i   
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE
STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN
PRIMARY INSOMNIA”...
    ii   
    iii   
    iv   
    v   
    vi   
ACKNOWLEDGEMENTS
I bow to the sacred feet of Almighty, without the blessings of whom this study would
not have b...
    vii   
Dr. Shantaram, Dr.Rajendra, Dr.Shreevathsa, Dr.Mythreyi, Dr.V.A.Chate and
Dr. Anand Katti and all other teacher...
    viii   
I also owe my heart felt gratitude to my Teachers of Under Graduation at GAMC,
Bangalore, who initiated and in...
    ix   
ABSTRACT
Background of the Study
Our treatises emphasized the importance of Trayopastambhas viz. Aahara, Nidra a...
    x   
Guda-pippalimula yoga is described to be effective in Nidranasha in Bhaishajya
Ratnavali.
Hence there is a need f...
    xi   
Group C: Only advised to follow Diet chart for Nidranasha created as per our
classics, for a period of 48days.
T...
    xii   
CONTENTS
Introduction
1
Review of Literature
Historical Review 3
Concept of Nidra 5
Concept of Sleep 26
Nidrana...
    xiii   
List of Tables
Table
No
Particulars Page
No.
1 Showing the Synonyms of Nidranasha 35
2 Showing the different N...
    xiv   
26 Showing the properties of Shali Dhanya 89
27 Showing the Properties of Dadhi 90
28 Showing the Properties of...
    xv   
49 Distribution of Diet among the 45 patients 113
50 Distribution of Chronicity among the 45 patients 114
51 Dis...
    xvi   
76 Symmetric Measures in Component 2: Sleep latency 130
77 Showing total scores of C3 in Group A 131
78 Showing...
    xvii   
List of Illustrations
1 Showing age wise distribution of 45 patients in Nidranasha 119
2 Showing sex wise dist...
    xviii   
List of Abbreviations
1. A H Ut - Astanga Hridaya Uttaratantra
2. A H Ni - Astanga Hridaya Nidanasthana
3. A ...
    xix   
22. Sha P Kh - Sharangadhara Poorva Khanda
23. Su Ni - Sushruta Samhita - Nidanasthana
24. S S - Sushruta Sauhi...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Dr Kavit...
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Nidranasha ss-mys
Upcoming SlideShare
Loading in...5
×

Nidranasha ss-mys

1,581

Published on

A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN
PRIMARY INSOMNIA” By Dr. Kavitha, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,581
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
38
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Nidranasha ss-mys

  1. 1.     i    “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” By Dr. Kavitha S. B.A.M.S. Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In the partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE (AYURVEDA) in AYURVEDA SIDDHANTA Under The Guidance of Dr. Bala Krishna D. L. M.D. (Ayu) Professor Head of the Department, Department of Panchakarma, G.A.M.C., Mysore-21. DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010
  2. 2.     ii   
  3. 3.     iii   
  4. 4.     iv   
  5. 5.     v   
  6. 6.     vi    ACKNOWLEDGEMENTS I bow to the sacred feet of Almighty, without the blessings of whom this study would not have been completed. I am extremely thankful to Dr. Naseema Akthar, HOD, Department of PG Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for her constant guidance and support. I sincerely express my indebtedness and profound gratitude to my Guide Dr. Balakrishna D. L., Professor, Head of the Department of Panchakarma, Government Ayurveda Medical College, Mysore for his valuable guidance & encouragement through out my PG studies. I am grateful to Principal Dr.Ashok D. Satpute, Professor and Head, Department of Rasashastra and Bhaishajya Kalpana, Government Ayurveda Medical College, Mysore for his support and encouragement. I am highly thankful to (Late) Dr.G.N.Shakuntala, former HOD, Department of PG Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for her constant guidance, continuous supervision and help at every stage of this study. I sincerely express my indebtedness and profound gratitude to Dr.N.Anjaneya Murthy, Joint Director of AYUSH, Professor and former HOD, Department of PG Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for his ever lasting support and inspiration. I owe my deep sense of gratitude to all my teachers Dr. T. D. Ksheera Sagar, Dr. Shanthala Priyadarshini, Dr.H.M.Chandramouli, Dr. Gopinath,
  7. 7.     vii    Dr. Shantaram, Dr.Rajendra, Dr.Shreevathsa, Dr.Mythreyi, Dr.V.A.Chate and Dr. Anand Katti and all other teachers and hospital staff for their support in this study. I also thank Dr.Ramchandra Naik, Senior Physician, GAMCH, Mysore for his constant support. I also convey my special thanks to Dr. Raveesh, Professor & HOD, Dept. of Psychiatry, MMC, for this valuable guidance and support during my study. I thank Dr.Lancy D’souza for his valuable help and guidance in the statistical analysis and interpretations. I express enormous amount of thanks to my senior Colleague Dr.Soubhagya Bilagi, my colleague Dr.Aparna.K and My junior colleague Dr.Rekha.A.R for their timely suggestion, support and encouragement through out my study. I am thankful to my senior colleagues Dr.Savita Shenoy, Dr. Vijayalakshmi, Dr.Yogesh and Dr.Kedar Sharma. I owe my special thanks to my classmates Dr.Annapoorani, Dr.Pankaj Pathak and Dr.Rajesh Bhat. I thank my colleagues Dr. Ranjith, Dr. Kalyani, Dr.Ramesh and Dr.Geetha for their help. I also thank my Kayachikitsa colleagues Dr. Parveen, Dr. Kiran, Dr. Ranjini, Dr. Vyas Raj, Dr. Anatha Sayena, Dr. Sameena and Dr. Pallavi for their support. I also thank our junior colleagues Dr. Athika Jan, Dr. Pallavi and Dr.Aravind for their help. I thank Kayachikitsa juniors Dr. Shridhar Murthy, Dr. Shubha, Dr. Geeta, Dr. Soumya, Dr. Aditya , Dr. Mahesh and Dr. Vidya for their help I also thank our Department employee Annaiahachar.
  8. 8.     viii    I also owe my heart felt gratitude to my Teachers of Under Graduation at GAMC, Bangalore, who initiated and instilled in me the knowledge of this holy science. This acknowledgement would not be complete without paying obeisance to my parents Sri S. Subramanyam and Smt. S. Saroja. Their constant encouragement and guidance propelled me to achieve my goal. I am especially indebted to my in-laws Sri T. Muralikrishna and Smt. T. Varalakshmi for all their support and taking care of my daughter during my study. I convey my special thanks to my beloved husband Dr. T. Sundar Raj Perumall for his valuable timely help and support and also to my little daughter Sai Krishna priya for allowing me to complete my study. I also thank my sister Jyothi Nandi, brother-in-law Gopal S. Nandi(CA) brother S. Venkatesh, sister-in-law Dr. Susheela Murthy her husband Commander M.S.N.Murthy( Indian Navy) and brother Prof. S. D. Prasad for their support. I wish to convey my thanks to U.G. and P.G. Librarian Mrs. Varalakshmi and Mr. Somasundar for providing library facilities. I also thank library employee Raju. I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in a documented form. Last but not the least, I express my thanks to all persons who helped me directly or indirectly in my studies with apologies for my inability to identify and thank them individually. Date: Place: Mysore Dr. Kavitha S.
  9. 9.     ix    ABSTRACT Background of the Study Our treatises emphasized the importance of Trayopastambhas viz. Aahara, Nidra and Brahmacharya as the pillars of a healthy life. Nidra is the most neglected part of modern life style where one gives least importance to the timing, duration, and quality of sleep with stress playing an important role in inducing insomnia. This negligence is leading to Vata prakopa and in turn causing various physical and psychiatric illnesses. Recent studies have shown that about 40 percent of women and 30 percent of men are suffering from insomnia. Considering this, Insomnia has become a major health hazard, drawing the attention of professionals and researchers all over the world. Primary insomnia, where the cause of sleeplessness is obscure, is normally treated with antidepressants, sedatives, tranquilizers, hypnotic drugs, etc. Slowly people are getting addicted to these drugs, and also experiencing the side effects of these strong chemicals. Other modalities of treatments such as relaxation therapy and psycho- therapy also have their own limitations. When insomnia is neglected or wrongly treated it leads to impaired mental functioning, accidents, headaches, increase in mortality rates, stress, depression and heart diseases. Holistic management of Nidranasha is the need of the day and Ayurvedic professionals need to re evaluate the management of nidranasha. Nidranasha has been described in detail by all our acharyas. Nidranasha is mentioned in various contexts like vataja nanatmaja vikaras, vataja jwara, vataja hridroga etc. Various drugs are also mentioned to be highly effective in Nidranasha. Diet and life style modifications have a great role to play in assisting patients of primary insomnia as per our treatises. Many promising formulations have been described and one such yoga has been selected.
  10. 10.     x    Guda-pippalimula yoga is described to be effective in Nidranasha in Bhaishajya Ratnavali. Hence there is a need for a detailed study of physiological, pathological and curative aspects of Nidranasha. The present study is aimed at studying concepts of Nidranasha and evaluating the importance of diet and comparing it with a simple yoga on primary insomnia patients. Objectives of the Study  To systematically review & study the literature on Nidranasha, available in all Ayurvedic classics.  To review literature on Nidrajanaka Ahara and modifications suggested to prevent and manage Nidranasha.  To clinically evaluate the efficacy of Guda Pippalimula yoga in Nidranasha by comparing with Ayurvedic diet suggested in Nidranasha (Primary Insomnia). Method: A Comparative Single Blind Clinical Study with pre and post design. Intervention: As it is a comparative study, the patients are divided in to three Groups consisting of 15 patients in each Group. Group A: 2g Pippalimula choorna along with 2g of Guda was administered with milk, in the evening after meals; along with Diet chart for Nidranasha created as per our classics, for a period of 48days. Group B: 2g Pippalimula choorna along with 2g of Guda was administered with milk, in the evening after meals, for a period of 48days.
  11. 11.     xi    Group C: Only advised to follow Diet chart for Nidranasha created as per our classics, for a period of 48days. The follow up period was for 48days. Statistical Analysis to assess Individual and Comparative effects of the groups was done using Chi- Square test, One Sample t- test, Contingency Co-efficient Test and Repeated Measures ANOVA. Results: All the patients with Nidranasha considered for the study showed improvement in all the Parameters in all three Groups. However in Groups A and B the improvement is Highly significant. Changes within the group were also found to be highly significant. Interpretation and Conclusion After treatment period good result was observed in group A followed by group B and in group C Mild improvement was observed. After follow up period, also good result was observed in Group A followed by Group B and Mild improvement was seen in Group C. Overall result was good in Groups A and B Keywords  Nidra  Nidra nasha  Primary insomnia  Guda Pippali mula Yoga  Nidra Janaka Ahara
  12. 12.     xii    CONTENTS Introduction 1 Review of Literature Historical Review 3 Concept of Nidra 5 Concept of Sleep 26 Nidranasha 34 Nidana Panchaka 36 Nidana 36 Poorvaroopa 40 Roopa 40 Upashaya 41 Samprapti 42 Upadrava 47 Arista lakshana 47 Modern Review 48 Chikitsa 58 Pathya apathy 64 Modern Treatment 66 Drug review 76 Previous works 94 Materials and Methods 95 Observation 109 Results 126 Discussion 143 Conclusion 176 Summary 177 Bibliographic References 179 Annexure I Master Chart X
  13. 13.     xiii    List of Tables Table No Particulars Page No. 1 Showing the Synonyms of Nidranasha 35 2 Showing the different Nidanas of Nidranasha 38 3 Showing the Ahara-viharajanya nidana of Nidranasha 38 4 Showing the Upacharajanya Nidanas 39 5 Showing the Manasika Nidana 39 6 Showing the Anya Nidanas 39 7 Showing Rupa of Nidranasha 40 7a Differential Diagnosis 54 8 Showing Bahya upacharas in Nidranasha 59 9 Showing the Manasika Upacharas in Nidranasha 59 10 Showing Aahara Upacharas in Nidranasha 60 11 Showing Different Ahara vargas used in Nidra nasha 61 12 Showing Anya upachara in Nidranasha 61 13 Showing the Pathya ahara in Nindranasha 64 14 Various viharas promoting Nidra mentioned in Brihattrayee 65 15 Hypnotic Drugs and their Hypnotic Effect 72 16 Showing the properties of Pippalimoola 77 17 Showing the properties of Guda 80 18 Showing the Nutrient content of Jaggery (per 100 gms) 81 19 Showing the Rasa panchaka of Ksheera 82 20 Showing nutritive value of milk (per 100 gms) 83 21 Showing the Properties of Masha 84 22 Showing the Properties of Ikshu 85 23 Table showing Properties of Ghrita 86 24 Showing the Properties of Upodika 87 25 Showing the properties of Godhuma 88
  14. 14.     xiv    26 Showing the properties of Shali Dhanya 89 27 Showing the Properties of Dadhi 90 28 Showing the Properties of Palandu 90 29 Showing the Properties of Draksha 91 30 Showing the Properties of Tila 92 31 Showing Different varieties of mamsa used in Nidranasha 93 32 Showing the diet chart given to the Groups A and C 104 33 Showing Component 1: Subjective sleep quality—question 9 105 34(a) Showing the response to C2/Q2 subscore 105 34(b) Showing the response to C2/Q5a subscore 105 34(c) Showing the sum of Q2 and Q5a subscores (C2) 105 35 Showing Component 3: Sleep duration—question 4 106 36 Showing Component 4: Sleep efficiency—questions 1, 3, and 4 106 37(a) Showing Component 5: Sleep disturbance—questions 5b-5j 106 37(b) Showing the sum of 5b to 5j scores 107 38 Showing Component 6: Use of sleep medication—question 6 107 39(a) Showing the response to C7/ Q7 subscore 107 39(b) Showing the respone to C7/Q8 subscore 107 39(c) Showing the sum of Q7 andQ8 subscores(C7) 108 40 Distribution of Age Group among the 45 patients 109 41 Distribution of Sex among the 45 patients 109 42 Distribution of Marital Status among the 45 patients 110 43 Distribution of Religion among the 45 patients 110 44 Distribution of Location among the 45 patients 111 45 Distribution of Occupation among the 45 patients 111 46 Distribution of Socio-Economic Status among the 45 patients 112 47 Distribution of Education among the 45 patients 112 48 Distribution of Nature of Work among the 45 patients 113
  15. 15.     xv    49 Distribution of Diet among the 45 patients 113 50 Distribution of Chronicity among the 45 patients 114 51 Distribution of Habits among the 45 patients 114 52 Distribution of Prakruti among the 45 patients 115 53 Distribution of Sara among the 45 patients 115 54 Distribution of Samhanana among the 45 patients 115 55 Distribution of Pramana among the 45 patients 116 56 Distribution of Satmya among the 45 patients 116 57 Distribution of Sattva among the 45 patients 116 58 Distribution of Agni among the 45 patients taken for Study 117 59 Distribution of Koshta among the 45 patients 117 60 Distribution of Vyayama Shakti among the 45 patients taken for Study 117 61 Distribution of Onset among the 45 patients taken for Study 118 61a Associated symptoms complained by 45 patients of Nidranasha 118 62 Showing Global PSQI in Group A 126 63 Showing Global PSQI in Group B 126 64 Showing Global PSQI in Group C 126 65 Showing the Mean Global PSQI values in Group A,B and C 126 66 General Linear Model-Descriptive Statistics of Global PSQI score 127 67 Showing total scores of C1 in Group A in Subjective sleep quality 128 68 Showing total scores of C1 in Group B in Subjective sleep quality 128 69 Showing total scores of C1 in Group C in Subjective sleep quality 128 70 Symmetric Measures in Component 1: Subjective sleep quality 128 71 Showing Significance Symmetric Measures in Component 1 129 72 Showing total scores of C2 in Group A in Sleep latency 129 73 Showing total scores of C2 in Group B in Sleep latency 130 74 Showing total scores of C2 in Group C in Sleep latency 130 75 Showing results of Component 2: Sleep latency 130
  16. 16.     xvi    76 Symmetric Measures in Component 2: Sleep latency 130 77 Showing total scores of C3 in Group A 131 78 Showing total scores of C1 in Group B 131 79 Showing total scores of C1 in Group C 131 80 Showing results of Component 3: Sleep duration 132 81 Symmetric Measures in Component 3: Sleep duration 132 82 Showing total scores of C4 in Group A 133 83 Showing total scores of C4 in Group B 133 84 Showing total scores of C4 in Group C 133 85 Showing results of Component 4: Sleep efficiency 133 86 Symmetric Measures in Component 4: Sleep efficiency 134 87 Showing total scores of C5 in Group A 134 88 Showing total scores of C5 in Group B 134 89 Showing total scores of C5 in Group C 135 90 Showing results of Component 5: Sleep disturbance 135 91 Symmetric Measures in Component 5: Sleep disturbance 135 92 Showing total scores of C6 in Group A 136 93 Showing total scores of C6 in Group B 136 94 Showing total scores of C6 in Group C 136 95 Showing results of Component 6: Use of sleep medication 136 96 Symmetric Measures in Component 6: Use of sleep medication 137 97 Showing total scores of C7 in Group A 137 98 Showing total scores of C7 in Group B 138 99 Showing total scores of C7 in Group C 138 100 Showing results of Component 7: Daytime dysfunction 138 101 Symmetric Measures in Component 7: Daytime dysfunction 138 102 Showing the similarities in types of sleep by Charaka and Vagbhata 148 103 Similarities of the types of sleep in Brahatrayis 149
  17. 17.     xvii    List of Illustrations 1 Showing age wise distribution of 45 patients in Nidranasha 119 2 Showing sex wise distribution of 45 patients in Nidranasha 119 3 Showing marital status wise distribution of 45 patients in Nidranasha 119 4 Showing religion wise distribution of 45 patients in Nidranasha 119 5 Showing Occupation wise distribution of 45 patients in Nidranasha 120 6 Showing Education wise distribution of 45 patients in Nidranasha 120 7 Showing socio economic status wise distribution of 45 patients 120 8 Showing diet wise distribution of 45 patients in Nidranasha 120 9 Showing locality wise distribution of 45 patients in Nidranasha: 121 10 Showing mode of onset wise distribution of 45 patients in Nidranasha 121 11 Showing Nature of work distribution of 45 patients 121 12 Showing prakruti wise distribution of 30 patients in Vataja Kasa 121 13 Showing Sara wise distribution of 45 patients in Nidranasha 122 14 Showing Samhanana wise distribution of 45 patients in Nidranasha 122 15 Showing Samhanana wise distribution of 45 patients in Nidranha 122 16 Showing Satmya wise distribution of 45 patients in Nidranasha 122 17 Showing Sattva wise distribution of 45 patients in Nidranasha 123 18 Showing agni wise distribution of 45 patients in Nidranasha 123 19 Showing koshta wise distribution of 45 patients in Nidranasha 123 20 Showing Vyayama wise distribution of 45 patients in Nidranasha; 123 21 Showing chronicity distribution of 45 patients in Nidranasha 124 22 Showing Component 1(Subjective Sleep Quality) Score distribution 139 23 Showing Component 2( Sleep Latency) Score distribution 140 24 Showing Component 3( Sleep Duration) Score distribution 140 25 Showing Component 4 ( Sleep Efficiency) Score distribution 140 26 Showing Component 5( Sleep Disturbance) Score distribution 141 27 Showing Component 6( Use of Sleep Medication) Score distribution 141 28 Showing Component 7( Daytime Dysfunction) Score distribution 141 29 Showing Global PSQI Score distribution in 45 patients of Nidranasha 142
  18. 18.     xviii    List of Abbreviations 1. A H Ut - Astanga Hridaya Uttaratantra 2. A H Ni - Astanga Hridaya Nidanasthana 3. A H - Astanga Hridaya 4. A S - Astanga Sangraha 5. A H Su - Astanga Hridaya Sutrasthana 6. A S Su - Astanga Sangraha Sutrasthana 7. B S - Bhela Samhita 8. B P - Bhavaprakasha 9. B P M Kh - Bhavaprakasha Madhyama Khanda 10. B R & Bh Rat- Bhaishajya Ratnavali 11. Ch. Sam - Charaka Samhita 12. Ch Chi - Charaka Samhita Chikitsasthana 13. Ch Vi - Charaka Samhita Vimana sthana 14. D N - Dhanwantari Nighantu 15. H S - Hareeta Samhita 16. K S - Kashyapa Samhita 17. M P N - Mandanapala Nihantu 18. N A - Nightantu Adarsh 19. R N - Raja Nighantu 20. Sha U Kh - Sharangadhara Uttara Khanda 21. Su Su - Sushruta Samhita Sutrasthana
  19. 19.     xix    22. Sha P Kh - Sharangadhara Poorva Khanda 23. Su Ni - Sushruta Samhita - Nidanasthana 24. S S - Sushruta Sauhita 25. S Y - Sahasra Yoga 26. Y R - Yogaratnakara. 27. PSQI - Pittsburgh Sleep Quality Index 28. G PSQI - Global PSQI Score 28. C1-C7 - Component 1 to Component 7 of Global PSQI Score
  20. 20. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            1  INTRODUCTION Human beings in their eternal efforts to triumph over nature, are finding themselves engulfed in the day-tight compartments of concrete jungle called modern life. In their every quest filled with emotional stress and physical strain humans are encountering an enormous army of diseases which is highly successful in creating major hurdles in the human journey. Sometimes these problems become so intense that humans often find themselves entangled in the web of solving and creating problems into a vicious circle, which makes them forget their real purpose in life deprives them their basic right, the perfect health. Among the web of diseases, Sleeplessness is the most common problem which is often neglected, until it becomes an irreversible hazard. Gelder. M. etal ( 1990 ) have estimated that atleast 10 – 20 % of the population is suffering from Insomnia, among them 15% are suffering from this condition, where the cause is not known. i.e., Primary Insomnia. The condition of Insomnia may not be a life threatening illness, but it has a tendency to damage the person’s daily life, including his social and occupational life. If it is very chronic, the person may devolop varieties of Psychiatric illness also. Considering this, Insomnia is considered to be a major health hazard, drawing the attention of professionals and researchers all over the world. Nidranasha is not explained as a separate disease in any of classical text books of Ayurveda. The minimum descriptions that are available are also scattered and mentioned incidentally in the context of Vatajananatmaja Vikara, Vatajajwara, Vataja hridroga etc.
  21. 21. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            2  Primary Insomnia, where the cause of sleeplessness is obscure, is normally treated with anti depressant drugs, sedatives, tranquilizers and hypnotic drugs etc. But these drugs may lead to many complications such as hang-over, tolerance towards the drug, reoccurance of the symptoms on the withdrawal of the drug, etc. Other modalities of treatment such as Relaxation therapy and Psychotherapy also have their limitations. In the above situation, we need an alternative therapy which is useful and deviod of the hazards of modern drug therapy. Fortunately we find a ray of hope in treating the patients of Insomnia with an age old therapy of Ayurveda. Guda Pippalimula yoga was indicated in the management of Nidranasha in Bhaishajya Ratnavali, Bhava prakasha, etc. So the study was undertaken to evaluate the efficacy of Guda Pippalimula yoga in the management of Nidranasha. A large group of aharas are mentioned in various classics which are useful in promoting sleep. So a diet chart was prepared using the references with an intention of relieving insomnia with a healthy diet. This diet regimen alone was given to one group of patients and to another group diet regimen along with guda pippalimula yoga was advised The duration of study was one Mandala (48 days). Pittsburg sleep Quality Index was used to assess the effect of study before and after the treatment. Post therapy follow-up was conducted after 48 days. The study contains two parts. First part deals with conceptual study of Nidra nasha and drug review. In second part the materials and methods, observation and results, discussion and conclusion with summary are dealt. The results obtained are now being presented before the scholars for evaluation and acceptance.
  22. 22. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            3  CHAPTER-1 CONCEPT OF NIDRA Historical review Ayurveda regards Nidra as one of the most essential factors responsible for a healthy and fulfilled life. It is one of the trayopastambhas or three great supporting pillars on which the health of a person is firmly balanced. Every country has had great scientists who have tried to study the sleep, its nature and causes. Vedic and Upanishad period 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 phase), Svapnavastha (dream phase), Sushuptavastha (sleep phase) and Samadhi Avastha (the conscious sleep phase having detachment from the external world in different degrees). In Atharvaveda Shounakeeya shakha, the reference is available of Nidrajanana as Karma, while explaining the Moulika Sidhanta in Dravya-Guna 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 deep sleep, the senses of perception cease to function because their king, the mind, is at rest. This is Abhava, a state of void, a feeling of emptiness.1 The onset and progress of sleep as described in Brahmanopanishad, pertaining to Yogasutra runs as under:
  23. 23. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            4  When the Chitta becomes exhausted, it goes inward, away from the sense impulses of 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 a sense of pleasure and sense of satisfaction.2 Lord Shri Krishna has explained the importance of proper sleep for a Dhyana Yogi in Bhagwad Gita. According to him, both excessive sleep and ceaselessly awakening are not good. Yuktaahaara vihaarasya yukta cheshtasya karmasu | yukta svapnaava bodhasya yogo bhavati duhkhahaa || 3 Samhita kala. In Samhita kala, the books written were Charaka Samhita, Sushruta Samhita, Bhela Samhita and Hareeta Samhita. All of these are having the descriptions of Nidranasha. Although Charaka and Sushruta Samhita have not explained this separately, Bhela and Hareeta have mentioned special chapters on Nidra. In this context they have also explained the nidana and chikitsa of Nidranasha. In Kashyapa Samhita Nidranasha is explained as the lakshanas of some disease and in some Grahadushta lakshanas. Various oushadhis for chikitsa of Nidranasha are available. Sangrahakala In Sangrahakala Astanga Sangraha, Astanga Hridaya and Madhava Nidana were written. Nidana and chikitsa of Nidranasha are available in Astanga
  24. 24. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            5  Hridaya and Astanga sangraha. In Madhava Nidana, Nidranasha is mentioned as a lakshana in some diseases. Adhunika Kala In Adhunikakala i.e., 13th to 16th century AD two more texts were written. They are Bhavaprakasha of Bhavamishra and Yogaratnakara, In Bhavaprakasha, Nidranasha has been explained as the lakshana in some diseases such as vatajajwara, Nidana and Chikitsa of nidranasha have also been explained in some contexts. In Yogaratnakara the reference is available of Nidranasha as a Lakshana in some diseases along with the Chikitsa of Nidranasha. In Bhaishajya Ratnavali of Govindadas, the Oushadhi yogas are explained for nidranasha, and the author mentions some drugs like Potaki shaka, Sura, Masha, Ikshu vikara, etc., which induce sleep. Concept of Nidra Sleeping for six hours in the middle of the night and keeping awake during the first and last quarters as well as during day time, 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. Acharya of Charaka Samhita has considered ‘Nidra’ as one among the three Upastambhas (sub- pillars).4 Commentator Chakrapani has explained ‘Upastambha’ as sub-post. 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 determine the intake of food, sleep and bramhacharya. So they are known as Upastambhas- secondary supports of life.
  25. 25. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            6  It is observed that all the living creatures must enjoy the sleep in quality and quantity to keep themselves fit. From the very birth, the amount of sleep (in hours) of a new born is maximum. Bhavamishra has mentioned that during pregnancy, when the mother sleeps, the baby in the womb enjoys better rest and comfort5 . Similarly the botanists have observed that not only animals but plants also enjoy recreation in the night by contracting the petals of the flowers, leaves etc., at the time of sunset and in the next morning relaxing and reopening. The sleep is an indicator of good health because it brings the normalcy in body tissue and relaxes the person. 5,6 Persons residing in unhygienic locality but obeying the rules of diet, sleep and exercises are not harassed by untoward effects of various pathogenic conditions.7 Generally, sleep occurs during the night and at about the same time for a particular duration everyday and as such in Ayurveda, Nidra is said to be Ratrisvabhava Prabhava.8 According to Sushruta Samhita, Nidra is provoked due to nature and considered as Svabhavika Roga.9 Therefore, our Acharyas have advised that a man should not suppress this natural urge.10 In Charaka Samhita, it has been explained that the sleep occurring at night is a natural & nourishing phenomenon so it is termed as Bhutadhatri – that which nurses all the living beings.11
  26. 26. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            7  In metaphoric language it is also called the ‘Vaishnavi Maya’, which means that Nidra provides the nutrition to the living body and maintains the health like Lord Vishnu, who is the nourisher and sustainer of the world.12 The role and importance of sleep are very widely accepted. Even if sleep is not taken appropriately, in appropriate quantity and irregularly, it may have adverse effects on the body. Therefore, sleep should be watchfully enjoyed because excessive sleep causes various sins (Papma).The control over sleep and wakening for the meditation is useful for the upliftment of Atma. The saints always prefer to keep awake at night for meditation, conversely person having antisocial attachment do sleep during the day time, which is considered as one of the root causes of many evils.12 Natural instincts Four natural instincts of the living organisms are mentioned In Yoga Ratnakar Pu. 64, which are as under: 1) Desire to take food 2) Desire to take water 3) Desire to sleep and 4) Desire to have sexual contact for pleasure.13 These are considered as the pioneers for health. It is quite evident from the above discussion that the sleep is a fundamental need of every living being. When people are deprived of this sleep for too long a period, they find it hard to concentrate or remember what was said or done a moment earlier.
  27. 27. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            8  Any living organism of whatever nature always feels the need for resting after a period of activity. The various organs and the parts of the body can be given rest independently but complete 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 is beneficial for health, happiness and longevity. The modern science also confirms the function and physiology etc., told by our ancient sages, but still has not come to any conclusion as far as sleep is concerned. Finally, Manu, the great law maker of the world, after describing the small divisions of time, remarks that 30 Muhurta period (24 hours), are divided based on the sun’s rise and fall, into day and night; the day time is intended for activities and the night time is designed for rest and repose. The daily rhythm of the life is thus a natural instinct related to the rhythm of night and day existing in nature.14 Etymology: Derivation of the word ‘Nidra’ The term ‘Nidra’ is feminine gender. It is derived from the root ‘Dra’ with suffix ‘Ni’ and the root ‘Dra’ means undesired, ‘Gatu’ to lead, it is a state which is hated, therefore, it is termed as ‘Nidra’. Nidra is formed by Sutra ‘Ataschopasarge.’15
  28. 28. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            9  Also it is derived as “Ityuktam hetuke vishayebhyo karmendriyanam vyaparoparmaroope jeevasya avasthabhedaha”, means nidra is the state of life where, gnanendriyas and karmendriyas are not doing their functions.16 Definition: It is a question from time immemorial as to what sleep is and how it occurs and what is the role of sleep in health and in the treatment of diseases. Scientists have tried to think over the phenomena of sleep. The great sages of India had the perfect knowledge regarding the sleep. In Upanishad and Ayurvedic literature, it is considered as one of the essential functions of the living organism. Maharshi Patanjali has given the perfect definition that Sleep is the mental operation having the absence of cognition for its grasp. The commentator Vyas made it clear that sleep is a state of unconsciousness, but the consciousness remains about his own unconsciousness.1 According to Chanda Kaushika, the maintenance of the body is caused by the sleep. In Mandukya Upanishad, sleep is described as a condition in which the Atma doesn’t have desire for anything and also doesn’t dream anything and this condition is called Sushuptavastha or Nidra.2 The young sage Shankaracharya in his Brahmasutra Bhasya, while explaining the position of Atma during Nidra, also collectively mentioned the different opinions regarding sleep.17 In Chhandogya Upanishad, the role in which the mind is unaware about its surroundings and does not see any dream is called Supta or Nidra.18
  29. 29. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            10  Collectively the above verses from Brihadaranyaka Upanishad and Kaushika Sutra refer that, sleep is such a state where Atman for the time being enjoys Brahmananda and only the vital functions of body are carried out through Prana. 19,20 Vachaspatyam explains Nidra as “ Sarvalokaha Samakshudha yada yamena ratrishu”. Ie, Ratrishu yogena samanyena means Nidra is the phenomenon, which occurs usually with Samyoga of Ratri.21 Kashiraja, Goodarthadeepikakara defines Nidra as “Nidradayopi Shareera shramasambhabaha, tamokaphabhyam nidrasyat bhavet”. Means Nidra is the resultant state of Shareerashrama, predomenance of Tamas and kapha dosha & Swabhava.22 Definitions from Ayurveda Acharya of Charaka Samhita and commentators Chakrapani and Gangadhar explained that when the mind as well as the soul gets exhausted or becomes inactive and the sensory and motor organs become inactive, then the individual gets sleep. Yada Tu Manasi Klanti Kamatmana Klamanvita Vishayebhyo nivartante Tada Swapati Manava 4 In Sushruta Samhita, it is described that sleep occurs when Hridaya the seat of Chetana is covered by Tama.19 According to Acharya Vagbhatta, the Srotas become accumulated with Sleshma and the mind is devoid of sense organs because of fatigue, hence the individual gets sleep.20
  30. 30. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            11  Nidra can be defined as “Nidra medhya manasamyogaha” which means Nidra is the stage of mind and intellect are at rest.23 Nidra can be defined as “Tamakaphabhyam Nidra”, it is the state where predominance of kapha and tamas is seen.24 Adhamalla defines Nidra as “Nidra Swapnechcha Sa Tamakaphabhyam syat Tamoguna kaphasamsargena Bhavati Ityarthaha”. Means Nidra is the stage in which the Tamoguna combines with Kaphadosha.24 Adhamalla further says “Nidra Indriyamanomohaha” which means the Mohavastha of Indriya and Manas is called as Nidra. Dalhanacharya defines nidra in Sushruta Samhita Sutrasthana 1st chapter, “Nidra Medhyamanasamyogat Dehendriya Sukhabhogaha”. Nidra is that state of combination of mind and intellect, in which the person feels happy. Synonyms of Nidra : The prefix “Ni” is the Sanskrit root of the English word “nether” or down, as in “nether world”(underworld) while the suffix ‘dra” may be cognated with the English “drowsy” “to be half sleep, to be inactive or present an appearance of peaceful inactivity or isolation.”25 In Amarkosha, four synonyms have been mentioned- 1) Shayanam 2) Svapah 3) Svapnah
  31. 31. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            12  4) Samvesh 26 Similarly, in Vaidyaka Shabda Sindhu, three synonyms are available. 1) Sambhashah 2) Suptih 3) Svapanam27 In Charaka Samhita, Bhutadhatri has been used as a synonym and in Sushruta Samhita the word Vaishnavi Maya is used. Concept of the phenomenon of Nidra Different Interpretations: There is a natural relation of sleeping and waking. During the24 hour cycle of day and night, sleep comes naturally during the night but it is not a necessary consequence of darkness, as is proved by those people working at night, who sleep during the day, and they readily adopt themselves to this condition. Our ancient sages and Acharyas had crystal clear view regarding the physiology of sleep, but explained it in different ways, according to their working field. The different explanations regarding the phenomena of Nidra may be classified under the following four groups. 1) Upanishad Theories 2) Yogic Theories 3) Ayurvedic Theories 4) Recent Concept
  32. 32. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            13  1) Upanishad Theories The sleep is only a palliated form of death. The discussion about sleep is one of the important concepts of the Upanishads. The seers of antiquity have enunciated many interesting theories on this subject. a) The fatigue theory of sleep is just in the pattern of modern physiology. The concept has been explained by citing an example in which a falcon or any other bird after having flown in the sky, becomes tired and folding his wings repairs to his nest, so does a person hasten to reach to that state where, he does not have any desires or dreams, called sleep. b) Another view holds that sleep is caused by the senses being absorbed in the highest ‘sensorium’ or in the mind just similar to the rays of sun,which become collected in the bright disc at the time of sunset. This is the reason why a man is not able to hear, to see or to smell in deep sleep and the people say about him, that he has slept. c) The above statement can be further exemplified. Accordingly, the reason for sleep is that the mind is merged into the ocean of life. When he is over-powered by light, then the soul sees no dreams and at that time great happiness arises in the body. d) One another theory says that sleep is caused by the soul, which gets lodged in the Nadis. The same idea is elaborated elsewhere. It states that the heart sends forth about 72,000 arteries to the Puritata. Deussen translates Puritata as the ‘pericardium’ and Maxmullar as ‘the surrounding body’. This Puritata corresponds to the pineal gland so far as the function is concerned. The ancient seers imagined that the soul moves from the heart by means of the arteries and gets lodged inside the Puritata and then the sleep follows.
  33. 33. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            14  e) Ancient Rishis gave another explanation. They say that sleep occurs when the mind is merged in Prana. It is a breath or energy, “As a bird when tied by a string flies first in every direction and finding no rest anywhere, settles down at last on the very spot, from where, it is fastened, exactly in the same manner, mind after flying in every direction, rests in the breath, for indeed mind is fastened to breath.” f) Still one another explanation says that sleep occurs when the soul goes to rest in the space inside the heart. In order to prove this to Gargya – an experimental inquiry was done by Ajatashatru. He took him to a sleeping man by the hand. He called him by his name very loudly but he didn’t rise. Then he rubbed him with his hand, the man got up. Then Ajatashatru said, “When this man was asleep, then the soul, full of intelligence lay in the space inside the heart. The sleep is only a parallel form of death.” The fatigue theory states that during sleep a man restores his lost energy. Then the senses are all absorbed in the mind itself. The mind merges into the ocean of light. Under its power there is sound sleep and the man derives real happiness in the body. At this time the soul gets its lodgement in the arteries. The soul moves then inside the Puritat. During sleep the mind merges into Prana and the soul goes to rest in the heart. Here, the soul is one with the Brahman. 2) Yogic Theories The Yogic philosophers of India have given explanation regarding sleep and have also explained the Samadhi state which resembles the sleep, but is entirely opposite to that. a) Lord Shri Krishna, while discussing the Dhyana Yoga has said that the Yogi should be regulated in sleep and wakefulness. He has also said that seeing, smelling etc., are the functions of five sense organs, whereas breathing points to the function of five vital airs and that sleeping denotes the function of inner sense or mind.28
  34. 34. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            15  b) There is another opinion of Yogis that the Upavayu Devadatta controls the Nidra of the individual. c) Maharshi Patanjali mentioned that: 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 consciousness in the being. In deep sleep, the senses of perception cease to function because their king, the mind, is at rest. After awakening the consciousness or mind will be aware about its unconsciousness. d) It is also mentioned that the Tamoguna is responsible for sleep. e) Yoga Nidra – A Yogic sleep process Upanishadic doctrine, describes the existence of four levels of consciousness, they are: 1. Waking consciousness – Jagritavastha 2. Dreaming consciousness – Svapnavastha 3. Dreamless sleep – Sushuptavastha 4. Conscious dreamless sleep – Turiya / Turiyavastha 3) Ayurvedic Theories Several theories have been explained by our ancient seers to explain the phenomenon of natural sleep. They are as under- a) Tamoguna Theory: This is the Darshanika theory of sleep. In Darshanas, Tamas has been held responsible for ignorance, loss of consciousness, inattention, sloth and
  35. 35. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            16  sleep. The theory states that at night the Tamas being powerful, the higher psychic centers being overpowered by it, the living organisms go to sleep.29 In Sushruta Samhita, it is said that Hridaya is the seat of consciousness, when it is covered by Tama, the person goes to sleep. Tamas is hence the cause for sleep and the Satva for consciousness.19 Acharya Kashyapa has mentioned that the Satva is Prakashaka, the Rajoguna is Pravartaka while the Tamoguna is Niyamaka and Moha Sambhava. Therefore, the Tamoguna is more predominant than the Satva and Rajasa. And hence it causes the sleep. According to Harita, the centre of sleep is in the upper half part of nose, between the two eyebrows in the cerebrum or brain. When the Tamas reaches this sleep center, the knowledge and activity get diminished and sleep occurs. b) Kapha Dosha Theory: This is the ancient medical theory of sleep. In fact, it is just a modification of the Tamoguna theory. Kapha is supposed to be composed mostly of Tamas. Therefore, increased Kapha has been related with more or less qualities of Tamas. According to this theory, whenever the Chetana is overpowered by the accumulation of Tamas, the sensation conveying channels of the body are blocked or checked by the Sleshma. When this Sleshma is over saturated with Tamasika quality, the living being gets sleep. 19,20 Acharya Sushruta also clearly mentioned the role of Sleshma and Tamas in Nidra.30 By the above verses it is clear that during the commencement of sleep the body and mind are interrelated.
  36. 36. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            17  b) Depression Theory: Charaka Samhita propagated this theory. Both the Vagbhatas followed this view. When the mind and the organs of sense become so tired that they cannot be stimulated to activity, the person goes to sleep.31 The modern chemical theories can be correlated to these Ayurvedic concepts to some extent, where our concepts are perfect and treatment is also based on that, while the modern theories are changing every time. c) Svabhava : Just after describing the role of Tamas in sleep, Acharya of Sushruta Samhita has said that it is the natural instinct, which is the most powerful cause for sleep. Hence, he has also considered it as a Svabhavika Vyadhi. 32 At one another place, where diseases are classified, sleep is included in the list of natural diseases, along with hunger, thirst, ageing, death etc.12 Types of Nidra Our Acharyas have given different opinions regarding the types of sleep. Basically Nidra can be classified into two types viz. Svabhavika (natural) and Asvabhavika (abnormal).The Svabhavika Nidra comes regularly every night, which is having beneficial effects for the living beings, whereas Asvabhavika one may be due to different causes. Charaka Samhita classifies the sleep condition into seven categories and agrees with the ancient sages who have considered that sleep is Bhutadhatri, which comes on at night, spontaneously and regularly as a natural instinct and that the other categories are either due to sin or the disease. The seven types described by Charaka run as under-
  37. 37. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            18  1) Caused by Tamas 2) Caused by Kapha (vitiated) 3) Caused by Manasika Shrama 4) Caused by Sharirika Shrama 5) Agantuki – indicative of bad prognosis leading to imminent death. 6) Caused as a complication of diseases like Sannipata-jwara etc. 7) Caused by the very nature of night.8 A brief description of these different types of Nidra may be produced as under - 1) Tamobhava Nidra : Generally, sleep is due to the effect of Tamas, but the Tamobhava Nidra is 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 organism become inert or inactive. According to some scholars, the Tamobhava Nidra resembles with the Sanyasa condition, described in Charaka Samhita 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 deeds and so he subjects himself to sinful behavior.33 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, sleep ensues. Therefore, it is called Sleshma Samudbhava Nidra.
  38. 38. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            19  3) Manah Shrama Sambhava Nidra: Sleep is also said to be produced as a result of exertion. Due to excessive mental stress and strain, the mind gets tired and is unable to perform its activities; as a result the individual gets sleep. 4) Sharira Shrama Sambhava Nidra: The sleep has also been stated to be caused due to physical exertion. When a person indulges in excess physical activities he feels very much tired. The body and mind desire to take rest, and refuse to work further and the person gets sleep.34 5) Agantuki Nidra: Sometimes the cause of sleep remains obscure and the cause is not explainable. However this sleep is followed by death and as such Chakrapani has termed this sleep as a sign of death (Arishta). 6) Vyadhyanuvartini Nidra: There are some diseases like Sannipata Jwara where in along with severe weakness, the patient goes into this condition just similar to coma. This type of sleep is termed as Vyadhyanuvartini Nidra. 7) Ratri Svabhava Prabhava Nidra: As has been stated earlier 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 day time would feel sleepy in the night also, which is quite a natural phenomenon. The author of Ashtanga Sangraha followed the Charaka Samhita’s view with a slight change in the names. He has also mentioned seven types. The commentator Indu has
  39. 39. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            20  opined that Tamobhva is Antya i.e., comes at the time of death and Agantuka means Shastra Praharadina (due to injury) and considered that they are due to Vyadhis 35 . In Ashtanga Hridaya, Acharya Vagbhata considered only four types of Nidra and included all the seven types in these.36 The commentator Hemadri considered them as 1. Sleep taken in wrong manner 2. Excessively taken sleep 3. Inadequately taken sleep 4. Properly taken sleep The properly taken sleep brings happiness, nourishment, strength, virility, knowledge and life to the individual. The improperly taken sleep i.e., other three types may kill the individual like the Kalaratri, who killed all demons. Charaka Samhitakara also mentions these while explaining the effects of sleep.37 Acharya of Sushruta Samhita described only three types of Nidra: 1) Vaishnavi or Svabhaviki 2) Tamasi 3) Vaikari 19 1) Svabhaviki Nidra: This has been stated to be caused due to the Maya or illusion attached to the power of Vishnu. Here, Maya is a desire of the Manas to get detached from the worldly sensory objects on account of the tiredness of Manasa ; and the seat of Manasa and Atma is overpowered by the Sleshma and Tamas. This mostly happens at night and the individual gets sleep. This can be correlated with Charaka’s Ratri Svabhava Prabhava
  40. 40. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            21  Nidra. 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 Rajas. The person having qualities dominated by Satva Guna sleeps at the midnight. Because at this time Tamas will be in excess and Satva will be decreased38 . But practically it is observed that the time of onset of sleep differs from individual to individual and place to place according to the age, nature, occupation, constitution etc. The term Papma has been used to describe the Tamobhava of Nidra and also to mention the sinful activities of night. 2) Tamasi Nidra : It is the lack of consciousness preceding the death. This is induced due to the blockage of Sanjnavaha Srotasa by Tama dominant Kapha, and from this Nidra, the individual cannot be awakened.12 This can be correlated to Tamobhava and Agantuki Nidra mentioned by Charaka. 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 does not enjoy sufficient and sound sleep in quantity and quality. Disturbed sleep is also a type of Vaikariki Nidra.12 This Nidra may be correlated with Manaha-Sharira Shrama Sambhava, Vyadhyanuvartini and Sleshma Samudbhava Nidra varieties described in Charaka Samhita.
  41. 41. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            22  Physiology of Nidra When Manah is exhausted, then sleep occurs. This phenomenon can be understood in the following 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 Manah becomes Klanta, this causes sleep. Further, during sleep, Indriyas (Jnanendriya and Karmendriya - both) become inactive by the detachment from their sense organs or from their work. Kleitman explains that due to the reduction of muscle tone and discharge of less afferent impulses, the cerebral cortex remains inactive. This can be interpreted in 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 plausible factor in the production of sleep. Physiological effects of Sleep Charaka Samhita explains that in the night, the Hridaya gets contracted, the Srotasa as well as the Koshtha are contracted and the body elements get softened. 39 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. The first one seems more important because lack of sleep-wakefulness cycle in the nervous system at any point below the brain, causes neither harm to the bodily organs nor any deranged function. On the other hand, lack of sleep certainly does affect the
  42. 42. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            23  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. 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, 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 Nidra Sleep at night time makes for the balance of the body constituents (Dhatusamya), alertness, good vision, good complexion and good digestive power5,6 . Sushruta Samhita describes that, those who take proper sleep at proper time will not suffer from disease, their mind 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 a good hundred years.40 Importance of Nidra Ahara, Nidra and Brahmacharya are the three factors, which play an important role in the maintenance of a living organism. In the Ayurvedic literature, these factors i.e. Ahara, Nidra and Brahmacharya have been compared with the three legs of sub-
  43. 43. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            24  support and have been termed as the three Upastambhas4 . The inclusion of Nidra in the three Upastambhas 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.41 According to Acharya Kashyapa, getting good sleep at proper time is one of the characteristics of a healthy man7 . Nidra and Prakriti : The sleep according to Prakriti may be divided into two groups i.e. 1) According to Deha Prakriti and 2) According to Manasa Prakriti. According to the individual’s Prakriti and Vayoavastha the sleep requirement varies: 1) Nidra- according to Sharirika 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 and may be disturbed also. Similarly, sleep is related to the age or Vayah. In Balyavastha, Kapha is predominant, so a child sleeps for more time than the youth. In Vriddhavastha, Vata is predominant, so the aged people get very less sleep. Apart from the Deha Prakriti, some naturally get less sleep.42 2) Nidra- According to Manasa Prakriti: Mind is always flickering by virtue of it being governed by Prana Vayu. It is subjected to moods, principally the Rajas and Tamas. The former is a state of emotions while the latter is a state of inhibition.
  44. 44. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            25  Devoid of the two is a pure state of mind, the Satva. Rajasa surpasses even this and Tamasa however remains restrained. Hence, people who have an excess of Tamasa in their system tend to sleep heavily. They sleep both during day and night. Those with Rajasa as the dominant trait sleep either during daytime or during night and their sleep is light and disturbed. Persons with Satva as the main trait, sleep peacefully, but never before midnight. During sleep, the Jivatma (soul), which never sleeps, may convey the glimpses of the events and experiences of previous happenings to the Rajasika element of the mind. This Rajasika element does not completely loose its consciousness during sleep (person experiences dreams), but is unable to come back immediately to the normal state of consciousness. The normal consciousness is restored after sometime and the person awakens from sleep, only through the agency of the Satvika element. In Tamasika Nidra, the accumulation of Tamasa may be so great that the Satvika principle may find it difficult to perform the restoring function. If the Satvika principle is ultimately unable to overcome the Tamasika principles, then unconsciousness (coma) or death occurs 43, 44 Nidra and Kala : Manu, the great law maker has described the divisions of time, and then has remarked that the thirty Muhurta periods of 24 hours, is divided based on the sun’s rise and fall, into day and night; the day being intended for activities and the night is designed for rest and repose. Naturally, 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.
  45. 45. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            26  It is advised to take sleep avoiding 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 sparse45 . As it is a well known concept that early morning awakening is good for health and also to get Bramhajnana. Modern Concept of sleep: Sleep is one of the body's most mysterious processes. It is a state of unconsciousness in which the brain is relatively more responsive to internal than to external stimuli. The predictable cycling of sleep and the reversal of relative external unresponsiveness are features that assist in distinguishing sleep from other states of unconsciousness. The brain gradually becomes less responsive to visual, auditory, and other environmental stimuli during the transition from wake to sleep. Historically, sleep was thought to be a passive state that was initiated through withdrawal of sensory input. Currently, withdrawal of sensory awareness is believed to be a factor in sleep, but an active initiation mechanism that facilitates brain withdrawal also is recognized. Necessity of sleep Sleep helps to restore and rejuvenate many body functions: Memory and learning - Sleep seems to organize memories, as well as to recover memories. After something new is learnt, sleep may solidify the learning in the brain. Mood enhancement and social behaviors - The parts of the brain that control emotions, decision-making, and social interactions slow down dramatically during sleep, allowing optimal performance when awake. REM sleep seems especially
  46. 46. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            27  important for a good mood during the day. Tired people are often cranky and easily frustrated. Nervous system - Some sleep experts suggest that neurons used during the day repair themselves during sleep. When we experience sleep deprivation, neurons are unable to perform effectively, and the nervous system is impaired. Immune system - Without adequate sleep, the immune system becomes weak, and the body becomes more vulnerable to infection and disease. Growth and development - Growth hormones are released during sleep, and sleep is vital for proper physical and mental development. Sleep rhythm: Animals and man show one sleep period in 24 hours. Night, commonly being the period of rest, is used for sleep. Physiological changes during sleep: During sleep somatic activity is greatly decreased. Threshold of many reflexes is elevated and responsiveness is also lessened. Basic metabolic rate being least; all organs and tissues perform the least work. The changes are Cirulatory system – Pulse rate, cardiac output, vasomotor tone and blood pressure reduced.
  47. 47. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            28  Respiratory system – Tidal volume, rate of respiration and, therefore pulmonary ventilation-lowered (sometimes rate may be unchanged or even high due to shallow breathing). Basal metabolic rate – reduced by 10-15% Urine – Volume less, reaction variable, specific gravity and phosphates – raised. Secretions – salivary and lacrimal – reduced, gastric- unaltered or raised, sweat – raised. Muscles – relaxed (tone minimum) Eyes – Eyeballs roll up and out, due to flaccid external ocular muscles, eyelids come closer, specially due to the drooping of the upper lids, pupils are contracted. Blood – volume increased. (plasma diluted) Nervous system – deep reflexes are reduced, babinski, extensor, superficial reflexes- unchanged, vasomotor reflexes – more brisk, light reflex- retained. Theories of sleep: There are several theories for explaining the cause of sleep, but none is quite competent. 1. Cerebral ischaemia – Sleep is due to cortical ischaemia. The drowsiness after food is due to splanchnic vasodilatation, fall of blood pressure and consequent cerebralischaemia. Vulpian has shown that after stimulation of the cervical
  48. 48. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            29  sympathetic in animals, cerebral ischaemia was produced but no sleep was induced. 2. Pavlov’s theory – Sleep is a special manifestation of conditioned inhibition. It is due to spread of an internal inhibitory process and is considered to be concomitant sleep, as a symptom of the cortical inhibition. 3. Biochemical aspects: a) Acetylcholine – Since acetyl choline is closely related to the functional integrity of nervous system, sleep is claimed to be due to accumulation of acetylcholine in the cerebral cortex. b) Lactic acid – sleep is due to accumulation of lactic acid in the tissues during fatigue. Lactic acid depresses the acivities of the cerebral cortex. But in fatigue there is often sleeplessness and oxidation of lactic acid occurs which supplies energy to the brain tissue. So this theory is not acceptable. c) Hypnotoxin – According to some physiologists hypnotoxin which is liberated from the brain tissue, produces sleep. d) Bromhormone – Sleep is induced by the bromhormone liberated from the pituitary. There is no evidence in support of this theory. 4. Kleitman’s theory – Due to reduction of muscle tone and discharge of less afferent impulses, the cerebral cortex remains inactive. Fatigue of the muscle with consequent reduction of transmission of afferent impulses to the cerebral cortex and thereby keeping it inactive seems to be a plausible factor in the production of sleep. Kleitman also observed that reticular formation plays an important role in the production of sleep.
  49. 49. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            30  Stages of sleep: Sleep is a periodic state of rest during which consciousness of the world is interrupted. Additionally, sleep is marked by:  decreased movement of the skeletal muscles;  a relaxed posture, usually lying down;  reduced response to stimulation, such as sounds and touch;  slowed-down metabolism; and  complex and active brain wave patterns. Usually sleepers pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. These stages progress cyclically from 1 through REM then begin again with stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. The first sleep cycles each night have relatively short REM sleeps and long periods of deep sleep but later in the night, REM periods lengthen and deep sleep time decreases. Stage 1 is light sleep where one drifts in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and muscle activity slows. During this stage, many people experience sudden muscle contractions preceded by a sensation of falling. In stage 2, eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves. In stage 3, extremely slow brain waves called delta waves are interspersed with smaller, faster waves. In stage 4, the brain produces delta waves almost exclusively. Stages 3 and 4 are referred to as deep sleep, and it is very difficult to wake someone from them. In deep sleep, there is no eye movement or muscle activity. This is when some children experience bedwetting, sleepwalking or night terrors.
  50. 50. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            31  In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, males develop erections and the body loses some of the ability to regulate its temperature. This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night. Infants spend almost 50% of their time in REM sleep. Adults spend nearly half of sleep time in stage 2, about 20% in REM and the other 30% is divided between the other three stages. Older adults spend progressively less time in REM sleep. The waveform during REM has low amplitudes and high frequencies, just like the waking state. Early researchers actually called it "paradoxial sleep". Neuronal centers, Neurohumoral substances and mechanisms that cause sleep: Stimulation of several specific areas of the brain can produce sleep with characteristics very near those of natural sleep. Some of these are the following: 1. The most conspicuous stimulation area for causing almost natural sleep is the raphe nuclei in the lower half of the pons and in the medulla. These are a thin sheet of nuclei located in the midline. Nerve fibers from these nuclei spread widely in the reticular formation and also upward into the thalamus, neo-cortex, hypothalamus, and most areas of the limbic system. In addition, they extend downward into the spinal cord, terminating in the posterior horns where they can inhibit incoming pain signals. It is also known that many of the endings of fibers
  51. 51. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            32  from these raphe neurons secrete serotonin. Also, when a drug that blocks the formation of serotonin is administered to an animal, the animal often cannot sleep for the next several days. Therefore, it is assumed that serotonin is the major transmitter substance associated with production of sleep. 2. Stimulation of some areas in the nucleus of the tractus solitarius, which is the sensory region of the medulla and pons for the visceral sensory signals entering the brain via the vagus and glosso-pharyngeal nerves, will also promote sleep. However, this will not occur if the raphe nuclei have been destroyed. Therefore, these regions probably act by exciting the raphe nuclei and the serotonin system. 3. Stimulation of several regions in the diencephalons can also help promote sleep, including the rostral part of the hypothalamus, mainly in the suprachiasmal area and an occasional area in the diffuse nuclei of the thalamus. Characteristics of REM sleep During REM sleep, a person dreams actively, but limb muscles are immobile. Breathing is rapid, irregular, and shallow. Heart rate increases, blood pressure rises, brain is at least as active during REM sleep as it is when the person is awake. The major muscles do not move during REM sleep. (Sleepwalking occurs during NREM sleep.) Infants spend about 50 per cent of their sleep time in REM sleep; after infancy, fifteen to twenty per cent of sleep time is spent in REM sleep..
  52. 52. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            33  Waking usually transitions into NREM sleep. REM follows NREM sleep and occurs 4-5 times during a normal 8 to 9 hour sleep period. The first REM period of the night may be less than 10 minutes in duration, while the last may exceed 60 minutes. For the purpose of analysis, overnight sleep has been divided into 3 equal time periods: sleep in the first third of the night, which comprises the highest percentage of NREM; sleep in the middle third of the night; and sleep in the last third of the night, the majority of which is REM. Awakening after a full night's sleep is usually from REM sleep. Sleep in adults: In adults, sleep of 8-8.4 hours is considered fully restorative. In some cultures, total sleep often is divided into an overnight sleep period of 6-7 hours and a mid afternoon nap of 1-2 hours. Sleep in infants: Infants have an overall greater total sleep time than any other age group; their sleep time can be divided into multiple periods. In newborns, the total sleep duration in a day can be 14-16 hours. Sleep in elderly persons: In elderly persons, the time spent in stages III and IV sleep decreases by 10–15% and the time in stage II increases by 5% compared to young adults, representing an overall decrease in total sleep duration. Latency to fall asleep and the number and duration of overnight arousal periods increase. Thus to have a fully restorative sleep, the total time in bed must increase. If the elderly person does not increase the total time in bed, complaints of insomnia and chronic sleeplessness may occur. Knowledge of the mechanism and importance of sleep helps us in understanding and treating insomnia in a better way.
  53. 53. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            34  Chapter-2 Nidra Nasha and Insomnia In the ancient texts of Ayurveda we find several references for insomnia in the form of Nidra Nasha and Anidra. In Charaka Samhita, Nidra and Nidranasha are explained in the context of Astauninditiya Adhyaya. According to Charaka Samhita, Nidra is pushtida, while jagarana does the Karshana of the body; it is also stated that happiness and sorrow, growth and wasting, strength and weakness, virility and impotence, the knowledge and ignorance as well as existence of life and its cessation depend on sleep. Untimely and excessive sleep and prolonged vigil take away both happiness and longevity like the Kaala ratri.46 In Charaka Samhita, Nidranasha is included under the 80 Nanatmaja vata vikaras. Sushruta Samhita has explained this under the chapter Garbha Vyakarana Shaariram, as Nidra plays a vital role in nutrition and development of the foetus. In the same chapter along with chikitsa, Vaikariki Nidra has been explained which can be correlated to sleep disorders. Astanga Sangraha has mentioned this in Viruddhanna vijnaniya Adhyaya, where the Trayopastambhas are explained. It states that Manda Nidra is due to Vata, and the term Asvapna has been used in Vataja Nanatmaja vikaras. In Astanga Hridaya Nidra, Nidra Vikaras and its chikitsa are mentioned under Anna - rakshadhyaya, where Trayopastambhas are explained. Sharangadhara Samhita has considered Nidranasha in Vataja Nanatmaja vikara, Alpa Nidra in Pittaja Nanatmaja vikara and Atinidra under Kaphaja Nantmaja Vikara. By observing these descriptions regarding Nidra and Nidranasha, it can be concluded that all the texts have considered the importance of Nidranasha, hence Nidranasha has
  54. 54. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            35  been explained along with the physiology of Nidra. Nidranasha or Alpanidra is seen in many diseases as a Laksana and it may be Upadrava or Arista Lakshana also. Hence, the Nidana, Samprapti and Chikitsa are explained regarding nidranasha, the Acharyas considered its independent manifestation too as a disease. The derivation of word Nidranasha: Nidranasha is composed of two words ‘Nidra’ + ‘Nasha’. Nidra is ‘Ni’ + ‘Dra’, Drayi, Santi, i.e. Dadrushu Naish, means to fall asleep. Sleep, Slumber, Sleepiness. The suffix ‘Nasha’ provides negative meaning to the act of Nidra.47 Nidranasha means less or no sleep. In Ayurvedic texts the term ‘Nidranasha’ is used indicating a pathological condition in which the patient is devoid of sleep. Table No. 1: showing the Synonyms of Nidranasha:  Aswapna  Alpanidra  Akala nidra  Avyavahita Nidra  Ratri jagarana  Prajagarana  Manda nidra  Nashta nidra  Nidra nasha  Nidra bhanga  Nidraghata  Nidra vighata  Nidra viparyaya  Nidrabhighata  Jagaruka, Jagarth, Jagrya, Jagriya, Jag etc.
  55. 55. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            36  NIDANA Charaka Samhita has mentioned the specific cause for nidranasha like atiyoga of virechana, shirovirechana, vamana, bhaya, krodha, dhumrapana, ati vyayama and rakta mokshana48 and also, Upavasa, uncomfortable bed, predominance of Satva and suppression of Tamasa –These check the unwholesome and excessive occurrence of sleep. The cause for nidranasha are the Karya, Kala, Vikara, Prakriti and Vayu 49,50 which can be elaborated as under: 1) Karya – Absorption in the work: When an individual is deeply involved in any work, either mental or physical, his mind would be deviated from the sleep, or he would not get the sleep. This happens in persons who are having a heavy load of mental work. 2) Kala – It is another factor which plays an important role in the Nidra and Nidranasha both. Everyone experiences in day to day life, that as soon as the night comes, he feels the desire for sleep. This type of feeling, under normal circumstance is never seen during the day time except in the summer. It indicates that the sleep has got a relationship with the time factor. 3) Vikara –There are various diseases in which sleep is disturbed or they may be causative factors for sleeplessness. The list of diseases is given in the foregone pages. 4) Prakriti –The Vata Prakriti persons have been described as Jagaruka i.e., those who sleep very less or who practically don’t sleep. The Satvika persons also sleep for less time. The individuals of Rakshasa kaya and Pashava kaya get excessive sleep. 5) Vata –Vata Dosha is considered mainly as sleep dispeller. Vata is having ‘Chala’ Guna and by virtue of this Guna, it does not allow the Manas to take rest and
  56. 56. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            37  therefore, it doesn’t allow the individual to sleep well or have a sound sleep. Hence, we can consider all Vata Prakopaka Hetus as the causative factors for Nidranasha also. According to Sushruta Samhita, Nidranasha is caused by aggravated Anila and Pitta, manastaapa, dhatu kshaya and abhighata.51 The loss of sleep is not only found in all Vata rogas, but it is also found in those diseases where Shula exists, viz. Pindikodveshtana, Gridhrasi, Udavarta, Akshepaka. Astanga Hridaya has mentioned the manasika cause for Nidranasha, it is stated that due to excess of Kama, Nidrakshaya occurs52 . Both Ashtanga Hridaya and Sangraha, have followed Charaka Samhita, but have added some other factors also.53 The excessive hunger, thirst, mental and physical misery, excessive happiness, sadness, coitus, fear, anger, worry, eagerness and excessive use of dry dietetics are the extra causes mentioned for sleeplessness. The Vata and Pitta provoking Ahara and Vihara also cause sleeplessness. In Ashtanga Hridaya, the edge of Tikshna Anjan and Dwadashavidha Langhana are also mentioned as the causes for Nidranasha 54 . Bhavamishra mentioned the same things which are mentioned in previous texts. Nasya, fasting, worry, excess exercise, sadness, fear, Kaphakshaya etc. are the causes of Nidranasha55 . By going through the above description, it is quite evident that Nidranasha may be due to a variety of causes and these may also act so effectively as to keep the person awake altogether or may serve, when present in a less degree to produce one of the forms of dreaming and unrefreshing slumber mentioned above. In Garuda Purana it is stated that poor men, servants, men infatuated with woman and thieves cannot get good sleep. In Skanda Purana it is mentioned that due to anxiety, arising out of frailness of a
  57. 57. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            38  person, occupied and afflicted by the innumerable hopes and expectations, may not get proper sleep. Finally all the above causes of Nidranasha can be listed under four categories Table No 2: showing the different Nidanas of Nidranasha Ahara & viharajanya Manasika Chikitsajanya Anya Yavanna Bhaya Virechana Kshaya Rookshanna Chinta Vamana Abhighata Dhooma Krodha Shirovirechana Vyayama Manastapa Raktamokshana Upavasa Vyatha Sweda Asukhashayya Harsha Anjana Kshudha Lobha Langhana Mithuna Shoka Table No.3: showing the Ahara-viharajanya nidana of Nidranasha NIDANA CS SS AS AH BS HS BP Rookshanna Sevana - - - + - - - Yavanna Sevana - - - - + - - Dhoomapana + - - + + - - Vyayama + - - + + - + Upavasa + - - + - + - Asukhashayya + - + - - - - Kshudha - - + - - - - Maithuna - - + - - - - Trit - - + - - - -
  58. 58. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            39  Table No. 4: showing the Upacharajanya Nidanas NIDANA CS SS AS AH BS BP Vamana + - + + - - Virechana + - + - + - Shirovirechana + - + + + + Raktamokshana + - + - - - Sweda - - - + - - Anjana - - - + - - Langhana - - - + + - Table No. 5: showing the Manasika Nidana NIDANA CS SS AH AS BS HS BP Bhaya + - - - - + + Chinta + - + + - + + Krodha + - + - - - + Manastapa - + - - - - - Shoka - - + + - - + Vyatha - - - + - - - Harsha - - - + - - - Lobha - - - - - + - Goodarthaparichitana - - - - + - - Table No.6: showing the Anya Nidanas NIDANA SS Abhighata + Kshaya +
  59. 59. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            40  PURVARUPA: Purva Rupa of Nidranasha is not mentioned in Ayurvedic classics. RUPA: In Ayurvedic classics some symptoms are mentioned due to restraint of sleep. Charaka Samhita has described the following symptoms. Suppression of sleep, causes jrumbha, anga marda, tandra, shiro roga, akshi gaurava.56 Sushruta Samhita has described following symptoms due to restraint of sleep: Jrumbha, anga marda, Jadya in the anga, shiro and akshi, along with tandra are the symptoms caused by restraint of sleep.57 Astanga Sangraha and Hridaya have mentioned that due to Nidranasha, anga marda, shiro gaurava, jrumbha, jadya, glani, bhrama, apakti, tandra and Vataja rogas will be manifested. 58,59 Table No. 7: Showing Rupa of Nidranasha Rupa Cha.Sam. Su.Sam A.H. A.S. Jrumbha + + + + Angamarda + + + + Tandra + + + + Shiroroga + _ _ _ Shirogaurava _ + + + Akshigaurava + + _ _ Jadya _ _ + + Glani _ _ + + Bhrama _ _ + + Apakti _ _ + + Vataroga _ _ + +
  60. 60. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            41  UPASHAYA AND ANUPASHAYA Goodhalinga Vyadheenam Upashayanupashayabhyam Pareekshet If disease is not diagnosed properly, Upashaya and Anupashaya can help in diagnosing the disease. As Nidranasha is not explained as a separate disease, obviously the references of Upashaya & Anupashaya is not available in Ayurvedic texts. However Upashaya for Nidranasha can be evolved. Mamsa sevana, Ksheerasevana, Ksheeravikarasevana, Madyasevana, Abhyanga, Utsadana, Tarpana, Snehasevena can be considered as Upashaya for Nidranasha. In Anupashaya, Rookshannasevana, Yavannasevana, Dhoomapana, Krodha, Shoka can be considered, other nidanas explained previously can also be considered as Anupashaya for Nidranasha.
  61. 61. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            42  SAMPRAPTI Relation of various Manasika Bhavas on the Sharirika Doshas is well known. Hence Charaka Samhita has mentioned it as: The interplay between the body and mind is the core of Samprapti of every Manasa roga.60 Though, nidranasha is considered under Vataja Nanatmaja roga, here it is better to consider it as Vataja Manasika Nanatmaja roga. Even though, it is Vataja Vikara, in the pathogenesis of nidranasha, the Manasika Dosha ‘Rajas’ plays an important role. Broadly, the etiological factors of nidranasha can be categorized into two headings, viz. Sharirika and Manasika. The former category comprises Shodhana Atiyoga, Vyayama, Upavasa, ahaara and vihara causing Vata-pitta vitiation etc. On account of mental dispositions such as Chinta, Krodha, Bhaya and Shoka, Vata Prakopa takes place in addition to the physical factors. The Vata vitiation occurs, due to both kinds of etiological categories. Fundamental functions of Vata, in connection with mental operations are Activation (Pravartakaha), Controlling (Niyantrana) and Motivation (Preraka). These basic functions are impaired, when Vata aggravation takes place on account of specific Nidanas. Impairment of Basic Functions of Vata: Activation function is altered due to a more hightened state of activity. This results in over indulgence of Karmendriya, leading to the absence of exhausted Karmendriya state. Consequently, Mano-nivritti, a necessary requisite for Nidra, is not at all ensued. An abnormality in the controlling function leads to a very active mind. This implies that, the Rajoguna, universal motivator of everything must have
  62. 62. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            43  been overwhelming. In addition to this, over activity of mind, causes over activation of Gyanendriya and Karmendriya, because Manas is an Ubhayendriya and it is juxtaposed to both. As seen earlier, this again renders a state of Manas without exhaustion. This prevents revoking of mind from its objects. Constant perception of Vishaya by the sense organs can be reckoned, as an impact of perseverant motivation function. Following, detachment of mind from its corresponding sense organs is not likely to occur. All the three psychosomatic functions of mind, when impaired, restricts the detachment of Manas from Indriyas of both kind, seeking rest in Nirindirya Pradesha (Chakrapani), results in the pathological state Nidranasha Another View: The aetilogical factors of nidranasha results in gunatah vrudhi of rooksha, laghu and chalaguna of vata, ushnaguna of pitta and its kshaya of sasneha guna. Gunataha kshaya of guru, sheeta, manda and snigdha of kaphadosha and tamogunakshaya, which seems to be similar to kapha. The kaphadosha and tamoguna are responsible to get sleep. When kaphadosha and tamoguna fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya. Due to kshayavastha of kaphadosha and tamoguna are unable to fillup the samgnavahasrotas. On the other hand vitiated vatadosha gets lodged in majjadhatu. Mastulunga has been explained as shiromajja, as a part of samgnavahasrotas is not filled with kapha and tamoguna, it results in nidranasha. On the other hand the manasika karanas enlisted in hetus of nidranasha, vitiates rajas and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiates them, thus results in nidranasha
  63. 63. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            44  Schematic presentation of nidranasha samprapti NIDANA SEVANA VATAVRUDHI PITTAVRUDHI Rooksha Laghu Chala Ushna Takes Ashraya in Asthi Enters majja Rajogunavrudhi KAPHAKSHAYA Snigdha Sheeta Guru Manda Tamogunakshaya KAPHA WILL NOT ABLE TO FILL UP SAMGNAVAHASROTAS ( which is responsible for Nidra ) NIDRANASHA Types of Samprapti: Sankhya: According to our ancient Acharyas, Asvapna is of two types viz., Nidranasha due to Vataprakopa and Nidralpata due to Pittaprakopa61 . So Sankhya Samprapti of Nidranasha can be two in number. Vikalpa: In nidranasha, mainly Vata Prakopa occurs, due to its Chala and Laghu Guna , which keeps the mind active, causing Nidranasha.
  64. 64. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            45  Pradhanya : In Pradhanya Samprapti, the predominance of morbid humors are described in terms of the comparative and superlative degrees but here as nidranasha is a Vataja Nanatmaja Vyadhi, vitiation of Vata only takes place. So there would not be Pradhanya Samprapti in the case of nidranasha. Bala: Bala of Asvapna can be determined by the strength of manifestation of its symptoms, severity, duration etc. Kala: It is an important factor, while considering Nidra as well as Nidranasha. Charaka Samhita has mentioned Kala under the causative factors of Nidranasha, which indicates that Kala or time factor has an influential effect on it. Samprapti Ghataka: Dosha: Vata & Pitta (Vriddhi), Kapha (Kshaya) Dushya: Rasa Agni: Jatharagni Srotasa: Manovaha, Rasavaha Srotodushti Prakara: Atipravritti (Over indulgence) Adhisthana: Hridaya Udbhavasthana: Hridaya Dosha: Doshas involved in nidranasha are Vata, Pitta and Kapha. But the deviation from the normal level is to be considered with due importance. Vata and Pitta are in increased state, while in case of the Kapha, Kshaya is usually observed. Dushya: Rasa Dhatu has its role in the Dhatu level of Samprapti. Because it provides Tushti, Prinana- both functions are evaluated by Acharyas in the psychic level. Agni: Here, vitiation of Jatharagni takes place, because Nidra is said to enhance the Agni.62 Apakti - one symptom of Nidranasha also indicates its vitiation.
  65. 65. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            46  Srotasa: The role of Manovaha Srotas can be understood without any controversy. Rasavaha Srotasa, in this context, too has a pivotal role in the pathogenesis. Root of Manovaha Srotasa is Hridaya and Hridaya is substantiating to the seat of Mana. Moreover, etiological factor, responsible for Rasavaha Dushti, includes mental cause such as Chintyanam Chatichintanat. Srotodushti Prakara: The main mode of vitiation is Atipravritti. Since, the over indulgence of Manasa is a common feature of the disease. Adhisthana and Udbhavasthana: Hridaya is the abode for these two factors. It is the place form where the whole Samprapti process is supposed to be eventualised. As seen earlier, Hridaya is the seat for Manas and its role in nidranasha is already defined by Acharyas. The etilogical factors of nidranasha results in gunataha vrudhi of rooksha, laghu and chalaguna of vata, ushnaguna of pitta and its kshaya of sasneha guna. Gunataha kshaya of guru, sheeta, manda and snigdha of kaphadosha and tamogunakshaya, which is seems to be similar as kapha. The kaphadosha and tamoguna are responsible to get sleep. When kaphadosha and tamoguna will fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya. Due to kshayavastha of kaphadosha and tamoguna are unable to fillup the samgmavahasrotas. On the other hand vitiated vatadosha get lodged in majjadhatu. Mastulunga has been explained as shiromajja, is a part of samgnavahasrotas is not filled with kapha and tamoguna and results in nidranasha. On the other hand the manasika karanas enlisted in hetus of nidranasha, vitiates rajas and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiates them and results in nidranasha
  66. 66. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            47  UPADARVA In Ashtanga Sangraha, it is mentioned that increased Vayu due to Nidranasha produces Kaphakshaya, this decreased and dried Kapha sticks in the walls of Dhamanis and causes Srotorodha. This, results in so much exhaustion that eyes of the patient remain wide open with watery secretion from eyes. This dangerous exhaustion is Sadhya up to three days then becomes Asadhya 63 Having a detailed knowledge of Nidra Nasha helps us in understanding and diagnosing the condition of patient which leads to correct treatment. ARISHTA LAKSHANA Arishta lakshanas are indication of imminent death. Specific arishta lakshanas are told in the classics for particular disease. A disease with Arishta lakshanas is very difficult to treat. Death may occur after the appearance of Arishta lakshanas. As such there is no specific Arishta lakshanas mentioned in Nidranasha. Sushruta stated that Nidranasha ( complete loss of sleep ) itself is Arishta lakshana which denotes definite death.
  67. 67. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            48  INSOMNIA MODERN REVIEW Insomnia is the complaint of difficulty initiating or maintaining sleep, waking too early and not being able to get back to sleep, or waking feeling unrefreshed and lethargic. Data available on chronic insomnia suggest that about 30 percent of the general population have complaints of sleep disruption, while approximately 10 percent have associated symptoms of daytime functional impairment. The effects of insomnia can include daytime fatigue, impaired mood and judgment, poor performance, and an increased likelihood of accidents at home, in the workplace, and while driving.64 Types of insomnia: 1.Transient - It can last up to one month and may be caused by many things, among them jet lag, stress, a major life change such as a new job or loss of a relationship, environmental factors like noise, or even consuming too much caffeine. 2. Intermittent - Short term insomnia which happens from time to time. 3. Chronic insomnia - Occurs when a person has insomnia a minimum of three nights a week for a month or longer. Chronic insomnia is present in either the primary or secondary forms. Primary - It is not directly associated with any other health condition or problem. Secondary - It is associated with health condition such as depression, heartburn, cancer, asthma, or arthritis, or as a result of medications or drugs, including alcohol and caffeine. In the secondary forms it usually is caused by a medical condition or medication taken for other disorders, or by alcohol consumption. Patients with chronic insomnia should be evaluated to ensure the sleep problem is not
  68. 68. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            49  due to an underlying medical or psychiatric condition that may require treatment. Primary insomnia is sleeplessness that is not attributable to any medical, psychiatric, or environmental cause. The diagnostic criteria for primary insomnia (307.42) from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) are as follows:  The predominant symptom is difficulty initiating or maintaining sleep, or non- restorative sleep, for at least 1 month.  The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia.  The disturbance does not occur exclusively during the course of another mental disorder (eg, major depressive disorder, generalized anxiety disorder, a delirium).  The disturbance is not due to the direct physiological effects of a substance (eg, drug abuse, medication) or a general medical condition.65 The International Classification of Sleep Disorders (ICSD-2) diagnostic and coding manual66 consists of 3 primary insomnia categories:  Psychophysiological insomnia  Idiopathic insomnia  Paradoxical insomnia
  69. 69. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            50  Pathophysiology The pathophysiology of primary insomnia is not well understood and essential features assist with diagnosis. The focus of management is on symptoms. Psychophysiological insomnia The essential features include learned or behavioral insomnia and heightened arousal. The primary components involved are intermittent periods of stress that result in poor sleep and maladaptive behaviors. These include (1) a vicious cycle of trying harder to sleep and becoming tenser (ie, patients “trying too hard to sleep”) and (2) bedroom habits and routines (eg, brushing teeth) that actually condition the patient to become frustrated and aroused. Patients often report "racing thoughts" and sensitivity to their environment. Bad sleep habits such as those naturally acquired during periods of stress are occasionally reinforced. These are therefore not resolved and become persistent. Insomnia continues for years after the stress is abated and is labeled persistent psychophysiological insomnia. Idiopathic insomnia The essential feature of idiopathic insomnia is lifelong sleeplessness with onset in infancy or childhood. Lifelong sleeplessness is attributed to an abnormality in the neurologic control of the sleep-wake cycle for many areas of the reticular activating system (which promotes wakefulness) as well as in areas such as supra nuclei, raphe nuclei, and medial forebrain areas (which promote sleep).
  70. 70. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            51  Possibly, a so-called neuroanatomic, neurophysiologic, or neurochemical lesion exists in the sleep state that patients tend to be on the extreme end of the spectrum toward arousal. Paradoxical insomnia Paradoxical insomnia is also called sleep state misperception. The essential feature is reports of severe insomnia without supporting objective evidence such as daytime sleepiness. Frequency Primary insomnia is diagnosed in approximately 15-25% of patients with insomnia who are referred to sleep disorder centers following exclusion of other predisposing conditions. However, true incidence is not known. Primary insomnia is estimated to occur in 25% of all patients with chronic insomnia. Mortality/Morbidity Whether the consequences associated with chronic insomnia outweigh the costs of treatment remains debatable. Despite that, the following associations have been noted:  Increased risk of mortality is associated with short sleep lengths.  Insomnia is the best predictor of the future development of depression.  Catastrophic worry about the consequences of not sleeping is common among patients with chronic insomnia and serves to maintain the sleep disturbance.  Increased risk exists of developing anxiety, alcohol and drug use disorders, and nicotine dependence.
  71. 71. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            52   Poor health and decreased activity occur.  Onset of insomnia in older patients is related to decreased survival. Sex Primary insomnia is more common in women than in men. Age Persons of any age may be affected, although primary insomnia is more common in the older population. Clinical History A thorough clinical interview with the patient and his or her sleep partner is critical in making the correct diagnosis of primary insomnia. Psychophysiological insomnia Sleep disturbance varies from mild to severe. Insomnia may manifest as difficulty falling asleep or as frequent nocturnal awakenings. Patients often find that they can sleep well anywhere else but in their own bedroom. Patients with this type of insomnia tend to be more tense and dissatisfied compared to people who sleep well. Emotionally, they typically are repressors, denying problems. Idiopathic insomnia Insomnia is long-standing, typically beginning in early childhood. Patients often present with other hard-to-localize neurologic signs and symptoms such as difficulties with attention or concentration, hyperactivity, and mild nonfocal electroencephalographic abnormalities.

×