ANIDRA(Insomnia)

Introduction

Insomnia is the perception or complaint of inadequate or poor quality of sleep because of difficulty in falling asleep, difficulty in maintaining sleep or waking too early in the morning. Chronic Insomnia can lead to severe fatigue, anxiety, depression and lack of concentration. Insomnia can be classified in terms of its duration. It comes under Vata nanatmaja vikara and called Anidra or Nidranasha in Ayurvedic terminology.

Sleep disorders are 1.5 times more common in persons aged more than 65 years

compared to younger counter parts and incidence in women is 1.3 times greater than in men. The prevalence of Insomnia increases steadily with age and reported by up to one in 3 people aged 65 years and above.

Insomnia can be classified as-

1. Transient Insomnia - lasting from a night to a week and is usually caused by

events which alters normal sleep pattern, such as traveling or sleeping in an unusual environment.

2. Short term Insomnia - lasts about two to three weeks and is usually attributed to emotional factors such as worry or stress.

3. Chronic Insomnia - occurs most nights and lasts a month or more.

Aetiology

Insomnia is occasionally a symptom of an underlying medical or psychological condition but it may be caused by stress or life style changes. About half of Insomnia cases have no identifiable cause. Some conditions or situations that commonly lead to Insomnia include-

1. Substance abuse; such as smoking, excessive consumption of caffeine, alcohol and recreational drugs

2. Disruption of circadian rhythms; such as shift work, change in work schedule

3. Uncomfortable and unusual sleeping environment

4. Psychiatric and neurological conditions; such as depression, manic depressive

disorder, restless leg syndrome (RLS), post traumatic stress disorders.

5. Biological factors – Due to advancement in age, the internal biological 'clock' that regulate sleep creeps slightly forward, compelling most senior citizens sleep earlier and wake up early.Reuction of physical and social activities and degenerative changes in all aspects of health may cause insomnia in advance age.

6. Sleep disordered breathing - sleep apnea

7. Chronic illness - such as congestive heart failure, chronic obstructive

pulmonary disease, heart burn, prostatic problems, menopause, diabetes, arthritis and hyperthyroidism

8. Use of certain medicins – long term use of decongestants, bronchodilators, beta blockers and sleep producing medication

9. Excessive computer work or watching Telivision.

Pathogenesis

Sleep disorders are associated with an impairment of melatonin production. Melatonin produced by the pineal gland at night, plays a role in regulation of sleep-wake cycle and diminished-melatonin secretion may cause insomnia.

Clinical features

Common symptoms of insomnia include

1. Not feeling refreshed

2. Inability to sleep despite being tired

3. Day time drowsiness, irritability, difficulty in concentrating

4. Impaired ability to perform normal activities

5. Body-ache and heaviness of the body

Complications

1. Depression

2. Anxiety disorder

3. Fatal accident

4. Increase in severity of chronic diseases VIZ. high blood pressure and diabetes

Investigations

1. Polysomnography

2. Evaluation for depression and anxiety

3. Multiple sleep latency test (MSLT)

4. Thyroid function test

5. EEG

Management approaches

a. Preventive

1. Use of madhura rasa (sweet in taste) as pradhana ahara and warm buffalo milk before bed time

2. Maintenance of active mental and physical life

3. Practice of yoga and meditation

4. Practice of siroabhyanga and padabhyanga (massage of scalp and plantar region).

5. Avoidance of excessive consumption of coffee, tea, soft drinks, alcohol and smoking

6. Avoidance of incompatible, indigestible, hot and spicy food article.

7. Avoid heavy meal and stress at night

8. remedial measures for hypertension diabetes mellitus and urological problems, if exists.

b. Medical management

Line of treatment

1. Nidana parivarjana (avoidance of aetiological factors) - before starting medicine

for insomnia psychiatric, neurological condition and chronic medical illness need to be treated first and smoking, excessive consumption of caffeine, alcohol, excessive computer work or T.V. watching need to be avoided.

2. Panchakarma procedures followed by samana chikitsa (Palliative therapy)

i. Virecana (Purgation) with Eranda taila 10 - 20 ml with half glass of milk at night

ii. Abhyanga (body massage), Padabhyanga (foot massage),shiroabhyanga (head

massage) with medicated oils.

iii.shiirodhara with medicated liquids (milk/ water/ oils (Narayana taila) daily 45-90 minutes for 21 days

iv. Pichu with Ksheerabalsa taila/ Himas!gara taila

v. Takra dhara daily 45 minutes for 14 days

3. Drug therapy

SINGLE Useful Herbs

Plant	Dose	vehicle	Duration
Aswagandha churna	3 to 5gm	Suger and ghee before meal	7 days
Jatamansi churna	500 mg to 1gm	Milk after meal	7days
Brahmi churna	1 to 2gm	Milk	7days
Mandukparni churna	1 to 2gm	Milk	7 days

Useful Ayurveda Drugs

Drug	Dose	Vehicle	Duration
Mamsyadi Kwatha	15 to 30 ml.	Water	7days
Brahmi Vati	125 to 250 mg.	Honey	7days
Sarpagandhadi Vati	125mg.	Milk	7days
Manas Mitra Vataka	125mg.	Milk	7days
Maha Kalyanaka Ghrita	6 gm	Warm milk/ Warm water	7 days
Narayan tail	For shirodhara	NA	21 days
Himasagar taila	For shirodhara	NA	7 days
Ksheera bala taila	For pichu	NA	14 days

NOTE-Medicines should be taken only in consultation with qualified Ayurveda physician either in combination of more than one drug or in the doses as decided by the physician depending upon the condition of the patient.

C. Yogic Practices - The following yogic practices are beneficial in Insomnia; however,these should be performed only under the guidance of qualified Yoga therapist. Duration should be decided by the Yoga therapist.

1. Practice of Pranayama (Chandra anuloma viloma, Ujjai, Bhramari, Cooling

pranayama) and meditation along with the practice of Yama and Niyama

2. Suryanamask!ra, Tadasana, Matsyasana, Mandkasana, Bhujangasana, Padmasana,Paschimottanasana and shavasana

3. Deep relaxation techniques, Yoga Nidra

D.Counselling – advice to

1. Drink warm milk before bed in night.

2. Light physical activities before going to bed in night

3. Bath with warm water before bedtime

4. Sleep on comfortable bed

5. Use of bed and bedroom for sleeping purpose only. (Bed room should not be used for watching TV and reading)

6. Maintain a regular sleep /wake up schedule

7. Practice yoga and meditation