the dhatu. The lakshana with the effect of Nidra as Rasayana is as follows.
Lakshanas Effect of Nidra Effect of Rasayana
Dheergha ayu ++++ ++++
Smruti ++++ ++++
Medha ++++ ++++
Aroghya ++++ ++++
Tarunya ++++ ++++
Vaya ++++ ++++
Vak-siddhi & Kanti ++++ ++++
Samyak Dhatu Karya Effect of Nidra Effect of Rasayana
Preenana ++++ ++++
Jeevana ++++ ++++
Lepa ++++ ++++
Snehana ++++ ++++
Dharana ++++ ++++
Poorana ++++ ++++
Garbhotpadana ++++ ++++
S.No Sleep efficiency
(Effect of placebo)
Effect of Rasayana
1 55.5 55.5
2 82.14 82.14
3 85.71 85.71
4 62.5 62.5
7
5 73.52 73.52
6 53.33 53.33
7 42.85 42.85
8 53.33 53.33
9 62.5 62.5
10 53.1 53.1
Total 624.48 624.48
Mean 62.43 62.43
Nidra – an essential phenomenon for maintenance and restoration of the life, which is
considered under Trayopastambha. Proper sleep provides balance of the body constituents,
alertness, good vision, good complexion, fired digestive power as well as happiness, vigor,
virility, nutrition and long life. According to modern science, sleep is said to nourish and repair
the damages to the tissues caused by various catabolic activities of the body.
Evaluation of Tamas in terms of RATR (Reticular Activity
Transmission Retardation) in Sleep patterns Author: Dr. K. Shiva Rama Prasad, M.D.(Ay), C.O.P.(German), M.A, Ph.D (Jyotish) 1
Co-Author & Presentation: Dr. Kamalaxi. M. Angadi2
Introduction
Ayurveda describes the genesis of Universe in detailed with 25 dimensions. Out of
narration it aspires the understanding of “Triguna” in terms of biological explorations. Here at
this juncture an attempt is made to understand the “Tamas” as retardate product of
biorhythms. Human requires the three fundamental objective fulfillments in his entire life
span, “Trayo Upasthambha” (§ÉrÉ EmÉxiÉqpÉÉ CÌiÉ AÉWûÉUÈ xuÉmlÉÉå oÉë¼cÉrÉïÍqÉÌiÉ|) viz. Ahara (Food),
Brahmacharya (regularized sex act) and Nidra (Sleep).
It is definite to say that “The best bridge between despair and hope is a good night’s
sleep”. As like the all essentials of life, even the Nidra is also very much, and that is evidential
even. Sound restorative sleep is the foundation of a healthy life, there by to have a
constructive and progressive society. A good night’s sleep is undoubtedly one of the most
precious gifts of the nature we are enjoying freely. Sleep provides rest there by the energy for
our needs. Sleep is the basis of our day-to-day activity, hence, the Ayurveda explained
physiological and pathological Nidra in detail. As the health is a first muse and sleep is the
condition to produce it. Improper sleep leads to disease both physical and mental. Such sleep
is not emphasized on par with the present day available knowledge for better understanding
what our ancient Indian scientists notified through their tenets. 1 Professor, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic Medical College, Gadag (+91-9448746450) 2 Final PG scholar, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic Medical College, Gadag
What is Nidra (sleep)?
The ancient Greeks endorsed the sleep to God Hypnos (sleep), the child of darkness
and night and the brother of death, whose power as he swept across humanity was so great
that even the gods succumbed to him. Even in our mythology we found the “Nidra Devata” as
sister of “Yama” who is simulating the death.
Sleep is defined as a regular, recurrent, easily reversible state that is characterized by
relative quiescence and by a great increase in the threshold of response to external stimuli
relative to the waking state. The definition is still far from being satisfactory; an absolute
definition is not yet available it is very much need of the hour to evaluate the facts related to
the sleep under the lime light of available science. Sleep is defined as unconsciousness from
which the person can be aroused by sensory or other stimuli. (Guyton). Sleep is a state of
altered consciousness or partial unconsciousness from which the person can be aroused.
(Tortora).
As we understand, the Sleep is a periodic functional state of man and higher animals,
characterized by specific changes in vegetative and motor systems by the absence of
purposeful activity and sensory interaction with the environment and the Sleep is
characterized by the inhibition of conscious mental activity.
Sleep is a physiologic state of relative unconsciousness and inaction of the voluntary
muscles, the need for which recurs periodically. The stages of sleep have been variously
defined in terms of depth (light, deep), EEG characteristics (delta waves, synchronization),
physiological characteristics (REM, NREM), and presumed anatomical level (pontine,
mesencephalic, rhombencephalic, Rolandic, etc.).
According Ayurveda, the sleep is induced by the increase of the inert universal
attribute called Tamas. The term Tamas literally means darkness. Satva, Rajas and Tamas are
the three major or universal attributes that pervade the universe. These three attributes or
dimensions play an important role in the functioning of the mind and even body, of them rajas
and Tamas are capable to vitiate mind (Manas). Because of their predominance’s affects and
afflicts the mind the mental diseases are resultant. On the other hand the satva increase cause
the conducive to mental health and rajas represents its action.
Onset of sleep is related to the increases of Tamas always. These said principles affect
inertia on general. Sleep usually occurs at night as the surroundings are dark and are
predominated by Tamas. This dark environment naturally increases the Tamas in human
beings according to the theory of generality. Apart from this the bioelectrical cells, which are
in the body, sustain the energy for activity in the day light by getting charged through Sun
light. At the night the Human is the only capable to generate Bioelectricity through the
activity of digestion (Jatharagni). At the darkness the person reserves the energy and wish to
retire as the activities are restricted and energy levels are inhibited.
The sensory and motor faculties are fatigued by day’s work. The fatigued faculties
become sluggish in their work and will loose their activity. They gradually withdraw from
their objects 1. The functions of the mind also blocked by the increase and influence of
Tamas. Mind gets detached from the faculties and its action of enjoying the faculties ceases.
This stage is entitled as sleep. But even in the sleep also mind maintains its connection with
the soul, as it is “Ubhayendriya” – dualistic organ 2.
Sleep is a natural function of Tamas where in both satva and rajas acts against the
sleep induction. Apart from sleep Tamas causes of fear, ignorance, depression and laziness
also. Satva represents cognition and enlightenment. It is the cause of awakening; Nevertheless
sleep is included among any natural diseases 3. Hence, the Satva is against the ignorant and
inert sleep. Rajas on par with satva represent action and hence, it is also a factor against to
sleep induction, where the physical and mental activities are subdued or restrained.
Types of sleep (Cha. Su 21/58)
Ayurveda has different opinions regarding the types of sleep. Basically Nidra can be
classified into types viz. Svabhavika (natural) and Asvabhavika (abnormal). Out of the former
Svabhavika Nidra is regularly every night, which offers beneficial effects for the living
beings, whereas the later Asvabhavika is one can be due to different causes of pathological in
origin.
Charaka classifies the sleep condition into seven folds. He agrees with the ancient
authors who considered the sleep is Bhutadhatri. Sleep comes at night, spontaneously and
regularly as a natural instinct and that the other categories were either due to sin or the
disease. The seven types described by Charaka run as under -
1. Tamobhava Nidra
2. Sleshma Samudbhava Nidra
3. Manah Shrama Sambhava Nidra
4. Sharira Shrama Sambhava Nidra
5. Agantuki Nidra
6. Vyadhyanuvartini Nidra
7. Ratri Svabhava Prabhava Nidra
Brief descriptions of these types of Nidra are as follows -
1) Tamobhava Nidra:
Generally the sleep is due to the effect of Tamas, but the Tamobhava Nidra as
particularly due to the excessive Tamas causing sleep. When Satva and Rajasa are diminished
in excess and the seat of Atma and Mana i.e. Hridaya is covered by the vitiated Tamas, then
the organization become inert or inactive. According to some scholars, the Tamodbhava Nidra
resembles with Sanyasa condition described by Charaka, which is the comatose state. The
sleep caused by Tamas is also the root cause for all sinful acts. Tamas always causes
excessive sleep. Thus, the individual is unable to perform the virtuous files and so he subjects
himself to sinful behavior.
2) Sleshma Samudbhava Nidra:
Sleshma is the material state of Tamas and as such the Sleshma and the Tamas are
having identical properties. When the Sleshma increases in the body the sleep ensues.
Therefore, it is called Sleshma Samudbhava Nidra.
3) Manah Shrama Sambhava Nidra:
The person also gets the sleep as the result of exertion. Due to excessive mental stress
and strain, the mind gets tired and unable to perform its activities, as a result the animal gets
sleep.
4) Sharira Shrama Sambhava Nidra:
The person also gets the sleep due to physical exertion. When a person indulges in
excess physical activities he feels too much tired. The body and mind desire to take rest and
agitate to work further and the person gets sleep.
5) Agantuki Nidra:
Sometimes the cause of sleep remains obscure and the cause is not explainable.
However, the sleep is followed by the death and as such Chakrapani has termed this sleep as a
death signal (Arishta) 1
6) Vyadhyanuvartini Nidra:
There are some diseases like Sannipata Jwara where severe weakness of the patient
and follows the condition just similar to coma. This type of sleep is termed as
Vyadhyanuvartini Nidra.
7) Ratri Svabhava Prabhava Nidra:
As has been stated earlier the sleep is a natural phenomenon and it comes at a
particular time in the night. There is no particular reason for this sleep and it is also termed as
Bhutadhatri. It has been observed that even the individual who has slept during the daytime
would also feel sleepiness in the night, which is quite a natural phenomenon.
Astanga Sangraha Vagbhata followed the Charaka’s view with a slight change in the
names. He also mentioned seven types. The commentator Indu opined that the Tamobhva is
Antya i.e. comes at the time of death and Agantuka means Shastra Praharadina (due to injury)
and considered these are due to Vyadhis.
Astanga Hridaya Vagbhata considered only four types of Nidra and included the all
seven types in these viz. Akale sevitha , Ati prasangath sevitha, Nacha sevitha and Nishevitha.
The commentator Hemadri considered them as – The properly taken sleep brings happiness,
nourishment, strength, virility, knowledge and life to the individual. The improperly taken
other three types may kill the individual like the Kalaratri, who killed all demons. Acharya
Charaka also mentions these while explaining the effects of sleep.
Susruta described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi and
Vaikariki Nidra.
1) Svabhaviki Nidra:
Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the
power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached from the
worldly sensory objects on account of the tiredness of Manasa; and the seat of Manasa and the
Sleshma and Tamas cover Atman. This mostly happens in the night and individual gets sleep.
The Tamoguna dominant persons may go to sleep at any time i.e. day or night. But a person
having Rajoguna in excess may get sleep sometimes in the day or in the night, because of
Chalatva of Rajasa. The person having qualities dominated by Satva Guna sleeps at the
midnight. Because, at this time Tamas is excess and Satva will be decreased (Dalhana)
The term Papma has been used to describe the Tamobhava of Nidra and also to
mention the sinful activities.
2) Tamasi Nidra:
It is the lack of consciousness preceding the death. Tama dominant Kapha induces this
due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individual.
3) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of
Vayu and also due to mental and physical pain, distress etc. the person doesn’t enjoy the
sufficient and sound sleep in quantity and quality 2,3. Disturbed sleep is also a type or
Vaikarika Nidra.
Instead of above seven fold classification we can make three types of classifications in
terms of tamas. As we seen that sleep is due to manodosha tamas, but here tamas means not
alone, the other manasika doshas are there i.e. according to Charaka vimansthana Dosha
anubhandhya anubhandha concept the nidra can be made into mainly three types.
Tamasika nidra
Rajayukta tamasika nidra
Satvayukta tamasika Nidra
According to Susruta (shareera 4/32) another sets of Nidra viz. Tamasika Nidra is sleeps
both day & night, Rajayukta tamasika Nidra get sleeps either in the day or night and
Satvayukta tamasika nidra sleep at midnight.
Contemporary theories of sleep (Nidra)
Until some time back, it was held that the condition of a sleeping man (or animal) may
be compared to an individual deprived of cerebral hemispheres and capable only of the most
elementary sensory motor acts. This view has since been shown to be inaccurate largely
because the decorticated animal exhibits sleep wake rhythm. In addition there is also evidence
that in sleep several areas of the nervous system are in a quiescent state and such functions as
still are carried out on in a modified manner. The question is if certain parts of the nervous
system exercise a control over sleep awake rhythm or does the nervous system, as a whole,
respond merely to some outside influence, such as a toxin on to be reduced blood flow, has
been sought to be answered thus; there are neural structure in the tagmentum of the mid brain
which maintains a state of wakefulness, somnolence lasting several weeks has been produced
in monkeys by causing lesions between the posterior hypothalamus and the mid brain. The
structure in the tagmentum of the mid brain has been shown to be activated by collaterals of
afferent sensory neurons which in turn excite a wide spread effect on the cerebral cortex. The
existence of a corticofugal influence on the mid brain, by which afferent valleys of nerve
impulses may be prevented from having there influence on the cortex is considered to be a
possibility.
No satisfactory answer has, as yet been found to the question if assuming that, this or
neighboring parts of the nervous system is essential to the sleep-wake rhythm by what means
it periodically subsides into tranquity? In the view of authorities entitled to an opinion there is
a growing measure of support to the view postulated by parkinjee that sleep represents “a
physiological interruption of afferent pathways at a central point”. It is of importance to note
that the cerebral blood flow does not appear to be reduced during sleep. This observation
should clear the prevalent notion that sleep is the outcome of cerebral ischaemia.
The sleep center:
Several clinical and experimental observations point to the existence of a center
concerned with sleep, in the hypothalamus, which is also the center for the sympathetic and
parasympathetic. It has been shown that drugs, which suspend the activity of the sympathetic
center, caused apreponderance of parasympathetic effects including sleep. The view that sleep
is the function of the parasympathetic has, therefore been advanced.
The validity of this view, apart, which according to other authorities needs further
experimental corroboration the evidence for the participation of the hypothalamus, is the
causation of sleep is seen to be very strong. Nonetheless, contrary to the view, that sleep is
caused by the excitation of some part of the hypothalamus, some authorities hold that it
results from the depression of the hypothalamus. Thus the hypothalamus is considered to
contain a waking center, the inhibition of which is stated to follow by sleep.
Cortical theory of sleep:
Reticular activating system (RAS) is a physiological term denoting that part of the
brainstem reticular formation that plays a central role in the organism's bodily and behavioral
alertness; it extends as a diffusely organized neural apparatus through the central region of the
brainstem into the sub-thalamus and the intra-laminar nuclei of the thalamus; by its ascending
connections it affects the function of the cerebral cortex in the sense of behavioral
responsiveness; A Proactive or Retroactive inhibition of sleep patterns can be assessed
through behavioral responsiveness.
Yet another theory, the one advanced by Kleitman- holds that sleep is due to the
inactivity of the cerebral cortex, which arises from the reduction in the number of affarent
impulses, especially from the muscles, reaching the sensory areas. The factor which is
considered to bring about the reduction in the number of afferent impulses, especially from
the muscles due to fatigue of the neuromuscular mechanism which latter mediates muscle
tone & the consequential suppression of impulses from the proprioceptors of the muscles is
stated to be important.
Secondly, the exclusion of stimuli from the visual auditory and cutaneous receptors is
also an important factor, which is stated to lead to sleep. Not withstanding the above, it has
been recognized that cortical activity due to psychic causes viz. anxiety, worry, excitement
etc, may prevent sleep with those of the hypothalamus.
Looking at all the above theories of contemporary about the mechanism of sleep, a
review of the concept of Nidra is essential. None of them are truly sufficient to explain their
phenomenon undoubtedly. However each one of them has contributed some facts, based on
either experimental or clinical observations. These are of values added studies along with the
concept of Nidra vividly described by Charaka, Susruta and Dalhana. The concepts of sleep
are –
1) Initially, in view of the fact finding the portion of Mastiska that is known as
the cerebra cortex is essential for sensory appreciation and voluntary movements in
the body. As both these capacities are reduced during sleep, recent investigators
looked in to the cortex for an explanation of sleep. Sleep results from a decrease in the
number of impulses flowing to the cerebral cortex. It is an important factor responsible
for impulses reduction has been attributed to the fatigue of the neuromuscular
function, which in turn is unable to pass on proprioceptive impulses, would lend
support klama of Charaka, reference to fatigue of the mind. The klama or the fatigue
of body and senses leading especially to divorce of the sense objects from the senses
by implication. The affarent pathways are unable to conduct different kinds of external
and internal stimuli due to fatigue.
2) It is well known that sleep usually requires a reduction in external disturbing
agents such as light and sound, which also reduces the sensory barrage to the cerebral
cortex, is the Tamas described as Ratri swabhavaja (Night habituations).
3) Anxiety, fear, worry and elation of spirits, which tends to excite the cerebral
cortex and prevent sleep are also stated to be due to Tamas 5.
“The important factor responsible for reduction of sleep has been shown to be the fatigue
of neuromuscular function which in turn unable to pass on proprioceptive impulses may be
the Tamas.” This is proved with the sleep efficiency and sleep fragmented time calculations of
10 patients who underwent the insomnia and sleep pattern disturbances. The data is as
follows.
In this paper an attempt is made to evaluate the quantity and quality of Tamas in terms of
sleep efficiency and the Tamo-abhava (vitiation of tamas ) in terms of sleep fragmented
time,i.e. disturbed sleep, awakening during normal sleep.
Tamas = sleep efficiency
Vitiation of Tamas = Sleep fragmented time
S.No Sleep efficiency Sleep fragmented
time
Tamas
1 55.5 1.66 55.5
2 82.14 1.91 82.14
3 85.71 3.0 85.71
4 62.5 1.25 62.5
5 73.52 2.13 73.52
6 53.33 2.0 53.33
7 42.85 1.5 42.85
8 53.33 1.0 53.33
9 62.5 1.66 62.5
10 53.1 1.4 53.1
Total 624.48 17.51 624.48
Mean 62.43 1.9 62.43
020406080
1002
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9
10
Sleepefficiency
Sleepfragmentedtime
Conclusion:
Sleep is considered as one of the supporting pillars of life. Hence, Ayurveda offers
importance to proper sleep at the most. Its importance is equal to that of food and daily
routines along with regulated sexual act. Food and sex may mainly require maintaining one’s
own health and pleasure satisfaction but the sleep imparts both at once with relaxation. as
sex is essential for the continuity of human race. Ayurvedic treatises advocate various norms
for practicing sleep in proper manner. Acharyas (A.H.Su 7/53 & C.S.Su 21/36) even told that
sleep is the root cause of pleasure, pain, proper nutritional status, emaciation, strength,
weakness, sexual power, impotency, knowledge, ignorance, life and death. It is interesting to
note that sleep can produce favorable and unfavorable results even. Favorable results are
caused by proper practice of sleep, whereas unfavorable results produced by improper
practice of sleep. One should sleep in time for the required period, lest he may fall victim to
diseases (C.Su.21/37). So, one should not indulge excessive sleep and should resort to
untimely sleep.
Here, tamo-abhava is reticular activity transmission and tamobhava is RATR. We see
that, the satvika purusha with less tamas, who wants achievement in life, thinks that “If I
sleep, the world will move front, leaving me behind”. But dear, friends to maintain both
physical and mental health sleep in time for required period.
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