“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
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
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
“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
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
Management of Anidra with Nidra caps – Literary Review 15
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.
Management of Anidra with Nidra caps – Literary Review 17
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.
Management of Anidra with Nidra caps – Literary Review 18
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
Management of Anidra with Nidra caps – Literary Review 19
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 -
Management of Anidra with Nidra caps – Literary Review 20
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.
Management of Anidra with Nidra caps – Literary Review 21
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.
Management of Anidra with Nidra caps – Literary Review 22
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
Management of Anidra with Nidra caps – Literary Review 23
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.
Management of Anidra with Nidra caps – Literary Review 24
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
Management of Anidra with Nidra caps – Literary Review 25
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.
Management of Anidra with Nidra caps – Literary Review 26
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.
Management of Anidra with Nidra caps – Literary Review 27
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.
Management of Anidra with Nidra caps – Literary Review 28
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.
Management of Anidra with Nidra caps – Literary Review 29
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.
Management of Anidra with Nidra caps – Literary Review 30
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.
Management of Anidra with Nidra caps – Literary Review 31
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
Management of Anidra with Nidra caps – Literary Review 33
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 -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
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
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
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
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
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
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,
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
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), [email protected] 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
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
3
48
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.