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A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN ...

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

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Nidranasha ss-mys Nidranasha ss-mys Document Transcript

  •     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
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  •     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,
  •     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.
  •     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.
  •     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.
  •     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.
  •     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
  •     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
  •     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
  •     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
  •     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
  •     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
  •     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
  •     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
  •     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
  • “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.
  • “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.
  • “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:
  • “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
  • “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.
  • “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
  • “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.
  • “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
  • “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
  • “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
  • “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
  • “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
  • “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.
  • “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
  • “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
  • “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.
  • “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-
  • “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.
  • “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
  • “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
  • “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.
  • “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
  • “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-
  • “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.
  • “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.
  • “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
  • “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.
  • “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
  • “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.
  • “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.
  • “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
  • “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..
  • “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.
  • “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
  • “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.
  • “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
  • “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
  • “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 - - + - - - -
  • “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 +
  • “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 _ _ + +
  • “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.
  • “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
  • “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
  • “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.
  • “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.
  • “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
  • “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.
  • “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
  • “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
  • “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).
  • “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.
  • “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.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            53  Emotionally, persons with childhood-onset insomnia are often repressors, denying and minimizing emotional problems. These individuals often show atypical reactions, such as hypersensitivity or insensitivity, to medications. Insomnia tends to persist over the entire life span and can be aggravated by stress or tension. Sleep state misperception: Patients report insomnia subjectively, while sleep duration and quality are completely normal. Physical Findings. Physical findings that indicate sleep deprivation and fatigue may include features such as eye redness. Depending on the origin of the sleep dysfunction, other physical findings would be included to rule out secondary causes (ie, weight, neck circumference, thyroid). A complete neurologic examination is included in the evaluation of insomnia to assess for comorbid conditions. Recognition of mental disorders that may be contributing to insomnia is key to effectively manage symptoms. When performing a complete Mental Status Examination, drowsiness and mood changes such as irritability, anxiety, and sad feelings from underlying depression may be noted. The clinician should also note the patient's orientation, memory, judgment, insight, and the presence of any hallucinations or delusions. As with any mental status (but especially with the concern about depression), assess the patient's suicide potential. For completeness, assess the patient's homicidal potential as well.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            54  Causes Exclusion of other common causes is required to make the diagnosis of primary insomnia. Medical causes Chronic pain, especially neuropathic pain Primary sleep disorders (eg, sleep apnea, periodic limb movements, restless legs syndrome) Dyspnoea from any cause Pregnancy Differential Diagnoses Adjustment Disorders Major Depression Alcohol-Related Psychosis Obstructive Sleep Apnea-Hypopnea Syndrome Amphetamine Abuse Parasomnias Anxiety Disorders Postpartum Depression Apnea, Sleep Posttraumatic Stress Disorder Bipolar Affective Disorder Schizophrenia Caffeine-Related Psychiatric DisordersSleep Disorder, Geriatric Cocaine-Related Psychiatric Disorders Depression Other Problems to Be Considered A number of occult medical, psychiatric, and substance abuse disorders can cause sleep disturbance. Also consider other sleep-related disorders, such as circadian rhythm sleep disorder and parasomnias, in the differential diagnosis. Substance abuse can cause insomnia during the intoxication phase, during the sustained use phase, and during withdrawal.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            55  Psychiatric and/or psychological causes Mood disorders (eg, depression, mania): Recent findings have strengthened the evidence that primary insomnia may be linked with mood disorders and is associated with hypothalamic-pituitary-adrenal (HPA) axis overactivity and excess secretion of corticotropin-releasing factor (CRF), adrenocorticotropin-releasing hormone, and cortisol. Anxiety disorders (eg, generalized anxiety, panic attacks, obsessive–compulsive disorder) Substance abuse (eg, alcohol or sedative/hypnotic withdrawal) Major life stressors and/or events Environmental causes Noise Jet lag or shift work Bedroom too hot or cold Laboratory Studies Laboratory studies essentially are not required for the diagnosis of primary insomnia. Tests required to exclude other causes of insomnia include the following:  Thyroid function tests (hyperthyroidism)  Blood alcohol levels (alcohol-related psychosis) Imaging Studies Neuroimaging studies may be helpful if a structural lesion is suspected to cause insomnia.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            56  Other Tests Sleep diary This is a questionnaire completed by the patient each morning to describe the previous night's sleep. Data from the sleep diary may help minimize distortions in sleep information recalled in the physician's office. Actigraphy: This is a recently developed technique that makes use of an activity monitor to record activities during sleep and waking. It is useful in the diagnosis of circadian rhythm sleep disorders, sleep state misperception, and other types of primary insomnia. In older adults treated for chronic primary insomnia, the clinical use of actigraphy is still suboptimal in detecting wakefulness. Procedures Full-night polysomnography (PSG) is indicated when suspicion of sleep apnea or movement disorders arises, when initial diagnosis is uncertain, when treatment fails, or when precipitous arousal occurs with violent or injurious behavior. Multiple sleep latency test Psychophysiological insomnia and idiopathic insomnia manifest as increased sleep latency, reduced sleep efficiency, and increased number and duration of awakenings. Sleep state misperception manifests as normal sleep latency (15-20 min), normal number of arousals and awakenings, and normal sleep duration (6.5 h). The multiple sleep latency test shows normal daytime vigilance. Sleep state misperception can be diagnosed only in the laboratory because of the need to document that sleep duration and quality are normal when a person claims to have poor sleep
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            57  Drug use or withdrawal (eg, selective serotonin reuptake inhibitors, stimulants, antihistamines, caffeine, diet pills, herbal preparations containing ma huang, anticonvulsants, steroids)
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            58  Chapter-3 CHIKITSA AND PATHYAPATHYA IN NIDRANASHA Vaidya is considered next to God owing to his unquestionable ability to treat the disease. This ability is a result of his indepth shastraadhyayana coupled with practical experience. Maharshi Atreya has mentioned the qualifications of a good physician, that along with so many other things he should also know well about the wholesome and the unwholesome sleep, sleeplessness and excessive sleep including their causation and treatment67 . Charaka Samhita has recommended the following measures for insomnia. Abhyanga, utsadana, snana, intake of mamsa rasa of gramya, anupa and audhaka animals, shali rice with dadhi, ksheera, sneha, madhya, manah sukham, smell of scents and hearing of sounds of one’s taste (manaso anugunaa gandhah, shabdah), samvahana, Netra Tarpana, shiro lepa, vadana lepa, comfortable bed and home and proper time brings sleep, to those who are suffering from sleeplessness.68 Astanga Sangrahakara has narrated the following regimens for sleeplessness: Milk, sugarcane juice, mamsa rasa of gramya, anupa and audhaka animals, foodstuffs prepared from jaggery and rice, Alcoholic beverages,masha, kilata and curd of buffallow’s milk, abhyanga and bath, shiro-abhyanga, Sravana purana and Netra tarpana, application of ointments on head and face, kneading of body by beloved ones, sleeping in the hands of beloved, sexual intercourse, fantasysing the mind with blissful things gives sleep and makes the person happy.69,70 Sushruta Samhita also mentions the same regimens.71 Bhavaprakash Samhita mentions the following treatment for insomnia: Abhyanga, Udvartana, Snana, Akshitarpana, Samvahana.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            59  Panchakarma chikitsa Abhyanga, Utsadana, Chakshu Tarpana, Shiro Lepa, Vadana Lepa, Murdha Taila, Karna Purana, Shiro Basti, Shirodhara. Table No. 8: Showing Bahya upacharas in Nidranasha Upachara CS SS AH AS YR BP KS HS BS BR Abhyanga + + + + + + - - + - Utsadana + - - - - - - - - - Samvahana + + - + + + - - - - Akshitarpana + - + + + - - - - + Moordhnitaila + + - - - - - - - - Udvartana - + + + - + + - - - Shirobasti - - + + - - - - - - Shirastarpana - - + - - - - - - - Moordhnapoorana - - - + - - - - - - Karnapoorana - - - + - - - - - - Padabhyanga - - - - + + - - - - Angamardana - - - - - - - - - - Mardana - - - - - - - - + - Karnatarpana - - - - - - + - - - Table No. 9: showing the Manasika Upacharas in Nidranasha Upacharas CS SS AH AS HS BP Manonukula Vishaya grahana + - - - - - Manonukula Sabda granaha + - - - - - Manonukula Gandha granaha + - - - - + Mrudu shayya - + - - - - Sukha shayya - - - + - - Sukha sparsh - - - + - - Nischinta - - + - - - Nityatrupti - - + - - -
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            60  Bhaya tyaga - - - - + - Chintatyaga - - - - + - Lobha tyaga - - - - + - Swasteerna Sayana + - - - - - Sukhavartalapa - - - - + - Santosha - - - - - + Table No. 10: showing Aahara Upacharas in Nidranasha Upacharas CS SS AH YR BP KS HS BR DN RN Gramya mamsa rasa + - - - - - - - - - Anupa mamsa rasa + - - - - - - - - - Jaleeya mamsa rasa + - - - - - - - - - Mahisha ksheera + - + + - - + + + + Peeyusha + - + + - - - - - - Morata + - - + - - - - - - Goodhooma - + - - + + - - - - Varahamamsa - - - - - - - - + + Guda - - - - - + - + - - Matsya - - - - + + - + - - Dadhi - - - - - + - - - - Koorchika - - - + - - - - - - Masha - - - - + - - + - - Sita - + - - - - - - - - Yoosha - - - - + - - - - - Sneha - - - - + - - - - - Kilata + - + + - - - - + + Madhya - - + - - - - - - -
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            61  Table No. 11: showing Different Ahara vargas used in Nidra nasha Mamsa varga Ksheeravarga Madyavarga Dhanyavarga Anya Gramyamamsarasa Mahishaksheera Paistikamadaya Godhooma Guda Anoopamamsa Dadhisevana Goudamadya Masha Sneha Udakamamsa Koorchika Shastikashali Snigdhabhojana Bileshayaprani Morata Vishkarimamsa Kilata Peetanamatsya Peeyoosha Roheetakamatsya Mahishamamsa Varahamamsa Table No. 12: showing Anya upachara in Nidranasha Upacharas CS AH AS BP KS HS YR Snana + + + - - - - Shirolepa + + + - - - - Varsa sevana in Varsa Ritu - - - + - - - Lehana karma - - - - + - - Vastra kruta vayu sevana - - - - - + - Kamsya patrakruta vayu sevana - - - - - + - Talapatra kruta vayu sevana - - - - - + - Kadali patrakruta vayu sevana - - - - - + - Viewing dance and hearing humorous voice - - - - - + - For somatic management several medicines are mentioned. Pippali Moola Churna with Jaggery 72,73 Loknath Rasa 74
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            62  Ashwagandha Churna with Sharkara & Ghee75 Decoction of Jeevaniya Gana with milk 76 Roasted Vijaya powder with honey 77 Decoction of root and bark of Kakamachi with Jaggery 78 Nidrodaya Rasa79 Kalyanaka Guda80 Indumareechadi vati (musta, yasti, ahiphena, badarasthimajja)81 Mamsa rasa, shaka, sarpi, yoosha, ksheera- all mixed with Palandu.82 Aragwadha, vacha, nimbi, patola, usheera, kutaja, kakamachi, ativisha, moorva, triphala, duralabha, bala, patha, madhooka, rohini should be taken in equal quantity and quatha is to be prepared.83 Kantakaridwaya, vasa, kakamachi, punarnava, vartakimoola- all in equal quantity, quatha is to be prepared.84 Kakajangha, apamarga, kokilaksha shooraparnika- all in equal quantity, quatha is to be prepared.85 Ghrita + Taila, Yamaka krutha yoosha.86 Kambalika is prepared from boiled roheetakamatsya blended with kanji and dadhi mastu is to be consumed along with kutaja beeja and 5 pala of guda.87 Ghrita bharjita nagara.88 Ghrita bharjita bhanga with madhu.89 Kakajangha twak quatha with madhu.90 Shalmalee niryasa + kiratatikta91 Swarna makshika bhasma92 Tungadrumadi taila93
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            63  Some external treatments are also described- Harita Samhita also states that sleep is induced by fanning with the help of cloth, Bamboo-chip (fan) or use of bronze vessel and the use of banana leaf.94 It is also mentioned that the sleep can be achieved by hearing the sounds produced by the animals like ox, horse etc., and by viewing dance and hearing humorous words.95 Hareeta Samhita in Nidra Chikitsa Adhyaya advices the application of Dadhi Mastu to the soles of the feet to get sleep. In the same context it is said that by keeping the roots of Kakajangha, Apamarga, Kokilaksha, Suparnika in the hair/plait, causes sleep95 . Bhaishajya Ratnavali in Murcha roga Adhyaya, advices the application of Bhanga lepa to the soles of the feet to promote sleep in those who have not slept since long. Bhava Prakasha advices to keep the roots of upodika and Kakamachi in the hair/plait to get sleep. Adravya Chikitsa: Pleasant smell and sound96 Gentle rubbing97 To listen good music and news98 To keep the mind in a calm and happy state99 Living without worry100 To remain always satisfied 100
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            64  PATHYAAPATHYA Pathya is the wholesome regimen which does not impair the body system and which is pleasant to the mind101 . If one follows certain principles and controls the activities and makes changes in the regimen, he can get a sound, normal and good sleep. Pathye sati gadartasya kimoushadha nishevanam Pathye asati gadartasya kimoushadha nishevanam says Lolimbaraja . He simply states that there is no point in planning a treatment regimen if one is not following Pathyaapathya. This is especially true in the case of Nidranasha where diet and life style play an important role in its treatment. The following table is a collection of all food items promoting nidra in various Ayurvedic text. Table No.13: Showing the Pathya ahara in Nindranasha Pathya Ahara Ch. Su. A.H. A.S. B.P Mamsa rasa of gramya, anupa and audaka animals + - - - - Shali anna + + - + - Dadhi + - + + - Ksheera + + + + - Godhuma - + - - - Ikshu - + - + + Pishta - + - + - Mamsa rasa - + + - + Madhura - + - - - Mamsa of Bila and Vishkira animals - + - - - Draksha - + - - - Sita - + - - - Sura - - + + + Mamsa of Anupadeshiya animals and birds - - - + - Masha - - - + + Kilata - - - + - Shaka - - - - + Dala - - - - + Ghrutha - - - - + Yusha - - - - + Tila - - - - + Matsya - - - - +
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            65  Life Style: Pathya viharas in nidranasha mentioned in classics are given below: Table No. 14: The following table is a collection of various viharas promoting comfortable nidra mentioned in Brihattrayee. Vihara Ch. Su. A.H. A.S. Comfortable bed + + - + Comfortable room + - - - Proper time + - - - To wear clean clothes - + - - To speak softly - + - - To take bath - - + + To observe celibacy - - + - To lay down in fragrant and airy place - - - + Apathya Apathya –– those which adversely affect the body and mind are considered to be unwholesome (Apathya) All the ahara viharas mentioned as nidana for nidra nasha can be considered as Apathya and their parivarjana forms an important aspect of treatment.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            66  CONTEMPORARY MEDICAL TREATMENT FOR INSOMNIA In many cases, insomnia is caused by another disease, side effects from medications, or a psychological problem. It is important to identify or rule out medical and psychological causes before deciding on the treatment for the insomnia. Attention to sleep hygiene is an important first line treatment strategy and should be tried before any pharmacological approach is considered. Non-pharmacological Non-pharmacological strategies are superior to hypnotic medication for insomnia because tolerance develops to the hypnotic effects. In addition, dependence can develop with rebound withdrawal effects developing upon discontinuation. Hypnotic medication is therefore only recommended for short term use, especially in acute or chronic insomnia. Non pharmacological strategies however, have long lasting improvements to insomnia and are recommended as a first line and long term strategy of managing insomnia. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education and relaxation therapy. Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep or sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            67  another location if sleep does not result in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps. A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, only sleeping at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when sleep efficiency improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs). Cognitive behavior therapy A recent study found that cognitive behavior therapy is more effective than hypnotic medications in controlling insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            68  misconceptions and expectations that can be modified include: (1) unrealistic sleep expectations (e.g., I need to have 8 hours of sleep each night), (2) misconceptions about insomnia causes (e.g., I have a chemical imbalance causing my insomnia), (3) amplifying the consequences of insomnia (e.g., I cannot do anything after a bad night's sleep), and (4) performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process. Hypnotic medications are equally effective in the short term treatment of insomnia but their effects wear off over time due to tolerance. The effects of cognitive behavior therapy have sustained and lasting effects on treating insomnia long after therapy has been discontinued. The addition of hypnotic medications with CBT adds no benefit in insomnia. The long lasting benefits of a course of CBT shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short term hypnotic medication such as zolpidem (Ambien), CBT still shows significant superiority. Thus CBT is recommended as a first line treatment for insomnia. Medications Many insomniacs rely on sleeping tablets and other sedatives to get rest, with research showing that medications are prescribed to over 95% of insomniac cases. Certain classes of sedatives such as benzodiazepines and newer nonbenzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully tapered down. The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side effects such as day time fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects. Review of the literature regarding benzodiazepine hypnotic as well as the nonbenzodiazepines concluded that these drugs caused an
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            69  unjustifiable risk to the individual and to public health and lack evidence of long term effectiveness. The risks include dependence, accidents and other adverse effects. Gradual discontinuation of hypnotics in long term users leads to improved health without worsening of sleep. Preferably hypnotics should be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible in the elderly. Benzodiazepines The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. Benzodiazepines bind unselectively to the GABAA receptor. These include drugs such as temazepam, flunitrazepam, triazolam, flurazepam, midazolam, nitrazepam and quazepam. These drugs can lead to tolerance, physical dependence and the benzodiazepine withdrawal syndrome upon discontinuation, especially after consistent usage over long periods of time. Benzodiazepines while inducing unconsciousness, actually worsen sleep as they promote light sleep whilst decreasing time spent in deep sleep such as REM sleep. A further problem is with regular use of short acting sleep aids for insomnia, day time rebound anxiety can emerge. Benzodiazepines can help to initiate sleep and increase sleep time but they also decrease deep sleep and increase light sleep. Non-benzodiazepines Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone and eszopiclone, are a newer classification of hypnotic medications. They work on the benzodiazepine site on the GABAA receptor complex similarly to the benzodiazepine class of drugs. Some but not all of the nonbenzodiazepines are selective for the α1 subunit on GABAA receptors which is responsible for inducing sleep and may
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            70  therefore have a cleaner side effect profile than the older benzodiazepines. However, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence though less than traditional benzodiazepines and can also cause the same memory and cognitive disturbances along with morning sedation. Alcohol Alcohol is often used as a form of self-treatment for insomnia and to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headache, polyurea, dehydration and diaphoresis. Glutamine rebound also plays a role as when someone is drinking, alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep. Opioids Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia which is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            71  Antidepressants Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can often have a very strong sedative effect, and are prescribed off label to treat insomnia. The major drawback of these drugs is that they have properties which can lead to many side effects,. Some also alter sleep architecture. As with benzodiazepines, the use of antidepressants in the treatment of insomnia can lead to withdrawal effects; withdrawal may induce rebound insomnia. Mirtazapine is known to decrease sleep latency, promoting sleep efficiency and increasing the total amount of sleeping time in patients suffering from both depression and insomnia. Melatonin and melatonin agonists The hormone and supplement melatonin is effective in several types of insomnia. Melatonin has demonstrated effectiveness equivalent to the prescription sleeping tablet zopiclone in inducing sleep and regulating the sleep/wake cycle. One particular benefit of melatonin is that it can treat insomnia without altering the sleep pattern which is altered by many prescription sleeping tablets. Melatonin agonists, including ramelteon (Rozerem) and tasimelteon, seem to lack the potential for misuse and dependence. This class of drugs have a relatively mild side effect profile and lower likelihood of causing morning sedation. Antihistamines The antihistamine diphenhydramine is widely used in nonprescription sleep aids such as Benadryl. Its effectiveness may decrease over time and the incidence of next-day sedation is higher. Anticholinergic side effects may also be a draw back of these particular drugs. Dependence does not seem to be an issue with this class of drugs.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            72  Cyproheptadine is a useful alternative to benzodiazepine hypnotics in the treatment of insomnia. Cyproheptadine may be superior to benzodiazepines in the treatment of insomnia because cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality. Atypical antipsychotics Low doses of certain atypical antipsychotics such as quetiapine, olanzapine and risperidone are also prescribed for their sedative effect but the danger of neurological, metabolic and cognitive side effects make these drugs a poor choice to treat insomnia. Over time, quetiapine may lose its effectiveness as a sedative. Eplivanserin is an investigational drug with a mechanism similar to these antipsychotics, but probably with less side effects. Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but this has not yet been proven. A healthy diet containing magnesium can help to improve sleep in individuals without an adequate intake of magnesium. Table No. 15: Hypnotic Drugs and their Hypnotic Effect Hypnotic drugs Effect on Serotonin Effect on REM Sleep Effect on Stage 3-4(Slow wave) Sleep L-Tryptophan +++ +++ +++ Doxepin ++++ + +++ Amitriptyline ++++ + +++ Imipramine +++ ++ ++ Phenobarbital -- --- - Flurozepam -- 0 --- Diazepam --- -- -- Chlorpromazine 0 +++ 0 Desipramine 0 +++ 0 These are the presently available treatment procedures in modern medicine.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            73  FOOD AND DIET ACCORDING TO CONTMPORARY SCIENCE Diet is especially important when treating sleep disorders, and it is essential to rule out food intolerances as a cause. Foods to Eat Chlorophyll-rich foods, such as leafy, green vegetables, steamed or boiled. Microalgae, such as chlorella and spirulina. Oyster shell can be taken as a nutritional supplement. Whole grains: Whole wheat, brown rice, and oats have a calming and soothing effect on the nervous system and the mind. Carbohydrates also boost serotonin, which promotes better sleep. Mushrooms (all types) Fruits especially mulberries and lemons, which calm the mind. Seeds: jujube seeds are used to calm the spirit and support the heart. Chia seeds also have a sedative effect. Foods such as bread, and crackers that are high in complex carbohydrates have a mild sleep-enhancing effect because they increase serotonin, a brain neurotransmitter that promotes sleep. Milk contains tryptophan which, when converted to seratonin in the body, induces sleep and prevents waking. Vitamins for Insomnia: Vitamin B is important as it plays a vital role in treating insomnia. When our body does not get sufficient amount of this vitamin it finds it difficult to calm down and relax hence one cannot sleep. This vitamin is found in
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            74  foods such as whole grains, cereals, pulses and nuts. A decoction made of lettuce seeds is used and proved to be very helpful. Lettuce has a long-standing reputation for promoting healthy sleep. This is due to an opium-related substance combined with traces of the anticramping agent hyoscyarnin present in lettuce. The meal should also include legumes, peanuts, nutritional yeast, fish or poultry. These foods contain vitamin B3 (niacin). Niacin is involved in seratonin synthesis and promotes healthy sleep. Mixed with a little lemon juice for flavor, lettuce juice is an effective sleep- inducing drink highly preferable to the synthetic chemical agents in sleeping pills Foods to Avoid Coffee, Tea, Spicy foods, Cola, Chocolate, Stimulant drugs, Alcohol, refined carbohydrates (They drain the B vitamins.), Additives, Preservatives, Non-organic foods containing pesticides. Canned foods or any source of toxicity or heavy metals. Sugar and foods high in sugar and refined carbohydrates. These raise blood-sugar levels and can cause a burst of energy that disturbs sleep. Foods that are likely to cause gas, heartburn, or indigestion, such as fatty or spicy foods, garlic-flavored foods, beans, cucumbers, and peanuts. Foods such as meat that are high in protein can inhibit sleep by blocking the synthesis of serotonin, making us feel more alert. Monosodium glutamate (MSG), often found in Chinese food. This causes a stimulant reaction in some people. One should avoid cigarettes and tobacco. While smoking may seem to have a calming effect, nicotine is actually a neurostimulant and can cause sleep problems.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            75  Alcohol and caffeine are two beverages/food that you must avoid for a healthy sleep. One should avoid caffeine in all forms (tea, coffee, cola, chocolate) The sensitivity to the stimulant effects of caffeine varies greatly from one person to the next. This is largely a reflection of how quickly the body can eliminate caffeine. Even small amounts of caffeine such as those found in decaffeinated coffee or chocolate, may be enough to cause insomnia in some people. Alcohol produces a number of sleep-impairing effects. In addition to causing the release of adrenaline, alcohol impairs the transport of tryptophan into the brain, and, because the brain is dependent upon tryptophan as the source for serotonin (an important neurotransmitter that initiates sleep), alcohol disrupts serotonin levels. One should avoid too many ingredients in a meal and too much food late at night. One should avoid bacon, cheese, chocolate, eggplant, ham, potatoes, sugar, sausage, spinach, tomatoes, and wine close to bedtime. These foods contain tyramine, which increases the release of norepinephrine, a brain stimulant. Our digestive system slows at night. So, it is harder to digest late meals. Heavy meals before bedtime must be avoided.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            76  DRUG REVIEW The term Drug is derived from the French word ‘drogue’ i.e. dry herb. A Drug is defined as any substance used for the purpose of diagnosis, prevention, relief or cure of a disease in man or animals. According to W.H.O., the Drug is “A substance used in the diagnosis, treatment, or prevention of a disease or as a component of a medication”. A Drug is any substance or product that is used or intended to be used to modify or explore physiological systems or pathological states for the benefit of the recipient. Drug is one of the chief factors of Chikitsa Chatushpada. Acharya Charaka has emphasized, the awareness of therapeutic Drug by considering it as one among ‘Trisutra’ i.e. Hetu, Linga and Ausadh of Ayurveda.102 Bheshaja is the key ingredient for a successful chikitsa and understanding the virtues of the bheshaja forms an important part of research which helps the researcher to discuss why the pirticular bheshaja is acting in a specific way in treating the problem , what properties and components make the drug act in a pirticular fashion, and what difference is seen in the action of drug with and with out dietary regulations. This section is divided into two to study the properties of two ingredients of Guda Pippalimoola in one section and the properties of the food items included in the diet chart in the second section. Guda Pippalimula Yoga was described to be effective in the following texts 1. Bhava Prakasha Samhita 2. Bhaishajya Ratnavali 3. Yoga ratnakaram 4. Vangasena
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            77  PIPPALI MULA Pippali moola is the root of the plant pippali, which is a key ingredient of many formulations. However pippalimoola is attributed with a special property of releiving nidranasha when it is used along with guda. Table No. 16: showing the properties of Pippalimoola. Latin Name Piper longum Family Piperaceae Vernacular Name: Hindi- Pipal ki mool English- Roots of Long pepper Telugu- Modi Malyalam-Tippali moola Kannada- Hippali beru Tamil- Tippali moola Synonyms Granthikam, Ushanam, Catakasira moola, Kanamoola.Katu granthi, Kolamoolam, Katumoolam, Katushanam,sarvagranthi, Chavika sira, Patradyam, virupam,shonasambhavam, Granthilaam.103 Gana Dipaniya, Shulaprashamanam (Ch.) Pipalyadi Varga(Pr. Ni) (Su.) ( Ad. Ni)(R.Ni) Panchkola, Haritakyadi Varga (B.P.) Satapushpadi vargam (Dh. Ni) Rasa Katu Vipaka Katu Guna Laghu, Snigdha, Tikshna Virya Anushna Chemical Composition It contains Essential oil, Resin, Volatile oil, starch, gum, fatty oil, inorganic matter and an alkaloid, Piperine- 0.15-0.18%, Pipalartin- 0.13-0.20%, Piperleguminin ,Glyosides, Beta-Sitosterol, Cepharadiones sesamin, piplasterol, piperronguminin, steroid etc. Parts Used Mula (root)
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            78  Doshaghnata Kapha-vata shamaka, Karma Deepana, Pachana, Bhedana Krimighna, Kasahara, Swasahara, Hiccanigrahana, Triptighna Roghaghnata Vatavyadhi, Aruchi, Pandu, Gulma, Swasa, Kasa Indications Udara, Anaha, Pliha roga, Gulma, Krimi, Svasa, Ksaya, Nidra nasha104 In Paniniya gana patha (4/2/90) we come across the reference of Pippalimoola. It is also extensively described in the Vedic literature. Morphology: It is an aromatic tender climber, stems creeping, jointed, attached to other plants while climbing, leaves- 5-9 cm X 3-5 cm, sub-acute, entire, glabrous, cordate at the base, flowers in pendulate spikes straight, fruits yellowish-orange in fleshy spike. The roots are noded and brownish in colour Different Varieties: Dymock (1885) reported that there are three kinds of Pippalimoola viz., a. Mirzapuri b. Bengali and c. Malva varieties Guda (Jaggery): Guda and its vikara are indicated in nidranasha as promotive of sleep in various classical texts like Astanga Sangraha, Bhaishajya Ratnavali, Bhava Prakasha and Kashyapa Samhita Jaggery is a dark, course, unrefined sugar made either from sugar-cane juice. It is primarily used in India, where many categorize sugar made from sugar-cane as
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            79  jaggery and that processed from palm trees as "gur". Jaggery has a sweet, wine-like fragrance and flavor that lends distinction to whatever food it embellishes. Ayurvedic Review: Sweetening substances are being used in the Ayurvedic formulations to increase it’s palatability, for preservation and also to have, tonic effect. They are responsible for the generation of alcohol in Asavarishtas and serve as base in Avaleha Kalpana. In our Ayurvedic formulation, various sweetening agents used are Guda, Sita, Sharkara etc. Among these Guda (Jaggery), Sita (Purified sugar candy), Sharkara (sugar) are very commonly used the preparation of different Kalpanas i.e. Avaleha, Gutika, Asava-Arishta, Sharkara, Panaka, etc. But in Asava-Arishta, percentage of Jaggery (Guda) found is more in comparison to others. Jaggery is explained under the heading of “Ikshuvarga” in all Samhitas and Nighantus. It is prepared by the juice of sugarcane. According to Cha. Su. 27/239 - Before formation of Jaggery, the sugarcane juice undergoes four stages i.e. (i) Chaturbhagavasheshita - 1/4th remain (ii) Tribhagavasheshita - 1/3rd remain (iii) Ardhabhagavasheshita - ½ remain All these three varieties are called “Kshudraguda” and they are light for digestion in their ascending order. (iv) Dhauta Guda: The finally formed Guda will be clean and of good quality, it is called as Dhauta Guda and used for medicinal purpose as well as dietetic purpose.105
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            80  Properties of Navaguda (New Jaggery): Newly prepared jaggery is Kapha, Shwasa-Kasakrita, Krimikara and Agnideepaka.106 Properties of Purana Guda (Old Jaggery): It is Laghu, Pathya, Anabhishyandi, Agnivardhaka, Vata Pittaghna, Madhura, Vrishya, Raktaprasadana.107 Guda with different Anupana having Trisodhashashamaka activity:108 With Ardraka - Kaphaghna Haritaki - Pittaghna Sunthi – Vatghna108 Table No.17: showing the properties of Guda. Vernacular Names Hindi - Guda English - Treacle/Jaggery Marathi – Gula Kannada – Bella Synonyms Sishupriya, Sitadih, Arunorasaja, Rasapakajah109 Rasa Madhura Vipaka Madhura Guna Guru, Snigdha Virya Ushna Chemical Composition It contains sharkara, albumine, calcium oxelate. Doshaghnata Tridoshashamaka Karma Deepana, Pachana, Anulomana, Vrishya, Hridya, Mutra-Rakta shodhaka, Increase Medodhatu, Kapha and Krimi, Pittaghna,Vatashamaka110
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            81  b. Modern Review: Jaggery is nutritious. It improves digestion, prevents fatigue,purifies blood and provides strength to the muscles. Jaggery is rich in minerals, iron and instant glucose. It is not only easily digestible, but also has various minerals and vitamins in right proportion, which is extremely useful for our body. Jaggery and sugar not only differ in their composition but also in their effect on the human metabolism. Carbohydrate, which is prominently present in sugar, need B- vitamins for their proper utilization by the body and the nature has so arranged it that, in their natural states, both cereals and natural sugar items (like, cane-juice, fruits, nuts etc.), and also protein foods, have more than enough of the B-vitamins needed for the assimilation of all the carbohydrate present. If excess of refined sugar is eaten, it is likely to lead to some degree of B-vitamin deficiency. Symptoms of B-vitamin deficiency include irritability, nervous exhaustion, sleeplessness, heart trouble, digestive disorders and mental trouble. On the other hand, one hundred gm. of jaggery provides 200 calories and so requires about 0.1 mg of vitamin B and, it contributes many times this amount itself. Table No.18: showing theNutrient content of Jaggery (per 100 gms) Moisture 3.80 gm Protein 0.40 gm Fat 0.10 gm Carbohydrate 95.00 gm Energy 183 k. Cals Calcium 80.20 mg Phosphorous 40.20 mg Iron 11.4 mg Total Minerals 0.60 gm Carotine 168 mcg Thiamine 0.02 mg Riboflavin 0.05 mg Vitamin C 0.50 mg
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            82  REVIEW OF AHARA DRAVYAS SELECTED IN DIET CHART Some of the ahara dravyas mentioned in the context of nidranasha were selected to prepare the diet chart for one of the groups. Following are those dravyas and their properties.Bhaishajya Ratnavali states sone of the dravyas as Nidrakara viz., Ikshu, Pothaki, Masha, Sura, Mamsa, Ghritha, Payah, Godhuma, Guda and Matsya in the 21st Chapter (Murcha Roga Chikitsa) Iksvaha potaki mashaah suraa maamsam ghrutham payah | Godhuma guda matsyaascha nidraam kurvanti dehinaam || KSHEERA Snighdam ruchikaram cha tandraanidraakaram vrushyatamam shramaghnam|| Balapradam pustikaram kaphasya sanjeevanam chaasti peyo mhishayaah |111 Ksheera is considered as complete diet. It is indicated for all, right form the child to the aged. Among all the jeevaneeya dravyas ksheera is said to be superior. The regular consumption of ksheera brings rasayana effect in the body. Charaka samhita describes ten qualities of ksheera which are similar to that of ojus. It is the pathyatama dravya, especially in debilitating conditions. Synonyms: Dugdha, soumya, dhari, satmya, paya, prasravana, asraja, jeevana, ksheera, peeyusha, udhasya and amruta. Table No. 19 – showing the Rasa panchaka of Ksheera Rasa Madhura Guna Snigdha, guru, mrudu, shlakshna, picchila, manda. Veerya Sheeta Vipaka Madhura Dosha karma Vatapitta hara, shleshma kruth.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            83  The quality of milk varies depending upon the nature of animal, duration of boiling, time of consumption etc.Dharoshna ksheera is amrutatulya. Kwathitha dugdha is said to be sarva rogahara, balapushtikari and ojoprada.If it is taken in the morning it acts as balya, bruhmana and agnivardhana. It is ruchikara and baladayaka when taken in the afternoon. The consumption of milk at night acts as tridoshahara. In balyavastha, it improves agni and bala. In vardhakya, it acts as virya vardhaka. MILK Milk is a fine blend of all the nutrients necessary for growth and development of the young ones. Milk is a good source of proteins, fats, sugars, vitamins and minerals. Milk is being used throughout the world for feeding infants and as a supplement to the diets of children and adults. Table No. 20: Showing nutritive value of milk (per 100 gms) Sl.No. Nutrients Nutritional value 1 Fat 4.1g 2 Protein 3.2g 3 Lactose 4.4g 4 Calcium 120mg 5 Iron 0.2mg 6 Vitamin C 2mg 7 Minerals 0.8gm 8 Water 87% 9 Energy 67 kcal Masha: Masha is said to be nidrajanaka in Sushrutha Samhita, Astanga Sangraha, Bhava Prakasha and Bhaishajya Ratnavali. (Ch. Su.25, Ch.Su. 27/24, Su. Su. 46, A.H.Su.6. R.N. Bh.P.)
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            84  Table No. 21: showing the Properties of Masha Latin Name: Phaseolus radiatus Family: Leguminoseae Sub family: Papilonaceae Gana: Palashadi Varg (Bh.P.) Synonyms: Mansala, Baladhya, Vrushtakar, Kuruvinda, Dhanyavir, Pitrya, Pitrujyottama. Rasa Madhura Guna Guru, Snigdha Veerya Ushna Vipaka Amla112 Doshaghnata Vatashamak, Kaphapitta Vardhak Part used Bija Rogaghnata: Gudakila, Ardita, Swasa, Paktishula, Vata Roga. Chemical Compsition It contains minerals like Ca, P, Mg. Cu and K; and Vitamins like carotene, thiamine, riboflavin, niacin, choline, folic acid, Vit B12 is present in minute quantity. A suceinoides with properties similar to those of muscle enzyme has been obtained. Globulin, albumin, prolamin and glutelin are the proteins found. Allantoin, glutathione is also present. It’s a good source of lysine, valin, amino acids, leucines, etc. (Wealth of India – Raw materials Vol. X). It contains albuminoids 22.7%, starch 55.8%, oil 2.2%, fibre 4.8% and Ash 4%. An analysis of some samples grown in Bombay presidency shows moisture 6.05 to 11.95, Ether extract 1.25 to 2.60,
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            85  Albuminoids 19.81 to 27.50; soluble carbohydrates 50.05 to 60.69, woody fibres – 4.25 to 5.90 and Ash 3.45 to 5.35. (Bombay Govt. Agri. Bulletin). Actios and uses It is used in rheumatism, affection of nervous system and disease of liver. In Indo- China countries black gram is considered as diuratic and is used in dropsy and cephalagia. (Kirt. & Basu. I). It is the most demulcent cooling as well as nutritious of all pulses, also aphrodisiac, lactogene and nervine tonic. The pulses shows marked cholesterole lowering effect (in serum, liver and aorta) when fed to rats receiving normal hypercholesterolemic diet, serum phospholipids levels are also lowered. (Chem, Abstr. 1971, 74, 10942) Also used in gastric catarrh, dysentry, diarrhoea, cystitis, paralysis, piles, rheumatism and affections of liver and of nervous system. (Indian Meteria Medica). IKSHU: Ikshu and its vikara are considered as Nidrajanaka in Sushrutha Samhita, Astanga Sangraha, Bhava Prakasha and Bhaishajya Ratnavali. Table No. 22: showing the Properties of Ikshu Latin Name: Saccharum officinarum Family: Gaminae Sub family: Papilonate Gana: Shukrashodhan ( Cha) Trinapanchamula (Su) Synonyms: Madhutruna, Bhuriras, Gudadara, Gudamula, Trinaraj, Maharas. Rasa Madhura Guna Guru Veerya Shita Vipaka Madhura
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            86  Doshaghnata Vatapittahara Part used Stem Karma: Balya, vrishya, Kaphaprada, Mutrala, Brimhana Rogaghnata: Gudakila, Ardita, Swasa, Paktishula, Vata Roga. Sugar cane is sweet oleginous, indigestible, diuretic, tonic, cooling, aphrodisiac. Chemical Constituents: It contains sugar, watre, resin, fat, albumin, guanine, calcium oxalate. GHRITA: Ghrita is considered as Nidrakara in Bhava Prakasha and Bhaishajya Ratnavali. Ghrita is one among the Ajasrika Rasayanas. It is Ayuvardhaka, Balavardhaka, Ojovardhaka, Vayasthapaka, Dhatu poshaka and is supreme in snehana Dravyas. By virtue of Yogavahitwa, as per its ingredients the medicated Ghrita will be attaining different properties. Table No. 23: Table showing Properties of Ghrita Rasa Madhura Guna Snigdha, guru, Sara Veerya Sheeta Vipaka Madhura Doshaghnata Vata-Pitta Shamaka Karma Medhya, Agni vardhaka, Pandu, Kamala, Netra Rogahara Chemical composition Ghee contains 8% lower saturated fatty acids which makes it easily digestible. Due to having 4-5% lenoleic acid, an essential fatty acid, it promotes proper growth of human body. Ghee also contains vitamin A,B,E and K. vitamin A and E are anti oxidant
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            87  and are helpful in preventing oxidative injury to the body. Ghee is lipophilic and this action of ghee facilitates the transportation of ingredients of formulation to target organ and final delivery inside the cell, because cell membrane is highly lipophilic. Upodika: Upodika or Pothaki is said to be Nidrajanak in various texts like Bhava Prakasha, Bhaishajya Ratnavali and Vangasena. Pothakyupodika saa tu maalvaa amrutavallari | pothaki sheetala snighdha sleshmalaa vaatapittanut || Akantya pichillaa nidrashukradaa raktapittajit | Baladaa ruchikrut pathyaa brumhanee truptikaarinee |113 Upodikaa himaa snigdha swaadu paaka rasaa saraa sakshaaraa sleshmalaa balyaa nidraa shukraatipushtidaa akantyaa picchilaa hanti raktapittamadaanilaan|114 Table No. 24: showing the Properties of Upodika Latin Name: Basella rubra Linn. Family: Chenopodiaceae (vastuka kula) Sanskrit Name Upodika Vernacular Names Hindi: Poi, Poy, Poi shak English: Indian Spinach Telugu: Batsala Kannada: Basale Synonyms Amruta vallari,upodaka, Kantaki,Urdhvaga valli, Upodika, pothaki, Malva, vrittapatra, pichilachadana, mathsyakata, turangi, kalambika, rakta danda,sthira. Rasa Madhura Guna Guru, Snigdha, Picchila Veerya Shita Vipaka Madhura
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            88  Doshaghnata Kapha vardhaka, Vata-Pitta shamaka Part used Leaves and Stem Karma Balya, vrishya, Kaphaprada, Mutrala, Brimhana Rogaghnata Anulomana, Balya, Vrusya, Brumhana, Mada nashaka, Nidrajanana, vrana pachana ,vimlapana,sara, bhedana, daha prashamana. Chemical composition Protein-1.2%,calcium-15%,Iron-1.4mg/100g,vitamin-A-3.250I.U.,VitaminB1- 40 I.U.,VitaminB2-10 I.U., Leaves contain high amount of mucilage, red variety contains colouring matter and the fruits contain deep violet colouring matter. Godhuma: Godhuma is considered to be Nidrajanaka according to Sushrutha Samhita, Kashyapa Samhita, Bhava Prakasha and Bhaishajya Ratnavali. Godhumako yavanakah sumanashchamaddo matah || Godhumo madhuro vrushyo guruh snigdho himah sarah | jeevano brumhano varnyo balyo asyandi ruchipradah|| Sthyairya sandhana krud vaatapittaghnah kaphakrunna cha.115 Table No. 25: showing the properties of Godhuma Latin Name Triticum sativum Lam. Family Gramineae Vernacular names Hindi-gehu, Eng-wheat, Telugu-Godhuma,Kannada- Godhi. Synonyms Godhuma, Yavanaka, Sumana, chamada Rasa Madhura Guna Guru, snigdha, hima Virya Sheeta Vipaka Madhura Karma Vrushya, sara, jeevana, brumhana, Varnya, balya, asyandi, ruchiprada, Sthairya sandhana krut Doshagnata Vatapittaghna, Kaphakara
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            89  Shali Dhanya: Shali anna is said to be Nidrajanaka in the classical texts like Charaka Samhita, Sushrutha Samhita and Astanga Sangraha. Table No. 26: showing the properties of Shali Dhanya Latin Name Oryza sativa Linn. Family Gramineae Vernacular names Hindi-Dhaan, Chaval, English-Paddy,rice,Telugu- Vari,Biyam,Kannada-Batta,akki. Rasa Madhura, Anurasa Kashaya Guna Laghu, Snigdha, Virya Sheeta Vipaka Madhura Karma Brumhana, Vrushya,Hrudya, Ruchya, Ati mutrala, Balya, Swarya, Jwarahara Doshagnata Pittaghna, Vata-Kaphakara Dadhi: Dadhi is considered as Nidrakara in texts like Charaka Samhita, Astanga Sangraha, Astanga Hridaya and Kashyapa Samhita.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            90  Table No. 27: showing the Properties of Dadhi116 Vernacular names Hindi-Dahi, English-Yogurt,Curd,Telugu- Perugu,Kannada-Mosaru Rasa Madhura, Amla Guna Guru, abhishyandi, Ushna, Snigdha, Virya Ushna Vipaka Amla Karma Snehana, Agnideepanam, grahi, abhishyandi, Sristamutravit Doshagnata Vatahara, Pitta-Kaphakara Indications Aruchi, Pratishyaya, Shitajwara, Vishama jwara, kasa, krushata, Mutrakrucchra Palandu: Palandu is said to be Nidrajanaka in Bhava Prakash Samhita. Table No. 28: showing the Properties of Palandu117 Botanical Name Alium cepa Family Liliaceae Vernacular Names Hindi- Pyaz English- onion Telugu: ullipaya Tamil: vengayam Synonyms youvana eshta, mukha dushaka Chemical constituents cycloallin,quercetin,oleanolic acid,etc.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            91  Draksha: Draksha is considered as Nidrajanaka in Sushrutha Samhita. Table No. 29: showing the Properties of Draksha118 Botanical name Vitis vinifera Linn. Family Cyperaceae Gana Charaka- kanthya, virechanopaga, kasahara, sramahara. Sushruta- Parusakadi gana Vagbhata- Parusakadi gana Synonyms Mridwika, Gostani, Charuphala, Kapisha, Harahura, Swadophala Part used Fruit, Leaf, Stem, Flower Rasa Madhura Guna Snigdha,Guru,Mridu Veerya Sheeta Vipaka Madhura Doshaghnata Vata-Pitta Shamaka Karma Trishnanigrahana, Kaphanissaraka, Kanthya, Vata-Pittahara, Vrusya, Brimhana, Caksusya, Virechanopaga Jwaraghna, Balya, Brimhana, Raktaprasadana, Raktapittashamaka, Anulomana, Hridya, Medhya etc. Indications Jwara, Raktapitta, Kamala, Rajayakshma,Daha, Trsna. Chemical constituents 3 – monoglucosides of delphinidin, cyaniding, petunidin, peonodin, malvidin, acetyl and coumaryl glycosides, biflavonoids, malic acid, tannic acid, glucose, fructose, galactose, mannose, amino acids like alanine, arginine and proline (fruit) etc. Catechin, epicatechin, Betasitosterol, ergosterol, jasmanic acid. Pharmacological actions Antioxidant, Hepatoprotective, Antifungal, Anti bacterial, Anti ulcer, Cardio protective etc.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            92  Tila: Tila is considered be Nidrajanaka in Bhava Prakasha Samhita. Table No. 30: showing the Properties of Tila119 Latin name Sesamum indicum Family Pedaliaceae Gana:Charaka Svedopaga, Purisa virajaniya Vernacular Names Hindi: Til, English: Sesamum seeds, Telugu: Nuvvulu, Tamil: Ellu, Kannada :Ellu Rasa Madhura, Kashaya and Tikta Guna Snigdha, Tikshna, Guru, Vyavayi, Ushna, Sara Veerya Ushna Vipaka Madhura Action VataShamaka Tvachya, Balya, Kesya, Sukrala Indication Vata roga, Grahani, Agnimandya, Yoni-roga Chemical constituents Neutral lipids, glycolipids and phospholipids, sesamose, sesamolin, sesamolinol, sesamol, pinoresinol. Mamsa: Various vargas of Mamsa are considered as Nidrajanaka in different texts. Gramya, Anupa and Jaleeya mamsa rasa is said to be Nidrajanaka in Charaka Samhita, Astanga Hridaya and Bhava Prakasha.Mamsa of Bila and Vishkira animals is said to be Nidrajanaka in Sushrutha Samhita. Mamsa of Anupa deshiya animals and birds is considered as Nidrajanaka in Astanga Sangraha. Matsya is considered as Nidrajanaka in Kashyapa Samhita, Bhava Prakash and Bhaishajya Ratnavali. Varaha Mamsa is considered as Nidrajanaka in Dhanvantari Nighantu and Raja Nighantu.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            93  Table No. 31: showing Different varieties of mamsa used in Nidranasha120 Rasa Guna Karma Indication Gramya mamsa Madhura, Kashaya Laghu, Ruksha Dipana, Balya, Brumhana, Vrushya Vata Vyadhi, Prameha, Slipada, Galaganda. Anupa Mamsa Madhura Snighdha, Guru, Picchila, Abhishyandi, Kapha vardaka, Agnishamaka and Brumhana. Krisatva. Nidra nasha Aja Mamsa Madhura Na atisheeta, Guru, Snighda, Abhishyandi, Adoshakaraka Brumhana. tridoshanut, it is adaahi, Param Balakaram, Ruchyam, Virya Vardhanam. Shosha roga. Rajayakshma Nidra nasha. Avi Mamsa Madhura Sheeta Brimhana Nidra nasha. Mahisha Mamsa Madhura Snighda, Guru, Ushna Tarpana, Vrushya, Brumhana, Nidrajanana. Nidra nasha. Varaha Mamsa Madhura Guru, Snighda, Vata shamaka, Swedana, Shramagna, Balya, Rochana, Vrushya, Brumhana. Kukkuta Mamsa Madhura Guru, Snighdha, Ushn virya Vata shamaka, Kapha karaka, Balya, Vrushya, Brumhana, Chakshushya, Nidra nasha. Sasha Mamsa Madhura, Kashaya, Katu vipaka Laghu, Ruksha, Sheeta virya Tridoshagna Nidra nasha.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            94  Previous works done: 1. Pujari Muralidhar.P. The Effect of Shiro Basti in the management of Nidra Nasha w.s.r. to Primary Insomnia. Dept. of Kayachikitsa; Govt. Ayurveda Medical College, Mysore: 1999. 2. Sahoo Srinibash. A Compararitive Study on the Effect of Jala Dhara and Taila Dhara. Dept. of Manasa roga; S.D.M.College of Ayurveda, Hassan: 2002. 3. Chaudary Vinay. A Study on Nidranasha vis-a-vis Insomnia and Effect of Amalaki Shirolepa against Amalaki Shirodhara. Dept. of Manasa Roga; Govt. Ayurveda College, Kottakal: 2005. 4. Todkar Swati. Study of the Effect of Abhyanga Karma in Nidranasha. Dept. of Swasthavritta; Tilak Ayurveda Mahavidyalaya, Pune: 2005.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            95  MATERIALS The materials used for the study is categorized in to following three headings. 1. Literary source 2. Drugs 3. Assessment tools Collection of Material Literary source Literary source for the present study was obtained from Vedic scriptures, classical texts of Ayurveda, Sanskrit dictionaries, books related to western science, Articles published in reputed journals and also from the various media like Internet etc followed by retrospective study of related research works. Drugs 1. Sookshma churna of Pippalimoola was purchased from sri Anjaneya herbals Vijayawada, Andhra Pradesh 2. Guda was purchased from More mega store Mysore. Assessment tools 1. Pittsburgh Sleep Quality Index (PSQI) The Pittsburgh Sleep Quality Index (PSQI) (Buysse et al. 1989a) was developed to measure sleep quality during the previous month and to discriminate between good and poor sleepers. Sleep quality is a complex phenomenon that involves several dimensions, each of which is covered by the PSQI. The covered domains include Subjective Sleep Quality, Sleep Latency, Sleep Duration, Habitual Sleep Efficiency, Sleep Disturbances, Use of Sleep Medications, and Daytime Dysfunction.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            96  DESCRIPTION The PSQI is composed of 19 self-rated questions and 5 questions rated by a bed partner or roommate (only the self-rated items are used in scoring the scale). The self- administered scale contains 15 multiple-choice items that inquire about frequency of sleep disturbances and subjective sleep quality and 4 write-in items that inquire about typical bedtime, wake-up time, sleep latency, and sleep duration. The 5 bed partner questions are multiple-choice ratings of sleep disturbance. All items are brief and easy for most adolescents and adults to understand. The items have also been adapted so that they can be administered by a clinician or research assistant. Sample self-rated items are provided in Example 30 –1. The PSQI generates seven scores that correspond to the domains listed previously. Each component score ranges from 0 (no difficulty) to 3 (severe difficulty). The component scores are summed to produce a global score (range of 0–21). A PSQI global score >5 is considered to be suggestive of significant sleep disturbance. Cutoff scores are not available for component scales. PRACTICAL ISSUES It takes most patients 5–10 minutes to complete the PSQI. No training is needed to administer and score it. Scoring time is less than 5 minutes. PSYCHOMETRIC PROPERTIES Reliability Internal consistency was demonstrated in a sample of healthy control subjects (n = 52), patients with sleep disorders (n = 62), and depressed patients (n = 34); Cronbach’s alpha was 0.83 for the global score. Correlations between the component
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            97  scales and the total score ranged from 0.35 to 0.76. Correlations of items with the total score ranged from 0.20 to 0.66. Test-retest reliability (average interval of 28 days) with a subset of 91 of the patients and control subjects described earlier (43 control subjects, 22 depressed patients, and 26 patients with sleep disorders) was 0.85 for the global score and 0.65–0.84 for component scales. A small sample of elderly patients (n = 19) evaluated over an average interval of 19 days revealed similar findings (global reliability = 0.82; component scale score = 0.45–0.84). Validity Patients with sleep disorders (n = 62) or psychiatric disorders associated with sleep disturbances (e.g., depressive and anxiety disorders) (n = 34) scored significantly higher than healthy control subjects (n = 52) on global and component scales. Component scales significantly differentiated diagnostic groups. A post hoc cutoff score of 5 on the PSQI produced a sensitivity of 89.6% and a specificity of 86.5% of patients versus control subjects. This cutoff score correctly identified 84% of patients with disorders of initiating or maintaining sleep, 89% of patients with disorders of excessive sleepiness, and 97% of depressed patients. Group differences on the PSQI between patients and control subjects were substantiated by comparable group differences in polysomonographic measures for sleep latency, sleep efficiency, sleep duration, and number of arousals. However, PSQI component scale scores were not significantly correlated with corresponding polysomnographic measures (in the same sample of 148 patients and control subjects), with the exception of sleep latency (r = 0.33). The
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            98  global PSQI score was correlated with sleep latency (r = 0.20) but not with any other polysomnographic measures. In studies that compared patients with anxiety disorders with control subjects, those with panic disorder and those with social phobia exceeded the control group on global PSQI scores and on Subjective Sleep Quality, Sleep Latency, Sleep Disturbances, and Daytime Dysfunction subscales. CLINICAL UTILITY The PSQI was designed to provide a reliable, valid, and standardized measure of sleep quality. Preliminary results with the scale suggest that it is successful on all three counts. Within sleep disorder treatment settings, the test should be useful in providing initial indexes of the severity and nature of sleep disturbances. Within a general psychiatric or medical setting, the PSQI appears to be useful as an initial screen to identify good and poor sleepers. Furthermore, although not as psychometrically sound as the overall score, the component scales appear to provide preliminary signs of specific types of sleep disturbance. Although in theory the PSQI should be useful in identifying patients for whom polysomnographic evaluation may be necessary, its actual performance as a screening tool has not been reported (i.e., false-positive and false- negative rates compared with results from the polysomnogram). The PSQI component scales do not, by and large, reflect corresponding polysomnographic findings. In any case, the PSQI is not sufficient to provide accurate clinical diagnoses of sleep disorders. Furthermore, there are no data establishing its sensitivity to change; thus, it is not known whether the scale is useful for monitoring treatment response.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            99  PITTSBURGH SLEEP QUALITY INDEX (PSQI) Name__________________________ Date________ Age___ After Treatment / After Follow-up 1. During the past month, when have you usually gone to bed at night? USUAL BED TIME_________________________ 2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? NUMBER OF MINUTES_____________________ 3. During the past month, when have you usually gotten up in the morning? USUAL GETTING UP TIME__________________ 4. During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spend in bed.) HOURS OF SLEEP PER NIGHT______________ 5. During the past month, how often have you had trouble sleeping because you. Not during the past month Less than once a week Once or twice a week Three or more times a week a. Cannot get to sleep within 30 minutes b. Wake up in the middle of the night or early morning c. Have to get up to use the bathroom d. Cannot breathe comfortably e. Cough or snore loudly f. Feel too cold g. Feel too hot h. Have bad dreams i. Have pain j. Other reason(s), please describe: 6. During the past month, how often have you taken medicine to help you sleep (prescribed or “over the counter”)?
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            100  7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? No problem at all Only a very slight problem Some what of a problem A very big problem 8. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? Very good Fairlygood Fairly bad Very bad 9. During the past month, how would you rate your sleep quality overall? No bed partner or roommate Partner/roo m mate in other room Partner in same room but not same bed Partner in same bed 10. Do you have a bed partner or room mate? Not during the past month Less than once a week Once or twice a week Three or more times a week If you have a room mate or bed partner, ask him/her how often in the past month you have had: a. Loud snoring b. Long pauses between breaths while asleep c. Legs twitching or jerking while you sleep d. Episodes of disorientation or confusion during sleep e. Other restlessness while you sleep, please describe:
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            101  METHODS Aim: To evaluate the efficacy of Guda Pippalimula yoga on Nidranasha. 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). Source of data:  Literary Sources: All the available data on Nidranasha collected from different Vedic scriptures, Upanishads, Darshana shastras, Ayurvedic and Modern text books. b. Sample: 45 patients coming under inclusion criteria approaching the OPD & IPD of Government Ayurveda Medical College & Hospital, Mysore and special camps conducted in and around Mysore were selected for the study. Methods of Collection of data: Patients were selected on the basis of age, irrespective of sex, socio-economic status and caste, having the signs and symptoms of Nidranasha.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            102  Inclusion Criteria: Patients of either sex between the age group of 30-50 years. Patients with symptoms of Nidranasha (primary insomnia). Primary Insomnia with a history of one to five years. Exclusion Criteria: Patients suffering from other systemic illnesses and on any medication. Patients who have undergone any surgery within the past 6 months. Diagnostic Criteria: Normal sleep pattern- 6-8 hours of sleep will be considered as normal sleep. 15-30 minutes of duration to initiate the sleep without any disturbances will be considered as normal. Abnormal sleep pattern: If the patient is having difficulty in initiating sleep even after one hour. Reduction in sleep time for more than two hours. Discontinuation of sleep for at least two to three times. Parameters of the study: *Pittsburgh Sleep Quality Index (PSQI)
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            103  Sampling Method Purposive sampling was done. 45 patients coming under inclusion criteria approaching the OPD & IPD of Government Ayurveda Medical College & Hospital, Mysore and special camps conducted in and around Mysore were selected for the study. Research Design After the Diagnosis, the selected patients were assigned to identical group of 15 patients in each of the 3 Groups. This is a Single Blind Comparative Clinical Study. All the Patients were treated on O.P.D basis only and Pre- Treatment, Post- treatment and Post Follow-Up readings were recorded to assess various parameters of this study. 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. Analysis was considered by SPSS for windows (Statistical presentation system software) version 14 developed by SPSS, New York (2005). INTERVENTION: Patients were assigned into three groups of 15 subjects each: Group A: 2g Pippalimula choorna along with 2g of Guda was administered with milk, in the evening after meals; along with diet suggested in Nidranasha as per our classics, for a period of 48days. For Group B: 2g Pippalimula choorna along with 2g of Guda was administered with milk, in the evening after meals, for a period of 48days.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            104  For Group C: Only diet suggested in Nidranasha as per our classics was prescribed in the form of a Diet Chart, for a period of 48days. The follow up period was for48days. Table No. 32: showing the diet chart given to the Groups A and C Sl. NO. Time Diet 1 6.00 AM One glass of Milk{150 ml} with jaggery. 2 8.00 AM Chapati/poori/Idli/Dosa/Uddin Vada/Paratha with ghee/wheat upma with Ghee 3 11.00 AM Sugarcane juice/grape juice 4 1.00 PM Shastika Shali rice with curd and curry prepared from fish,prawns,chicken,mutton,Beef,Pork,Basella leaves,onion,Sesamum. Sweet prepared from milk,jaggery, wheat,black gram laddu 5 4.00 PM Sweet Lassi /Sugar cane juice/grape juice/ 6 7.30 PM Chapati or paratha with ghee and curry prepared from fish,prawns,chicken,mutton,Beef,Pork,Basella leaves,onion,Sesamum and Curd. 7 9.30 PM One glass of milk{150 ml } with jiggery Assessment Criterion In scoring the PSQI, seven component scores are derived, each scored 0 (no difficulty) to 3 (severe difficulty). The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            105  Table No. 33: showing Component 1: Subjective sleep quality—question 9 Response to Q9 Component 1 score Very good 0 Fairly good 1 Fairly bad 2 Very bad 3 Component 1 score:_____ Table No.34: showing Component 2: Sleep latency—questions 2 and 5a Table No. 34(a): showing the response to C2/Q2 subscore Response to Q2 Component 2/Q2 subscore < 15 minutes 0 16-30 minutes 1 31-60 minutes 2 > 60 minutes 3 Table No. 34(b): showing the response to C2/Q5a subscore Response to Q5a Component 2/Q5a subscore Not during past month 0 Less than once a week 1 Once or twice a week 2 Three or more times a week 3 Table No.34(c): showing the sum of Q2 and Q5a subscores (C2) Sum of Q2 and Q5a subscores Component 2 score 0 0 1-2 1 3-4 2 5-6 3 Component 2 score:_____
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            106  Table No. 35: showing Component 3: Sleep duration—question 4 Response to Q4 Component 3 score > 7 hours 0 6-7 hours 1 5-6 hours 2 < 5 hours 3 Component 3 score:_____ Table No. 36: showing Component 4: Sleep efficiency—questions 1, 3, and 4 Sleep efficiency = (# hours slept/# hours in bed) X 100% # hours slept—question 4 # hours in bed—calculated from responses to questions 1 and 3 Sleep efficiency Component 4 score > 85% 0 75-84% 1 65-74% 2 < 65% 3 Component 4 score:_____ Table No. 37(a): Showing Component 5: Sleep disturbance—questions 5b-5j Questions 5b to 5j should be scored as follows: Not during past month 0 Less than once a week 1 Once or twice a week 2 Three or more times a week 3
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            107  Table No. 37(b): showing the sum of 5b to 5j scores Sum of 5b to 5j scores Component 5 score 0 0 1-9 1 10-18 2 19-27 3 Component 5 score:_____ Table No. 38: showing Component 6: Use of sleep medication—question 6 Response to Q6 Component 6 score Not during past month 0 Less than once a week 1 Once or twice a week 2 Three or more times a week 3 Component 6 score:_____ Component 7: Daytime dysfunction questions 7 and 8 Table No. 39(a): showing theresponse to C7/ Q7 subscore Response to Q7 Component 7/Q7 subscore Not during past month 0 Less than once a week 1 Once or twice a week 2 Three or more times a week 3 Table No. 39(b): showing the respone to C7/Q8 subscore Response to Q8 Component 7/Q8 subscore No problem at all 0 Only a very slight problem 1 Somewhat of a problem 2 A very big problem 3
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            108  Table No. 39(c): showing the sum of Q7 andQ8 subscores(C7) Sum of Q7 and Q8 subscores Component 7 score 0 0 1-2 1 3-4 2 5-6 3 Component 7 score:_____ Global PSQI Score: Sum of seven component scores:__________
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            109  OBSERVATION Total 30 patients coming under the inclusion criteria were randomly selected for the clinical study and made into three groups. Observations in the present study were done in following manner ;  General Observations  Observation during intervention  Observation on results General observations The present study was conducted on 45 patients who were divided into three groups of 15 patients in each group. The following are the observations under different aspects. Age: Out of 45 samples, 15 patients (33.3%) were in the age group of 30-40 and 30 patients (66.7%) were in the age group of 40-50. Table No. 40: Distribution of Age Group among the 45 patients taken for Study Frequency Percent 30-40 15 33.3 40-50 30 66.7AGE Total 45 100.0 Sex: Table No.41 : Distribution of Sex among the 45 patients taken for Study Frequency Percent Male 14 31.1 Female 31 68.9SEX Total 45 100.0 Out of 45 samples, 14 were Male (31.1%) & 31 were Female (68.9%).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            110  Marital Status : Table No. 42: Distribution of Marital Status among the 45 patients taken for Study Frequency Percent Married 33 73.3 Unmarried 5 11.1 Widow 7 15.6 MARITAL STATUS Total 45 100.0 Out of 45 samples, 33 patients (73.3%) were Married and 5 patients (11.1%) were unmarried and 7 patients (15.6%) were Widow. Religion: Table No. 43: Distribution of Religion among the 45 patients taken for Study Frequency Percent Hindu 38 84.5 Muslim 5 11.1 Christian 1 2.2 Jain 1 2.2 RELIGION Total 45 100.0 Out of 45 samples, 38 patients (84.5%) were Hindus, 5 patients (11.1%) were Muslims, 1 patient was a Christian and 1 patient was a Jain.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            111  Location: Table No. 44: Distribution of Location among the 45 patients Frequency Percent Rural 11 24.5 Urban 34 75.5LOCATION Total 45 100.0 Out of 45 samples, 11patients (24.5%) were from Rural area and 34 patients (75.5%) were from Urban area. Occupation : Table No. 45: Distribution of Occupation among the 45 patients taken for Study Frequency Percent Agriculturist 2 4.4 Shop-keeper 3 6.7 House-wife 30 66.7 Salesman 3 6.7 Govt. Official 2 4.4 Teacher 4 8.9 Mason 1 2.2 OCCUPATION Total 45 100.0 Out of 45 samples, 2 patients (4.4%) were Agriculturists, 3 patients (6.7%) were Shopkeepers, 30 patients (66.7%) were House wives, 3 patients (6.7%) were
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            112  Salesmen, 2 patients (4.4%) were Government Officials, 4 patients (8.9%) were Teachers and 1 patient (2.2%) was a Mason. Socio-Economic Status: Table No. 46: Distribution of Socio-Economic Status among the 45 patients taken for Study Frequency Percent Poor 16 35.5 Lower Middle class 25 55.6 Upper middle class 4 8.9 SOCIO- ECONOMIC STATUS Total 45 100.0 Out of 45 samples, 16 patients were Poor (35.5%), 25 patients (55.6%) belonged to the Lower Middle Class and 4 patients (8.9%) belonged to the Upper Middle Class. Education: Table No. 47: Distribution of Education among the 45 patients taken for Study Frequency Percent Illiterate 13 28.9 Primary 7 15.5 Secondary 18 40.0 Graduate 4 8.9 Post graduate 3 6.7 EDUCATION Total 45 100.0
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            113  Out of 45 samples,13 patients (28.9%) were Illiterate, 7 patients (15.5%) had completed their Primary Education, 18 patients (40%) had completed their Secondary Education, 4 patients (8.9%) were Graduates and 5 patients (6.7%) were Post Graduates. Nature of Work : Table No48: Distribution of Nature of Work among the 45 patients Out of 45 samples, 25 patients (55.6%) were Active, whereas 20 patients (44.4%) had Sedentary nature of work. Diet: Table No. 49: Distribution of Diet among the 45 patients taken for Study Frequency Percent Veg 18 40.0 Mixed 27 60.0DIET Total 45 100.0 Out of 45 samples, 18 patients (40%) consumed Vegetarian Diet whereas 27 patients (60.0%) consumed Mixed Diet (both vegetarian and non-vegetarian foods) Frequency Percent Active 25 55.6 Sedentary 20 44.4NATURE OF WORK Total 45 100.0
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            114  Chronicity: Table No. 50: Distribution of Chronicity among the 45 patients Frequency Percent 12-24 months 33 73.3 25-60 months 12 26.7CHRONICITY Total 45 100.0 Out of 45 samples, 33 patients (73.3%) reported chronicity ranging between 12- 24 months, while 12 patients reported chronicity ranging between 25-60 months. Habits: Table No. 51: Distribution of Habits among the 45 patients taken for Study Frequency Percent No habits 1 2.2 Tea 16 35.6 Coffee 18 40.0 Tea & Coffee 9 20.0 Tea, Cigarette& Alcohol 1 2.2 HABITS Total 45 100.0 Out of 45 samples, 1 patient (2.2%) had no Habits, 16 patients (35.6%) had the Habit of taking tea, 18 patients (40%) had the Habit of taking coffee, 9 patients (20%) had the Habit of taking both tea and coffee, 1 patient (2.2%) had the Habit of taking tea, cigarette and alcohol.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            115  Prakruti: Table No. 52: Distribution of Prakruti among the 45 patients taken for Study Frequency Percent Vata-Pitta 28 62.2 Pitta-Kapha 2 4.4 Kapha-Vata 15 33.4 PRAKRUTI Total 45 100.0 Out of 45 samples, 28 patients (62.2%) were of Vata-Pitta Prakruti, 2 patients (4.4%) were of Pitta-Kapha Prakruti and 15 patients (33.4%) were of Kapha-Vata Prakruti. Sara: Table No. 53: Distribution of Sara among the 45 patients taken for Study Frequency Percent Pravara 2 4.4 Madhyama 33 73.4 Avara 10 22.2 SARA Total 45 100.0 Out of 45 samples, 2 patients had Pravara Sara (4.4%), 33 patients had Madhyama Sara (73.4%) and 10 patient had Avara Sara (22.2%). Samhanana: Table No. 54: Distribution of Samhanana among the 45 patients Frequency Percent Pravara 6 13.3 Madhyama 30 66.7 Avara 9 20.0 SAMHANANA Total 45 100.0 Out of 45 samples, 6 patient had Pravara Samhanana (13.3%), 30 patients had Madhyama Samhanana (66.7%) and 9 patients had Avara Samhanana (20%).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            116  Pramana: Table No. 55: Distribution of Pramana among the 45 patients Frequency Percent Pravara 4 8.9 Madhyama 39 86.7 Avara 2 4.4 PRAMANA Total 45 100.0 Out of 45 samples, 4 patients were of Pravara Pramana (8.9%), 39 patients were of Madhyama Pramana (86.7%) and 2 patients were of Avara Pramana (4.4 %). Satmya: Table No. 56: Distribution of Satmya among the 45 patients Frequency Percent Avara 21 46.6 Madhyama 24 53.4SATMYA Total 45 100.0 Out of 45 samples, 21 patients had Madhyama Satmya (46.6%) and 24 patients had Avara Satmya (53.4%). SATTVA Table No. 57: Distribution of Sattva among the 45 patients Frequency Percent Pravara 1 2.2 Madhyama 14 31.1 Avara 30 66.7 SATTVA Total 45 100.0 Out of 45 samples, 1 patient had Pravara Sattva (2.2%), 14 patients had Madhyama Sattva (31.1%) and 30 patients had Avara Sattva (66.7%).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            117  Agni: Table No. 58: Distribution of Agni among the 45 patients taken for Study Frequency Percent Sama 33 73.4 Manda 7 15.5 Vishama 5 11.1 AGNI Total 45 100.0 Out of 45 samples, 33 patients had Samagni (73.4%), 7 patients had Mandagni and 5 patients had Vishamagni (11.1). Koshta: Table No. 59: Distribution of Koshta among the 45 patients Frequency Percent Madhyama 30 66.7 Mridu 3 6.6 Kroora 12 26.7 KOSHTA Total 45 100.0 Out of 45 samples, 30 patients had Madhyama Koshtha (66.7%), 3 patients had Mridu Koshta (6.6%) and 12 patients had Kroora Koshtha (26.7%). Vyayama Shakti: Table No. 60: Distribution of Vyayama Shakti among the 45 patients taken for Study Frequency Percent Pravara 4 8.9 Madhyama 32 71.1 Avara 9 20.0 VYAYAMA SHAKTI Total 45 100.0 Out of 45 samples, 4 patients had Pravara Vyayama Shakti (8.9%), 32 patients had Madhyama Vyayama Shakti (71.1%) and 9 patients had Avara Vyayama Shakti(20%).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            118  Onset: Table No. 61: Distribution of Onset among the 45 patients taken for Study Frequency Percent Gradual 20 44.4 ONSET Sudden 25 55.6 Out of 45 samples, 20 patients (44.4%) had Gradual Onset of the disease whereas 25 patients had Sudden Onset of the disease.   Associated Symptoms : Associated symptoms like Shirogaurava was present in 46.6% of patients, Angamarda in 64.4%, Jrumbha in 60.0%, Shiroshula in 35.5%, Apakti is 48.8%, Glani is 51.1%, Klama in 71.1%, Shrama in 24.4%, Bhrama is 22.2% and Aruchi is44.4% each in 38.46% of patients (Table No. 36). Table No. - 61 Associated symptoms complained by 45 patients of Nidranasha Associated symptoms No.of patients % Angamarda 29 64.4 Apakti 22 48.8 Aruchi 20 44.4 Shirogaurava 21 46.6 Jrumbha 27 60.0 Glani 23 51.1 Bhrama 10 22.2 Shrama 11 24.4 Klama 32 71.1 Shiroshula 16 35.5
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            119  Illustration No. 1 – Showing age wise distribution of 45 patients in Nidranasha Illustration No. 2 – Showing sex wise distribution of 45 patients in Nidranasha Illustration No. 3 – Showing marital status wise distribution of 45 patients in Nidranasha Illustration No. 4 – Showing religion wise distribution of 45 patients in Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            120  Illustration No. 5 – Showing Occupation wise distribution of 45 patients in Nidranasha Illustration No. 6 – Showing Education wise distribution of 45 patients in Nidranasha Illustration No. 7– Showing socio economic status wise distribution of 45 patients inNidranasha; Illustration No. 8 – Showing diet wise distribution of 45 patients in Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            121  Illustration No. 9 – Showing locality wise distribution of 45 patients in Nidranasha: Illustration No. 10 – Showing mode of onset wise distribution of 45 patients in Nidranasha Illustration No. 11 – Showing Nature of work distribution of 45 patients Illustration No. 12 – Showing prakruti wise distribution of 30 patients in Vataja Kasa;
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            122  Illustration No. 13 – Showing Sara wise distribution of 45 patients in Nidranasha Illustration No. 14 – Showing Samhanana wise distribution of 45 patients in Nidranasha Illustration No. 15 – Showing Pramana wise distribution of 45 patients in Nidranasha Illustration No. 16 – Showing Satmya wise distribution of 45 patients in Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            123  Illustration No. 17 – Showing Sattva wise distribution of 45 patients in Nidranasha Illustration No. 18 – Showing Agni wise distribution of 45 patients in Nidranasha Illustration No. 19 – Showing Koshta wise distribution of 45 patients in Nidranasha; Illustration No. 20 – Showing Vyayama shakti wise distribution of 45 patients in Nidranasha;
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S            124  Illustration No. 21 – Showing chronicity distribution of 45 patients in Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  125    OBSERVATIONS DURING INTERVENTION It was observed that all most all the patients preferred and consumed pungent, hot and spicy foods. It was observed that most people had difficulty in initiating sleep The palatability of the drug was not very good, due to the katu rasa of Pippalimoola. Even the addition of Guda couldn’t make Pippalimula Palatable. Most of them were eager to get rid of sedatives they were using. Some of the patients observing the diet chart have complained difficulty in digesting the frequent non vegetarian meal.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  126    RESULTS Table No. 62: showing Global PSQI in Group A Sl.N o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 16 15 13 19 16 16 15 19 18 17 20 16 19 17 14 250 AT 8 8 3 9 5 4 4 4 5 6 6 7 5 3 9 86 FU 13 11 12 12 6 11 5 7 6 12 11 9 8 8 14 131 Table No. 63: showing Global PSQI in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 14 17 13 15 16 19 18 19 19 17 19 18 18 16 15 253 AT 5 4 5 9 5 4 6 6 6 8 10 4 10 8 8 98 FU 9 8 7 15 6 6 9 7 13 12 15 11 15 13 15 161 Table No. 64: showing Global PSQI in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 18 18 19 17 19 18 19 16 20 15 16 17 19 15 16 262 AT 8 13 14 14 13 3 5 8 16 9 6 11 14 12 7 153 FU 13 16 17 16 15 8 11 12 19 15 16 15 19 15 14 221 Table No. 65: showing the Mean Global PSQI values in Group A, B and C Group Before Treatment After Treatment After FollowUp Group A 16.67 5.73 8.73 Group B 16.87 6.53 10.73 Group C 17.47 10.20 14.73 Total 17 7.49 11.40
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  127    Table No.66: Showing General Linear Model-Descriptive Statistics of Global PSQI score GROUP Mean Std. Deviation N Group A 16.67 2.024 15 Group B 16.87 1.959 15 Group C 17.47 1.598 15 PSQI BT Total 17.00 1.859 45 Group A 5.73 2.052 15 Group B 6.53 2.134 15 Group C 10.20 3.913 15 PSQI AT Total 7.49 3.395 45 Group A 9.67 2.845 15 Group B 10.73 3.494 15 Group C 14.73 2.890 15 PSQI AF Total 11.71 3.739 45 Table showing Tests of Within-Subjects Effects for Global PSQI Source Type III Sum of Squares df Mean Square F Sig. CHANGE 2043.911 2 1021.956 219.938 .000 CHANGE * GROUP 90.444 4 22.611 4.866 .001 Error(CHANGE) 390.311 84 4.647
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  128    C1 Component 1: Subjective sleep quality Table No. 67: showing total scores of C1 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 2 2 3 2 2 2 3 3 3 3 3 2 2 2 36 AT 1 0 0 1 1 0 1 0 0 1 1 1 0 0 1 8 FU 2 1 2 1 1 1 1 1 1 2 1 1 1 1 2 19 Table No. 68: showing total scores of C1 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 2 2 3 2 3 3 3 2 2 3 2 3 2 2 36 AT 0 0 1 1 0 0 1 1 1 1 1 0 1 1 1 10 FU 1 1 1 2 0 1 1 1 1 2 2 1 2 2 2 20 Table No. 69: showing total scores of C1 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 2 3 3 3 2 3 1 2 2 3 2 2 37 AT 1 2 2 2 1 0 1 1 2 0 1 1 2 1 1 18 FU 2 3 2 2 1 1 2 2 1 1 2 2 3 2 2 28 Table No.70: Showing results of Component 1: Subjective sleep quality Group Before Treatment After Treatment After FollowUp Group A 2.4 0.53 1.27 Group B 2.4 0.67 1.33 Group C 2.47 1.20 1.87
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  129    Table No. 71: Showing Symmetric Measures in Component 1: Subjective sleep quality Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .709 .000 Group B Nominal by Nominal Contingency Coefficient .670 .000 Group C Nominal by Nominal Contingency Coefficient .581 .001 The Mean score of Group A in Subjective Sleep Quality Before Treatment is 2.4, After Treatment is 0.53 and After Follow up is 1.27. The Mean Score of Group B in Subjective Sleep Quality Before Treatment is 2.4, After Treatment is 0.67 and After Follow up is 1.33. The Mean Score of Group C in Subjective Sleep Quality Before Treatment is 2.47, After Treatment is 1.20 and After Follow up is 1.87. The Improvement in Subjective Sleep Quality is statistically highly significant in Group A and Group B; in Group C the Subjective Sleep Quality is statistically significant Component 2: Sleep latency Table No. 72: showing total scores of C2 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45 AT 2 1 1 2 1 1 1 1 2 1 1 1 2 0 2 19 FU 3 2 3 3 2 2 1 2 1 2 2 2 2 1 3 31
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  130    Table No. 73: showing total scores of C2 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45 AT 1 1 1 2 1 1 1 0 1 1 2 1 2 2 1 18 FU 3 1 2 3 1 1 2 1 3 2 3 2 3 3 3 33 Table No. 74: showing total scores of C2 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45 AT 2 2 3 2 3 1 0 1 2 2 2 2 2 3 1 28 FU 3 3 3 2 3 2 2 2 3 3 3 3 3 3 2 40 Table No. 75: Showing results of Component 2: Sleep latency Group Before Treatment After Treatment After FollowUp Group A 3 1.27 2.07 Group B 3 1.20 2.20 Group C 3 1.87 2.67 Table No. 76: Showing Symmetric Measures in Component 2: Sleep latency Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .682 .000 Group B Nominal by Nominal Contingency Coefficient .646 .000 Group C Nominal by Nominal Contingency Coefficient .584 .001 The Mean score of Group A in Sleep Latency Before Treatment is 3, After Treatment is 1.27 and After Follow up is 2.07.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  131    The Mean Score of Group B in Sleep Latency Before Treatment is 3, After Treatment is 1.20 and After Follow up is 2.20. The Mean Score of Group C in Sleep Latency Before Treatment is 3, After Treatment is 1.87 and After Follow up is 2.67. The Improvement in Sleep Latency is statistically highly significant in Group A and Group B; in Group C the Sleep Latency is statistically significant. C3 Component 3: Sleep duration Table No. 77: showing total scores of C3 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 2 3 3 3 3 3 3 3 3 2 3 3 2 42 AT 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 17 FU 2 2 2 2 1 2 1 1 1 2 2 1 1 1 2 23 Table No. 78: showing total scores of C3 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 2 3 3 3 3 3 3 3 3 2 3 3 2 42 AT 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 17 FU 2 2 2 2 1 2 1 1 1 2 2 1 1 1 2 23 Table No. 79: showing total scores of C3 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 44 AT 1 3 2 2 2 0 1 1 3 2 1 2 3 1 1 23 FU 2 3 3 3 3 1 2 2 3 3 3 3 3 2 3 39
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  132    Table No. 80: Showing results of Component 3: Sleep duration Group Before Treatment After Treatment After FollowUp Group A 2.8 1.13 1.53 Group B 2.8 1.13 1.53 Group C 2.93 1.53 2.60 Table No. 81: Showing Symmetric Measures in Component 3: Sleep duration Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .693 .000 Group B Nominal by Nominal Contingency Coefficient .641 .000 Group C Nominal by Nominal Contingency Coefficient .558 .002 The Mean score of Group A in Sleep duration Before Treatment is 2.8, After Treatment is 1.13 and After Follow up is 1.53. The Mean Score of Group B in Sleep duration Before Treatment is 2.8 , After Treatment is 1.13 and After Follow up is 1.53. The Mean Score of Group C in Sleep duration Before Treatment is 2.93, After Treatment is 1.53 and After Follow up is 2.60. The Improvement in Sleep duration is statistically highly significant in Group A and Group B; in Group C the Sleep duration is statistically significant.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  133    C4 Component 4: Sleep efficiency Table No. 82: showing total scores of C4 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 1 3 3 3 3 3 2 3 3 3 3 3 2 41 AT 1 3 0 1 0 1 0 0 0 0 0 1 0 1 1 9 FU 2 3 1 3 0 3 0 1 0 2 1 2 1 2 2 23 Table No. 83: showing total scores of C4 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 0 3 1 3 3 3 3 3 3 3 3 3 3 3 3 40 AT 0 1 0 2 0 0 1 1 0 1 2 1 2 1 1 13 FU 0 2 0 3 0 0 2 1 2 3 3 3 3 2 3 27 Table No. 84: showing total scores of C4 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45 AT 1 2 3 3 3 0 0 2 3 3 2 3 3 3 1 32 FU 2 3 3 3 3 1 1 3 3 3 3 3 3 3 3 40 Table No. 85: Showing results of Component 4: Sleep efficiency Group Before Treatment After Treatment After FollowUp Group A 2.73 0.60 1.53 Group B 2.67 0.87 1.80 Group C 3.0 2.13 2.67
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  134    Table No. 86: Showing Symmetric Measures in Component 4: Sleep efficiency Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .637 .000 Group B Nominal by Nominal Contingency Coefficient .617 .000 Group C Nominal by Nominal Contingency Coefficient .453 .071 The Mean score of Group A in Sleep efficiency Before Treatment is 2.73, After Treatment is 0.60 and After Follow up is 1.53. The Mean Score of Group B in Sleep efficiency Before Treatment is 2.67, After Treatment is 0.87 and After Follow up is 1.80. The Mean Score of Group C in Sleep efficiency Before Treatment is 3.0, After Treatment is 2.13 and After Follow up is 2.67. The Improvement in Sleep efficiency is statistically highly significant in Group A and Group B; in Group C the Sleep efficiency is statistically significant. C5 Component 5: Sleep disturbance Table No. 87: showing total scores of C5 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 1 1 2 2 1 2 2 2 3 1 3 1 3 2 2 28 AT 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 FU 1 1 2 1 1 1 1 1 1 2 2 1 1 1 2 19 Table No. 88: showing total scores of C5 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 2 2 1 1 2 1 2 2 1 2 3 1 2 1 25 AT 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 17 FU 2 1 1 2 3 1 1 1 2 1 2 2 1 1 1 22
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  135    Table No. 89: showing total scores of C5 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 1 1 2 2 2 2 2 1 3 2 1 2 2 2 1 26 AT 1 1 2 2 2 1 1 1 3 1 1 1 1 2 1 21 FU 1 1 2 2 2 1 1 1 3 2 1 1 2 2 1 23 Table No. 90: Showing results of Component 5: Sleep disturbance Group Before Treatment After Treatment After FollowUp Group A 1.87 1,0 1.27 Group B 1.67 1.13 1.47 Group C 1.73 1.40 1.53 Table No. 91: Showing Symmetric Measures in Component 5: Sleep disturbance Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .566 .000 Group B Nominal by Nominal Contingency Coefficient .372 .124 Group C Nominal by Nominal Contingency Coefficient .274 .455 The Mean score of Group A in Sleep disturbance Before Treatment is 1.87, After Treatment is 1.0 and After Follow up is 1.27. The Mean Score of Group B in Sleep disturbance Before Treatment is 1.67, After Treatment is 1.13 and After Follow up is 1.47. The Mean Score of Group C in Sleep disturbance Before Treatment is 1.73, After Treatment is 1.40 and After Follow up is 1.53.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  136    The Improvement in Sleep disturbance is statistically highly significant in Group A, in Group B and Group C the Sleep disturbance is statistically significant. C6 Component 6: Use of sleep medication Table No. 92: showing total scores of C6 in Group A Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 2 2 3 3 2 2 3 2 3 3 2 3 2 2 37 AT 1 1 0 1 1 0 0 1 0 1 1 1 1 0 1 10 FU 2 1 1 1 1 1 1 1 1 2 2 1 1 1 2 19 Table No. 93: showing total scores of C6 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 2 2 3 3 3 3 3 3 3 3 3 3 2 2 40 AT 0 0 1 1 1 1 0 1 1 1 1 0 1 1 1 11 FU 1 1 1 2 1 1 1 1 2 1 2 1 2 2 2 21 Table No. 94: showing total scores of C6 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 3 3 3 3 2 3 2 3 3 3 3 3 2 2 40 AT 1 2 1 2 1 1 1 1 2 1 1 1 2 1 1 19 FU 2 2 2 3 2 1 2 1 3 2 3 2 3 2 2 32 Table No. 95: Showing results of Component 6: Use of sleep medication Group Before Treatment After Treatment After FollowUp Group A 2.47 0.67 1.27 Group B 2.67 0.73 1.40 Group C 2.67 1.27 2.13
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  137    Table No. 96: Showing Symmetric Measures in Component 6: Use of sleep medication Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .697 .000 Group B Nominal by Nominal Contingency Coefficient .703 .000 Group C Nominal by Nominal Contingency Coefficient .626 .000 The Mean score of Group A in ‘Use of sleep medication’ Before Treatment is 3, After Treatment is 1.27 and After Follow up is 2.07. The Mean Score of Group B in ‘Use of sleep medication’ Before Treatment is 3, After Treatment is 1.20 and After Follow up is 2.20. The Mean Score of Group C in ‘Use of sleep medication’ Before Treatment is 3, After Treatment is 1.87 and After Follow up is 2.67. The Improvement in‘Use of sleep medication’ is statistically highly significant in Group A and Group B; in Group C the ‘Use of sleep medication’ is statistically significant. Component 7: Daytime dysfunction Table No. 97: showing total scores of C7 in Group A No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 1 1 1 2 1 1 0 2 2 1 2 1 2 2 1 20 AT 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 8 FU 1 1 1 1 0 1 0 0 1 1 1 1 1 1 1 12
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  138    Table No. 98: showing total scores of C7 in Group B Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 2 2 1 2 1 2 3 2 3 2 2 1 2 1 1 27 AT 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 11 FU 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14 Table No. 99: showing total scores of C7 in Group C Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score BT 3 2 2 1 2 2 2 2 2 0 1 1 2 1 2 25 AT 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 12 FU 1 1 2 1 1 1 1 1 2 1 1 1 2 1 1 18 Table No. 100 – Showing results of Component 7: Daytime dysfunction Group Before Treatment After Treatment After FollowUp Group A 1.33 0.53 0.80 Group B 1.80 0.73 0.93 Group C 1.67 0.80 1.20 Table No. 101 – Showing Symmetric Measures in Component 7: Daytime dysfunction Groups Value Approx. Sig Group A Nominal by Nominal Contingency Coefficient .537 .001 Group B Nominal by Nominal Contingency Coefficient .629 .000 Group C Nominal by Nominal Contingency Coefficient .560 .002
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  139    The Mean score of Group A in ‘Daytime dysfunction’ Before Treatment is 1.33, After Treatment is 0.53 and After Follow up is 0.80. The Mean Score of Group B in ‘Daytime dysfunction’ Before Treatment is 1.80, After Treatment is 0.73 and After Follow up is 0.93. The Mean Score of Group C in ‘Daytime dysfunction’ Before Treatment is 1.67, After Treatment is 0.80 and After Follow up is 1.20. The Improvement in ‘Daytime dysfunction’ is statistically highly significant in Group A and Group B; in Group C the ‘Daytime dysfunction’ is statistically significant. Illustration No. 22 – Showing Component 1(Subjective Sleep Quality) Score distribution in 45 patients of Nidranasha Illustration No. 23 – Showing Component 2( Sleep Latency) Score distribution in 45 patients of Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  140    Illustration No. 24 – Showing Component 3( Sleep Duration) Score distribution in 45 patients of Nidranasha Illustration No. 25 – Showing Component 4 ( Sleep Efficiency) Score distribution in 45 patients of Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  141    Illustration No. 26 – Showing Component 5( Sleep Disturbance) Score distribution in 45 patients of Nidranasha Illustration No. 27 – Showing Component 6( Use of Sleep Medication) Score distribution in 45 patients of Nidranasha Illustration No. 28 – Showing Component 7( Daytime Dysfunction) Score distribution in 45 patients of Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  142    Illustration No. 29 – Showing Global PSQI Score distribution in 45 patients of Nidranasha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  143    DISCUSSION Discussion on title “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Ayurveda has considered Nidra as one among the three Upastambhas,which bring about maintenance of the living organism (Ch. Su. 11/35). While discussing about Nidra and Nidranasha in the context of Astaunindaniya Adhyaya, Charaka has stated that happiness & sorrow, growth & wasting, strength & weakness, virility & impotence, the knowledge & ignorance as well as existence of life and its cessation depend on the sleep. Moreover, Nidra is Pushtida whereas Jagarana or Nidranasha does the Karshana of the body. Untimely sleep, excessive sleep and prolonged vigil take away both happiness and longevity, like the night of destructions (Ch. Su. 21/36- 38). GudaPippalimoola is said to be very effective in treating Nidranasha in BhavaPrakasha samhita and Bhaishajyaratnavali. Hence this study has been taken up to evaluate the effect of Guda Pippalimula Yoga on Nidranasha. Diet is an important part in the management of disease. Various ahara vargas have been explained to promote sleep. A diet chart was made using these food items which was used to measure the effect of diet on nidranasha. Hence here a conceptual study of nidranasha was done along with a comparative study of the efficacy of Diet and Guda Pippali mula was done in Primary Insomia patients.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  144    Discussion on Nirukti, Paribhasha and Paryaya of Nidranasha: Nidranasha is the commonest symptom encountered in clinical practice. However the definition of Nidranasha is not mentioned in any of the popular dictionaries, such as Monier Williams Sanskrit English dictionary. But a transalatory work of 20th century authors, have termed Nidranasha as Insomnia. Nidranasha can be defined as Insomnia in terms of Reduction in sleep time, Difficulty in initiating sleep and disturbances while, sleeping. Based on the available references, “Kshaya” can be considered as the synonym of Nasha (Bhattacharya T.T. 1990). So, the disturbance in the quality and quantity of sleep, in terms of decreased quantity & disturbed quality of sleep can be, considered as Nidranasha. So the definition of Nidranasha is similar to the definition of Insomnia in all regards. Paryayas i) Nidranasha The term Nidranasha is constituted by two words viz., “Nidra” and “ Nasha”. The term “nidra” means, the phenomenon, of resting of the body which occurs usually during night. (Bhattacharya T.T. 1570). “Nasha” has many meanings, such as, being lost, loss, elimination, disappearance, destruction, (Williams MM 1970). Apachaya, Hrasa, Adarshana, Bhanga (Bhattachary TT 1970). Hence, the nidranasha can be considered as the loss of sleep i.e. which refers to the reduction in sleep time.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  145    ii) Anidra Na Nidra or Anidra; Nan Tatpursha which means the loss of sleep, i.e the reduction of sleep time. iii) Jagarana Jagarana means to awake, waking, or keeping awake, (Williams M.M. 1970). Jagarana is said as Nidrarahita and Nidraabhava (Bhathacharya T.T. 1970). Here the term awake refers to the disturbances during sleep. The term nidrarahita and nidraabhava refers to the loss of sleep i.e. reduction in sleep time. iv) Swapna adarshana Swapna is the synonym of nidra. Adarshana means Na darshana, i.e. the “Abhava” or absense. It is also a condition of the Reduction in sleep time. v) Nashtanidra The term ‘Nashta’ means Lost, disappeared, escaped, damage and deprived (Williams MM 1970). Here the term Nashtanidra refers to loss of sleep, damage in normal sleep, which refers to the Disturbances during sleep and Reduction in sleep time. vi) Alpanidra The term Alpa means small, minute, little (William MM 1970). Alpanidra means the little quantity of sleep which refers to the reduction in sleep time. viii) Nidrakshaya Kshaya means Hrasa, Adarshana & Bhanga (Bhattacharya 1970). This term refers to loss of sleep in terms of reduction in normal sleep time.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  146    ix) Nidrabramsha The term Bhramsha means ‘to drop’, ‘fall down’, cessation, and loss (William’s MM 1970). Bhramsha also means “Adhahapatana” (Bhattacharya TT 1970). So the term Nidra bramsha refers to the reduction in sleep time. x) Nidravighata The term Vighata refers to the ‘breaking in to pieces’, destruction and interruption (Williams MM 1970). So it refers to the disturbance during sleep. xi) Nidradourbalya Here the term Dourbalya means “wakefull” (William MM 1970). “Dourbalyam Durbalasya Bhavam” (Bhattacharya TT 1970) i.e. the nidradourbalya refers to the wakefull sleep i.e. the disturbances during sleep. xii) Vigatanidra The term Vigata means Gone, disappeared, ceased, (Willaims MM 1970). Vigatanidra means the reduction in sleep time and disturbance during sleep. Charaka Samhita has included Asvapna (Insomnia) in Nanatmaja Vata Vikaras. Acharya Sushruta explained this under the chapter Garbha Vyakarana Shariram, might be because, Nidra plays a vital role in nutrition and development of the body. We also find the explaination of Vaikariki Nidra in the same chapter which can be correlated to sleep disorders. Vagbhatta in Ashtanga Sangraha mentioned this in Viruddhanna-vigyaniya Adhyaya, where he explained the Trayopastambhas. Here he considered Manda Nidra due to Vata, but used Asvapna term in Vataja Nanatmaja Vikaras. In Ashtanga Hridaya –– Nidra, Nidra Vikaras and its Chikitsa are mentioned
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  147    under Anna-rakshadhyaya where Trayopastambhas are explained. Sharangadhara, included Anidra in Vataja Nanatmaja Vikara, Alpa nidra in Pittaja Nanatmaja Vikara and Atinidra under Kaphaja Nanatmaja Vikara. By observing these descriptions regarding Nidra and Anidra, it can be concluded that all Acharyas considered the importance of Nidra, hence Nidranasha is explained along with physiology of Nidra itself. Discussion on Physiology of Nidra. Charaka Samhita has stressed the importance of Klama (fatigue) in the causation of normal sleep. It is also an accepted fact that, the fatigue of sensory and motor organs, along with the inertness of the Manas, results in the liberation of lactic acid, which induces sleep. The lactic acid liberated at the myoneural junction causes the muscle fatigue, which inturn induces sleep. Achary Sushruta has given the importance to the organ Hridaya, which is responsible for the initiation and mantainance of Prakrutanidra and as the chetanasthana. In this context, the Hridaya, mentioned by Sushruta is considered as Shirohridaya which refers to brain i.e. the inhibition of the sleep centers situated in the brain, produces the sleep. Acharya Vagbhata has given the importance to Kapha dosha and Shareerashrama in the causation of Prakruta nidra. These references says that, Klama (fatigue) Shirohridaya (sleeping center in brain) and kapha dosha and shareerashrama are responsible for sleep. Other references say that the Tamogana is also responsible for the causation of normal sleep.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  148    Hence, sleep is the phenomenon in which, the mind is inert, the sensory and motor faculty are fatigued, increase in Kaphadosha, increase in Tamoguna and absence of gnanotpatti are present. Discussion on the types of Nidra The classification of sleep, by Charaka Samhitakara and Vagbhata are similar. Table No- 39 showing the similarities of sleep Charaka Vagbhata Tamobhava Tamobhava Shleshmalamudbhava Kaphobhava Manasharamajanya Chittakhedaja Shareera shramaga Dehakhedaga Agantuki Agantuka Ratriswashava Kalaswashana Vyadhayanuvartini Anayaja Acharya Sushruta mentions three types of Nidra. Such as 1. Tamasi Nidra (papma) 2. Prakruta nidra 3. Vaikarika nidra. Tamasi nidra is also called as Pampma, which occurs during the pralaya kala, due to the acculmuation of Kapha and Tamoguna in the samgnavaha srotas. Prakruta nidra is the normal sleep and vaikarika nidra is the abnormal stages of sleep.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  149    Table No – 102 shows the similarities of the types of sleep in Brahatrayis Sushruta Charaka Vagbhata Tamobhava Tamobhava Tamasi Nidra Shleshmasamdhbhava Kaphobhava Manashramasambhava Chittakhedaja Shareerashramasambhava Dehakhedaja Prakruta Nidra Ratriswabhava Kalaswabhava Agantuki AgantukaVaikrika Nidra Vyadhyanuvartini Amayaja The conditions of Atinidra and Nidranasha can also be considered under the heading of Vaikarika nidra. Hence, Sushruta’s classification seems accurate, while Charaka’s and Vagbhata’s classifications are very eloborate. Sushruta’s classification includes, all the types of sleep, explained by Charaka and Vagbhata. Discussion on Nidana Ayurveda gives importance to the prakrutanidra in the maintenance of health. Incidently the authors have, mentioned the physiology of sleep, management of atinidra condition and the caustive factors for nidranasha and its management. In Charaka samhita, Astanga Hridaya and Ashtanga sangraha, the nidana of Nidranasha has been explained in the context of Atinidra chikitsa. Both the authors opine that the therapeutic measures of atinidra itself will lead to nidranasha, by saying ‘Eva Eva Cha Vigneyo nidranashaya Hetavaha’. On the other hand Sushruta mentions, other causes of nidranasha, such as Manasika nidanas, Abhighata, Kshaya and Dosha (vata & pitta).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  150    The causitive factors, explained by different authors of Ayurveda, enlisted in the review of literature plays an important role in the production of Nidranasha. Nidranasha is also mentioned as a vatananatmaja vikara. In this context it is termed as “Aswapna”. Hence the vata dosha is the dosha hetu for nidranasha. Nidranasha has also been mentioned as a symptom in some diseases such as vataja jwara, pittaja jwara, vataja trishna etc. Primary Imomnia is that type of Insomnia, where the cause is obscure i.e. the Insomnia is not related to any diseased condition (psychological or physical). Nidranasha as a Vatananatmaja vikara is also not related to any secondary condition such as shoola daha etc., it occurs only by vatadosha not from any other conditions. So Nidranasha in the term of Aswapna explained as a Vatananatmaja vikara, is considered as Primary Insomnia. Broadly the nidanas of Nidranashs can be classified as 1. Aharajanya nidanas & viharajanya nidanas 2. Manasika nidanas 3. Chikitsajanya nidanas 4. Anya nidanas. Discussion on aharasambandhi nidanas Rookshana Increases rookshaguna in the body, which will lead to the vataprakopa or vatavrudhi and causes nidranasha.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  151    Yavanna It is having kashayarasa and rookshaguna. These gunas cause the vitiation of pitta and vata,thus causing nidranasha. Discussion on viharasambandhi nidanas Dhooma Excessive inhalation of dhooma causes the vitiation of vata and pitta by its teekshna, ushnu and rooksha guna. The vitiated vata and pitta will cause nidranasha. Vyayama Performance of excessive exercise, increases the laghu guna and Rooksha guna in the body, at the same time the snigdha guna decreases in the body leading to kaphakshya. As per the classics, kapha is an important cause for nidra, when there is kaphakshaya in the body, automatically it results in nidranasha. Upavasa It is one type of Dashavidhalanghana. Upavasa increases the laghuguna in the body, which lead to the gunatahavrudhi of vatadosha, which results in nidranasha. Asukhashayya Means improper bedding. If the bedding arrangements are not made properly, the person will not get sleep. Kshudha Due to vataprakopa in Kshudha avastha, nidranasha is often seen to occur.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  152    Maithuna Due to atimaithuna dhatukshaya will take place which leads to kaphakshaya and results in vatavrudhi and in turn causing nidranasha. Discussion on Chikitsajanya nidanas Virechana Atiyoga of virechana will lead to Vatavruddhi. The person will suffer from many vata rogas, when there is atiyoga of virechana. Atiyoga of virechana causes the vitiation of vata dosha, which in turn causes nidranasha. Nasyakarma Sukhaswapna is one of the lakshana seen in Samyak Nasya karma. In mithya yoga of nasya karma, the sleep pattern will change. Mithyayoga of nasyakarma will result in the vigunata of vata dosha, which increases the rookshaguna of vatadosha leading to nidranasha. In the mithyayoga of nasyakarma, the vatadosha takes its ashraya in Mastulunga, which is explained as shiromajja. When vata takes its ashraya in shiromajja, it leads to Nidranasha. Raktamokshana Atiraktasrava causes the kshaya of saptadhatu, which is also responsible for kaphakshaya. Due to kaphakshaya and resultant Vatavruddhi nidranasha occurs. Vamana
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  153    Nidranasha has been explained as an atiyogalakshana of vamanakarma. Chakrapani comments on this as “Nidrahanihi anilaprakopena” means in vamanatiyoga nidranasha occurs due to the vitiation of vata dosha. Discussion on manasika karanas Emotional disturbances play an important role in causing the disturbance of nidra. These include different emotions such as fear, anxiety, sorrow anger, passion etc. Bhaya The meaning of bhaya is fear, alarm, dread or to have fear. Bhaya can be defined as “Swanishta sambhavanuroope va chittavruttabhedhaaha”. In Bruhatrayee, in the context of vataprakopaka karanas all the classical authors of Ayurveda have stated that bhaya is also one of the nidana for vata prakopa. As a result of the emotional disturbance due to bhaya, the individual suffers from nidranasha. Shabdakalpadruma explains bhaya as “Chittavaikalyadam bhayam” i.e., the deformities of intellect takes place due to bhaya. When chitta is engaged in something, the person does not get sleep. Chinta It is also one of the manasika nidana which is responsible for vataprakopa and in turn nidranasha. In Ayurveda it is told that the chinta is also one among the factors responsible for vata prakopa. Chinta means to think too much, which is totally a mental exercise. This view is supported by Charakasamhita’s opinion that over indulgence {karyasakta} in mental work results to nidranasha. { Chakrapani }.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  154    Manastapa The person will not have peace of mind, if he has manastapa or anguish, which is defined as “Manastapaha anutapaha anutape Manapeedayamcha”. Anguish results in mental pain, which in turn causes Insomnia. Krodha or anger, shoka or sorrow, Harsha or euphoria; all such emotional imbalances have an impact on the normal psychosomatic state of an individual and have an impact on the quantum and quality of sleep. If prolonged, they all act as causitive factors for Nidranasha. Discussion on anya karanas Abhighata - Causes the Vitiation of vatadosha which lead to nidranasha. In Abhighata, the shoola will develop because of vata, this shoola lead to nidranasha. Kshaya - It can be considered as Dhatukshaya which is responsible for kapha kshaya and vitiation of vatadosha, which results in Nidranasha. Discussion on samprapti As nidranasha is not explained as a separate disease in Ayurveda, the samprapti of nidranasha is not available. Based on the physiology of swabhavika nidra, nidanas of nidranasha, lakshanas of nidranasha and chikitsa of nidranasha, the samprapti of nidranasha can be hypothised as follows, From the nidanas, it is clearly evident that vatavruddhi and kaphakshaya is going to occur. As tamogunapradhanakapha should fillup Sangnavaha srotas to induce nidra. Here in nidranasha, due to the indulgence in various causitive factors, the kapha
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  155    which is in kshayavastha {gunataha, dravyataha and karmataha} cannot fillup the samgnavahasrotas and so the result nidra does not occur. The other set of enlisted causitive factors, vitiates vatadosha. The vitiated vatadosha has antagonastic property of kaphadosha, which means that the aggravation of vatadosha by its nidana is going to result in kapha kshaya. The vrudha vatadosha enters in to the shirohridaya {chetanasthana, which is responsible in producing nidra and tamas} is responsible for jagrutavasta, which is contrary to the concept of nidra described by Sushruta. In Ayurveda it has been explained that vataprakruti purushas are jagarookaha, ie., they will get less quantity and disturbed quality of sleep. Sushruta has explained that Tamas is the cause for nidra and satva is the cause for jagrutavastha. These two references suggest that when the satvaguna become more predominant, then there will be kshaya in tamoguna, due to which the person remains awake. The aetilogical factors of nidranasha results in gunataha vruddhi of rooksha, laghu and chalaguna of vata, ushnaguna of pitta and kshaya of its sasneha guna. Gunataha kshaya of guru, sheeta, manda and snigdha guna of kaphadosha, and tamogunakshaya. The kaphadosha and tamoguna are responsible to get sleep, where the kaphadosha and tamoguna will fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya. Due to kshayavastha of kaphadosha and tamoguna, they are unable to fillup the samgmavahasrotas. On the other hand vitiated vatadosha get lodged in majjadhatu. Mastulunga, which has been explained as shiromajja, is a part of samgnavahasrotas , if it is not filled with kapha and tamoguna, it results in nidranasha.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  156    On the other hand the manasika karanas enlisted in hetus of nidranasha, vitiates rajas and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiate them, thus resulting in nidranasha. Discussion on lakshanas of nidranasha 1. Angamarda – It is because of Nidranasha, which occurs due to vruddhi of vatadosha and ksheenata of kaphadosha in the body. 2. Shirogourava – By prakruta nidra, physiologically disturbed doshas come into samanyavastha. In Nidranasha vatadosha is increased which is responsible for utsaha. In the course of Nidranasha this will result in Shirogourava. 3. Jadya – If Nidranasha continues for a long time, there will be no rest to the body, due to which the patient feels heavyness of the body. 4. Glani – It can be considered as exhausted state, or depression of the mind. Persons suffering from Nidranasha, feel exhausted, an suffers from depression, which leads to further Nidranasha. 5. Bhrama – The maintenance of the equilibrium of the body is the function of vatadosha. Here in case of Nidranasha the vata is increased, causing Bhrama. 6. Tandra – Due to Nidranasha there will not be rest to the Indriyas. Due to this Indriyas will not perform their proper function, which results in Tandra Discussion on upashaya and anupashaya In the classical text books of Ayurveda some substances, such as ksheera, sneha, mamsa etc., are said to induce good sleep. The same can also be considered as upashaya of nidranasha, because they have the properties, such as, Madhura rasa,
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  157    Sheetaveerya and Madhura vipaka and Gunas like sheeta, snigdha and Guruguna, which helps to induce sleep in individuals. In the same way regular practicing of dinacharya procedures such as Abhyanga, padabhyanga, maradana, samvahana etc., also act as upashaya and the factors which bring about psycological comforts and tranquility such as manonokoolavishayagrahana and sukhashayya are also considered as upashaya for nidranasha. Dicussion on sadhyasadhyata The diagnosis of nidranasha or Insomnia is made only if the symptoms persists for a long time, for atleast one month. Usually the disorder persists, if it is not attended properly. The course of disease is not predictable, usually it does not change its form. However it may lead to many physical psychological disease, if prolonged for many years. It usually waxes and vanes in response to life stressors. Nidranasha otherwise known as Aswapna is a condition of vatananatmaja vikara. The text books of Ayurveda call vatavyadhis as Daruna i.e. not easily managable. However, there are many factors such as age, duration, prakruti, satwa and occupation, which influence the sadhyasdhyata of the disease nidranasha. Age & duration If insomnia presented at an early age, and /or is of short duration, normally the prognosis is good. On the other hand insomnia of an elderly man or /of a longer duration has poor prognosis.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  158    Prakruti The people having predominatly vataprakruti lakshanas, usually does not respond well to the treatment, when compared to pitta and kapha prakruti. Satva People having Avara satva, are having poor prognosis, as compared to pravara & madhyama satva. Occupation The patients who involved in stressful jobs have poor prognosis. A stable personality and good occupational support usually help in alleviating nidranasha. Discussion on sapeksha nidana Nidranasha has been explained as the lakshana in many of the diseases, mentioned in Review of literature. On the basis of lakshanas of other conditions such as jwara, rise in temperature in this condition, dravamala pravrutti in Atisara, shwasakruchrata in Tamakashwasa, trishna in vatajatrishna, history of panchakarma chitista in panchakarma chiksajanya nidranasha, Abhighata in abhighotajanya nidranasha and manasika karanas, such as krodha, shoka etc., The primary insomnia have been differentiated with the secondary conditions, i.e. when the nidranasha is presented as a symptom in other diseases, then the differentiation has been made by their respective pathagnosis symptoms. Even the nidranasha occuring due to the misconduct of panchakarma and abhighata, has to be differentiated by history of panchakarma treatment done previously and any history of Abhighata.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  159    Discussion on materials and methods Present study is a Controlled Clinical Single Blind study with pre and post design where there are three groups. Group A was treated with 2g Pippalimula choorna along with 2g of Guda with milk in the evening after meals, along with Diet Chart prepared as per our classics, for a period of 48days. Group B was treated with 2g Pippalimula choorna along with 2g of Guda with milk, in the evening after meals, for a period of 48days. For Group C Only diet chart was suggested as per our classics, for a period of 48days. The follow up period was for 48days. Reason for Selection of Guda Pippalimula Yoga: Reason for Selection of Guda Sweetening substances are being used in the Ayurvedic formulations to increase it’s palatability, for preservation and also to have, tonic effect. They are responsible for the generation of alcohol in Asavarishtas and serve as base in Avaleha Kalpana. In our Ayurvedic formulation, various sweetening agents used are Guda, Sita, Sharkara etc.Guda makes Pippali mula more palatible. Apart from Palatibility, Guda is having madhura rasa madhura vipaka Guru Snigdha Guna. It is vata samaka and can increase kapha, both of these properties promote Nidra. Jaggery and sugar not only differ in their composition but also in their effect on the human metabolism. Carbohydrate, which is prominently present in sugar, need B- vitamins for their proper utilization by the body and the nature has so arranged it that, in their natural states, both cereals and natural sugar items (like, cane-juice, fruits,
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  160    nuts etc.), and also protein foods, have more than enough of the B-vitamins needed for the assimilation of all the carbohydrate present. If excess of refined sugar is eaten, it is likely to lead to some degree of B-vitamin deficiency. Symptoms of B-vitamin deficiency include irritability, nervous exhaustion, sleeplessness, heart trouble, digestive disorders and mental disturbance. On the other hand, one hundred gram of jaggery provides 200 calories and so requires about 0.1 mg of vitamin B and, it contributes many times this amount itself. It improves digestion, prevents fatigue,purifies blood and provides strength to the muscles. All these properties help in promoting sleep. Reason for Selection of Pippalimula: With its Laghu Snigdha and Tikshna gunas pippalimula acts as an excellent Vata shamaka drug. Vata vriddhi takes place in nidranasha and vata haratva property might promote sleep in nidranasha. Reason for Selection of Milk as anupana: Ksheera is said to be the Agryadravya in generating nidra. In Harita samhita Ksheera is said to be tandra nidra kara. With its Madhura rasa, Snigdha, guru, mrudu, shlakshna, picchila, manda gunas, sheeta virya, madhura vipaka, vatapittahara and sleshmakrit properties, milk can act as an excellent adjuvant to guda and pippalimula for inducing sleep. Discussion on the Diet chart: A diet chart was prepared for groups A and C by including all the ahara dravyas which were quoted by several samhitas as nidra janaka ahara dravyas. Following are the ingridients of the diet chart.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  161    Masha: patients were adviced to use Masha for preparing Idly, Vada, dosa, laddu etc. Masha with its Madhura rasa, Guru snigdha gunas, Madhura Vipaka, might act wonderfully in promoting sleep due to its Vatashamaka and Kapha vardhaka properties Godhuma: Patients were advised to make Chapati, Puri, Paratha, Upma (broken wheat semolina), etc. Godhuma with its Madhura rasa , Guru Snigdha Hima Gunas, Sheeta virya, Madhura Vipaka, helps in promoting sleep due to its Vatapittaghna and Kaphakara properties Ghrita: Patients were advised to use ghrita in all the food items they consume. Ghrita with its Madhura rasa, snigdha, guru and sara Gunas; Sheeta virya and Madhura vipaka, helps in promoting sleep due to its vata shamaka properties Ikshu Rasa: Patients were advised to take ikshu rasa and ikshu vikaras like guda. Ikshu rasa with its Madhura rasa, guru guna, shita veerya, madhura vipaka, and, helps in promoting sleep due to its vata hara property Upodika : patients were advised to cook this leafy vegetable which is having madhura rasa, Guru, snigdha, picchila gunas, shita veerya, madhura vipaka. It helps in promoting sleep due to its Vatapittaghna and Kaphakara properties. Shali Dhanya: patients were advised to use Shali Dhanya extensively which is having Madhura rasa, Sheeta veerya, Madhura Vipaka. It helps in promoting sleep due to its Vata hara properties.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  162    Dadhi: Patients were advised to eat Dadhi liberally which contains madhuramla rasa, Guru, abhishyandi and snigdha gunas, and amla vipaka. It promotes sleep by the virtue of its vata hara and kapha kara, properties. Draksha: Patients were advised to drink the juice of Draksha as it contains Madhura rasa, Snigdha, Guru, Mridu, Gunas, Sheeta virya, Madhura vipaka. It helps in promoting sleep by the virtue of its Vata pitta shamaka properties. Tila: Patients were advised to eat sweets made out of tila, guda and ghrita as tila contains Madhura, Kashaya, and Tikta rasas, Snigdha guna and madhura vipaka. It promotes sleep by the virtue of its vata hara properties. Gramya Mamsa: Patients were advised to take Gramya mamsa which is vata hara and promotes sleep. Anupa Mamsa: Patients were advised to consume mamsa of Anupa animals as it contains madura rasa, snigdha guru picchila and abhishyandi gunas. As anupa mamsa helps in promoting sleep by virtue of its Kapha vardhaka Properties. Inclusion criteria: Reason for Selecting the age group between 30 – 50 years: Patients above 50 years may suffer with Jara janya Nidranasha which takes it out of the primary insomnia category. So patients above 50 years were excluded. Patients in this group (30-50) are health conscious and usually follow what doctor says by using the medicines and following diet regulations strictly. Younger patients who are unmarried or college going or school going might find difficulty in following the diet chart prepared for
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  163    nidranasha. More over as primary insomnia is seen to occur more in middle aged group, and also Charaka has considered 30-60 years as Madhyavastha of life, but as in the present era of modernisation and lifestyle changes 60years tends to be more towards oldage. Hence the upper limit of age was taken as 50 years. Reason for Selecting Primary Insomnia with a history of one to five years: Chronic insomnia with a history of more than 5 years usually gets associated with other symptoms and diseases resulting out of insomnia which takes this disease out of the primary insomnia category. More over the gudapippalimoola yoga is said to bring sleep to those who have not slept since along duration of time in Bhaishajya Ratnavali as in the sloka: “Gudam pippalimoolasya churnennatichiram lihan | Ciradapi cha samnashtaam nidraamapnoti asamshayam ||” in the context of Murcha roga chikitsa (21st Chapter) Exclusion criteria: Reason for excluding Patients suffering from other systemic illnesses and on any medication: These patients may suffer with insomnia, which might be a complication of the systemic illness or medication they are using. Unless and until the systemic illness is cured, or the medication is avoided his/her insomnia cannot be managed. So such patients were excluded. Reason for excluding Patients who have underwent surgery within the past 6 months: These patients might suffer from severe pain due to surgery which can cause insomnia. It becomes impossible to cure such insomnia unless and until such pain is
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  164    relieved which happens only after the surgical wounds are healed completely. So such patients were excluded. Discussion on Sampling Method and Research Design: Reason for Purposive Sampling: This sampling method helps us to divide the patients into three convinient groups which allows us to make three purposeful categories which can show particular effects on Nidranasha , which can be compared. Discussion on Statistical Analysis - Contingency Co-efficient – It is applied when Categorical Data Analysis is to be done. Then a contingency table can be used to express the relationship between the variables Descriptive statistics - The Descriptives procedure displays univariate summary statistics for several variables in a single table and calculates standardized values (z scores). Variables can be ordered by the size of their means (in ascending or descending order), alphabetically, or by the order in which one select the variables (the default). t-test: This test is used as the sample size is small and so as to find significance of the Qualitative data. Chi-square test: The Chi-Square Test procedure tabulates a variable into categories and computes a chi-square statistic. This goodness-of-fit test compares the observed and expected
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  165    frequencies in each category to test either that all categories contain the same proportion of values or that each category contains a user-specified proportion of values. ANOVA: This test is used as there are multiple variants involved in the study. Repeated measures ANOVA: This test is used as in the study the same sample is subjected to statistical analysis repeatedly at different phases of study Intervention: Reason for making 3 Groups in the study: This was done so as to get a clear picture regarding individual efficacies of the interventions and also to know their combined effects. This design even would help to compare the efficacies of the three Groups. Discussion on observation and results AGE–In the present study, 15(33.3%) patients were in the age group of 30-40, 30 patients(66.7%) were in the age group of 30-40. The age in relation with nidranasha is statistically insignificant. This might be because of smaller sample size. SEX – In the present study, 14 patients (31.1%)were males & 31 patients(68.9%) were females. This is statistically significant (p value =0.040) indicating more prevalence of Nidranasha in females. MARTIAL STATUS - In the present study, 33 patients (73.3%)were married,5 patients(11.1%) were unmarried & 7 patients(15.6%) were widowers. This is statistically insignificant (p value =.139) indicating more prevalence of Nidranasha in married people. Marital troubles might account for stress which might have induced sleeplessness
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  166    RELIGION - In the present study,38 patients (84.5%)were hindu,5 patients(11.1%) were muslim, 1 patient(2.2%) was Christian & 1 patient(2.2%) was jain. This is statistically insignificant (p value =.320) indicating more prevalence of Nidranasha in hindus which might be only because of more hindu population followed by muslims in and sround mysore area. Larger sample can give an idea about prevalence of Nidranasha among several religious groups. HABITAT - In the present study, 11 patients (24.5%) were rural, 34 patients(75.5%) were urban. This is statistically significant (p value =0.040) indicating more prevalence of Nidranasha in Urban people which indicates that the effect of urban living under stressful conditions and pollution causes more prevelance of nidranasha in urban people when compared with rural people. OCCUPATION - In the present study, 2 patients (4.4%)were agriculturists, 3 patients (6.7%) were shop-keepers, 30 patients (66.7%) were house–wives, 3 patients (6.7%) were salesman, 2 patients (4.4%) were govt. officials, 4 patients (8.9%) were teachers & 1 patient (2.2%) was a mason. This is statistically insignificant (p value =0.625). More prevalence of Nidranasha in housewives however cannot be attributed to a specific reason and a study on a larger sample gives a better picture. SOCIO-ECONOMIC STATUS - In the present study, 16 patients were Poor (35.5%), 25 patients (55.6%) belonged to the Lower Middle Class and 4 patients (8.9%) belonged to the Upper Middle Class. This is statistically insignificant (p value =0.748) indicating more prevalence of Nidranasha in lower middle class. A larger sample study will give better results
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  167    EDUCATION - In the present study, 13 patients (28.9%) were Illiterate, 7 patients (15.5%) had completed their Primary Education, 18 patients (40%) had completed their Secondary Education, 4 patients (8.9%) were Graduates and 5 patients (6.7%) were Post Graduates. This is statistically insignificant (p value =0.273) indicating more prevalence of Nidranasha in people who have completed secondary education. NATURE OF WORK - In the present study, 25 patients (55.6%) were Active, whereas 20 patients (44.4%) had sedentary nature of work. This is statistically insignificant (p value =0.914) indicating more prevalence of Nidranasha in people who are active . DIET - In the present study, 18 patients (40%) consumed Vegetarian Diet whereas 27 patients (60.0%) consumed Mixed Diet (both vegetarian and non-vegetarian foods). This is statistically highly significant (p value =0.000) indicating more prevalence of Nidranasha in people with mixed diet. But according to ayurveda most of the ahara suggested for sleeplessness consists of mamsa of various animals. The cooking style of non vegetarians who add a lot of spices and oil to their foods which might cause vidaha might result in nidranasha. CHRONICITY - In the present study, 33 patients (73.3%) reported chronicity ranging between 12-24 months, while 12 patients reported chronicity ranging between 25-60 months. This observation is statistically insignificant (p value =0.256) PRAKRUTI - In the present study, 28 patients (62.2%) were of Vata-Pitta Prakruti, 2 patients (4.4%) were of Pitta-Kapha Prakruti and 15 patients (33.4%) were of Kapha- Vata Prakruti. This is statistically significant (p value =0.046) indicating more prevalence of Nidranasha in Vata Pitta prakruti people who might have vata pitta
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  168    prakopa and kapha kshya which is the basis for nidra nasha. SARA - In the present study, 2 patients had Pravara Sara (4.4%), 33 patients had Madhyama Sara (73.4%) and 10 patient had Avara Sara (22.2%). This observation is statistically insignificant (p value =0.233) SAMHANANA - In the present study, 6 patient had Pravara Samhanana (13.3%), 30 patients had Madhyama Samhanana (66.7%) and 9 patients had Avara Samhanana (20%). This is observation statistically insignificant (p value =0.097) PRAMANA - In the present study, 4 patients were of Pravara Pramana (8.9%), 39 patients were of Madhyama Pramana (86.7%) and 2 patients were of Avara Pramana (4.4 %). This observation is statistically insignificant (p value =0.827) SATMYA - In the present study, 21 patients had Madhyama Satmya (46.6%) and 24 patients had Avara Satmya (53.4%). This observation is statistically insignificant (p value =0.448) SATTVA - In the present study, 1 patient had Pravara Sattva (2.2%), 14 patients had Madhyama Sattva (31.1%) and 30 patients had Avara Sattva (66.7%). This observation is statistically insignificant (p value =0.710) AGNI - In the present study, 33 patients had Samagni (73.4%), 7 patients had Mandagni and 5 patients had Vishamagni (11.1%). This observation is statistically insignificant (p value =0.153) KOSHTA - In the present study, 30 patients had Madhyama Koshtha (66.7%), 3 patients had Mridu Koshta (6.6%) and 12 patients had Kroora Koshtha (26.7%). This observation is statistically insignificant (p value =0.249)
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  169    VYAMAMA SHAKTI - In the present study, 4 patients had Pravara Vyayama Shakti (8.9%), 32 patients had Madhyama Vyayama Shakti (71.1%) and 9 patients had Avara Vyayama Shakti (20%). This observation is statistically insignificant (p value =0.350) ONSET OF THE DISEASE - In the present study, 20 patients (44.4%) had Gradual Onset of the disease whereas 25 (63.6) patients had Sudden Onset of the disease. This is statistically significant (p value =0.021) indicating that some sudden changes in diet or area of work or sleeping place is causing an immediate effect on sleep quality and also causing nidranasha in many.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  170    DISCUSSION ON RESULTS Pittsburgh Sleep Quality Index (PSQI) is used to assess the results of the study. PSQI is divided into seven components which indicate seven traits of sleeplessness. They are as follows Discussion on C1 Component 1: Subjective sleep quality: This denotes the rating given by the patient about the quality of his/her sleep dring the past month. The results obtained shows that in all the three groups the change was highly significant. However by observing the mean scores we can say that the result is best in Group A followed by Group B and Group C occupies the third place. Discussion on Component 2: Sleep latency This denotes the time taken by the patient to become asleep after lying down on the bed. The results obtained shows that in all the three groups the change was highly significant. However by observing the mean scores we can say that the the group in which time taken to be asleep has reduced significantly is group A followed by Group B and Group C occupies the third place. Discussion on Component 3: Sleep duration It indicates the number of hours patients are experiencing sleep. The results obtained shows that in all the three groups the change was highly significant. However by observing the mean scores we can say that the the group in which sleep duration has increased significantly is group A, followed by Group B, and Group C occupies the third place.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  171    Discussion on Component 4: Sleep efficiency Component 4 indicates the sleep efficiency which can be calculated by dividing the number of actual hours of sleep with number of hours spent in bed multiplied by hundred. Results obtained shows that there is a significant increase in sleep efficiency in both the groups A and B which is highly significant. However in group C the increase is not statistically significant (P value 0.071) . This shows that intake of nidra janaka ahara itself is not sufficient in bringing a statistically significant increase in Sleep Efficiency. Discussion on Component 5: Sleep disturbance Component 5 indicates Disturbance in sleep during the night in terms of night awakening with out any reason or getting up for micturition. Results obtained show that there is a significant decrease in sleep disturbance in group A . It is Statistically highly significant. But in group B( P value .124) and group C(P value 0.455) the decrease in sleep disturbance is not significant . However Among B and C groups, the average mean scores show that the decrease in sleep disturbance is more in Group B. this observation indicates that to bring a highly significant decrease in sleep disturbance a combination of Guda Pippali Mula , Nidrajanaka Ahara is very useful. Discussion on Component 6: Use of sleep medication Component 6 represents the patients need for medication to induce sleep. Results obtained show that in all the three groups there is a significant decrease in the use of sleep medication. It shows that the present study is highly succuessful in bringing down the need for a sleep medication. The statistical values in all the three groups are highly significant. However when
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  172    we compare the mean scores Group C in which only nidrajanaka ahara was used decrease in score is a bit less. Discussion on Component 7: Daytime dysfunction Component 7 represents Daytime dysfunction which indicates the patients had trouble staying awake while driving, eating meals, or engaging in social activity during day time or trouble in keeping up enough enthusiasm to get things done. Results show that in groups A and C there is a significant decrease in Daytime dysfunction where the result is statistically significant. In group B the decrease in daytime dysfunction is highly significant statistically. Discussion on Global PSQI Global PSQI score is the sum of all the seven components of PSQI . when we compare the mean values of Group A before Treatment (16.67) After Treatment(5.73) and After follow up (9.67) we observe significant improvement which indicates Guda Pippalimula Yoga along with a Nidra janaka Diet regimen, helps in producing highly significant improvement in nidra nasha. When we compare the mean values of Group B before Treatment (16.87) After Treatment(6.53) and After follow up (10.73) we observe significant improvement which indicates Guda Pippalimula Yoga alone is also capable of producing highly significant improvement in nidra nasha. However the mean values indicate that Group A (medicine + diet) is still better than Group B (only medicine). When we compare the mean values of Group C before Treatment (17.47) After Treatment(10.20) and After follow up (14.73) we observe a moderate improvement which indicates Nidra janaka Diet regimen helps in producing moderate improvement in nidra nasha. The change in scores of Global PSQI before
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  173    the treatment, after the treatment and after follow up is highly significant both in the groups(P=0.000). and within the groups (P=0.001). By comparing the mean values of both the groups, overall effect of group A was found to be better. Proposed Mode of action of Guda Pippali Mula Yoga. Guda Pippali Mula yoga advised in Bhava prakasha and Bhaishajyaratnavali, with Kseera anupana has shown highly significant improvement in the patients of Nidranasha. This action may be due to the synergistic effect of the three ingridients Guda, Pippali Mula and Ksheera. Guda with its Madhura Rasa, Madhura Vipaka, Guru and Snigdha Gunas exhibits all the useful properties to promote sleep. However its ushna virya is a debatable property. Though ushna virya acts as vatahara it might also produce kapha hara properties. But its effect is being cleverly balanced by the sheeta virya of its anupana ksheera. In the same way Pippalimula with its katu rasa katu vipaka Laghu and tikshna gunas seems to be against the context of nidra janakatva but its snigdha guna helps in becoming Vata hara. As vata vitiation is the most important phase of nidra nasha, Pippali mula might help in the samprapti vighatana by virtue of its vata hara property. Its anushna sita veerya coupled with the properties of Milk and Guda also helps in increasing kapha and promoting sleep. Ksheera with its Madhura rasa, Snigdha, guru, mrudu, shlakshna, picchila, manda gunas, sheeta virya, madhura vipaka, vatapittahara and sleshmakrit properties milk can act as an excellent adjuvant to guda and pippalimula for inducing sleep. And more over mahisha ksheera has been regarded as the Agryadravya in promoting sleep. With the above insights we can infer that Guda pippali mula yoga with Ksheera anupana is
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  174    a wonderful yoga containing three potent yet different drugs chosen by our acharyas which balance each others’ properties in a synergistic fashion to bring about successful promotion of Nidra in Nidranasha patients.Pippalimoola has piperine and piplartine which are known to have sedative effect and are used in epilepsy for its sedative effect.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  175    RECOMMENDATION FOR FURTHER STUDY  The same study could be done with a larger sample for more accurate results and conclusions.  For the clinical trail, all types of insomnia should be considered.  A study on Insomnia should be done in collaboration with the Sleep laboratory.  An attempt has to be made on the effect on manasika chikitsa, such as ashwasana etc., in Nidranasha.  The Guda Pippalimula Yoga, being non-palatable, could be used in capsule form or any other palatable form (according to convenience).
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  176    CONCLUSION On the basis of conceptual Analysis and Observations made in this clinical Study, the following conclusion can be drawn:  Nidranasha effectively represents Insomnia.  Vata Vriddhi along with Kapha kshaya is the main reason for Nidra nasha  It was observed that the primary insomnia is more in Vata-Pitta prakruti patients.  More patients were from urban areas.  Guda Pippalimula Yoga with Ksheera anupana is having vatashamaka and kapha vardhaka property.  Diet regimen given to the group also helps in pacifying vata and increasing Kapha.  Individual effect of Group A (Guda Pippalimula Yoga and Diet Regimen) is best during all phases of treatment  Individual effect of Group B (Guda Pippalimula Yoga) is good in all the phases of treatment.  Individual effect of Group C(Only Diet Regimen) is Not significant during any phase of treatment and during overall intervention.  Guda pippalimula Yoga with Ksheera anupana along with a Nidrajanaka Diet Regimen is found to be very effective in Managing Primary insomnia.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  177    SUMMARY An estimated 30%-50% of the general population are affected by insomnia, and amoung them 15% are suffering from this condition, where the cause is not known i.e., primary insomnia. The whole world is looking towards a safer and more natural way to overcome insomnia. Ayurveda with its ability to teach people how to lead a healthy life can help mankind in overcoming insomnia. Present study concentrates on finding an effective way to treat Insomnia with medicines and diet regimen. Being a Single Blind comparative study, three groups were made- Group A, Group B & Group C. Hence the study was designed to compare & understand the effect of the Guda Pippali Mula Yoga, effect of Diet Regimen comprising of Nidra janaka Ahara and combined effect of both. The present dissertation work is divided into 2 parts. The first part deals with the Introduction, Nirukti, Paribhasha, Concept of Nidra Nasha, Nidana, Poorva Roopa, Roopa, Upashaya-Anupashaya, Samprapti, Upadrava, Sadhyasadhyata, Arista Lakshana, Chikitsa, and Pathya- Apathya of Nidranasha. In the same part modern review on Insomnia was also dealt. Drug review is dealt at the end of first part. In the second part, Materials & Methods, Observation of clinical trials, Results, Statistical tables & graphs, Discussion, Summary, and Conclusions are dealt. A total of 45 Patients were selected for the study. For 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, for a period of 48 days. For group B 2g Pippalimula choorna along with 2g of Guda was administered with milk, in
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  178    the evening after meals, for a period of 48days. Members of Group C were advised only to follow Diet chart for Nidranasha created as per our classics, for a period of 48 days. The followup period was 48 days. PITTSBURGH SLEEP QUALITY INDEX (PSQI) was used to assess the effect of medicine and diet on three groups. The Observations and Results were statistically analyzed for better interpretation. During the period of overall treatment best result was seen in Group A, followed by Group B and in Group C though improvement was seen, it is not statistically significant. During the period of follow up Best result was seen in group A , followed by Group B and Group C. The conclusion derived on the basis of detailed observation & deep study is submitted under the chapter on Conclusion. Future perspective of the study is highlighted as an aid for the future research workers.
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  179    Bibliographic References 1. Iyengar B.K.S, Light on the Yoga Sutras of Patanjali, Paperback Ed, Thorsons Publication, 1993, PP:52 2. Swami Krishnananda, Mandukya Upanishad, The Divine Life Society, Rishikesh, 1996, PP: 42 3. Swami Prabhupada, Bhagavad Gita As It Is, 2nd Ed,The Bhaktivedanta Book Trust, Mumbai, 2008, PP:28 4. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 74 5. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP: 150 6. Indradev Tripathi, Yoga Ratnakara, 1st ed., Varanasi, Krishna Das Academy, 1998, PP:82 7. P.V.Tewari, Vruddhajivakiya Tantra of Kashyapa, 1st Ed, Varanasi, Chaukhambha Vishva Bharati, 1996, PP: 256 8. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 9. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:358
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  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  182    33. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 34. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 35. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:94 36. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 96 37. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 118 38. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:358 39. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 525 40. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:359 41. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 118 42. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 Ch. Su. 21/57- Chakrapani
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  183    43. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP: 358, 359 44. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:358 45. Indradev Tripathi, Yoga Ratnakara, 1st ed., Varanasi, Krishna Das Academy, 1998, PP: 549 46. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 118 47. M. Monier Williams. A Sanskrit-English Dictionary. 1st reprint ed., Delhi; Motilal Banarasidas Pvt. Ltd.,1990, PP:548. 48. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 49. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 50. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 51. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:359 52. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 454
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  184    53. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:93 54. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 143 55. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP: 115 56. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP:50 57. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:778 58. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:95 59. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 143 60. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 323 61. Brahmanand Tripathi, Sharangadhara Samhita of Sharangadhara, Varanasi, Chowkambha Surabharathi Prakashan, 2007: 108 62. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:491 63. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:93
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  185    64. (http://www.sleepfoundation.org retrieved 12/8/07) 65. 307.42,.Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) 66. International Classification of Sleep Disorders (ICSD-2) diagnostic and coding manual 67. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 182 68. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 119 69. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 143 70. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 143 71. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:359 72. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP: 217 73. Haridatta Shastri. Bhaishajya Ratnavali of Govindadasa. 7th ed., Varanasi; Choukhamba Surabharati Prakashana, 1987:303. 74. Brahmanand Tripathi, Sharangadhara Samhita of Sharangadhara, Varanasi, Chowkambha Surabharathi Prakashan, 2007, PP:291 75. Bapalal Vaidya, Nighantu Adarsha, Varanasi, Chaukhamba Bharati
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  186    Academy,2005, PP: 139 76. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:93 77. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP:215 78. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP:349 79. Prof. Kashinath Shastri, Rasatarangini of Sadananda Sharma, 9th Ed, 1973, Motilal Banarasidas, Delhi, PP: 698 80. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 154 81. Bh.Rat.15/162-166 82. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP:321 83. P.V.Tewari, Vruddhajivakiya Tantra of Kashyapa, 1st Ed, Varanasi, Chaukhambha Vishva Bharati, 1996, PP: 256 84. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP: 333 85. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP:334 86. P.V.Tewari, Vruddhajivakiya Tantra of Kashyapa, 1st Ed, Varanasi, Chaukhambha Vishva Bharati, 1996, PP: 380
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  187    87. P.V.Tewari, Vruddhajivakiya Tantra of Kashyapa, 1st Ed, Varanasi, Chaukhambha Vishva Bharati, 1996, PP: 253 88. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 410 89. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005, PP: 316 90. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005: 59 91. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP: 32 92. A.F.I 93. A.F.I 94. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP: 33 95. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP:60. 96. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP:118 97. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 117 98. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:359
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  188    99. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th ed, Varanasi: Chowkamba Samskrit Adhishtan, 2002, PP: 119 . 100. Jyotirmitra Acharya, Ashtanga Sangraha, 2nd Ed, Varanasi: Chowkamba Samskrit series, PP:93 101. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 296 102. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 296 103. Vishwanatha Dwivedi, Rajanighantu of Narahari, 1st ed., Varanasi, Krishnadas Academy, 1998, PP:138 104. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005: 19 105. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha Prakashana, 2007, PP: 296 106. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:209 107. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed, Varanasi: Chowkamba Orientalia, 2003, PP:209 108. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005: 797 109. Vishwanatha Dwivedi, Rajanighantu of Narahari, 1st ed., Varanasi, Krishnadas Academy, 1998, PP: 492
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  189    110. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005: 140 111. Kali Prasad Shasti Tripathi, Hareetha Samhita, 1st ed, Khemraj Sri Krishna Das, Mumbai, 1849, PP:60 112. Sharma. P.V, Guruprasad Sharma, editors. Kaiyadeva Nighantu of Kaiyadeva, 1st ed., Varanasi, Chaukamba Orientalia,1979, PP: 35 113. Pt. Brahma Shankara Mishra, Bhava Prakasha of Bhavamishra, Chowkambha Samskrita Samsthan, 2005: 665 114. Sharma. P.V, Guruprasad Sharma, editors. Kaiyadeva Nighantu of Kaiyadeva, 1st ed., Varanasi, Chaukamba Orientalia,1979, PP:343 115. Sharma. P.V, Guruprasad Sharma, editors. Kaiyadeva Nighantu of Kaiyadeva, 1st ed., Varanasi, Chaukamba Orientalia,1979, PP:310 116. Sharma. P.V, Guruprasad Sharma, editors. Kaiyadeva Nighantu of Kaiyadeva, 1st ed., Varanasi, Chaukamba Orientalia,1979, PP:353 117. Bapalal Vaidya, Nighantu Adarsha, Varanasi, Chaukhamba Bharati Academy,2005, PP: 516 118. Bapalal Vaidya, Nighantu Adarsha, Varanasi, Chaukhamba Bharati Academy,2005, PP: 111 119. Bapalal Vaidya, Nighantu Adarsha, Varanasi, Chaukhamba Bharati Academy,2005, PP: 385 120. Sharma. P.V, Guruprasad Sharma, editors. Kaiyadeva Nighantu of Kaiyadeva, 1st ed., Varanasi, Chaukamba Orientalia,1979, PP:440
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  190    Modern review  Guyton and Hall, Textbook of Medical Physiology, 11th Ed, Elseveir publications India private limited, 2000  Chaudhri, Concise Medical Physiology, 3rd ed., Calcutta, New Central Book Agency, 2000  M.S.Bhatia , Essential of Psychiatry 3rd Ed, New Dehli : CBS publishers & distributors Darya ganj,2000  Anonymus ; Davidson’s Principle and practice of Medicine ; ELBS with churchil Living Stone for Chistopher RW Edwards et al 1992 PP 1009 ; 1010.  Anonymus – ICD – 10 ; Vol 10, WHO Geneva 1992, 352 – 353  Hornald I Kaplan & Benjamin J Sadak ; Synopsis of Psychiatry & Behavioural Science 7th Edn. BI Nartray Pvt. Ltd., New Delhi 1994 ; PP:703 – 716  Buysse DJ, Reynolds CF, Monk TH, et al: Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213, 1989a  Buysse DJ, Reynolds CF, Monk TH, et al: Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index. Sleep 14:331–338, 1989b
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  191     Gentilli A, Weiner DK, Kuchhibhatla M, et al: Test-retest reliability of the Pittsburgh Sleep Quality Index in nursing home residents (letter). J Am Geriatr Soc 43:1317–1318, 1995  Stein MB, Chartier M, Walker JR: Sleep in nondepressed patients with panic disorder, I: systematic assessment of subjective sleep quality and sleep disturbance. Sleep 16:724–726, 1993  Stein MB, Kroft CDL, Walker JR: Sleep impairment in patients with social phobia. Psychiatry Res 49:251–256, 1993  Rush J, et al: Handbook of Psychiatric Measures, APA, Washington DC, 2000
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  192    List of References 1. Samadhi Pada-10,Yogasutras of Patanjali Verse 6,10 2. Man. Upa. 5 3. Shrimad Bhagvad Gita 6-17 4. Ch. Su. 11/35 5. B.P.Pu.5/ 316 6. Y.R. Pu. 48/88 7. Ka. Sam. Khi. 5/7 8. Ch. Su. 21/58 9. Su. Sha.4 /33 10. Ch. Su. 7/4 11. Ch. Su. 21/59 12. Su. Sha. 4/33 13. Yoga Ratnakar Pu. 64 14. Laws of Manu(Manusmriti) 15. Amarkosha 3/3/106 16. Shabdastoma Mahanidhi 17. Brahmasutra 3/2/7 18. Chhan. 8/6/3 19. Su. Sha. 4/33 20. A. S. Su. 9/29 21. Vachaspatyam 22. Ch. Su. 21/58 23. Shabdakalpadruma 24. Sh.P.Kh.6/4 25. Webster’s Third International Dictionary 26. Amarskosha 27. Shabdakalpadruma 28. Shrimad Bhagwad Gita 5/8-9 29. A. S. Su. 9/28 30. Su. Sha. 4/56 31. Ch. Su. 21/35 32. Su. Sha. 4/34 33. Ch. Su. 21/59 – Chakrpani 34. Ch. Su. 21/58- Chakrapani 35. A. S. Su. 9/49 – Indu 36. A. H. Su. 6/54 37. Ch. Su. 21/37 38. Su. Sha. 4/33-Dalhana 39. Ch. Chi. 15/241 40. Su. Sha. 4/40 41. Ch.Su. 21/36 42. Ch. Su. 21/57- Chakrapani 43. Su. Sha. 4/35-37 44. Su. Sha. 4/36 45. Y.R.Pu.259 46. Ch. Su. 21/36- 38 47. M.M. Williams 48. Ch.Su.21/55 49. Ch.Su.21/56 50. Ch.Su.21/57 51. Su. Sha. 4/42 52. A.H. Ni. 2/42 53. A. S. Su. 9/41-42 54. A. H. Su. 7/63 55. B.P. Dwitiya Khanda 56. Ch. Su. 7/23 57. Su. Ut. 55/17 58. A.S.Su.9/56 59. A.H.Su.7/64 60. Ch.Sha.4/36 61. Sha. Sam. Pra. Kh. 7 62. Su. Chi. 24/88
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  193    63. A. S. Su. 9/44 64. http://www.sleepfoundation.org retrieved 12/8/07 65. 307.42,.Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) 66. International Classification of Sleep Disorders (ICSD-2) diagnostic and coding manual 67. Ch. Su.29/7 68. Ch. Su. 21/52-54 69. A. H. Su. 7/66 70. A. H. Su. 7/67 71. Su. Sha. 4/42-46 72. B.P.M.Kh.7/327 73. B.R.21/9 74. Sh.Sam.M.Kh.2/58-83 75. Vangasena 76. A.S.Su.9/47 77. B.P. Hareetakyadi varga.82 78. B.P. Hareetakyadi varga.82 79. Rasatarangini 698 80. Ch. Su.27/21 81. Bh.Rat.15/162-166 82. B.P.M.Kh.1/331 83. Ka.Sam.Khi 84. Ha. Sam.III/Ch. 15/5 85. Ha. Sam. III/Ch. 15/6 86. Ka.Sam.Khi.4 87. Ka.Sam.Khi.4/57 88. Cha.Chi.3 89. B.P.Hareetakyadi varga 90. B.P.M.Kh.1/317-320 91. Ha. Sam. III/Ch. 15/7 92. A.F.I 93. A.F.I 94. Ha. Sam.I/ch.5/35,36,37,38,39 95. Ha. Sam.III/ch.15/34 96. Ch.Sam.21 97. Ch.Sam.21 98. Su.Sha.4/46 99. A. H. Su. 7/67 100. A.S. Su. 9/47 101. Ch. Su. 25/45 102. Ch. Su. 1/24 103. R.N. Pippalyadi varga 21-22 104. B. P. Pu.Hareetakyadi varga,64,65 105. Cha. Su. 27/239 106. Su. Su. 45/160 107. Su. Su. 45/161 108. B.P.Pu. Ikshuvarga, 32 109. R.N. Paneeyadi varga,100 110. B.P.Pu. Ikshuvarga, 29 111. H.S.Pra.stha.8/21 112. Kai.Ni.3/33 113. Bh.P.Ni. Shaka varga8-9 114. Kai.Ni.1/181 115. Kaiyadeva nighantu,3/28 116. Kai. Ni. Dadhi varga,3.186,187 117. N.A. Laashunadi varga,516 118. Ni.A. Drakshadi varga,111 119. Ni.A. Tiladi varga,385 120. Kai. Ni. Mamsavarga 
  • “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” Dr Kavitha S  194     
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        I    ANNEXURE-I CASE SHEET DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. “A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA” HEAD OF THE DEPARTMENT : DR. SHAKUNTHALA G. N. M.D (AYU) GUIDE : DR. BALAKRISHNA D.L. M.D (AYU) RESEARCHER : Dr. KAVITHA S. B.A.M.S Part A: History taking & Examination- 1) Name of the Patient Sl.No 2) Gender Male Female OPD No. 3) Age Years 4) Religion I P D No. 5) Marital Status Married Unmarried Others 6) Occupation Sedentary Active Working in shifts 7) Economical Status Poor Middle Lower Upper Middle Rich 8) Educational status UE PS MS HS G PG Others 9) Present Address 10) Living since __ years Pin 11) Schedule Dates Initiation Completion 12) Result Complete relief Marked relief Moderate Relief Mild Relief No change
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        II    1) Chief complaints a. Reduction in sleep time b. Initiation of sleep c. Sleep interruption d. Day time naps e. Others 2) Associated Complaints a. Shirogaurava e. Bhrama b. Jadya f. Apakti c. Glani g. Angamarda d. Jrumbha h. Others 3) History of present illness Mode of Onset Sudden Gradual Insidious Duration of Sleeplessness Continuous / Intermittent / Change of Place /Bed/Stress/anxiety 4. Occupational History Nature of work : Sedentary /active /physical activity/ mental activity /any change of job /change of place due to work/ whether working in shifts 5. Personal History Food habits Vegetarian Non-vegetarian Rasa Preference Agni Sama Vishama Manda Teekshna Addictions Tobacco Alcohol Drugs Others If changed recently Bowel Habits Normal Loose Constipated Changed
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        III    Menustrual History Regular Irregular Amenorrhea Menopause Family history Other system medications Treatment History Antidepressant Sedatives Tranquilizes Hypnotics Underwent any Surgery recently (within 6 months) History of past illness 6. General examination Temperature °F Pulse / Min Respiration Rate /Min Height Cms Weight Kg B.P /mmHg 7. Systemic Examination CVS CNS R.S P/A 8. Asta stana pareeksha: Naadi: V/P/K/VP/PK/VK/VPK Mutra: times per day, times at night. Mala: Drava/ Baddha/ Samyak. Jihwa: Alipta/Alpa lipta/Lipta. Shabda: Prakruta / Vikruta. Sparsha: Prakruta / Vikruta. Druk: Prakruta / Vikruta. Aakruti: Pravara/ Madhyama/Avara.
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        IV    9. Dashavidha pareeksha: i. Prakruti: V/ P/ K/ VP/ PK/ KV/ VPK. ii. Vikruti: a) Dosha: V/ P/ K/ VP/ PK/ KV/ VPK. b) Dushya: R/ RA/ Ma/ Me/ As/ Mj/ Sh/ Others. iii. Sara: Pravara ( ), Madhyama ( ), Avara ( ) iv. Samhanana: Pravara ( ), Madhyama ( ), Avara ( ) v. Pramana: Pravara ( ), Madhyama ( ), Avara ( ) vi. Sathmya: Pravara ( ), Madhyama ( ), Avara ( ) vii. Sattva: Pravara ( ), Madhyama ( ), Avara ( ) viii. Ahara shakti: a) Abhyavaharana: Pravara ( ), Madhyama ( ), Avara ( ) b) Jarana: Pravara ( ), Madhyama ( ), Avara ( ) ix. Vyayama shakti: Pravara ( ), Madhyama ( ), Avara ( ) x. Vaya: Bala ( ), Madhyama ( ),Vruddha( ) 10. Nidana panchaka 1.Nidana: Aharaja: Viharaja: Manasika: 2. Poorva rupa: 3.Rupa: 4. Upashaya-Anupashaya:
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        V    Samprapti ghataka: Dosha: Dushya: Ama: Srotus: Srotodusti prakara: Udbhavastana: Sancharastana: Adhishtana: Roga marga: 5. Samprapti : 11. Vyadhi Viniscaya : Nidranasha Chikitsa Krama: Intervention Group A Group B Group C 2g Pippali mula churna with 2g Guda after dinner along with Nidra janaka Ahara. 2g Pippali mula churna with 2g Guda after dinner. Nidra janaka Ahara. Grading of PSQI Q 1 Q 2 Q 3 Q 4 Q5 Q6 Q7 Q8 Q9 Q10 Q 11 GlobalPSQI Before treatment After treatment After follow up Signature of Researcher Signature of H.O.D Signature of Guide
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        VI    ANNEXURE-II PITTSBURGH SLEEP QUALITY INDEX (PSQI) Name__________________________ Date________ Age___________ 1. During the past month, when have you usually gone to bed at night? USUAL BED TIME_________________________ 2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? NUMBER OF MINUTES_____________________ 3. During the past month, when have you usually gotten up in the morning? USUAL GETTING UP TIME__________________ 4. During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spend in bed.) HOURS OF SLEEP PER NIGHT________________ For each of the remaining questions, check the one best response. 5. During the past month, how often have you had trouble sleeping because you…….. (a) cannot get to sleep within 30 minutes Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (b) Wake up in the middle of the night or early morning Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (c) Have to get up to use the bathroom. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (d) Cannot breathe comfortably. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (e) Cough or snore loudly. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        VII    (f) Feel too cold. Not during the Less than Once or Three or more past month________ once a week_______ twice a week_______ times a week______ (g) Feel too hot. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (h) Had bad dreams. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (i) Have pain. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (j) Other reason(s), please describe_____________________________________ ____________________________________________________________________________ How often during the past month have you had trouble sleeping because of this? Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ 6. During the past month, how would you rate your sleep quality overall? Very good ___________ Fairly good ___________ Fairly bad ___________ Very bad ___________ 7. During the past month, how often have you taken medicine (Prescribed or "over the counter") to help you sleep? Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ 8. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        VIII    9. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? No problem at all _________ Only a very slight problem _________ Somewhat of a problem _________A very big problem _________ 10. Do you have a bed partner or share a room? No bed partner or do not share a room _________ Partner/ flatmate in other room _________ Partner in same room, but not same bed _________ Partner in same bed _________ 11. If you have a bed partner or share a room, ask him/her how often in the past month you have had……… (a) Loud snoring. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (b) Long pauses between breaths while asleep. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (c) Legs twitching or jerking while you sleep. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (d) Episodes of disorientation or confusion during sleep. Not during the Less than Once or Three or more past month_____ once a week____ twice a week___ times a week____ (e) Other restlessness while you sleep: please describe_________________________
  • A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA  Dr. Kavitha S                                                                                                                                                        IX    ANNEXURE-III DIET CHART Sl. NO. Time Diet 1 6.00 AM One glass of Milk{150 ml} with jaggery. 2 8.00 AM Chapati/poori/Idli/Dosa/UddinVada/Paratha with ghee/wheat upma with Ghee 3 11.00 AM Sugarcane juice/grape juice 4 1.00 PM Shastika Shali rice with curd and curry prepared from fish, prawns, chicken, mutton, Beef, Pork, Basella leaves, onion, Sesamum. Sweet prepared from milk, jaggery, wheat, black gram laddu 5 4.00 PM Sweet Lassi /Sugar cane juice/grape juice/ 6 7.30 PM Chapati or paratha with ghee and curry prepared from fish, prawns, chicken, mutton, Beef, Pork, Basella leaves, onion, Sesamum and Curd. 7 9.30 PM One glass of milk{150 ml } with jaggery