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“Management of Anidra with Nidra caps -

a placebo comparative study”


By

Kamalaxi. M. Angadi
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D.


In

Kayachikitsa
Under the Guidance of

Dr. Shiva Rama Prasad Kethamakka


M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish)

Department of Kayachikitsa
Post Graduate Studies & Research Center
D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2005-2008
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER
GADAG, 582 103

This is to certify that the dissertation “Management of Anidra with Nidra caps - a

placebo comparative study” is a bonafide research work done by Kamalaxi. M. Angadi in

partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka.

Date: Guide
Place: Gadag
Prof. Dr. Shiva Rama Prasad Kethamakka
M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)
Professor in Kayachikitsa
DGMAMC, PGS&RC, Gadag
J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE


POST GRADUATE STUDIES AND RESEARCH CENTER
GADAG, 582 103

Endorsement by the H.O.D, principal/ head of the institution


This is to certify that the dissertation entitled “Management of Anidra with Nidra caps

- a placebo comparative study” is a bonafide research work done by Kamalaxi. M. Angadi

under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm),

C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa in partial fulfillment of the

requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)”

Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka.

(Dr. V. Varadacharyulu) (Dr. G. B. Patil)


Professor & HOD Principal,
Dept. of Kayachikitsa DGM Ayurvedic Medical College,
PGS&RC Gadag
Date: Date:
Place: Gadag Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Management of Anidra with

Nidra caps - a placebo comparative study” is a bonafide and genuine research work carried

out by me under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu)

(Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa, DGMAMC, PGS&RC, Gadag.

Date

Place Gadag

Kamalaxi. M. Angadi
Copy right

Declaration by the candidate


I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or

electronic format for the academic / research purpose.

Date

Place Gadag

Kamalaxi. M. Angadi

© Rajiv Gandhi University of Health Sciences, Karnataka


Abstract of “Management of Anidra with Nidra
caps - A placebo comparative study”
Key words: Anidra, Nidranasha, Insomnia, Nidra cap, Placebo, sleep efficiency, Tamas in

terms of RATR, Somnus Rasayana

Anidra vis-à-vis Primary insomnia is one of the important diseases pertaining to

the Vata disorder affects the people of all age groups. The study objective is – to evaluate

a Nidrajanaka prabhava (sedation) with Nidra caps in comparison to placebo compared.

Simple random sampling technique with comparative clinical trial is adopted here under

two groups to test the significance. Induction of sleep it is said that when the mind gets

exhausted or becomes inactive, the sensory and motor organs become inactive then the

individual gets sleep. Onset of sleep is related to the increases of Tamas always. Here,

tamo-abhava is reticular activity transmission and tamobhava is RATR. When Vata along

with rajas gets increased the above told phenomena will not takes place leading to

Anidra. Here the rational combination Nidra cap is with bhutaghna manasa doshahara

Jatamamsi, vatahara and mastishka shamaka prabhava Tagara, adaptogen and immuno

modulator Ashwagandha and Vata hara and deepaniya Pippali moola are able to act

against the symptoms of Anidra and induces the good sleep. . The parameters show High

significance with Nidra caps as good sedative. Among the subjective and objective

parameters the Nidra cap group shows more High significance than the placebo group

and said to effective. Thus it is fair to conclude the Nidra cap has putative Nidra janaka

prabhava.
Acknowledgement
Any research is not an individual effort. It is a contributory effort of many hearts,
hands and heads. I am very much thankful to the subjects of this study.
I am extremely happy to express my deepest sense of gratitude to my beloved and
respected guide Prof. Dr. K.Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.],
for his guidance and timely help.
I express my gratitude to Dr. V. V. Varadacharyulu Professor and H.O.D for his
advice and encouragement in every step of this work.
I am sincerely grateful to Dr. G. B. Patil, Principal, for his encouragement and
providing all necessary facilities for this research work.
I extend my gratitude to Dr. R. V. Shettar, Dr. G. Purushottamacharyulu, Dr. P.
Shivaramudu, Dr. M. C. Patil, and Late. Dr. Dilip Dr. G. S. Hiremath. Dr. G.
Danappagoudar. Dr. S. H. Doddamani. Dr. Rajashekhar. Dr. S. N. Belawadi. Dr.
Nedugundi, Dr. Samudri, Dr. Kubersankh. Dr. Mulgund. Dr. J. Mitti. Dr. Mulki Patil. Dr.
Yasmin A.P. Dr. B. G .Swami all my U.G. Lecturers for time-to-time help offered.
I express my immense gratitude to my statistician Nandakumar, Tippanagoudar
(Lab), V.B. Mundinamani (librarian) and Shyavi and Kerur for facilitating me in
collection and production of my thesis.
My deep senses of gratification to my inspirations of this study are my husband
Shivanand. B. Manvi and my parents Mallappa. S. Angadi and Neelamma. M. Angadi
who are architects of my career. I am extremely happy to express my deepest sense of
gratitude to my mother-in-law Sharanamma.B.Manvi and my beloved son Bhuvan.
Last but not least I express my deepest thankfulness whose names are not taken
here but helped me a lot along with my kith and kilns to my family members and Dr.
Sanjeevkumar and all my senior and junior friends.

(Dr. Kamalaxi M. Angadi)


Contents of
“Management of Anidra with Nidra caps - a placebo
comparative study”
by
Kamalaxi. M. Angadi

Chapter Content Pages

1 Introduction 1 to 7

2 Objectives 8 to 10

3 Literary Review 11 to 59

4 Methods 60 to 71

5 Results 72 to 95

6 Discussion 96 to 108

7 Conclusion 109 to 111

8 Summary 112 to 114

9 Bibliographic References i to vi

10 Annex 1 – Master Charts Data of trial 1 to 8

11 Annex 2 – Case sheet 1 to 6

-1-
Tables of
“Management of Anidra with Nidra caps - a placebo
comparative study”
SN TITLE OF TABLE PAGE
1 Stages of sleep in the NREM 30
2 Synonyms of Anidra 38
3 Anidra Ahara Nidana 41
4 Anidra Vihara Nidana 41
5 Chikitsa atiyogajanya Nidana of Anidra 41
6 Anidra Manasika Nidana 41
7 Symptoms of Anidra 42
8 Anidra – Samprapti ghataka 45
9 Bahya Upacharas for Nidranasha 47
10 Aahara Upacharas for Nidranasha 48
11 Manasika Upacharas for Nidranasha 48
12 Anya upachara for Nidranasha 49
13 Single drugs useful for Nidranasha 50
14 Distribution of Patients by Age- Gender in Group A & B 73
15 Gender wise Results in Group – A (Placebo cap) 75
16 Gender wise Results in Group –B (Nidra cap) 75
17 Religion wise Results in Group – A (Placebo cap) 76
18 Religion wise Results in Group – B (Nidra cap) 76
19 Occupation wise Results in Group – A (Placebo cap) 77
20 Occupation wise Results in Group – B (Nidra cap) 78
21 Economical status wise Results in Group – A (Placebo cap) 79
22 Economical status wise Results in Group – B (Nidra cap) 79
23 Diet wise Results in Group – A (Placebo cap) 80
24 Diet wise Results in Group –B (Nidra cap) 81
25 Showing chief complaints of Anidra 82
26 Showing Associated complaints of Anidra 83

-2-
27 Showing Mode of onset in Anidra 84
28 Showing Anidra course in study 84
29 Showing Anidra frequency in study 85
30 Showing Anidra duration in study 85
31 Showing Anidra preceding factors in study 86
32 Showing Anidra change of regularities in study 87
33 Showing Anidra Nidana in study 87
34 Showing Anidra Nidra (sleep) Examination in study 88
35 Showing Anidra Results of the Group A (Placebo caps) in study 89
36 Showing Anidra Results of the Group B (Nidra caps) in study 91
37 Subjective Statistical assessment Group-A 92
38 Objective Statistical assessment Group-A 92
39 Subjective Statistical assessment Group- B 92
40 Objective Statistical assessment Group-B 92
41 Comparative Statistical assessment of Both Groups 93
42 Comparative Statistical assessment of Both Groups in % of 94
comparison

Figures and Photos of


“Management of Anidra with Nidra caps - a placebo
comparative study”

SN TITLE OF FIGURES AND PHOTOS PAGE


1 Schematic diagram of Anidra Samprapti 43
2 Ingredients of Trial drug Nidra cap 57
3 Distribution of Patients by Age- Gender in Group A & B 73
4 Gender wise Results in Group – A (Placebo cap) 75
5 Gender wise Results in Group –B (Nidra cap) 76
6 Combined Religion wise Results 77
7 Occupation wise Data of Both Groups 78
8 Economical status wise Data of Both Groups 80
9 Combined Diet data of Group A & B 81
10 Associated compliant in the study 83
11 Results of the Group A (Placebo caps) 90
12 Results of the Group B (Nidra caps) 91

-3-
Chapter – 1
Introduction
Barenked Ladies sung “Who needs sleep?” as -

“Now I lay me down not to sleep

I just get tangled in the sheets,

I swim in sweat three inches deep,

I just lay back and claim defeat…

Lids down, I count sheep,

I count heartbeats,

The only thing that counts is that

I won’t sleep…. My mind is racing,

Filled with lists of things to do

And things I’ve done.

Another sleepless night’s began….”

How the food, water and air are essential for life, like the same sleep i.e. Nidra is also

very much essential. ‘The best bridge between despair and hope is good night’s sleep. Sound

restorative sleep is the foundation of a healthy life. Hence, the Ayurveda explains Nidra as

one among the “Trayo-Upasthambha” i.e. primary tripod of life.

In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a

winding up of the vital clock, a recharging of life’s battery or “Chief nourisher at life’s feast”.

Three sub-pillars are diet, sleep and celibacy. If these three are fulfilled properly, the body is

supported well by these pillars, it continues well endowed with strength, complexion and

developments till the complexion of life span provided one abstains from harmful practices

which will be explained here itself 1.


Management of Anidra with Nidra caps – Introduction 1
Ahara

Ahara, partaking food confers satisfaction and immediate strength supports the

body, increases span of life, radiance, enthusiasm, memory, valiance and digestive

capacity 2. It is a fact that the empty stomach doesn’t give sleep.

Brahmacharya

The end product of ahara rasa is said as the shukra dhatu. Loss of shukra

causes death on the other hand conservation of sukra promotes life. Thus it is said as

the shukra is the bala (strength) for purusha (human) ultimately 3.

Nidra

Sleep enjoyed at the proper time bestows nourishment, good color

(Complexion), and strength, enthusiasm, keenness of digestive power, wakefulness

and maintains normalcy of tissues 4.

Hence, these three trayopasthmbha exhibits their importance in the life and necessity

of the induction or regulation of the Nidra effect to add flavor to the life. As we know that

satisfaction alone is sufficient to have better life thus the satisfaction of the Nidra gives raise

every positive effect to live happy and healthy.

The importance of sleep is well accepted by modern science also, because of its

restorative, recuperative and resting actions to the living organisms. We spend at least 1/3rd of

our lives asleep. Yet little understand why our body requires it or for what reasons nature

often chooses to transform the soothing slumbers of youth into the restless tossing of

maturity. Only for the last half century has this universal subject of human concern or distress

stimulated seriousness and physiologists and neurological physicians to examine its mysteries

and mechanisms.

Management of Anidra with Nidra caps – Introduction 2


Now a day due to altered lifestyles busy schedule and stressful living conditions,

struggle for existence etc, the (sleeplessness) Anidra (Insomnia) became a major problem.

Incidences / Prevalence of Anidra

According to American Association 5 of sleep medicine, Insomnia is “the inability to

fall asleep or to stay asleep; A broader definition of insomnia is difficulty initiating sleep,

difficulty maintaining sleep, early-morning awakening with difficulty resuming sleep or un

refreshing sleep. The subject must also suffer some degree of impairment in social

occupational, or other important areas of daytime functioning.

Now a days about 40% women and 30% men and about 25% of elderly people and

15% of the general population suffer from this altered sleep i.e. insomnia 6.

Nidranasha/Anidra is not discussed as a disease anywhere in the classical texts,


7
mentioned as vataja nanatmaja vikara bears much weight in this regard. The merits and

demerits, classification and the management of insomnia are also dealt along with the concept

of sleep in every Ayurvedic treatise.

Recent researches on Anidra

So far the problem of Nidra, Anidra and the management of Anidra are concerned, it is

surprising, and that research work carried out on this topic is very less 8:

• Dr. Kala Kasliwal (1984), in N.I.A. Jaipur, has carried out the study on Nidra and tried

some Nidra janana drugs to assess their efficacy in inducting the sleep.

• In P.G.T and R.A Jamanagar- Dr.U.D.Joshi (1987) has carried out a study on Anidra,

an etiopathological and manage mental approach.

• Dr. Kavitha Trivedi (1995) has carried out the comparative study of shirodhara and

shirobasti in the management of Anidra.

Management of Anidra with Nidra caps – Introduction 3


• Dr. Prakash. B.(2000) has carried out the management of asvapna (sleep disorders)

with certain indigenous drugs and ashwagandha taila dhara,

• Dr. Muralidhar Pujar carried out a comparative study on Nidranasha/Anidra

Mention of lacunae in current knowledge

The management of Nidranasha/Anidra in contemporary sciences mainly depends on

most commonly available antidepressant drugs, sedatives, tranquillizers and hypnotic drugs.

The drawback with this approach is drug dependence, tolerance towards the drugs and

reoccurrence of the symptoms on withdrawal of the drug. Apart from these internal

medications, counseling, cognitive therapy, physiotherapy and meditation have also been

advised. Still we find no satisfactory and safe measures for Nidranasha/Anidra.

Purpose of the Study

In comparison to the therapeutic procedure of different systems of medicine,

Ayurveda has a very good approach towards the treatment of Nidranasha/Anidra by both

internal and external medications.

The main purpose of the study is to evaluate a medication which doesn’t give any drug

dependence along with tolerance. Chiefly the purpose relays on two areas viz. 1) control of

Vata and 2) correction of Manasa vyakula Bhavas which cause the Anidra. Such medicament

under the principles of Ayurveda based upon the theories and concepts are erected as “Nidra

caps”.

Charaka has mentioned that the controller and stimulant of the mind is Vata. The

Vatahara herbs are said to be the best medicines to induce sleep as they are the Kapha

promoters. The Kapha is of “Tamo” guna, thus the dravyas which are of Kapha in nature offer

better relaxation and induction of sleep.

Management of Anidra with Nidra caps – Introduction 4


Chinta, Shoka, Bhaya, Krodha and other disturbed Manasa bhava, are stressors plays

an important role in causing Anidra. The Nidra cap is designed as cost effective and corrects

the disturbed mental faculties and provoked Vata. Thus pacify all kinds of stressors to achieve

the state of tranquility leading to deep relaxation which helps in the normalization and

stabilization of manasa bhava to make patient healthy and happy.

As the internal medication is concerned a number of herbal preparations and plant

extracts have been used with varying degree of success in the management of

Nidranasha/Anidra. Among them –

1. Tagara 9 (Valerian walichi),

2. Jatamamsi 10 (Nordostachys jatamamsi),

3. Ashwagandha 11 (Withania somnifera),

4. Pippalimoola 12 (piper longum) –

When made as a rational combination induces sleep in a better way making the Dosha

samyata in the body. The rationality of the combination is justified by the rasa, guna, veerya,

vipaka and karma prabhava attributed to the individual drugs with Nidrajanakatwa prabhava

embedded in them.

Hypothesis and Research questions

According Ayurveda sleep is induced by the increase of the inert universal attribute

called Tamas. The term Tamas literally means darkness. Satva, Rajas and Tamas are the three

major or universal attributes that pervade the universe. These three attributes play an

important role in the functioning of the mind, of them rajas and Tamas are the vitiators of

mind (manodosha) because there predominance affects mental diseases.

Management of Anidra with Nidra caps – Introduction 5


Sleep is a periodic functional state of man and higher animals, characterized by

specific changes in vegetative and motor systems by the absence of purposeful activity and

sensory interaction with the environment. Sleep is characterized by the inhibition of conscious

mental activity.

Onset of sleep is related to the increase of Tamas and Kapha. Both these principles

effect inertia, sleep usually occurs at night as the surroundings are dark and are predominated

by Tamas. This dark environment naturally increases the Tamas in human beings according to

the theory of generality.

During night the biological channels are blocked by Kapha. The sensory and motor

faculties are fatigued by day’s work. The fatigued faculties become sluggish in their work and

will loose their activity. Considering the physical plane, the humor Kapha i.e. responsible for

conservation of energy has a role in inducing sleep, Kapha is stable and sluggish. Increase of

satva is conducive to mental health, rajas represents action.

They gradually withdraw from their objects. The functions of the mind also are

blocked by the increase of Tamas. Mind gets detached from the faculties and its action of

enjoying the faculties ceases. This stage is called sleep, even in sleep mind maintains its

connection with the soul.

The hypothesis is made on the basis of Vata shamaka in terms of controlling the mind

through its functions. The present medicine acts as Vata shamaka in terms of regulating the

mind thus sleep is induced by initiating the Tamas. The important factor responsible for

reduction of sleep has been shown to be the fatigue of neuromuscular function which in turn

unable to pass on proprioceptive impulses may be the Tamas. The action of the trial drug is

Management of Anidra with Nidra caps – Introduction 6


compared to the placebo, to rule out the psyche involvement in induction of sleep. At this

juncture many questions are raised such as -

1. What is the Tamas which induces the Nidra in living beings?

2. How Rajas and Tamas disturb the mind to induce Anidra?

3. How Vata is responsible for disturbing the inhibition of conscious mental activity i.e.

sleep

4. What is the role of Kapha in sleep?

The search for the answers are made at this study named as – “MANAGEMENT OF

ANIDRA WITH NIDRA CAPS - A PLACEBO COMPARATIVE STUDY”, under the

headings of Introduction, Objectives, Literary study, Methodology, Results, Discussion and

Conclusion along with necessary documents and appendices attached.

Management of Anidra with Nidra caps – Introduction 7


Chapter – 2
Objectives

Today’s man has become a tired and chronically sleep-deprived generation.

Technology and the industrial revolution is one of the biggest factors. People live in a fast-

paced, high-tech world that operates 24 hours a day. Working fields like a myriad of

businesses and services are accessible around the clock. Television, radio and movie channels

broadcast day and night. To cope up such conditions occurring around the clock, people work

long hours and something must be sacrificed. Unfortunately sleep is a very common thing to

sacrifice. Consequently, insomnia has spread up very widely like other harassing diseases.

Insomnia has a great impact on social, occupational and other functioning areas of the

individual. The modern medical science is still not having a definite treatment for this disease.

Although, hypnotics and sedatives are there in all the prescriptions of psychiatrists and in

maximum prescriptions of general practitioners their role in curing the disease is very limited

rather the patients will be addicted for the particular drug.

There comes the relevancy of our Ayurvedic principles for the treatment, which

reveals that the medicine or treatment that cures one disease and creates some other is not a

good therapy, but the therapy which cures one disease and does not create any other, is the
13
right treatment . Hence, here a humble attempt had been done to give an effective

management process for the disease Anidra.

Management of Anidra with Nidra caps – Objectives 8


Aims & Objectives

1) To evaluate the Nidrajanaka prabhava (sedation) of Nidra cap in Anidra

Dosha involvement in Anidra is Tridosha with predominance of Kapha. But

the deviations from the normalcy of Dosha are to be considered with due importance.

Vata and Pitta are in increased state, while in case of Kapha, the diminished is

observed usually. As in Anidra, mainly Vata Prakopa occurs due to its Chala and

Laghu Guna vitiate, thus keeps the mind active, causing Anidra.

The ingredients of the Nidra capsules are with Vata Dosha hara action having

snigdha guna, ushna veerya, with the sedative and hypnotic action, otherwise

understood as the Tamas initiation. By observing all these characteristics of medicine,

Nidra caps, it seems to be very much beneficial in the management of Anidra for

obtaining the requisite results, viz. induction of Tamas, initiation of sedation, relaxing

the body mind, etc.

2) To evaluate the Nidrajanaka prabhava (sedation) of placebo in Anidra

Anidra is one of the pshyco-somatic disease condition, many a times, the

anxious or phobic or even depressive patients, respond to the placebo. Thus the

placebo is responsible for many temporary successes in therapy acting on the mind. As

we know that many times placebo is used to understand the differentiate phenomenon

of the psyche physical disturbances, with good success of specifying the relief of the

problem, for a comparison to understand the Nidra cap efficacy, the placebo sedation

effect is undertaken as one of the objective. Hence, taken comparative study to

evaluate the effect of Nidra cap is justifiable.

Management of Anidra with Nidra caps – Objectives 9


3) To compare the Nidrajanaka prabhava (sedation) of placebo and Nidra cap in

Anidra

The study is incomplete if a comparative clinical Trial of sleep inductive effect

of the Nidra caps internally to pacify the Dosha in Anidra and placebo to overcome the

psychosomatic origin of the disease Anidra is not compared. Thus the trial is

compared at the clinical efficacy with respect to the subjective and objective

parameters chosen. At this attempt the group-A and group-B designated with

respective medicaments of Placebo and Nidra caps, are observed for the efficacy of

nidrajanaka prabhava (sedation) effect drawn in the comparative statement.

Management of Anidra with Nidra caps – Objectives 10


Chapter – 3
Literary Review
In fact, Nidra looks like a glimpse of Pralaya, which carries peace but in darkness.

After this glimpse of Pralaya – man awakens fresh like Srujana. For the living beings in the

world, it is an essential phenomenon for maintenance and restoration of both – body and

mind.

Since the dawn of the civilization the thinkers of the world tried to study the sleep, its

nature and causes. In India, from the Vedic and Upanishad period, the Yogis have studied the

Yogic phenomena pertaining to various stages associated with Atma. They have termed these

stages as Jagritavastha (waking state), Svapnavastha (dream state), Sushuptavastha (sleep

state) and Samadhi Avastha (the conscious sleep phase having Detachment from the external

world in different degrees).

IMPORTANCE OF SLEEP

Ahara, Nidra and Brahmacharya are the three factors, which play an important role in

the maintenance of a living organism. In the Ayurvedic literature, these factors i.e. Ahara,

Nidra and Brahmacharya have been compared with the three legs of sub-support and have

been termed as the three Upastambhas 14.

The inclusion of Nidra in the three Upastambha proves its importance. While

discussing about Nidra, the ancient Acharyas have stated that happiness and sorrow, growth

and wasting, strength and weakness, virility and impotence and the knowledge and ignorance

as well as the existence of life and its cessation depend on the sleep 15.

According to Kashyapa, getting good sleep at a proper time is one of the


16
characteristics of a healthy man . The importance of sleep for health and recovery from

diseases has been recognized intuitively if not scientifically in the modern texts; nearly all
Management of Anidra with Nidra caps – Literary Review 11
doctors recommended that their patients should get plenty of rest and their advice is followed

because that is just what patients want to do whether such sleep does have any adoptive value

is, however, unknown. Many disorders are associated with abnormal patterns of sleep. Some

important findings of sleep are listed below: Sleep is one of the factor upon which the pattern

of GH secretion is dependant. (Factors are stage of development, nutritional state, sleep stage,

stress and exercise.) Secretion is enhanced by sleep with levels highest during slow-wave

sleep and lowest during REM sleep. Oxygen consumption is lower during sleep, facilitating

an anabolic process. Physiological activities (e.g. exercise) and pathological disorders (e.g.

hyperthyroidism), which lead to increased catabolism are associated with increased slow-

wave sleep. Reduced activity and metabolic turnover (e.g. paraplegia and hypothyroidism) are

associated with decreased slow-wave sleep. Hormones that inhibit anabolic processes (e.g.

corticosteroids, adrenaline and noradrenaline) are inhibited during sleep.

Etymological derivation of Nidra

The word Nidra is feminine formed by the prefix ni+dra+rak+ta. This is a state of

nature which causes encapsulation to the consciousness of a person 17.

Definition

Ever since modern people are unable to define it accurately from the time it is a

question in every mind that what is sleep, how it occurs and what is its role in health. But the

great sages of India had the perfect knowledge regarding the sleep. The definitions are as

follows -

1. Sleep is the mental operation having the absence of cognition for its grasp. Vyas while

commenting Patanjali Yoga darshana made a statement as – “sleep is a state of

unconsciousness, but the consciousness remains about his own unconsciousness 18.

Management of Anidra with Nidra caps – Literary Review 12


2. According to Mandukya Upanishad Nidra is a condition in which ‘Atma’ does not

have any dream or desire for anything and that state is called ‘susupti” 19.

3. Chhandogya upanaishad states that “the state in which the mind is unaware about

surroundings or will not have any dream is termed as sputa or Nidra 20.

4. Nidra is defined as the temporary loss of contact with Jnanendriya and Karmendriya to

the manas 21.

5. Charaka affirmed that when the mind (as well as soul) gets exhausted or becomes

inactive and the sensory and motor organs become inactive then the individual gets

sleep 22.

6. Susruta described the sleep occurs when the Hridaya the seat of chetana is covered by

Tamas 23.

7. Dalhana the commentator of Susruta states that Nidra is the state of combination of

mind and intellectual in which the person feels happy 24.

8. Astanga sangraha Vagbhata stated that - the manovaha srotas become accumulated

with sleshma and mind is devoid of sense organs because of fatigue, when individual

fell asleep 25.

9. Sharangadhara mentions that Nidra is a state where predominance of Kapha and

Tamas is witnessed 26.

10. Adhamalla defines that the Nidra is a state in which the tamoguna combines with

Kapha where mohavastha of indriya and mana is observed 27.

Phenomena of Nidra

There is a natural relation of sleeping and waking during 24 hrs. The sleep comes

naturally during the night but it is not necessary consequence of darkness, as is proved by

Management of Anidra with Nidra caps – Literary Review 13


those persons who have to work in night sleeps in the day and readily adopt themselves to this

condition.

Authors of ancient Hindu literature made crystal clear explanations regarding the

physiology of sleep. They explained it in different ways according to their working field and

conceptualized. These explanations regarding the phenomena of Nidra may be summed and

classified under four groups -

1. Theories of Upanishad

2. Theories of Yoga

3. Theories of Ayurveda

4. Contemporary concepts developed

1) Theories of Upanishad
28
a) Ancient seers of Chandyogyopanishad stated that the Atma moves from

Hridaya through the nadis and gets lodged inside the membranous sac

around the Hridaya, then the sleep is induced.

b) Brihadaranyakopanishad 29 explains that the Nidra occurs when Atma goes

into rest in space in side the Hridaya

2) Theories of Yoga

The yogic philosophers have made a clear explanation regarding sleep resembles as

Samadhi state which is entirely different from it. They studied ‘Yoga Nidra’ pertaining to

various states associated with Atma.

They have termed these states as

™ Jagratavastha – waking consciousness

™ Svapnavastha – dreaming

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™ Susuptavastha – dreamless sleep

™ Turiyavastha – conscious dreamless sleep


30
Maharshi Patanjali states that the Sleep is a state in which all activities of thought

and feeling come to an end. In sleep the senses of perception rest in the mind, the mind in the

consciousness and unconsciousness in the being. In deep sleep, the senses of perception cease

to function, because their king, the mind, is at rest.

3) Theories of Ayurveda

a) Tamo prabhava theory

According Susruta 31, the sleep is induced by the increase of the inert universal

attribute called Tamas. The term Tamas literally means darkness. Satva, Rajas and

Tamas are the three major or universal attributes that pervade the universe. These

three attributes or dimensions play an important role in the functioning of the mind

and even body, of them rajas and Tamas are capable to vitiate mind (Manas). Because

of their predominance’s affects and afflicts the mind the mental diseases are resultant.

On the other hand the satva increase can cause the conductive to mental health and

Rajas which represents in action.

Onset of sleep is related to the increases of Tamas always. These said

principles affect inertia on general. Sleep usually occurs at night as the surroundings

are dark and are predominated by Tamas. This dark environment naturally increases
32
the Tamas in human beings according to the theory of generality . Apart from this

the bioelectrical cells, which are in the body, sustain the energy for activity in the day

light by getting charged through Sun light. At the night the Human is the only capable

to generate Bioelectricity through the activity of digestion (Jatharagni). At the

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darkness the person reserves the energy and wish to retire as the activities are

restricted and energy levels are inhibited.

b) Theory of Klama (Fatigue)

The sensory and motor faculties are fatigued by day’s work. The fatigued

faculties become sluggish in their work and will loose their activity. They gradually

withdraw from their objects. The mind functions are also blocked by the increase and

influence of Tamas. Mind gets detached from the faculties and its action of enjoying

the faculties ceases. This stage is entitled as sleep. But even in the sleep also mind

maintains its connection with the soul, as it is “Ubhayendriya” – dualistic organ 33.

c) Theory of Swabhava Nidra

Sleep is a natural function of Tamas where in both satva and rajas acts against

the sleep induction. Apart from sleep Tamas causes of fear, ignorance, depression and

laziness also. Satva represents cognition and enlightenment. It is the cause of

awakening: Nevertheless sleep is included among any natural diseases. Hence, the

Satva is against the ignorant and inert sleep. Rajas on par with satva represent action

and hence, it is also a factor against to sleep induction, where the physical and mental

activities are subdued or restrained 34.

d) Kapha Dosha theory

Kapha is said as the strength of the living being. Such Kapha when obliterates

the channels because of the over activity of the body the mind withdraws from the

sensory activities and induces the sleep as physical rest to the body. Such Nidra also

associates with the Tamas to fulfill the sound sleep 35.

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4) Contemporary Concepts of Sleep

Sleep remains one of the great mysteries of modern neuroscience. We spend nearly

one-third of our lives asleep, but the function of sleep still is not known. Fortunately, over the

last few years’ researchers have made great headway in understanding some of the brain

circuitry that controls wake-sleep states, but no single explanation can accepted as the final

word for the understanding of physiology of sleep 36. The views regarding the phenomenon of

the sleep throw light upon the phenomenon occurring during the rest and refreshing effect.

1) Vascular Theory:

Probably the oldest theory is that sleep is induced by a reduction

in the blood supply to the brain or at least to the conscious centers. This

is the so-called ischemic theory.

2) Pavlov’s Theory:

As a result of his study of conditioned reflexes in dogs, Pavlov

proposed a theory for sleep, base upon the cortical inhibition caused by

the repeated elicitation of a conditioned response without

reinforcement. The condition inhibition slowly spreads the entire cortex

that causes sleep.

3) Chemical Theory:

Some have favored the chemical theory. According to this

concept some chemicals, like lactic acid, acetylcholine, bromide or

specific fatigue toxins were supposed to accumulate during the waking

hours which irritates the nerve cells of brain and causes sleep as a

result.

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4) Kleitman’s Theory:

Sleep is caused due to reduction of the muscle tone and

discharge of less afferent impulses, thereby, keeping the cerebral cortex

inactive.

5) Oxygen Theory:

Explains sleep depends upon the utilization of oxygen.

Whenever brain utilizes less oxygen, at that time sleep is taking place.

6) Hypothalamus Theory:

This theory states that there is a sleep center in the

hypothalamus. The stimulation of which is responsible for sleep. To

explain this some experiments were carried out.

7) Parasympathetic Theory (Acetylcholine Theory – Dixit):

The depression of the sympathetic center is stated to be

responsible to inducing the sleep and as such sleep is regarded as a

parasympathetic function.

8) Lactic Acid Theory:

Sleep is supposed to be caused due to accumulation of lactic

acid in the nervous tissues.

9) Serotonin Theory:

The most conspicuous stimulation area for causing almost

natural sleep is the raphe nuclei in the lower half of pons and in the

medulla. Nerve fibers from these nuclei spread widely in the reticular

formation and upward into the thalamus, neocortex, hypothalamus and

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most areas of the limbic system. Ending of these nerve fibers secrete

serotonin. It has been assumed by the experiment that serotonin is a

major transmitter substance associated with production of sleep 37.

10) Neuronal Centers theory 38

Stimulation of some areas in the nucleus of tractus solitarius

(the sensory region of the medulla and pons) – also promotes sleep.

These regions perhaps act by exciting the raphe nuclei and serotonin

system. Stimulation of several regions in the diencephalon can also

help promote sleep, including –

a) The rostrum part of the hypothalamus, mainly in suprachiasmal area

and

b) An occasional area in the diffuse nuclei of the thalamus.

Types of Nidra

Ayurveda has different opinions regarding the types of sleep. Basically Nidra can be

classified into type’s viz. Svabhavika (natural) and Asvabhavika (abnormal). Out of the

former Svabhavika Nidra is regularly every night, which offers beneficial effects for the

living beings, whereas the later Asvabhavika is one can be due to different causes of

pathological in origin.

1) Charaka classification of Nidra 39

Charaka classifies the sleep condition into seven folds. He agrees with the ancient

authors who considered the sleep is Bhutadhatri. Sleep comes at night, spontaneously and

regularly as a natural instinct and that the other categories were either due to sin or the

disease. The seven types described by Charaka run as under -

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1. Tamobhava Nidra

2. Sleshma Samudbhava Nidra

3. Manah Shrama Sambhava Nidra

4. Sharira Shrama Sambhava Nidra

5. Agantuki Nidra

6. Vyadhyanuvartini Nidra

7. Ratri Svabhava Prabhava Nidra

Brief descriptions of said Charaka types of Nidra are elaborated is as follows -

a) Tamobhava Nidra:

Generally the sleep is due to the effect of Tamas, but the Tamobhava Nidra as

particularly due to the excessive Tamas causing sleep. When Satva and Rajasa are

diminished in excess and the seat of Atma and Mana i.e. Hridaya is covered by the

vitiated Tamas, then the organization become inert or inactive.

According to some scholars, the Tamodbhava Nidra resembles with Sanyasa

condition described by Charaka, which is the comatose state. The sleep caused by

Tamas is also the root cause for all sinful acts.

Tamas always causes excessive sleep. Thus, the individual is unable to perform

the virtuous files and so he subjects himself to sinful behavior.

b) Sleshma Samudbhava Nidra:

Sleshma is the material state of Tamas and as such the Sleshma and the Tamas

are having identical properties. When the Sleshma increases in the body the sleep

ensues. Therefore, it is called Sleshma Samudbhava Nidra.

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c) Manah Shrama Sambhava Nidra:

The person also gets the sleep as the result of exertion. Due to excessive

mental stress and strain, the mind gets tired and unable to perform its activities; as a

result the animal gets sleep.

d) Sharira Shrama Sambhava Nidra:

The person also gets the sleep due to physical exertion. When a person

indulges in excess physical activities he feels too much tired. The body and mind

desire to take rest and agitate to work further and the person gets sleep.

e) Agantuki Nidra:

Sometimes the cause of sleep remains obscure and the cause is not explainable.

However, the sleep is followed by the death and as such Chakrapani has termed this

sleep as a death signal (Arishta) 40.

f) Vyadhyanuvartini Nidra:

There are some diseases like Sannipata Jwara where severe weakness of the

patient and follows the condition just similar to coma. This type of sleep is termed as

Vyadhyanuvartini Nidra.

g) Ratri Svabhava Prabhava Nidra:

As has been stated earlier the sleep is a natural phenomenon and it comes at a

particular time cyclically in the night. There is no specific or particular reason for this
41
kind sleep and it is termed as Bhutadhatri . It has been observed that even the

individual who has slept during the daytime would also feel sleepiness in the night,

which is quite a natural phenomenon.

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2) Susruta classification of Nidra
42
Susruta described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi

and Vaikariki Nidra. The detailed description is as follows.

a) Vaishnavi or Svabhaviki Nidra:

Svabhaviki Nidra is caused due to the Maaya or illusionary effect

attached to the power of Vishnu Maaya. Here, Maaya is a desire of the Manasa

to get detached from the worldly sensory objects on account of the tiredness of

Manasa; and the seat of Manasa and the Sleshma and Tamas cover Atman.

This mostly happens in the night and individual gets sleep. The Tamoguna

dominant persons may go to sleep at any time i.e. day or night. But a person

having Rajoguna in excess may get sleep sometimes in the day or in the night,

because of Chalatva of Rajasa. The person having qualities dominated by

Satva Guna sleeps at the midnight, because, at this time Tamas is excess and

Satva will be decreased (Dalhana). The term Papma has been used to describe

the Tamobhava of Nidra and also to mention the sinful activities.

b) Tamasi Nidra:

It is the lack of consciousness preceding the death. Tama dominant

Kapha induces this due to the blockage of Sanjnavaha Srotasa, and this Nidra

cannot awaken individual.

c) Vaikariki Nidra:

This is a condition of insufficient sleep due to the decrease of Kapha

and increase of Vata and also due to mental and physical pain, distress etc. the

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2,3
person doesn’t enjoy the sufficient and sound sleep in quantity and quality .

Disturbed sleep is also a type or Vaikarika Nidra.

3) Vagbhata classification of Nidra


43
Astanga Sangraha Vagbhata followed the Charaka’s view with a slight change in

the names. He also mentioned seven types. The commentator Indu opined that the Tamobhva

is Antya i.e. comes at the time of death and Agantuka means Shastra Praharadina (due to

injury) and considered these are due to Vyadhis.


44
Astanga Hridaya Vagbhata considered only four types of Nidra and included the

all seven types in this viz. Akala sevitha, Ati prasangath sevitha, Nacha sevitha and

Nishevitha. The commentator Hemadri considered them as – The properly taken sleep brings

happiness, nourishment, strength, virility, knowledge and life to the individual. The

improperly taken other three types may kill the individual like the Kalaratri, who killed all

demons.

Instead of above seven fold classification we can make three types of classifications in

terms of Tamas. As we seen that sleep is due to manodosha Tamas, but here Tamas means not
45
alone, the other manasika doshas are there i.e. according to Charaka vimansthana Dosha

anubhandhya anubhandha concept the Nidra can be made into mainly three types.

™ Tamasika nidra

™ Rajayukta tamasika nidra

™ Satvayukta tamasika Nidra


46
According to Susruta another sets of Nidra viz. Tamasika Nidra is sleeps

both day & night, Rajayukta tamasika Nidra get sleeps either in the day or night and

Satvayukta tamasika nidra sleep at midnight.

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Sleep and immunity

There is much evidence to support the theory that sleep is a period of growth and

anabolic activity but little about the role of sleep in recovery from illness. Excessive sleep,

sleepiness fatigue and fever are symptoms of nearly all infections diseases and chronic

inflammatory disorders. Fever probably protects during illness, but the effects of sleep are m

ore difficult to measure.

Many processes could contribute to the link be in sleep and immune response. For

example the circadian release of melanotonin during the night is thought to counteract the

immuno-suppression association with glucocentricoids, melatonin is known to regulate both

the release of uptokines and cell mediated immunity.

Several molecules play a part in the regulation of sleep and immune processes

muranyl peptides that are produced by macrophages from phagocytosed bacterial cell walls

and certain viral products also increase the length of sleep and the production of modifiers of

the immune response, one class of that is called cytokines. Cytokines are concerned with the

amplification, coordination and regulation of the immune response. Specific ccytokines

known to effect sleep include interleukin L-alpha, interleukin l-beta, tunor necrasis factor and

interferon – alpha.

Though the studies regarding the close association between sleep and immune

regulation are carried out, further elucidation is required to prove this any how rest is part of

the host’s defense against infection 47.

Nidra as Rasayana

In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a

winding up of the vital clock, a recharging of life’s battery and “Chief nourisher at life’s

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feast”. Rasayana 48 (Achara) gives rise regularized sound sleep and vice versa the regularized

sleep patterns induce Rasayana effect. Health is a first muse and sleep is the condition to

produce it. The goal of the Ayurvedic approach is to create more potent individuals through

increased Ojas (immunity), which is the finest end product of digestion & metabolism that

provides energy, enthusiasm, happiness, clarity of thinking, better coordination between the
49
body and mind . Only the sound most restful (stage IV) sleep generates Ojas. A sound

quality sleep provides ultimate rest to the mind and senses, with enhanced capacities of

mental and physical work ability for the next day. On the other hand, lack of sleep vitiates &

initiates Vata, Ama (endo toxins), etc in the body.

Total Body Restoration:

The hypothesis is that sleep is a process by which the whole body may be restored.

This theory is based on an accumulation of evidences. The consumption of oxygen is lowest

during slow wave sleep. Though the process of catabolism and anabolism are continuous, the

relative rates vary according to whether the subject is awake or asleep, and it has been shown

that the rate of anabolism is at its peak during sleep.

Growth hormone is released mainly at night, also in association with slow wave sleep

and also treatment of short stature by growth hormone is more effective if given at night.

Further more, cell mitosis is at a peak during sleep 50.

It has been postulated that slow wave sleep being more important for macromolecular

synthesis and REM sleep for removing the synthetic products of slow wave sleep to maintain

synaptic connections which is necessary to maintain cognitive function (ABC of Sleep

Disorders) 51.

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Brain Restoration: 52

Some research workers have postulated that it is the brain not the body that

recuperates during sleep and that sleep counteracts the effects of the metabolism of the brain

during the day. They also claim that the exercise included increases in slow wave sleep can be

explained by an increase in brain temperature and metabolism and alter sleep deprivation it is

psychological rather than physiological deficits that are most apparent. This emphasizes that

restorative function is central rather than general.

No one hypothesis completely explains the complexities and vagaries of sleep, but

taken together may form the foundation of the explanation for the indisputable need for sleep.

Nidra and prakriti

Individuals vary sleep with the prakriti i.e. personality and vayah (age factor). The

sleep requirement differs with relation to either psychological or somatic personalities. The

sleep according to prakriti is classified into two groups’ -

a) According to Deha prakriti and

b) According to manasa prakriti.

a) Nidra - Deha prakriti

The sleep is produced by tamoguna and sleshma so according to the prakriti of a

person the quality and quantity of sleep varies. An individual of Kapha prakriti gets more

sleep which is sound also, while a person of Vata prakriti gets less sleep is related to the age

or vayah. In balyavastha, Kapha is predominant, so child sleeps more time than the youth. In

vriddhavastha, Vata is predominant, so the old aged gets very less sleep. Apart from the deha

prakriti some naturally get less sleep 53.

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b) Nidra - Manasa prakriti:
54
Susruta described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi

and Vaikariki Nidra.

1) Svabhaviki Nidra:

Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the

power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached from the

worldly sensory objects on account of the tiredness of Manasa; and the seat of Manasa and the

Sleshma and Tamas cover Atman. This mostly happens in the night and individual gets sleep.

The Tamoguna dominant persons may go to sleep at any time i.e. day or night. But a person

having Rajoguna in excess may get sleep sometimes in the day or in the night, because of

Chalatva of Rajasa. The person having qualities dominated by Satva Guna sleeps at the

midnight. Because, at this time Tamas is excess and Satva will be decreased (Dalhana)

The term Papma has been used to describe the Tamobhava of Nidra and also to

mention the sinful activities.

2) Tamasi Nidra:

It is the lack of consciousness preceding the death. Tama dominant Kapha induces this

due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individual.

3) Vaikariki Nidra:

This is a condition of insufficient sleep due to the decrease of Kapha and increase of

Vayu and also due to mental and physical pain, distress etc. the person doesn’t enjoy the
2,3
sufficient and sound sleep in quantity and quality . Disturbed sleep is also a type or

Vaikarika Nidra.

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Nidra and kala
55
Manu the great law maker has described the divisions of time, and then has

remarked that the thirty muhurta period (24hours) is divided by the sun into day and night, the

day being intended for the activities and the night designed for the rest and repose.

Naturally the night is described as a proper time for sleep. The person should not

awake at night and should not sleep in day time because both are Dosha prakopaka. It is

advised to take sleep avoiding at the first and last parts of night. As the sleep is one among
56
five varjyas of sandhya kala, if taken the person becomes needy or sparse . As it is well

known concept that early morning awakjening is good for health and also to get Bramhajnana.

Relationship between the Nidra and Dosha – Dhatu – Malas

By the previous descriptions regarding sleep it is very clear that sleep is having

important role in the maintenance of equilibrium of body. As Nidra is said to be Kapha

dominant process, it also maintains the equilibrium between three humors. In Ayurvedic

classics, it is mentioned that in the kaphaja vikaras, Nidra and tandra are commonly seen and

in vataja vikaras sleeplessness occurs and in pittaja vikaras lack of sleep is one of the

symptoms 57.
58
The equilibrium of the dhatus also depends upon the sleep. Charaka and Susruta59

have stated that by means of proper sleep the dhatusamya, the nourishment of the body, the

increase of strength and the stability of life are achieved. When the decrease of Rasa Dhatu

occurs, the sleep is diminished and the dhatus get proper nourishment again only when the

proper sleep is enjoyed. By the proper sleep the digestion power is properly mentioned and

the Agni functions remain normal. The evacuation of the bowel and the emptying of the

urinary bladder take place properly, if a person has slept well.

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The bad habits of waking at night and sleeping at day time have been stated to

provoke all the three doshas.

Karma of Nidra at different dhatu level

• Rasa – pushti and varnaprada


• Rakta –varna, agnidipti
• Mamsa –pushti and bala
• Meda –attractiveness (shriman)
• Asthi –bala
• Majja –varna, utsaha
• Ojas –jivana
• Manasa – gyana, and sukha
STAGES OF SLEEP

During each night, a person goes through stages of two types of sleep that alternate

with each other. The EEG (Electro encephalogram), EOG (Electro occulogram), EMG

(Electro myogram) can be conveniently record during the sleep by fixing small silver

electrodes to the scalp and to the face before the subject goes to sleep. EOG reveals the

eyeball movements while EMG indicates the tension of the muscles. Based on these records

two kinds of sleep classified are -

1) Non Rapid Eye Movement Sleep (NREM)

2) Rapid Eye Movement Sleep (REM)

NREM Sleep:

In NREM type of sleep the brain waves are very slow, so it is also called slow-wave

sleep. This sleep is exceedingly restful and is associated with decrease in peripheral vascular

tone and many other vegetative functions of the body.

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Characteristics of NREM Sleep:

Most sleep during each night is of slow-wave variety and it is deep, restful type of

sleep. NREM sleep is composed of four stages. (75 percent in young)

Table – 1
Stages of sleep in the NREM
Stage I Stage II Stage III Stage IV

5% 45% 12% 13%

™ NREM sleep is a peaceful state relative to waking. Because the decrease of pulse rate,

respiratory rate, blood pressure, basal metabolic rate is seen in this state.

™ The deepest portion of NREM sleep (stage III & IV) is sometimes associated with

unusual arousal characteristics. The organization during arousal during stage III or IV

may result in specific problems including enuresis, somnambulism and stage IV

nightmares or night terrors.

™ NREM sleep is frequently called ‘dreamless sleep’, but dreams do occur during it.

These dreams are not usually remembered whereas those of REM sleep are likely to

be remembered 60.

REM sleep (Paradoxical Sleep, Desynchronized Sleep): 61

REM sleep is a qualitatively different kind of sleep characterized by a high level of

brain activity and physiological activity levels similar to those in wakefulness. In a normal

night of sleep, bouts of REM sleep lasting 5 to 30 minutes usually appear on the average

every 90 minutes, the first such period occurring 80 to 100 minutes after the person falls

asleep. When the person is extremely sleepy, the duration of each bout of REM sleep is short

and even may be absent.

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Characteristics of REM Sleep

™ It is usually associated with active dreaming.

™ The person is even more difficult to arouse by sensory stimuli than during deep slow-

wave sleep and yet people usually awaken in the morning during an episode of REM

sleep, not from slow-wave sleep.

™ The muscle tone throughout the body is exceedingly depressed, indicating strong

inhibition of the spinal projections from the excitatory areas of the brain stem.

™ Probably the most distinctive feature of REM sleep is dreaming. The heart rate and the

respiratory rate usually become irregular, which is characteristic of the dream state.

™ Despite the extreme inhibition of peripheral muscles, a few irregular muscle

movements occur. These include, in particular, rapid movements of the eyes.

™ The brain is highly active in REM sleep and the overall brain metabolism may be

increased as much as 20%. This type of sleep is also called paradoxical sleep because

it is a paradox that a person can still be asleep despite marked activity in the brain.

However, the brain activity is not channeled in the proper direction for people to be

fully aware of their surroundings and therefore to be awake.

EEG Changes in Different Stages of Wakefulness & Sleep:

Alert wakefulness is characterized by high frequency β waves, whereas quiet

wakefulness is usually associated with α waves. Slow-wave sleep is divided into four stages.

In the first stage of slow-wave sleep, the voltage of the EEG waves becomes very low; this is

broken by “sleep spindles”, that is, short spindle-shaped bursts of α waves that occur

periodically. In stages II, III and IV of slow-wave sleep, the frequency of the EEG becomes

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progressive slower until it reaches a frequency of only 1 to 3 waves per second in stage IV,

these are typical δ waves 62.

It is often difficult to a difference between REM sleep brain wave pattern and that of

alert awake person. The waves are irregular high frequency β waves which are suggestive of

excess but desynchronized nervous activity as found in the awaken state. Therefore, REM

sleep is frequently called desynchronized sleep.

PHYSIOLOGY OF SLEEP

When Manas is exhausted then sleep occurs this phenomenon can be understood in

this manner. According to Howell, sleep is due to cerebral ischaemia. Cerebral cortex is the

seat of higher centers like pre and post central gyrus, association area etc., which have the

correlation with mental activities described in Ayurveda. So due to the reduction in cerebral

blood supply Manas becomes Klanta that causes sleep 63-64.

Further, during sleep, Indriyas (both Jnanendriya and Karmendriya) become inactive

by the detachment from their sense organs or from their work. Kleitman explains that due to

reduction of muscle tone and discharge of less afferent impulses, the cerebral cortex remains

inactive. This can be interpreted in the terms of ‘Guru’ and ‘Varanaka’ properties (according

to Sankhya theory) of Tamas. Fatigue of the muscles with consequent reduction of

transmission of afferent impulses to the cerebral cortex and thereby keeping it inactive seems

to be a possible factor in the production of sleep 65-66.

HOW SLEEP IS REGULATED

During wakefulness, the brain is kept in an alert state by the interactions of two major

systems of nerve cells, in the upper part of the pons and in the midbrain, which makes

acetylcholine as their neurotransmitter, sends inputs to the thalamus, to activate it. It in turn

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activates the cerebral cortex, and produces a waking EEG pattern. However, during REM

sleep the cholinergic nerve cells and the thalamus and the cortex are in a condition similar to

wakefulness but the brain is in REM sleep. The difference is supplied by three sets of nerve

cells in the upper part of the brain stem: nerve cells that contain the neurotransmitter a)

norepinephrine b) serotonin and c) histamine. These monoamine neurons fire most rapidly

during wakefulness, but they slow down during slow wave sleep, and they stop during REM

sleep.

The brain stem cell groups that control arousal are in turn regulated by two groups of

nerve cells in the hypothalamus. One group of nerve cells, in the ventrolateral preoptic

nucleus, contains inhibitory NT (neurotransmitter), galanin and GABA. When the

venterolateral pre-optic neurons fire, they are thought to turn off the arousal system, causing

sleep, damage to the ventrolateral preoptic nucleus produces irreversible insomnia (Anidra). A

second group in the lateral hypothalamus acts as an activating switch. They contain the NT

orexin and dynorphin, which provide an excitatory signal to the arousal system, particularly to

the monoamine neurons. Recent studies show that in humans with narcolepsy, the orexin

levels in the brain and spinal fluids are abnormally low. Two main signals control this

circuitry. First, there is homeostasis. There is an intrinsic need for a certain amount of sleep

each day. Some people think that a chemical called adenosine may accumulate in the brain

during prolonged wakefulness, and that it may drive sleep homeostasis. The other major

influence on sleep cycle is the body’s circadian clock, the suprachiasmatic nucleus. These

nerve cells in the hypothalamus contain clock genes, which go through a biochemical cycle of

almost exactly 24 hours, sleep, hormones and other bodily functions. The suprachiasmatic

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nucleus provides a signal to the ventrolateral preoptic nucleus and probably the orexin

neurons 67.

The Depth of Sleep:

The depth of sleep is not constant throughout the sleeping period, but varies from hour

to hour. Experiments upon man in which auditory stimuli were employed to arouse the subject

at different time or in the movements of the sleeper were recorded indicate that the depth of

sleep follows a characteristic curve. In most adults sleep deepens rapidly to the end of the first

hour, after which it lessens sharply for a time, and then more slowly till the time of waking.

Generally, sleep taken during the daytime is lighter than that during the night. Deep sleep is

dreamless, dreams occur only during light sleep and chiefly in the period, which just precede

waking. In sleep, unconsciousness is not uniform for all senses; the depth of sleep is greatest

for the sensations of smell and least for those of pain, hearing and touch. The sleep

requirement of different persons varies widely; it also alters with age. The following are

average figures for the hours of sleep required at different periods of life:

• Newborn (infant) 18 – 20 hours

• Growing children 12 – 24 hours

• Adults 7 – 9 hours

• Aged (old) persons 5 – 7 hours

Physiological Changes Accompanying Sleep: 68

™ During sleep most bodily functions are reduced their basal levels.

™ The blood pressure is lower, the systolic pressure showing a decline of from 10 to 30

mmHg. If the sleep is disturbed by exciting dreams the blood pressure might be

elevated well about the normal waking level.

Management of Anidra with Nidra caps – Literary Review 34


™ The pulse rate is slowed by from10 to 30 beats.

™ The metabolic rate is reduced by from 10 to 15% below the basal level and the rectal

temperature by a fraction of a degree Fahrenheit.

™ The heat regulating mechanisms are depressed.

™ The respirations are slowed as a rule they also tend to become irregular or periodic.

™ Muscle tone is minimal, the knee jerk is abolished and a positive Bebinski may be

present.

™ The thresholds for most somatic reflexes are definitely raised.

™ Vasomotor reflexes, however, are more active. The pupils are usually constricted, the

light reflect is retained. The eyeballs are turned upwards and outwards.

™ Urine volume is reduced and the specific gravity is raised.

™ The secretion of sweat gland is considerably increased.

™ Gastric secretion is increased or little altered during sleep.

™ Lacrimal and salivary secretions are reduced.

PHYSIOLOGICAL EFFECTS OF SLEEP

Charaka explains that in the night, the Hridaya (heart) gets contracted and the Srotasa

(the channels of circulation) as well as the Koshtha (the gastro-intestinal tract) are contracted,

the body elements get softened 69.

According to modern view, sleep causes two major types of physiological effects.

1) Effects on the Nervous System itself.

2) Effects on the other structures of the body

Management of Anidra with Nidra caps – Literary Review 35


The first one seems more important because lack of sleep wakefulness cycle in the

nervous system at any point below the brain cause neither harms to the body organs nor any

deranged function.

On the other hand, lack of sleep certainly does affect the functions of the central

nervous system. Prolonged wakefulness is often associated with progressive malfunction of

the mind and sometimes even causes abnormal behavioral activities of the nervous system.

So, in the absence of any definitely demonstrated functional value of sleep, we might

postulate that the principle value of sleep is to restore the natural balance among the neuronal

centers 70.

Sleep does have moderate physiological effects on the peripheral body. For instance,

during wakefulness, there is enhanced sympathetic activity and hence increases the muscle

tone. Conversely, during slow-wave sleep, sympathetic activity decreases while

parasympathetic activity increases. Therefore, a ‘restful’ sleep ensues – fall in blood pressure,

respiratory rate and pulse rate, and skin vessels dilate, activity of GIT sometimes increases,

muscles fall into a mainly relaxed state, and the overall basal metabolic rate of the body falls

by 10 to 30 percent.

FUNCTIONS OF SLEEP – 71-72

Sleep at the nighttime makes for the balance of the body constituents (Dhatusamya),

alertness, good vision, and good complexion and fired digestive power.

Susruta described that, those who takes proper sleep in proper time will not suffer

from disease, the mind of them will be peaceful, they gain strength and good complexion,

good virility, their body will be attractive, they won’t be lean or fatty and they live good

hundred years 73.

Management of Anidra with Nidra caps – Literary Review 36


Despite the wealth of information that is accumulating about the biochemistry and

physiology of sleep, its precise nature and functions are not exactly known to the modern

physiology. A number of theories have been proposed, which include the hypothesis that

sleep is needed; for consolidation of memory, for binocular vision, or as part of

thermoregulatory evolution, for conservation of energy. The most widely held theory about

the function of sleep is that its senses as a period of recuperation or restoration. There are two

ways in which this hypothesis is interpreted; total body restoration and neurological

restoration.

Disease review

By going through the previous description, it is quite evident that Nidra is not only an

important but an essential phenomenon of life, which affects the body and mind equally in a

favorable way when it is enjoyed in a rightful manner. Otherwise the inadequate Nidra

(Anidra) leads to various problems like dukha, karshya, abala, klibata, ajnana at last leads to

death also 74.

Charaka 75 explains Nidra and Nidranasha in context of ninditi purusha at sutra sthana
76.
which is included in 80 nanatmaja Vata vikaras But has no explanation of management at

either in Chikitsa sthana or else where.


77
Susruta describes it under the chapter of garbha vyakarana shariram might be – of

Nidra plays a role in nutrition and development of the body. He also describes vaikarika Nidra

(sleep disorders) in the same chapter along with Chikitsa.

Vruddha Vagbhata 78 of Astanga sangraha mentions Nidra and Nidra vikara along with

Chikitsa in viruddha annavijnaniya adhyaya and in Vagbhata 79 of Astanga hridaya dicuss the

same in annaraksha adhyaya, while affirming trayopastambha.

Management of Anidra with Nidra caps – Literary Review 37


80
Sarangadhara resolute the Anidra in vataja nanatmaj vikara, alpa Nidra in pittaja

nanatmaja vikara and atinidra under kaphaja nanatmaja vikara.

Deprivation of Anidra

It is composed of two words ‘A’+’Nidra’. The suffix ‘A’ provides negative meaning

to the act of Nidra 81. Anidra means less or no sleep. Ayurveda Vishwakosha part I 82 explains

Anidra as Nidranasha. In Ayurvedic texts the term ‘Anidra’ is used indicating a pathological

condition in which A+ is devoid of sleep.

Synonyms of Anidra

Table – 2
Synonyms of Anidra
Sno Synonyms CS SS AH AS YR MN HS BS DN RN
1 Anidra + + + + + + + +
2 Alpa Nidra + + +
3 Aswapna + + + +
4 Jagarana + + +
5 Nidranasha + + + + + +
6 Nidra vighata + +
7 Nasta Nidra + + + + + +
8 Nidra dourbalya +
9 Nidra bhramsha +
10 Nidra kshaya + +
11 Nidra bhanga +
12 Nidra vinasha +
13 Nidra cheda +
14 Nishi jagarana + +
15 Nidra viparyaya +
16 Prajagarana + + + +
17 Veatanidra + +

Management of Anidra with Nidra caps – Literary Review 38


Alpa Nidra:

Alpa means small minute 83 which refers to reduction in sleep time.

Jagarana:
84 85
Jagarana means awake or waking Nidra rahita, Nidra abhava which refers to the

loss of sleep or no sleep.

Nidra kshaya:

Kshaya means harsa, adarshana, bhanga 86 so, this term refers to disturbances in sleep

reduction in sleep time.

Nidra bhanga;
87
The word bhanga means breaking splitting, dividing, this shows disturbances of

sleep.

Nidra chheda:

Chheda 88 means cutting off, a section, apiece which shows disturbances during sleep,

Nidra bhramsha:
89
The term ‘bhramsha’ means to drop, fall down, cessation, loss which refers to

reduction in sleep time.

Vigata Nidra:
90
The term ‘vigata’ means gone, disappear, ceased which can be correlated with loss

of sleep or reduction in sleep time.

Nasta Nidra:
91
Nasta means lost, disappeared deprived which convey the meaning of loss of sleep.

By seeing all these synonyms Nidranasha can be considered as difficulty in initiation of sleep

reduction in sleep time and disturbances during sleep either one or more (icd-10) 92.

Management of Anidra with Nidra caps – Literary Review 39


Nidana Panchaka

Nidana

Charaka mentions the causes for Anidra as – eva eva cha vigneyo nidranashasya

hetavaha 93 the factors are Atiyoga of vamana, Atiyoga of virechana, Atiyoga of nasyakarma,

Atiyoga of rakta mokshana and Atiyoga of dhoomapana. Due to the excess use of these

factors makes the Vata vitiation and Anidra is inducted. Ati vyayama, Ati upavasa and

Asukha shayaa are the causatives of Vata vitiation, thus the Anidra is induced.

Ati chinta, Ati krodha and Ati bhaya are the manasika karana leading to tama kshaya

and rajo vruddi induces the Anidra.

Along with these, some others Chikitsa procedures of Atinidra advised by Charaka can

also are considered as causative factors for Anidra, which are as follows.

Satva audarya (increased satwa), Tamojayee (conqueror of tama), Karya (engaged in

work), Kala (old age), Vikara (disease), Prakriti (personalities such as Vata) and Vayu (Vata

Dosha) are the causes of Anidra 94-95.

Further Susruta has mentioned some extra Nidana factors which may cause Anidra;

these factors are Vata vridhi, Pita vridhi, Manastapa, Kshaya and Abhighata 96.

Bhavamishra considers atiyoga of nasya, upavasa, vyayama, chinta, dukha, bhaya,

Kapha kshaya as the causative factors of Anidra /Nidranasha 97.

Astanga sangraha Vagbhata mentions Nidana which may cause the Anidra are as

follows. Lobha, Harsha, Vyatha, Atimaithuna, Ati kshudha, Rukshanna sevana, Yavanna

sevana and Anjana are said to cause Anidra with their individualized qualities embedded 98.

At consideration of all these Nidana factors, the sharirika doshas such as Vata, Pitta,

and manasika Dosha raja are the principal causative factors for Anidra /Nidranasha.

Management of Anidra with Nidra caps – Literary Review 40


Table – 3
Anidra Ahara Nidana
Ahara CS SS AS AH BS HS BP
Rookshanna - - + - - - -
Yavaanna - - - - + - -
Table – 4
Anidra Vihara Nidana
Vihara CS SS AS AH BS HS BP
Vyayama + - - + + - +
Upavasa + - - + - + -
Asukhasaiyya + - + - - - -
Kshudha - - + - - - -
Atimaithuna - - + - - - -
Table -5
Chikitsa Atiyogajanya Nidana of Anidra
Chikitsa CS SS AS AH BS HS BP
Atiyogajanya
Vamana + - + + - - -
Virechana + - + - + - -
Nasya + - + - + - -
Rakta mokshana + - + - - - -
Dhoomapana + - + + + - -
Sveda - - - + - - -
Anjana - - - + - - -
Langhana - - - + + - -
Table -6
Anidra Manasika Nidana
Manasika CS SS AS AH BS HS BP
Bhaya + - - - - + +
Chinta + - + + - + +
Krodha + - - + - - +
Manastapa - + - - - - -
Shoka - - + + - - +
Vyatha - - + - - - -
Harsha - - + - - - -
Lobha - - - - - + -

Management of Anidra with Nidra caps – Literary Review 41


In addition to above discussed causative factors, Susruta has mentioned abhighata and

kshaya as Nidana of Anidra 99.

Purvarupa

Purvarupa is not mentioned for Anidra in any Ayurvedic classics.

Rupa

In Ayurvedic classics some symptoms are mentioned due to holding up of sleep

schedule. They are in the following table.

Table – 7
Symptoms of Anidra
Rupa CS 100 SS 101 AH 102 AS 103
Jrumbha + + + +
Angamarda + + + +
Tandra + + + +
Shiroroga + - - -
Shirogourava - + + +
Akshigaurava + + - -
Jadya - - + +
Glani - - + +
Bhrama - - + +
Apakti - - + +
Vataroga - - + +

Charaka has described the symptoms are suppression of sleep; yawning, body ache,

drowsiness, head disorders and heaviness in eyes are caused. Susruta has described following

symptoms due to restraint of sleep. Yawning, body aches, stiffness in the body, head and eyes

drowsiness are the symptoms caused by restraint of sleep. Vagbhata has mentioned that due to

Anidra – malaise, heaviness in head, yawning, laziness, languor, giddiness, indigestion, stupor

and vatajanya rogas will be manifested.


Management of Anidra with Nidra caps – Literary Review 42
Anidra Samprapti

Anidra is not explained as a separate disease in Ayurveda, thus no where the

Samprapti is available. Depending upon the Dosha, dushya involvement Anidra is

emphasized. Anidra is mentioned as Vata vikara with pita vriddhi associated with some other

disease states or symptoms which is common in aged people.

Figure – 1
Schematic diagram of Anidra Samprapti

Nidana

Ahara , Vihara & Anya Manasika

Vata Vruddhi (Chala, Rooksha & Laghu) Rajo Vruddhi (Chala, Rooksha & Laghu)
Pitta Vruddhi (Ushna & Teekshna) Tama Kshaya (Snigdha, Guru & Manda)
Kapha Kshaya (Snigdha, Guru & Manda)

Leads to Leads to Tama


Kapha kshaya kshaya

kshaya Kapha &


Tama avarana to the
chetana Hrudaya /
Sanjnavaha srotas

Anidra

At the description of Nidra it is mentioned that Kapha, Tamas, Hridaya and sanjavaha
104
srotas are responsible for it . But yogic concept defines Nidra as - when Atma having

Management of Anidra with Nidra caps – Literary Review 43


contact with manomaya kosha then susupti avastha (sleep) occurs. Consequently, when there

is any changes appear in this physiological process or path it causes the Anidra 105. Hence it is

evidential that the Vata Pitta, raja, Hridaya and sanjnavaha srotas play an important role in the

Samprapti of Anidra. Thus it is concluded that the vitiation of involved factors leads to the

condition of Anidra/ Nidranasha.

Types of Samprapti

Sankhya: According to Ayurveda, Asvapna/ Anidra is of two types viz., either due to

Vataprakopa or Pittaprakopa 106.

Vikalpa: In Anidra, mainly Vata Prakopa occurs and it’s Chala and Laghu Guna vitiates,

which keeps the mind active, causing Anidra. Thus the Dosha amshamsha kalpana is

essential.

Pradhanya: In Pradhanya Samprapti of Anidra, the predominance of morbid humors are

described in terms of the comparative and superlative degrees. As Anidra is of Vataja

Nanatmaja Vyadhi, vitiation of Vata takes place, and Pitta dominance is not ruled out. Thus

the validation of the Dosha pradhanyata is essential.

Bala: Bala of Anidra i.e. Vyadhi can be distinguished by the strength of manifestation of

symptoms, severity, duration etc, which will help as a prognostic tool.

Kala: Kala is an important factor, while considering Nidra as well Anidra. Charaka107

mentioned the Nishi Kala cause Nidra naturally. Sleeping at day time is contra indicated. Not

sleeping at night indicates that Kala interferences to cause the Anidra – thus the time factor

have an influential effect on Anidra / Nidra.

Management of Anidra with Nidra caps – Literary Review 44


SAMPRAPTI GHATAKA

Table - 8
Anidra – Samprapti ghataka
Dosha Vata & Pitta (Vriddhi), Kapha (Kshaya)
Dushya Rasa
Srotas Manovaha, Rasavaha
Srotodushti Prakara Atipravritti (Over indulgence)
Adhisthana Hridaya
Agni Jatharagn
Dosha: Dosha involvement in Anidra is said as Vata, Pitta and Kapha. But the deviation from

the normalcy is to be considered with due importance. Vata and Pitta are in Vruddhi state,

while in case of Kapha, the Kshaya is usually observed.

Dushya: As the Anidra is a psycho-somatic condition, initially no dushya is involved. Later

in due course the Dhatu involvement occurs to give rise associated symptoms and conditions

of Anidra viz. Glani, Aruchi, Apakti etc, which are the symptoms of Annavaha srotas and

Rasa Dhatu, do has their role in Samprapti of Anidra, as they provide Tushti, Preenana for the

entire body.

Srotas: The role of Manovaha Srotasa is understood without any controversy in Anidra as the

mind psychologically and body physically takes rest voiding the external stimuli. In this

context, Rasavaha Srotas too have a pivotal role in the pathogenesis of Anidra. Seat of

Manovaha and Rasavaha is Hridaya where the functions of different levels originate from the

same. Moreover, the etiological factors responsible for Rasa Dushti are said to be psycho

disturbing, such as Chintyanam Chatichintanat, where the chetana and stawa are disturbed.

Management of Anidra with Nidra caps – Literary Review 45


Srotodushti Prakara: Over indulgence of Manas is a common feature of Anidra, attributed

to the Manovaha sroto Atipravritti. But the sanga of Rasavaha srotas can not be ruled out, as

the symptoms of Rasavaha sroto dusti is witnessed.

Adhisthana: Hridaya is the abode for Rasa and Mana. It is the platform where the whole

Samprapti process is supposed to be observed. As earlier stated, Hridaya is the bed rock for

Mana and its role in Anidra is well defined.

Agni: Here, vitiation of Jatharagni takes place, because proper Nidra is said to enhance the

Agni 108. Apakti and Aruchi are the symptoms of Anidra, indicates the vitiation of Agni.

UPADRAVA

In Ashtanga Sangraha, it is mentioned that increased Vata is due to Anidra produces

Kapha kshaya. The decreased and dried Kapha sticks in Dhamanis walls and cause

Srotorodha. This, results in so much exhaustion that eyes of the patient remain wide open and

watery secretion from eyes. This dangerous exhaustion is Sadhya up to three days then

becomes Asadhya 109.

Upashaya and Anupashaya

As upashaya and anupashaya are not available in texts, they can be evolved. Mamsa

sevana, madya, ksheera and ksheera vikaras, abhyanga, utsadana, tarpana and sneha sevana

etc., can be considered as upashaya of Anidra, whereas rukshanna, yavanna, dhoomapana,

krodha, shoka etc., can be considered as its anupashaya.

Management of Anidra with Nidra caps – Literary Review 46


Chikitsa in general

There is no specific line of treatment mentioned for Anidra in our texts. Depending

upon the Chikitsa mentioned is in different contexts, for Anidra can be broadly divided into 2

types 1. Bahya Chikitsa 2. Abhyantara Chikitsa. Abhyantara Chikitsa can be again sub

divided into (a) ahara pradhana Chikitsa (b) aushadha pradhana Chikitsa.

Our acharyas have given more importance to bahya upacharas such as moordhni taila,

abhyanga etc. and manasika upacharas such as manonukula vatavarana manonukula vishaya

grahana etc., along with these therapeutic measures are also described along with some

specific aharas for patients of Anidra. All these therapeutic measures in the different contexts

may be classified into the following groups’ viz. Bahya upachara, Manasika upachara,

Ausadha upachara and Ahara upachara.

Table – 9
Bahya Upacharas for Nidranasha
Bahya CS SS AH AS YR BP KS HS BS BR
Upachara
Abhyanga + + + + + + - - + -
Utsadana + - - - - - - - - -
Samvahana + + - + + + - - - +
shitarpana + - + + - + - - - -
Moordhni Taila + + - - - - - - - -
Udvartana - + + + - + + - - -
Shirobasti - - + + - - - - - -
Shirastarpana - - + - - - - - - -
Karnapoorana - - - + - - - - - -
Padabhyanga - - - + + - - - - -
Angamardhana - - - - - - - - - -
Mardana - - - - - - - + - -
Shirolepa + - - - - - - - - -
Vadana lepa + - - - - - - - - -
Management of Anidra with Nidra caps – Literary Review 47
Table No. - 10
Aahara Upacharas for Nidranasha
Ahara Upacharas CS SS AH YR BP KS HS BR RV DN RN
Gramya mamsa rasa + - - - - - - - - - -
Anupa mamsa rasa + - - - - - - - - - -
Jaleeya mamsa rasa + - - - - - - - - - -
Mahisha ksheera + - + + - - + + + + +
Peeyusha + - + + - - - - - - -
Morata + - - + - - - - - - -
Goodhooma - + - - + + - - - - -
Varahamamsa - - - - - - - - - + +
Guda - - - - - + - + - - -
Matsya - - - - + + - + - - -
Dadhi - - - - - + - - - - -
Koorchika - - - + - - - - - - -
Masha - - - - + - - + - - -
Sita - + - - - - - - - - -
Yoosha - - - - + - - - - - -
Sneha - - - - + - - - - - -
Kilata + - + + - - - - - + +
Madhya - - + - - - - - - - -
Table No. - 11
Manasika Upacharas for Nidranasha
Manasika Upachara CS SS AH AS HS BP
Manonukula Vishaya grahana + - - - - -
Manonukula Sabda grahana + - - - - -
Manonukula Gandha grahana + - - - - +
Mrudu shayya - + - - - -
Sukha shayya - - - + - -
Sukha sparsh - - - + - -
Nischinta - - + - - -
Nityatrupti - - + - - -
Bhaya tyaga - - - - + -
Chintatyaga - - - - + -
Lobha tyaga - - - - + -
Swasteerna Sayana + - - - - -
Sukhavartalapa - - - - + -
Santosha - - - - - +

Management of Anidra with Nidra caps – Literary Review 48


Table No. - 12
Anya upachara for Nidranasha
Anya Upacharas CS A AS BP KS HS YR
H
Snana + + + - - - -
Shirolepa + + + - - - -
Varsa sevana in Varsa Ritu - - - + - - -
Lehana karma - - - - + - -
Vastra kruta vayu sevana - - - - - + -
Kamsya patrakruta vayu sevana - - - - - + -
Talapatra kruta vayu sevana - - - - - + -
Kadali patrakruta vayu sevana - - - - - + -
Viewing dance and hearing humorous voice - - - - - + -
Some other measures, which can be advised to the patient of Anidra/ Nidranasha,

though are not mentioned in Ayurvedic texts, are as follows:

• Maintaining regular time for going to bed.

• Avoid seeing excited pictures at night.

• Avoid smoking, tea, coffee or alcohol at night before going to sleep.

• Not indulge in any type of work or reading till late night.

• Should devoid of thoughts tensions before going to bed.

• Hearing soft music or favorite songs also induces sleep.

• 5-10 minutes mediation before going for sleep

• Offering prayer before sleep.

• Washing of hand, feet and face before goes to sleep

• Avoid of excess coitus

• Avoid of day sleep

• Proper evacuation of stool and urine

• Avoid mosquito bites

• Maintenance of adequate privacy and free from disturbances

Management of Anidra with Nidra caps – Literary Review 49


Aushadha Chikitsa (Upachara):

a) Single drug therapy: A good number of single drugs are described in Ayurvedic

literatures which gives relief from Nidranasha. These single drugs are:

Table No. - 13
Single drugs useful for Nidranasha

Ekamoolika BP KS HS DN RN BR

Palandu + - - + + -

Ikshurasa + - - - - -

Potaki + - - - - +

Tila + - - - - -

Trikatu - + - + - -

Ketaki - - + - - -

Vartaka - - + - - -

Kakamachi - - + - - -

Asuri - - - + + -

Some other single drugs are as follows :

• Brahmi • Kusmanda • Katu tumbi

• Aswagandha • Yamini • Jatiphala

• Drakshya • Pippali moola • Apamarga moola

• Bhanga • Sarpagandha • Khas khas

• Shankapuspi • Punarnava • Kupilu

• Jatamamsi • Karpura • Tagara

• Ahiphena • Parasika yavani • Raja sarshapa, etc.

Management of Anidra with Nidra caps – Literary Review 50


b) Compound drugs

o Sarasvata choorna o Indumarichadi vati 110


o Nidrakara choorna o Swarna Makshika Bhasma 111
o Ashvagandharista o Yashada Bhasma 112
o Shankhapushpyarista o Tungadrumadi Taila 113
o Chandravaleha o Dhanyamla
o Chintamani Chaturmukha Rasa o Kantakaryadi kwatha 114
o Vatakulantaka rasa o Kakajanghadi Kwatha 115
o Nidrodaya rasa o Ghrita Bharjita Nagara 116
o Sarpagandha ghana vati o Mukta Bhasma – mainly for Pittavridhi
o Agasti Sutaraja Vati Janya Nidranasha.
c) Amayika Prayoga
1. Ghrita Bharjita Bhanga + Madhu 117
2. Pippalimoola + Guda 118
3. Aswagandha Choorna + Pippalimoola Choorna + Parasika Yavani Choorna with milk.
4. Sarpagandha powder – 1gm + Rasasindura ¼gm with milk
5. Sarpagandha powder (50gm) + Jaharamohara Pisti 6 gms + Pravala Pisti (6 gm) +
Amrita Satva (6 gms)
Dose – ½ - 1 gm BID or TID with Gulab Arka (mainly for Insomnia due to HTN)
6. Amalaki – 2 parts + Pippalimoola – 1 part + Jatamansi – 1 part
Dose – 1 tsf twice daily.
7. Aswagandha Choorna + Pippalimoola Choorna with milk
8. Kakajangha Twak Kwatha + Madhu 119
9. Shalmali Niryasa + Kiratatikta 120
10. Ghrita + Taila Yamaka Yusha 121
11. Mahisha Ksheera + Khas Khas
12. Rohitamatsya Kambalika + Kutajaveeja Choorna + Guda 122

Management of Anidra with Nidra caps – Literary Review 51


Contemporary concepts of Anidra vis-à-vis Insomnia 123

Interests on sleep disorders started in the early 1970’s when obstructive sleep apnea

becomes established as a common and often life threatening condition. A number of survey’s

carried out in different countries indicates that sleep related complaints are most commonly

encountered in modern medicine. The disturbances of sleep are also very common complaints

in psychiatry. Sleep is disturbed in several ways in its pattern, quality and duration. As age

advances the average sleeping time decreases which is normal phenomenon. In some

pathological problems like mania, insomnia may be total. Delay in falling asleep (early

insomnia) occurs in anxiety, depression is characterized by early waking up (late insomnia)

and the sleep is usually non-refreshing. The sleep wake pattern is disturbed in certain organic

conditions like delirium and dementia. As sleep is interrupted in several conditions, it has

vital interest in proper appreciation and understanding of sleep related symptoms.

Classification of Sleep Disorders:

A. The classification of sleep disorders introduced in 1979 by the Association of Sleep

Disorders Centers (ASDC) which has been widely accepted. It consists of 4 major types

of sleep disorders.

1. DIMS (Disorders of initiating and maintaining sleep)


2. DOES (Disorder of Excessive somnolence)
3. DOSWS (Disorder of sleep wake schedule)
4. Parasomnias
B. Sleep disorders according to ICSD (International Classification of Sleep Disorders)
1. Dyssomnias
2. Sleep disorders associated with medical or psychiatric illness
3. Parasomnias
4. Proposed sleep disorders (Sleep related laryngeal spasm)

Management of Anidra with Nidra caps – Literary Review 52


C. Sleep disorders according to DSM-IV

1. Dyssomnias
2. Parasomnias
3. Sleep disorders related to another mental disorders
4. Others sleep disorders
Dyssomnias:

Dyssomnias are described under headings, viz. Hypersomnia (DOES), Disorders of

Sleep-wake schedule (DOSWS) and Insomnia (DIMS). Out of insomnia (DIMS) are

discussed here elaborately.

Insomnia (DIMS) –

During classification of sleep disorders Insomnia is mentioned under Dyssomnia. A

synonym also gives for insomnia which shows its clinical features i.e. DIMS (Disorders of

Initiation and Maintenance of Sleep).

Causative factors of Insomnia:

Symptoms Medical conditions Psychiatric / environmental


conditions
1. For falling • Any painful or • Anxiety
asleep uncomfortable conditions • Pre psychotic tension (stress)
(Difficulty in • CNS lesion • Environmental changes
initiation of • Sleep-wake cycle disorders
sleep)
2. For remaining • Sleep apnoea syndrome • Depression
asleep (difficulty • Nocturnal myoclonus • Sleep-wake disorders
in maintaining of • Parasomnias • Dream interruption
sleep) • Alcohol withdrawal • Environmental changes
• CNS/ Painful diseases • Mania
• Drug effects • Dementia, etc.

Management of Anidra with Nidra caps – Literary Review 53


Two unique disorders, which produce DIMS, include periodic leg movements and

restless leg syndrome

Diagnosis of Insomnia:

People are varying in their amount of sleep they require and some of those who

complain of insomnia may be having enough sleep without realizing it.

Usually the diagnosis of Insomnia can be based on the account given by the patient.

EEG recordings are occasionally helpful whether there is continuing doubt about the extent

and nature of the insomnia. So diagnosis of insomnia made on the basis of following points:

• The sleep disturbances like –

- Difficulty in initiation of sleep

- Difficulty in maintaining of sleep (may be frequent awakening or early morning

awakening)

- Non restorative sleep (i.e. despite adequate duration of sleep, feeling of not having

proper sleep) (Poor quality of sleep)

• It causes either marked distress or interferes with social and occupational functioning.

Above sleep disturbances (either one or more) if occurs at least 3 times in a week for

at least one month can be diagnosed as Insomnia.

Types of Insomnia:

Mainly Insomnia is of 2 types

I) Primary – No discernible cause for insomnia

II) Secondary – It is caused by one of several medical conditions that affect

sleep.

Management of Anidra with Nidra caps – Literary Review 54


I) Primary Insomnia:

About 15% of all the insomnia is primary origin. They are rare in childhood and

adolescences but become more prevalent as age advances. Females are more affected.

Symptoms of primary insomnia are

- Difficulty in initiating of sleep (more common in younger adults)

- Difficulty in maintaining of sleep (common in elderly)

- Not related to any mental disorders or physical conditions

- Individual shows excessive worry during the day about not being able to fall

asleep.

- In evening the person shows intense efforts to fall asleep but becomes

unsuccessful.

- Person complaining of lethargy, fatigue, lack of concentration, easily irritable.

- He may resort to hypnotics or alcohol to reduce tension or cups of coffee or other

stimulants to overcome the tired feelings.

II) Secondary Insomnia

- Secondary to other disorders

- Several psychiatric disorders are associated with insomnia

- Also occur secondary to substance abuse like alcohol, amphetamine, steroids and

several others

- After a course of progressive worsening a chronic stable stage is reached which

continue for several years

- Sometimes the course is episodic with short periods of improvement and

worsening.

Management of Anidra with Nidra caps – Literary Review 55


Investigative tools 124

The investigations are not only for Insomnia but also can be applied for other sleep

disorders. These are as follows:

1. Clinical evaluation:

A detailed sleep history is the most informative diagnostic tool. A thorough sleep

history can help for deciding whether the sleepiness or sleeplessness is normal or

pathological.

2. Multiple Sleep Latency Test (MSLT):

Objective conformation of hypersomnolence and determining its severity are

mandatory in a patient before using long term treatment with CNS stimulants initiated. MSLT

is widely used for evaluation of hyper somnolence.

3. Polysomnography:

Most patients with sleep-wake disorder require monitoring of various physiologic

parameters during sleep (polysomnography). The basic parameters in polysomnography are:

- Several changes of EEG to distinguish wakefulness from sleep and for sleep

staging.

- Eye movements

- Electro cardiogram

- Electro myogram of chin muscles, tibialis anterior muscle.

- Oral and nasal air flow by thermistor or a mask.

- Respiratory effort of the chest and abdomen by impedance pneumography.

- Oxygen saturation by ear oximeter.

Management of Anidra with Nidra caps – Literary Review 56


Drug review

Management of Anidra is divided in to three modalities viz. general sleep measures,

behaviour treatment and pharmacological treatment. General sleep measures include some

activities like regular exercise, avoidance of nicotine, alcohol and heavy meals close to

bedtime, etc. behaviour therapy includes relaxation, sleep restriction, stimulus control and

cognitive therapy. Pharmacological treatment includes several hypnotics and sedative drugs.

All these modalities of management are not capable enough to meet the challenges of Anidra.

Vata plays the most important role in the pathogenesis of the Anidra. Thus, the main aim

behind the management of the Anidra is directed towards pacification of Vata. In the present

study Nidra cap, mentioned below is a rational combination.

Each 500 mg Nidra cap consists of –

Drugs Botanical Names Quantity

Tagar Valeriana wallichii 125mg

Jatamanshi Nordostachys jatamamshi 125mg

Ashwaganda Withania somnifera 125mg

Pippalimoola Piper longum 125mg

The above Rational combination has been formulated based on the pharmacological

properties and pharmacokinetics of individual drugs included in Nidra cap are individually

scrutinised for its Nidra janakatwam and Nidra prabhava from the classical texts. To check the

suitableness of this combination through information of these herbs which are included in

Nidra cap are discussed on the basis of Rasa, guna, veerya, vipaka is as under.

Management of Anidra with Nidra caps – Literary Review 57


Tagar - Valeriana wallichii 125 to 128

Prayojyanga Moola
Rasa Madhura, Tikta, Katu
Guna Ushna
Veerya Ushna
Vipaka Katu
Prabhava Sedative, Hypnotic
Doshagnata Kapha Vata shamana
Rogaghnata Agnimandya, Unmada, Apasmara
Chemical consttiuents Volatile oil of Estates, Valerianic acid
Prepared Medicines useful at Vataraja vati-2
Manovaha Srotas

Jatamanshi - Nordostachys jatamamshi 129 to 132

Prayojyanga Moola
Rasa Tikta, Kashaya
Guna Laghu, Snigdha
Veerya Sheeta
Vipaka Katu
Prabhava Bhootaghna, sedative
Doshagnata Tridosha shamaka
Rogaghnata Shira shoola, Anidra
Chemical consttiuents Oleum Jatamamsi, Resin, Sugar, Starch
Prepared Medicines useful at Vatarajavati -2
Manovaha Srotas

Management of Anidra with Nidra caps – Literary Review 58


Ashwaganda - Withania somnifera 133 to 136

Prayojyanga Mooola
Rasa Tikta, Kashaya
Guna Ushna, Snigdha,Laghu
Veerya Ushna
Vipaka Katu
Prabhava Sedative, Hypnotic
Doshagnata Kapha vata shamaka
Rogaghnata Bhrma, Moorcha, Anidra
Chemical consttiuents Somniferen,
Prepared Medicines useful at Ashwagandhavalehyam
Manovaha Srotas
Pippalimoola - Piper longum 137 to 140
Prayojyanga Moola
Rasa Katu
Guna Laghu, Snigdha, Teekshna
Veerya Sheeta
Vipaka Madhura
Prabhava Rasayana, Yogavahi, srotoshodhaka
Doshagnata Kapha vata shamaka
Rogaghnata Aruchi, Ajeerna, Dourbalya
Chemical consttiuents Piperine, Piplartine, Piperlongumirin, Steroids,
Glycosoids
Prepared Medicines useful at Sudarshana choorna
Manovaha Srotas

Management of Anidra with Nidra caps – Literary Review 59


Chapter – 4
Methods
Human is the superior out of all the living creatures has always been trying to find

new things, which will, helpful for his better living, since time immemorial. Now-a-days

many varieties of diseases are coming up, out of which some are challenging to medical

sciences and some affects the health and longevity of human life. One of such symptom and

disease is insomnia, which is a challenge to the physician as well as adversely, affects the

patients in all the sphere of their life. Cause and diagnosis of Insomnia is difficult, because the

kind of sleep patterns and degree of daytime fatigue differs to that of people considering the

indications of insomnia for other people is normal. Ayurveda considers Anidra (Aswapna) is
141
one out of 80 Nanatmaja Vata Vikaras described by Charaka . However its detail

description is not available may be due to low prevalence of the disease in the society at that

time. Now days due to fast mechanical sleep patterns style makes prevalence to increase.

METHOD OF COLLECTION OF DATA

A) Study Design:

A comparative placebo control single blind clinical study

B) Sample:

A minimum of 30 patients with Anidra/Nidranasha are scrutinized with preset

inclusion/ exclusion criteria. Selected patients are distributed randomly and equally in two

groups, viz. Nidra caps and placebo. 15 patients are treated in each group for the stipulated

period.

C) Grouping:

Group A: Control group of 15 patients with placebo

Group B: Trial group of 15 patients with Nidra cap


Management of Anidra with Nidra caps – Methods 60
D) Study duration:

21 days of study with every 7th day drug distribution where patients under went

periodical checkups.

E) Follow up:

21 days after the study period completion with drug withdrawal

F) Exclusive criteria:

1. Nidranasha due to Madatyaya - is excluded because, the intoxication induced

Mada and Nidra are very difficult to differentiate

2. Nidranasha due to Abhighata are excluded because, it is a condition where the

pain dominates to induce sleep disturbances

3. Pregnant women are excluded because - even though the drug composition is

herbal and safe still may be placental barrier and affect the foetus.

4. Lactating mothers are excluded because - even though the drug composition is

herbal and safe still may have effect over food (milk) of infant.

5. Associated with any other systemic and metabolic disorders are excluded

because, they may alter the results of observation

G) Inclusive criteria:

1) Any of below or all are included

a) Patients complaining of reduction in sleep time are included because they are the

prime objective parameters of assessment.

b) Difficulties in initiating sleep are included because they are the prime objective

parameters of assessment.

Management of Anidra with Nidra caps – Methods 61


c) Wakefulness during normal sleep is included because they are the prime objective

parameters of assessment.

2) Along with Nidranasha patients complaining of angamarda, shirogourava, jrumbha, jadya

glani, bhrama and apakti will be included because they are the prime subjective parameters

of assessment.

3) Patients already diagnosed for primary insomnia with the duration of 1 month to 5 years

will be included because, the disease said as kasta sadhya from the Ayurvedic classics

4) Patients those who are in between 18 to 70 years of the age are included

H) Posology:

2 caps of 500mg or 15mg /kg body weight/24 hours, 1 hour before to retiring with

buffalo milk as Anupana. Charka mentioned that the buffalo milk is the best for inducing

sleep, thus the Buffalo milk is selected as Anupana to enhance the effect of the medicament.

I) Examination of an Anidra Patient vis-à-vis Insomnia

For diagnosis, a detailed medical history is taken and physical examination also

undertaken in detail according to Ayurvedic and contemporary clinical methods. Patients are

diagnosed according to diagnostic criteria given for insomnia in DSM – IV 142. A special case

sheet is prepared incorporating all Anidra aspects is placed as annexure.

Patient may be asked to complete a questionnaire to determine wake-sleep pattern and

level of daytime sleepiness. If the problem is grave patient may be suggested to spend a night

at a sleep disorders center for evaluation. A team of people at the center can monitor and

record a variety of body activities during the night, including brain waves, breathing,

heartbeat, eye movements and body movements. But for most people whose main complaint

is insomnia, polysomnography does not provide useful information.

Management of Anidra with Nidra caps – Methods 62


Screening and diagnosis of Anidra patient

Doctor may ask patient many questions about sleep patterns; such as 143–

How long the patient is experienced with symptoms

Whether symptoms occur every night or not

Whether patient snore

How well patient function during the day

Whether patient take any medications

Whether patient have any other health disorders

1) Demographic data

The patient identity is prime in diagnosing the disease as Ayurveda specifies the

Sadhya and Asadhya based on age and relative factors such as desha, Kala etc. thus Name,

Age, Gender, Occupation, Economical status, Birth place and Food habits are recorded in the

demographic data of the case sheet along with the consent signed.

2) Chief complaints and associated complaints

The symptoms of presenting complaints enumerated in the classical textbooks and

contemporary systems are detailed for the studies are noticed with chronological order and

duration is as follows. The chief complaints of the possible are tabulated and rest are added to

the main list in the clinical trial to understand the complaints of an Anidra patient. The listed

complaints and associated complaints are as under -

Management of Anidra with Nidra caps – Methods 63


Chief Complaints

1) Difficulty in initiating sleep –

Difficulty in initiating sleep is a gradual process which changes from person to person.

For proper assessment of the sleep quality and to measure the quantity, the following

gradations are put forth.

Grade 0 = No difficulty in getting sleep after going to bed

Grade 1 = Getting sleep 1hr after going to bed

Grade 2 = Getting sleep 2 hrs after going to bed

Grade 3 = Getting sleep > 3 hrs after going to bed

2) Reduction in sleep time

Since the sleeping state and the waking state are both integral components of a 24 hour

continuum. The quality of the patients waking state is equally relevant. How does the patient

feel upon awakening in the morning? How does the person function during the day? Does the

patient feel tired and / or involuntarily fall asleep during the day? A few patients awaken

refreshed and function perfectly well despite sleeping much less than expected. Except for

brevity their sleeping appears to be normal. These so called short sleepers regularly have a

daily sleep total that is less than 75% of that usually expected for their age. Hence it is

necessary to measure the reduction of sleep time in hours with respect to the patients

complained of Anidra. The units of measurements here are hours and minutes.

3) Wakefulness during sleep

In the proper context sleep disturbance may constitute strong evidence for diagnosis of

uni-polar depression. How patient is sleeping? A frequent response is not good. In what way

Management of Anidra with Nidra caps – Methods 64


the sleep is not good? Commonly the reply is that the patient awakens and has difficulty in

getting back to sleep. The number of awakens are recorded here.

4) Body ache (Angamarda)

Body ache is common symptom of the Anidra patients as they are subjected for

increased muscle tone with enhanced sympathetic activity. Thus the compliant of Angamarda

is observed in the study with the grades of following.

Grade 0 = Getting of body ache never

Grade 1 = Getting of body ache Occasional

Grade 2 = Getting of body ache periodically

Grade 3 = Getting of body ache Always

5) Yawning (Jrumba)

Yawning is the expression of the sleep and lack of sleep, seen in Anidra. It may or

may not be present in all patients. The intensity of the yawning is necessary to measure to

evaluate the sleep patterns. Thus the following grades are inducted.

Grade 0 = Getting of Yawning never

Grade 1 = Getting of Yawning Occasional

Grade 2 = Getting of Yawning Periodically

Grade 3 = Getting of Yawning Always

Associated Complaints

Associated complaints are the symptoms associated with the main complaint or

seldom may lead to Anidra. The listings of the Anidra associated symptoms observed in the

study are put forth here under with explanations.

Management of Anidra with Nidra caps – Methods 65


Tandra (Stupor) is a condition characterized by reduced activity of perception or

helplessly amazed state with dazed where the intense urge for the sleep is noticed. It is caused

by the increase of the Tamas, Vata and Kapha. This is observed as present or absent with

duration.

Klama (Fatigue), Shirogourava (Head Heaviness), Shirasoola (Headache), Akshi

Jadya (heaviness in eyes), Deha Jadya (Body heaviness), Glani, Bhrama (Giddiness), Apakti

(Indigestion) and Aruchi (Anorexia) are associative symptoms of Anidra are commonly seen

in sleeplessness observed as present or absent with duration.

3) History of present illness

At the history of present illness, Mode of onset, Course of Anidra, Frequency of

Anidra, Duration of Anidra, and Preceded by what factors & Change of Regularities are

discussed as listed in the annex-1 (Case sheet).

4) History of sleep

Taking history of the patient with due importance of the bed habits as the questioner is

the technique followed here. The answer obtained from the patient is in the form of yes/no to

rule out the bias in the research. The questioner is of St. Joseph Hospital Sleep Disorders

Center, 1310 West Stewart Drive (Suite 403), Orange, CA 92868, is followed as under 144.

ƒ Hearing soft Music before going to bed Yes/ No

ƒ Perfume applications before going to bed Yes /No

ƒ Having Bath Before going to Bed Yes /No

ƒ Massage of feet etc before going to bed Yes /No

ƒ Passing Urine before going to bed Yes /No

ƒ Passing Stools before going to bed Yes /No

Management of Anidra with Nidra caps – Methods 66


ƒ Masturbation before going to bed Yes /No

ƒ Prayers before going to bed Yes /No

ƒ Reading before going to bed Yes /No

ƒ Consuming alcohol before going to bed Yes /No

ƒ Sexual Intercourse before going to bed Yes /No

5) Personal history

The personal history is discussed as - Food habits with reference to taste, Taste

preferred, Agni, Kosta, Nidra, Addictions, Bowel habits, Menstrual History, Family history –

Specify if any has the same disease, Treatment history and History of past illness, along with

the vital (BP, PR, RR, t °F) examination.

6) Sleep examination

Patient is examined for the sleep with sleep questionnaires having the following

grades set for the respective answers. The questioner is from St. Joseph Hospital Sleep

Disorders Center, 1310 West Stewart Drive (Suite 403), Orange, CA 92868, is followed as

under.

Examination of sleep (Sleep questionnaires)

As sleep is the basis of our day to day activity to determine the sleep questioner is

inquired from patient to get absolute information of his sleep patterns. The detailed questioner

is shown here under with the marks awarded for each possible answer.

0 = Never,

1=. Slight Chance

2 = Moderate Chance

3 = High Chance

Management of Anidra with Nidra caps – Methods 67


1. Do you wake frequently during the night and feel un-refreshed in the morning?

2. Do you have difficulty staying awake during the day?

3. Do you have diabetes, hypertension or another health problem that affects your sleep?

4. Are you overweight? Do you find it difficult to lose weight?

5. Do you wake up with a dry mouth, sore throat or headache in the morning?

6. Do you have difficulty concentrating during the day?

7. Do you need to take naps during the day?

8. Does your snoring bother you or your spouse enough for you to consider treatment?

9. Doze off or fall asleep in Sitting and reading position

10. Doze off or fall asleep while Watching TV

11. Doze off or fall asleep in sitting inactive in a public place

12. Doze off or fall asleep as a passenger for 1 hour without a break

13. Doze off or fall asleep in Lying down to rest in the afternoon

14. Doze off or fall asleep in Sitting & talking to someone

15. Doze off or fall asleep while sitting quietly after lunch without alcohol

16. Doze off or fall asleep while stopping for a few minutes in traffic

7) Ayurvedic examination

In Ayurvedic examination Dosha Vruddhi, Kshaya lakshanas are examined with

reference to the symptoms affirmed in Ayurvedic texts. The Dasha vidha pareeksha and

Astastana pareeksha were also included to understand the pathogenesis under the lime light of

Ayurvedic pathology. The special emphasis of the Agni is made as the Chikitsa is to regulate

the Agni in Ayurveda.

Management of Anidra with Nidra caps – Methods 68


8) Observation of Pancha Lakshana Nidana

The pancha lakshana Nidana i.e. Nidana, Lakshana along with the Upashaya and

anupashaya are examined according to the classical references as detailed in the annex-1.

Subjective parameters

Apart from the mentioned chief complaints the following are taken as the subjective

parameter described along with the gradations of evaluation is as under.

Vitality after morning awakening

Grade 0 = Awakening with freshness


Grade 1 = Awakening with feeling of UN freshness
Grade 2 = Heaviness over forehead & irritation during work with Family & work
Grade 3 = Disturbing routine work
Performance of daily activities

Grade 0 = No any change


Grade 1 = Slight disturbed
Grade 2 = Moderately disturbed
Grade 3 = Highly disturbed
Objective parameters

The objectivity of the sleep is difficult to establish but as the researchers have

evaluated sleep measurements in mathematical way through a tabulator work sheet shown

below. The objective parameters evaluated are -

1. Total sleep time (hrs)

2. Sleep onset latency (min)

3. Number of awakenings

4. Efficiency of sleep (TST/TTSR * 100)

5. Sleep Fragmental Time (TST/ # Awk)

Management of Anidra with Nidra caps – Methods 69


Sleep worksheet

– (Daw + SL)
Going to Bed

TST = TTSR
S.No

Awakenings
Completion

Duration of
Awakening
Number of
Latency
Falling
asleep

TTSR
Sleep

Sleep
1
before

1
After

1
Follow up

The above shown work table is used to calculate the objective parameters in the study.

9) Investigations

The following routine investigations are undertaken to estimate the patient general

health condition but has no significance with Anidra.

™ Haemoglobin %

™ Differential count

™ Erythrocytes sedimentation rate

10) Assessment of Result and declaration

Subjective and objective parameters of base line data (subjective and objective

parameters) to the after treatment data comparison are done for the assessment of results.

Management of Anidra with Nidra caps – Methods 70


Result declaration is made upon the cumulative assessment of the parameters used in

the study. Out of Subjective parameters, Difficulty in initiating sleep, Body ache

(Angamarda), Yawning (Jrumba), Vitality after morning awakening and Performance of daily

activities were considered. At the objective parameters Total sleep time (hrs), Sleep onset

latency (min) Number of awakens, Efficiency of sleep (TST/TTSR * 100) and Sleep

Fragmental Time (TST/ # Awk) are considered. The Result is declared as Well Responded,

Moderately Responded, Poorly Responded and Not Responded categories. The discontinued

patients were not considered for the result declaration.

J) Statistical analysis:

The parameters going to be compared are subjective parameters and objective

parameters. The paired T – test is used for the objective parameter assessment and non

parametric tests are used for the testing subjective parameters. If the test hypothesis p value is

< 0.05, the test is highly significant.

Management of Anidra with Nidra caps – Methods 71


Chapter – 5
Results

Present study registers 30 patients, out of 42 approached patients. Out of this, 7

patients were discontinued and 5 patients not fulfilled the inclusion criteria hence their data

has not been included in the assessment. The remaining 30 patients of Anidra viz. Insomnia

defined as a psycho-somatic disturbance in an individual due to the presence of an agent to

which patient is reactive. Patients fulfilling the criteria of diagnosis and inclusive criteria were

included in the study, fewer than two groups as discussed in the Methodology, distributed

patients in Group-A are 15 (Placebo) and Group-B (Nidra caps) are 15.

All the patients were examined before and after the trial, according to the case sheet

format given in the annex. Both the subjective and objective criteria were recorded. The data

recorded are presented under the following headings.

A. Demographic data

B. Evaluating disease Data and

C. Result of the Nidra caps in comparison with placebo

D. Statistical assessment

Management of Anidra with Nidra caps – Results 72


E. A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 15 patients in each

group are as follows.

A1) Age & Gender relation

Table- 14
Distribution of Patients by Age- Gender in Group A & B
Age Group-A (Placebo cap) Group –B (Nidra cap) Total Patients

Number
Female

Female
Male

Male
%

%
20-30 3 20 2 13.3 1 6.66 2 13.3 8 26.7
30-40 3 20 1 6.66 0 0 0 0 4 13.3
40-50 1 6.66 1 6.66 2 13.3 3 20 7 23.3
50-60 3 20 1 6.66 2 13.3 2 13.3 8 26.7
60-70 0 0 0 0 3 20 0 0 3 10
Total 10 66.6 5 33.4 8 53.4 7 46.6 30 100

Figure – 3
Distribution of Patients by Age- Gender in Group A & B

Distribution of Patients by Age- Gender in Group


A& B

3
2.5
2 Group A Male
1.5 roup A Female
1 Group B Male
0.5 Group B Female
0
20-30 30-40 40-50 50-60 60-70

Management of Anidra with Nidra caps – Results 73


Age relation with the gender is identified here in the above table. The study reveals

that the Anidra is much identified at the ages progressing from the 40 years till to the upper

age limit of the study as 70 years. This is an evidence for the Vata implications with Anidra

induction. Apart from this observation an alarming 26.7% of the youngsters of 20 to 30 years

of age group are in the study with Anidra. This strongly suggests that the present trends of

environmental and social disturbances.

In the Group A (placebo), out of 15 patients, the over all results declared are 1 well

responded, 7 each in Poor responded and not responded. The patient who is well responded is

of 30-40 age group. On the other hand the result in the group –B declared as 4 well responded

And 11 moderately responded. No poor or not responded patients recorded. Out of the well-

responded 4 patients 2 patients are of 50-60 age groups and 1 in 40-50 years of age and 1 in

20-30 age groups.

A2) Gender

The gender distribution in the trial with the result is tabulated as under. This trial

reveals that the distribution of the male community is more. The ratio in the group A is 1:3 of

the female to male and in the group B it is as almost 1:1. The results declared in the group A

(placebo) suggests that the 1 male as well responded and 4 poorly responded. The percentage

of the not responded in the male group are 33.33% i.e. 5 patients. The females has poor

response at the treatment are 3 and not responded as 2. In the group B (Nidra caps) out of 8

males 3 well responded and 5 moderately responded. Out of 7 females 1 well responded and 6

moderately responded. The reasons of obtaining these results are discussed in the next

chapter. The tabular forms and pictorial forms are shown below.

Management of Anidra with Nidra caps – Results 74


Table- 15
Gender wise Results in Group – A (Placebo cap)
Gender

Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

%
Male 10 66.6 1 13.3 0 0 4 26.6 5 33.3

Female 5 33.4 0 0 0 0 3 20 2 13.3


Total 15 100 1 13.3 0 0 7 46.6 7 46.6

Figure - 4

Gender wise Results in Group – A (Placebo cap)


10
10
Total patients
8
Well responded
6 5 5
Moderately
4 responded
4 3 Poor Responded
2
2 1 Not responded
0 0 0
0
Male Female

Table- 16
Gender wise Results in Group –B (Nidra cap)
Gender
Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

Male 8 53.4 3 20 5 33.34 0 0 0 0

Female 7 46.6 1 6.66 6 40 0 0 0 0


Total 15 100 4 26.66 11 73.34 0 0 0 0

Management of Anidra with Nidra caps – Results 75


Figure - 5

Gender wise Results in Group –B (Nidra cap)


8
8 7
Total patients
7 6
6 5 Well responded
5
Moderately
4 3 responded
3 Poor Responded
2 1
Not responded
1 0 0 0 0
0
Male Female

A3) Religion
Table- 17
Religion wise Results in Group – A (Placebo cap)
Religion
Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

%
Hindu 12 80 1 6.66 0 0 5 33.34 6 40

Muslim 2 13.34 0 0 0 0 1 6.66 1 6.66


Christian 0 0 0 0 0 0 0 0 0 0
Others 1 6.66 0 0 0 0 1 6.66 0 0
Total 15 100 1 6.66 0 0 7 46.6 7 46.6
Table- 18
Religion wise Results in Group – B (Nidra cap)
Religion
Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

Hindu 9 60 4 26.6 5 33.3 0 0 0 0

Muslim 5 33.3 0 0 5 33.3 0 0 0 0


Christian 1 6.66 0 0 1 6.66 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0
Total 15 100 4 26.6 11 73.33 0 0 0 0

Management of Anidra with Nidra caps – Results 76


The religion wise looking at a limited geographical area doesn’t give any specificities

of the condition related exploration. But as a routine the data is collected here and presented

in tabular form for the Group A and B separately with results obtained. The over all

expression of the religion census is represented in the pie diagram.

Figure -6

Christian , 1 Others , 1
Muslim , 7

Hindu, 21

Combined Religion wise Results

A4) Occupation
Table-19
Occupation wise Results in Group – A (Placebo cap)
Occupation
Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

Sedentary 1 6.66 0 0 0 0 1 6.66 0 0

Active 11 73.3 0 0 0 0 4 26.6 7 46.6

Labor 3 20 1 6.6 0 0 2 13.3 0 0

Total 15 100 1 6.66 0 0 7 46.66 7 46.66

Management of Anidra with Nidra caps – Results 77


Table- 20
Occupation wise Results in Group – B (Nidra cap)
Occupation

Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

%
Sedentary 1 6.66 0 0 1 6.66 0 0 0 0

Active 12 80 4 16.66 8 53.33 0 0 0 0

Labor 2 13.33 0 0 2 13.33 0 0 0 0

Total 15 100 4 16.66 11 73.33 0 0 0 0

The occupation level of this study refers with three groups’ viz. sedentary, active and

labor. The study reveals that the active group people are prone to get the problem of

sleeplessness i.e. Anidra. In the study 73.3% of group A and 80% of group B are active

workgroup people. The rest are very small in number.

Figure - 7

Occupation wise Data of Both Groups


12
12 11 Group A
10 Group B

8
6
3
4 2
2 1 1

0
Sedentary Active Labor

The sedentary group patient in group A poorly responded and where in group B

moderately responded. The labor group patients in group A poorly responded and in B

Management of Anidra with Nidra caps – Results 78


moderately responded. The effect of the Nidra caps over active group is good as the 4 well

responded and 8 moderately responded are recorded. The graphical representation is as above.

A5) Economical Status


Table- 21
Economical status wise Results in Group – A (Placebo cap)
Economical

Moderately
Total no of

Responded
responded

responded

responded
patients
Status

Poor
Well

Not
%

%
Poor 4 26.66 1 6.66 0 0 3 20 0 0

Middle 10 66.66 0 0 0 0 4 26.6 6 40


Higher 1 6.66 0 0 0 0 0 0 1 6.66
Middle
Higher 0 0 0 0 0 0 0 0 0 0
Total 15 100 16.66 0 0 7 46.66 7 46.66
Table- 22
Economical status wise Results in Group – B (Nidra cap)
Economical
Moderately
Total no of

Responded
responded

responded

responded
patients

Status Poor
Well

Not
%

%
Poor 3 20 0 0 3 20 0 0 0 0

Middle 8 53.33 3 20 5 33.33 0 0 0 0


Higher 4 26.66 1 6.66 3 20 0 0 0 0
Middle
Higher 0 0 0 0 0 0 0 0 0 0
Total 15 100 4 26.66 11 73.33 0 0 0 0

The class mass to differentiae is difficult in this small study. But certainly a target of

middle class is observed in the study with Anidra. The percentages of the cumulative groups

are expressed here as 18 (60%) patients of middle 7 (23.33%) of poor and 5 (16.66%) of

higher middle are recorded. The tabulations above with graphical representations below are

shown.

Management of Anidra with Nidra caps – Results 79


Figure - 8

Economical status wise Data of Both Groups

10
10 Group A
8 Group B
8

6
4 4
4 3

2 1
0 0
0
Poor Middle Higher Higher
Middle

A6) Diet
Table- 23
Diet wise Results in Group – A (Placebo cap)
Diet
Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

%
Vegetarian 11 73.33 0 0 0 0 5 33.33 6 40

Mixed 4 26.6 1 6.66 0 0 2 13.33 1 6.66

Diet

Total 15 100 1 6.66 0 0 7 46.66 7 46.66

The food has always influence over the Tridosha and also on mano bhava. The

vegetarian food consumers are supposed to be comfortable always but in the study it is found

that much of the patients are of vegetarians as 11 and 10 patients respectively in group A & B.

on the other hand the mixed diet practitioners are only 4 and 5 in group A & B. well response

Management of Anidra with Nidra caps – Results 80


to Nidra caps is found with vegetarians but not with mixed diet practitioners. The summed up

distributions are shown in pie diagram as below along with group B distributions.

Table- 24
Diet wise Results in Group –B (Nidra cap)
Diet

Moderately
Total no of

Responded
responded

responded

responded
patients

Poor
Well

Not
%

%
Vegetarian 10 66.66 4 26.66 6 40 0 0 0 0

Mixed 5 33.33 0 0 5 33.33 0 0 0 0


Diet
Total 15 100 4 26.66 11 73.33 0 0 0 0

Figure - 9

Combined Diet data of Group A & B

Mixed Diet , 9

Vegetarian , 21

Management of Anidra with Nidra caps – Results 81


B) Evaluating disease Data

B1) Chief complaints

Table – 25
Showing chief complaints of Anidra
SN Chief complaint Group –A Group –B Total
(Placebo) (Nidra cap)
Patient % Patient % Patient %
s s s
1 Difficulty in initiating 15 100 14 93.33 29 96.66
sleep
2 Reduction in sleep time 15 100 14 93.33 29 96.66

3 Wakefulness during sleep 11 73.33 13 86.66 24 80

4 Body ache (Angamarda) 7 46.66 9 60 16 53.33

5 Yawning (Jrumba) 4 26.66 4 6.66 8 26.66

The study includes with the 30 patients in two groups. The prime complaint Difficulty

in initiating sleep and Reduction in sleep time is observed with 96.66% of patients. The

second common presenting complaint is Wakefulness during sleep with 80% of patients

involved. Body ache with 16 (53.33%) patients and yawing with 8 (26.66%) patients are

observed in the study.

B2) Associated Complaints

The trial observes 70% of patients with the shirogourava, Shirasoola and Deha jadya.

Out of 30 patients 66.66% of patients reported withAkshi jadya. The rest of the features of the

associated complaints are minimal and expressed in the tabulation and also in graph below.

Management of Anidra with Nidra caps – Results 82


Table - 26
Showing Associated complaints of Anidra
SN Associated complaint Group –A Group –B Total
(Placebo) (Nidra cap)
Pts % Pts % Pts %
1 Tandra (Stupor) 3 20 6 40 9 30

2 Klama (Fatigue) 8 53.33 9 60 17 56.66


3 Shirogourava (Head 12 80 9 60 21 70
Heaviness)
4 Shirasoola (Headache) 12 80 9 60 21 70
5 Akshi Jadya (heaviness in 11 73.33 9 60 20 66.66
eyes)
6 Deha Jadya (Body heaviness) 12 80 9 60 21 70
7 Glani 0 0 5 33.33 5 16.66
8 Bhrama (Giddiness) 5 33.33 4 26.66 9 30
9 Apakti (Indigestion) 4 26.66 4 26.66 8 26.66
10 Aruchi (Anorexia) 4 26.66 3 20 7 23.33

Figure 10
Associated compliant in the study

Associated Complaints in the study


Aruchi
Apakti Tandra (Stupor),
(Anorexia), 7 Klama (Fatigue),
(Indigestion), 8 9
17
Bhrama
(Giddiness), 9

Glani , 5

Deha Jadya
Shirogourava
(Body Akshi Jadya
Shirasoola (Head
heaviness), 21 (heaviness in
(Headache), 21 Heaviness), 21
eyes), 20

Management of Anidra with Nidra caps – Results 83


B3) History of Mode of onset

Table -27
Showing Mode of onset in Anidra
SN Group –A (Placebo) Group –B (Nidra Total

cap)

Mode of onset Patients % Patients % Patients %


Number Number Number
1 Sudden 2 13.33 2 13.33 4 13.33

2 Gradual 11 73.34 8 53.33 19 63.33


3 Insidious 2 13.33 5 33.34 7 23.34
Total 15 100 15 100 30 100

The mode of onset observed in the study revels that the Anidra is a gradual in onset for

a population of 63.33% and 7 patients are of insidious. Very few of 4 patients went in to

sudden mode of onset in the study.

B4) History of Anidra course

Table – 28
Showing Anidra course in study
SN Group –A Group –B (Nidra Total

(Placebo) cap)

Course of Patients % Patients % Patients %


Anidra Number Number Number
1 Transient 5 33.34 8 53.34 13 43.34

2 Continuous 10 66.66 7 46.66 17 56.66


Total 15 100 15 100 30 100

Management of Anidra with Nidra caps – Results 84


The course of the Anidra was observed in the study expresses that the continuous

course is for 17 (56.66%) and the rest of patients i.e. 13 (43.33%) are at the transient course of

Anidra.

B5) History of Anidra frequency

Table -29
Showing Anidra frequency in study
SN Group –A (Placebo) Group –B (Nidra Total

cap)

Frequency of Patients % Patients % Patients %


Anidra Number Number Number
1 Few days 9 60 4 26.66 13 43.34

2 Few weeks 6 40 11 73.34 17 56.66


Total 15 100 15 100 30 100

Anidra frequency is calculated in days and weeks. Few weeks of frequency is shown

by 56.66% of patients and rest 43.34% of the patients show the few days’ frequency. More or

less the distribution is 1:1.

B6) History of Anidra duration

Table -30
Showing Anidra duration in study
SN Group –A (Placebo) Group –B (Nidra Total

cap)

Duration of Patients % Patients % Patients %


Anidra Number Number Number
1 Continuous 8 53.34 6 40 14 46.66

2 Intermittent 7 46.66 6 40 13 43.34


3 Sleeps with 0 0 3 20 3 10
medication
Total 15 100 15 100 30 100

Management of Anidra with Nidra caps – Results 85


The duration of the Anidra makes the results to understand in a better manner. Here in

the study 46.66% of the patients’ exhibit the continuous patterns and 43.33% show

intermittent duration. Very few of 10% patients are reported with medication usage for

achieving sleep.

B7) Anidra preceding factors

Table 31
Showing Anidra preceding factors in study
SN Group –A (Placebo) Group –B (Nidra Total
cap)
Preceding Patients % Patients % Patients %
factors Number Number Number
1 Anxiety 11 73.33 9 60 20 66.66

2 Anger 1 6.66 7 46.66 8 26.66

3 Fear 9 60 4 26.66 13 43.33

4 Restlessness 6 40 4 26.66 10 33.33

5 Pain 4 26.66 7 46.66 11 36.66

Sleep and psychology are hand in hand to give rise sleep. Here an attempt is made to

understand the sleep in relation with psychological factors. To disturb sleep anxiety has major

role i.e. 66.66%. Later to it 43.33% express fear. 36.66% of patients expressed pain either

physical or psychological. In the present study along with the above said psychological

factors Restlessness (33.33%) and anger (26.66%) are associated.

B8) Anidra causes – change of regularities

In the study 56.66% of patients were observed with Anidra due to change of place and

40% with bed. 26.66% of patients expressed that the environmental changes cause Anidra.

Management of Anidra with Nidra caps – Results 86


Table -32
Showing Anidra change of regularities in study
SN Group –A Group –B (Nidra Total
(Placebo) cap)
Change of Patients % Patients % Patients %
regularities Number Number Number
1 Place 8 53.33 9 60 17 56.66

2 Bed 4 26.66 8 53.33 12 40


3 Environmental 2 13.33 6 40 8 26.66
B9) Nidana of Anidra

Table -33
Showing Anidra Nidana in study
Group –A (Placebo) Group –B Total
(Nidra cap)
Pts % Pts % Pts %
Ahara

Yavanna 0 0 0 0 0 0
Rookshanna 2 13.33 3 20 5 16.66
Dhooma 0 0 0 0 0 0
Vyayama 0 0 0 0 0 0
Vihara

Upavasa 0 0 2 13.33 2 6.66


Asukhashayya 2 13.33 0 0 2 6.66
Kshudha 3 20 1 6.66 4 13.33
Mithuna 0 0 0 0 0 0
Bhaya 11 73.33 10 66.66 21 70
Chinta 13 86.66 11 73.33 24 80
Manasika

Krodha 6 40 8 53.33 14 46.66


Manastapa 4 26.66 6 40 10 33.33
Vyatha 8 53.33 7 46.66 15 50
Harsha 0 0 0 0 0 0
Virechana 0 0 0 0 0 0
Vamana 0 0 0 0 0 0
Anya

Shirovirechana 0 0 0 0 0 0
Raktamokshana 0 0 0 0 0 0
Kshaya 0 0 0 0 0 0
Abhighata 0 0 0 0 0 0

In the present study manasika Nidana are major factors for Anidra showing

89%patients of chinta, 70% patients of bhaya, 50% patients of vyatha and 46.66% patients of

Management of Anidra with Nidra caps – Results 87


krodha are recorded. Where as aharaja, viharaja & anya nidanas are not that much

contributory.

B10) Nidra (sleep) Examination

The examination of the Anidra patient is a Herculean task. Here the help of questioner

is taken to understand the patient before and after. The sum of the patients in both groups

suggests that inclination to the susceptibility of Anidra has reduced in later study of

questioner. The tabulation is as follows. The group A initially shows the 8 points mean later

reduced to 3.33. The group B mean initially is 7.53 which reduced to the 1.2 at later stage.

The mean difference observed at both groups suggests that the efficiency of the Nidra caps

(Group B) is more than that of group A.

Table – 34
Showing Anidra Nidra (sleep) Examination in study
Questioner Group –A (Placebo) Group –B (Nidra cap) Total
Points Mean Points Mean Points Mean
obtained obtained obtained
Before 120 8 113 7.53 233 7.76

After 50 3.33 18 1.2 68 2.66

Difference 70 4.66 95 6.33 165 5.55

C) Result of the Nidra caps (Group B) and placebo (Group A)

As it is described in the methods the baseline data to the after trial final data was

compared to get the results of the trial. Here all the parameters are individually compared to

get percentage of the result in terms of individual. The percentages are cumulated and mean

percentage is drawn. Above 75% of cumulative percentage achieved patients are considered

as the well responded in the study. The patients between 50 to 75% recognized as moderately

responded for the study and less than 50 and above 25 percentages are considered as poorly

Management of Anidra with Nidra caps – Results 88


responded. Below 25% of cumulative result patients are pronounced as not responded. The

result cumulated table is shown in Annex.

C1) Results of the Group A (Placebo caps)

The results as discussed in the methods were classified under 4 groups viz. well

responded, moderately responded, poorly responded and not responded. The group A placebo

study doesn’t show any well and moderate response except one patient of well responded in

general. The result is mainly poor responded with 7 patients and 7 patients of not responded.

Thus it is a clear and evidential that the placebo doesn’t induce sleep. The placebo

psychological effect of inducting sleep is mere chance i.e., One in 15 patients of the study.

The detailed tabulation along with pictorial presentation is as follows.

Table 35
Showing Anidra Results of the Group A (Placebo caps) in study
Result Number of patients Percentage

Well Responded` 1 6.66

Moderately Responded 0 0

Poorly responded 7 46.67

Not Responded 7 46.67

Total 15 100

Management of Anidra with Nidra caps – Results 89


Figure - 11

Results of Group A (Placebo caps)


Well
Responded`
Moderately
6.67%
Responded
0.00%
Not
Responded
46.67%

Poorly
responded
46.67%

C2) Results of the Group B (Nidra caps)

The results as discussed in the methods were classified under 4 groups viz. well

responded, moderately responded, poorly responded and not responded. The group B Nidra

caps study show well and moderate response only but not of either poor or no response

categories. The result is mainly moderate responded with 11 (73.33%) patients and 4

(26.66%) patients of well responded. Thus it is a clear and evidential that the Nidra caps has

induced sleep. The Nidra caps effect is not only psychological but also has drug effect in

inducting sleep is not mere a chance. The detailed tabulation along with pictorial presentation

is as follows.

Management of Anidra with Nidra caps – Results 90


Table 36
Showing Anidra Results of the Group B (Nidra caps) in study
Result Number of patients Percentage

Well Responded` 4 26.66

Moderately Responded 11 73.34

Poorly responded 0 0

Not Responded 0 0

Total 15 100

Figure - 12

Results of Group B (Nidra caps)


Not
Poorly Responded Well
responded 0.00% Responded`
0.00% 26.67%

Moderately
Responded
73.33%

Management of Anidra with Nidra caps – Results 91


D) Statistical assessment

Table -37 : Subjective Statistical assessment Group-A


Parameter Mean SD SE t value P value Remark
Difficulty in initiating 0.733 0.961 0.248 2.955 <0.02 HS
sleep
Body ache (Angamarda) 0.266 0.593 0.153 1.7385 >0.05 NS
Yawning (Jrumba) 0.2 0.5606 0.144 1.388 >0.05 NS
Vitality after morning 0.4 0.736 0.19 2.105 >0.05 NS
awkng
Performance of daily 0.4 0.736 0.19 2.105 >0.05 NS
activities
Table -38 : Objective Statistical assessment Group-A
Parameter Mean SD SE t value P value Remark
Total sleep time (hrs) 0.8166 0.893 0.230 3.55 <0.01 HS
Sleep onset latency 35.33 40.85 10.54 3.55 <0.01 HS
(min)
Number of awakens 0.6 0.92 0.235 2.55 <0.05 HS
Efficiency of sleep 10.272 12.18 3.144 3.267 <0.01 HS
(TST/TTSR * 100)
Sleep Fragmental Time 1.495 2.2 0.569 2.67 <0.05 HS
(TST/ # Awk)
Table -39 : Subjective Statistical assessment Group-B
Parameter Mean SD SE t value P value Remark
Difficulty in initiating 1.8 0.5606 0.114 12.5 <0.001 HS
sleep
Body ache 1.0 0.654 0.169 5.917 <0.001 HS
(Angamarda)
Yawning (Jrumba) 1.0 0.534 0.138 7.246 <0.001 HS
Vitality after morning 1.266 0.457 0.118 10.728 <0.001 HS
awkng
Performance of daily 1.2 0.414 0.1069 11.225 <0.001 HS
activities
Table -40 : Objective Statistical assessment Group-B
Parameter Mean SD SE t value P value Remark
Total sleep time (hrs) 1.833 0.523 0.135 13.577 <0.001 HS
Sleep onset latency 90.0 32.07 8.28 10.86 <0.001 HS
(min)
Number of awakens 1.866 0.915 0.236 7.906 <0.001 HS
Efficiency of sleep 23.46 7.608 1.964 11.94 <0.001 HS
(TST/TTSR * 100)
Sleep Fragmental Time 3.468 1.487 0.384 9.031 <0.001 HS
(TST/ # Awk)

Management of Anidra with Nidra caps – Results 92


Table -41
Comparative Statistical assessment of Both Groups
Parameter Gr Mean SD SE PSE T value P value Remark
Difficulty in A 1.2 0.9411 0.242 0.274 2.919 <0.01 HS
initiating sleep B 0.4 0.507 0.130
Body ache A 0.8 0.774 0.2 0.226 2.65 <0.02 HS
(Angamarda) B 0.2 0.414 0.106
Yawning A 0.933 0.457 0.118 0.171 3.508 <0.02 HS
(Jrumba) B 0.333 0.487 0.125
Vitality after A 0.6 0.507 0.1309 0.1588 2.94 <0.01 HS
morning awkng B 0.133 0.351 0.090
Performance of A 0.6 0.507 0.1309 0.1588 2.94 <0.02 HS
daily activities B 0.133 0.351 0.090
Total sleep time A 5.9 0.976 0.252 0.401 1.246 >0.05 NS
(hrs) B 6.4 1.213 0.313
Sleep onset A 74.0 40.67 10.501 11.903 2.016 >0.05 NS
latency (min) B 50.0 21.71 5.606
Number of A 1.8 0.861 0.222 0.298 2.013 >0.05 NS
awakens B 1.2 0.774 0.2
Efficiency of A 78.382 11.154 2.88 4.438 0.025 >0.05 NS
sleep B 78.494 13.08 3.377
(TST/TTSR *
100)
Sleep Fragmental A 3.7433 1.903 0.491 0.662 1.948 >0.05 NS
Time (TST/ # B 5.033 1.723 0.445
Awk)

Management of Anidra with Nidra caps – Results 93


Table -42
Comparative Statistical assessment of Both Groups in % of comparison
Group –A (Placebo) Group –B (Nidra cap)

Parameter Mean % Mean %

Difficulty in initiating 1.933 37.92 2.2 81.8


sleep
Body ache (Angamarda) 1.066 24.95 1.2 83.33
Yawning (Jrumba) 1.133 17.65 1.333 75.1
Vitality after morning 1.0 40 1.4 81.92
awakening
Performance of daily 1.0 40 1.333 78.44
activities
Total sleep time (hrs) 5.01 17.76 4.566 40.16
Sleep onset latency (min) 110 32.72 140 64.28
Number of awakens 2.4 25.1 3.066 60.86
Efficiency of sleep 67.44 16.22 55.03 42.638
(TST/TTSR * 100)
Sleep Fragmental Time 2.248 66.516 1.565 221.59
(TST/ # Awk)

To compare the effectiveness of drugs in two different groups, here statistical analysis

is done by using un-paired t-test, the conclusion is done as highly significant if P <0.05 by

assuming that the mean effect of two if among subjective parameters all groups is same. The

parameters show High Significant in both the groups. There is High Significant in body ache,

yawning, and performance of daily activities but in the parameter difficulty in initiating sleep

and vitality after morning awakening is less highly significant.

Among the objective parameters all the parameters shows non significant is both the

groups, (i.e. the mean effect of the two groups is not same groups). To know the effectiveness

of drug on individual group the Statistical analysis is done by using paired t test by assuming
Management of Anidra with Nidra caps – Results 94
that drug is not responsible for changes in grading before and after the therapy. The

conclusion is drawn as High Significant if P<0.05. Among the subjective parameters the

Nidra cap group shows High Significant, than the placebo group in all the parameters (by

comparing P values) in the placebo group except the parameter difficulty is initiating sleep all

parameters shows not significant by comparing P value.

Among the objective parameters the Nidra cap group shows High Significant than the

placebo group is all the parameters by comparing the t-values.

The parameter efficiency of sleep is more High Significant in Nidra cap group than

placebo group with more mean effect and less variation, (by comparing t-value, mean and

S.D). The % improvement in subjective parameter in group placebo is 17.65% is yawning and

40% is vitality after morning awakening and performance of daily activities.

In group Nidra, caps less % improvement in yawning (75.1%) and more %

improvement in body ache (83.33%). Among objective parameters is group placebo the least

% improvement is efficiency of sleep (16.22%) and most % improvement is sleep fragmental

time (66.51%)

In the group B the least % improvement in total sleep time (40.16%) and more than

100% improvement in sleep fragmental time.

Management of Anidra with Nidra caps – Results 95


Chapter – 6
Discussion

In introduction Barenked Ladies song say –

I won’t sleep . . . . . . . Another sleepless night began . . . .

From birth to death almost half of the lives we spend for sleep. Insomnia became a

major problem now-a-days, by stress, anxiety etc., which play a key role in causing the

Anidra. It is for all religions and economical people who are under the sky. But it is more with

middle class people.

Adequate sleep is critical to good health, yet many adults have sleep related problems

that prevent them from getting adequate sleep. Many Foundations working for sleep disorders

say that at least 1/3rd people of the world suffer from sleep disorders. Additionally,

sleeplessness has been associated with a broad range of complications, including depression,

heart disease, lost productivity and an increased risk of high-way and work related accidents.

In majority of the people, various mental factors causing insomnia cause numerous mental

disorders too. The present study intended to evaluate the Anidra with Nidra cap a rational

combination made from the various Nidra janaka, pravartaka prabhava herbs cited at the

Ayurvedic treasure. The comparison of the test drug Nidra cap is compared with the placebo

to rule out the psychoneural involvement in the study. The discussion is made under the

following heads to facilitate discussion.

I) Discussion on demographic data


II) Discussion on disease aspects
III) Discussion on probable mode of action of Nidra cap
IV) Statistical discussion of parameters
V) Limitations of the study and suggestions

Management of Anidra with Nidra caps – Discussion 96


I) Discussion on demographic data

a) Age relation discussion in Anidra

Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.

sleep often becomes less restful as age progresses. But, a lack of restful sleep is not normal

consequence of aging. With age, people’s bio clock often alters, that means, they get tired

early than normal and seek rest and consequently wakeup early in the morning. It is

physiological; often it results as Anidra with reduction in sleep time and associated

symptoms of Anidra.

Here in the study, out of the 30 patients of Anidra studied exhibits each 26.7%

patients belong to 50 to 60 and 20 to 30 years age group. 50 to 60 age group data denotes

the age stage of Vata. On the contrary the early ages of 20 to 30 years suggests that the

psychological and insecurities of life style mainly related to Rajas which ultimately

influence the Vata. This observation strongly suggests that the present trends of

environmental and social disturbances influences over the causative factors of Anidra and

plays an active role in the pathogenesis of Anidra.

In placebo group one male patient of 32 years responded well, where as all others

show either not responded or poor responded. At the counseling it is reveled that the patient

is unmarried and workaholic not consuming the food at proper time. The patient is at the

early insomnia responded well with placebo up to 70% of symptom variance. In this patient

added stress led to have Anidra with associations of deleterious effect on day time

functioning. Increased efforts to obtain sleep can it self induce sleep with timely

suggestions and placebo. Thus the patient achieved result apart from others in the same

group of study.

Management of Anidra with Nidra caps – Discussion 97


Vata and Manas are interdependently dependent and when one vitiated the other

vitiates excessively. In this disorder Anidra, both of the above are seems to be vitiated.

Consequently, Charaka gave importance to Vata in the management of Anidra. Treating a

psychic disorder is a difficult task. Proper counseling, relaxation techniques applied along

with other oral or methodical managements is considerable in the management of Anidra.

Thus the Manaha Sukham, Manonukula Vishaya etc. of pleasing techniques of mind is

mentioned in sleeplessness, which is indicative of psychic management. Here a treatment

module consisting herbal formulation by name Nidra caps is planned for the study. The

result of the Nidra caps on the ages strata are discussed here under.

b) Gender relation discussion in Anidra

Generally insomnia is seen on higher side in females than males. It is said in texts as

sukrabahulya (Soma) in male and rajo (Agni) bahulya in females is usual physiologically.

Thus the reason behind influence of the drug could be understood as the Agni predominance

in females helps to assimilate the drug faster and safer. In this study maximum number of 60

% male patients and 40% female patients were observed. This observation is at this

geographical area not to be considered as standard due to variances. The result of the Nidra

cap on this part of the study show more inclination over the male community.

c) Religion relation discussion in Anidra

Religion is not a marker of the sleep disturbances. The Anidra at communal riots are

may be claimed to insecurity, but the area of study is free of any disturbances the religion

relation is not existing. Thus the Maximum patients of 70% Hindus are recorded in Hindu

dominated area of the study.

Management of Anidra with Nidra caps – Discussion 98


d) Economic Status relation discussion in Anidra

Economics of a person influence health. The insufficiency of money makes insecurity

and leads ultimately to Anidra. Here in the study middle class people are found more. The

results as already told that the placebo doesn’t have any better effect and Nidra caps exhibited

its excellence.

e) Occupation relation discussion in Anidra

Occupation has a good role in the induction of sleep naturally. People who are well

tired gets sleep well. Even the same is observed with the mentally active too. But when it

crosses the threshold level the same induce the Anidra. Thus the study has a many either

mentally tired or physically people as 23 patients out of 30. Businessmen, labor or service

persons suffer from excessive mental tension and worry, which may lead to Anidra. The

Nidra cap result implication over these exhibited 80% success. The reason behind could be

that Nidra cap is Vata and Rajodosha pacifier to release the neuron chemical action at the time

of either stress or strain.

f) Diet Pattern relation discussion in Anidra

In the Ahara Nidana and of people food consumption methods as observed that the

vegetarian food takers are usually less unctuous and non vegetarians with more unctuous food

intake. The former makes the Vata vitiation and the later to Kapha. Even though Kapha

involvement is not justified at the installation of Anidra, the other factors suggesting

influential over the Vata is a marker here. The Vata and Kapha predominant food takers are

not away from the involvement of Rajas, thus the Maximum 70% patients of Niramisha

(vegetarian) food are observed with Anidra along with 30% patients Samisha. The result of

Nidra cap has nodding effect over the Niramisha takers with 66%.

Management of Anidra with Nidra caps – Discussion 99


II) Discussion on disease aspects

Anger and intolerance are the twin enemies of correct understanding – Mahatma

Gandhi; with increasing industrialization and a faster pace of life developing countries like

India are also following the pattern set by western nations. A stressful life style resulting from

day to day problems of finance, education, family and inter personal relationships; as also the

demands of work, travel, insecurity of job and business; and an urge to exceed and

accomplish more than what already a person possess. All these lead to a degree of stress,

which results in slow but progressive damage to the sleep pattern.

Mans best escape from the stress of life is provided by sleep and rest, recuperation

which it affords. Sleep occupies 1/3 of our lives and turns out to involve the basic biological

states of the brain and body. But sleep and getting enough of it is not a simple problem.

Insomnia is the most common of sleep related symptoms.

Chief Complaints:

All the patients (100%) have complained of sleeplessness, followed by 96.66%

patients having Difficulty in initiating sleep and Reduction in sleep time. Out of 80% were

having Wakefulness during sleep as complaint. As sleeplessness (Anidra) is due to vitiation

of Vata and Rajo Dosha – sleeplessness/ disturbed sleep might be seen due to their Chala

and Pravartaka Guna respectively.

Associated Complaints:

These associated complaints are due to Vata, Pitta and Rajo guna. Though some of

the symptoms like Akshi Gaurava, Shiro Gaurava etc. are seen as in Kapha Prakopa, even in

Nidranasha also they are witnessed, is due to Vata alone. It is observed that the Anidra

Management of Anidra with Nidra caps – Discussion100


symptoms they are included with angamarda, shirogourava, jrumba, jadyata, glani, bhrama,

apakti, tandra and other Vata rogas, which may fall under different areas.

We have seen that proper sleep does have moderate physiological effects on the

peripheral body, for instance during wakefulness, there is enhanced sympathetic activity and

hence increases the muscle tone, conversely, during slow wave sleep sympathetic activity

decreases while parasympathetic activity increases. Therefore a restful sleep ensues fall in

blood pressure, respiratory rate and pulse rate and skin vessels dilate, activity of GIT

sometimes increases, muscles fall into a mainly relaxed state, and the over all basal metabolic

rate of the body falls by 10 to 30%.

On the other hand, lack of sleep certainly does affect the functions of the central

nervous system. Prolonged wakefulness is often associated with progressive malfunction of

the mind causing the above said symptoms. It is not necessary to have all symptoms in Anidra

patient, sometimes without these symptoms only there is disturbed sleep or sleeplessness.

Nidana observed at trial

A sound mind in a sound body has been recognized as a social ideal for many

centuries. In present study both the physical and psychological etiology are noticed. Majority

of patients are having the psychological implications are declared at results are of 89% of

Chinta, 70% of Bhaya, 50% of Vyatha, 46.66% of the Krodha.

Stress

Concerns about work, school, health or family can keep many patients mind too

active, making them unable to relax. Excessive boredom, such as after retirement or

during a long illness, may occur and also can create stress and keep patient awake.

Management of Anidra with Nidra caps – Discussion101


Anxiety

Everyday anxieties as well as severe anxiety disorders may keep patients mind too

alert to fall asleep.

Depression

Patients may either sleep too much or have trouble sleeping if they're depressed. This

may be due to chemical imbalances in their brain or because worries that accompany

depression may keep them from relaxing enough to fall asleep.

Stimulants

Prescription drugs, including some antidepressants, high blood pressure and

corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC)

medications, including some pain medication combinations, decongestants and

weight-loss products, contain caffeine and other stimulants. Antihistamines may

initially make the patients groggy, but they can worsen urinary problems, causing

them to get up more during the night.

Change in their environment or work schedule

Travel or working a late or early shift can disrupt patients’ body's circadian rhythms,

making them unable to get to sleep when they want to. The word "circadian" comes

from two Latin words: "circa" for "about" and "dia" for "day." Their circadian

rhythms act as internal clocks, guiding such things as there wake-sleep cycle,

metabolism and body temperature.

Behavioral insomnia

This may occur when patients worry excessively about not being able to sleep well

and try too hard to fall asleep. Most people with this condition sleep better when

Management of Anidra with Nidra caps – Discussion102


they're away from their usual sleep environment or when they don't try to sleep, such

as when they're watching TV or reading.

Eating too much too late in the evening

Having a light snack before bedtime is OK, but eating too much may cause patients

to feel physically uncomfortable while lying down, making it difficult to get to sleep.

Many people also experience heartburn, a backflow of acid and food from the

stomach to the esophagus after eating. This uncomfortable feeling may keep them

awake.

A change in activity

Patients may be less physically or socially active. Activity helps promote a good

night's sleep. Some patients may also have more free time and, because of this, drink

more caffeine or alcohol or take a daily nap. These things can also interfere with

sleep at night.

A change in health

The chronic pain of conditions such as arthritis or back problems as well as

depression, anxiety and stress can interfere with sleep. Older men often develop

noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which

can cause the need to urinate frequently, interrupting sleep. In women, hot flashes

that accompany menopause can be equally disruptive.

Ayurveda lays down the hypothesis that physical life depends largely on the psychic

life. The development of all the limbs of human body merely follow the mind which under the

control of Vata. Charaka say’s that “Sarvaangnaam hi asya hrudayam moolam” (Ch.Sa 6/30).

Management of Anidra with Nidra caps – Discussion103


Hrudayam means here the mind. The importance of the mind is brought forward to make

limbs to rest physically at sleep. Sleep occurs during the sensory and motor faculties are

fatigued by day work. The fatigue faculties become sluggish in their work and will lose their

objects and the functions of the mind also blocked by the increase of Tamas. Mind gets

detached from the faculties and its action of engaging the faculties ceases. When there is over

indulgence of engaging of Manas it will not cease causing Anidra.

Now to discuss how Vata and Tamas are involved in causing Anidra. Jean Martin

Charcot says that – disease is very old and nothing about it has changed, it is we who change,

as we learn to recognize what was formerly imperceptible. There are many theories are

explained to understand the induction of sleep which are mentioned in the earlier while

explaining the contemporary concepts. By observing all these the conclusion can be drawn

that, there are some centers in the brain which are responsible for causing induction of sleep.

The theories are going on changing as the science and technologies advances. There is

no end for the science which is like flowing river stagnant water goes and new water comes.

Here, I tried my level best to record all the up date knowledge in my dissertation. According

to Ayurveda Vata vriddhi is the main cause for the Anidra, after proper analyzing we see that

mastishka and vatavahasrotases (brain and nervous system) are the important seats of Vata in

respect to its two functions viz., gati and gandhana i.e., motor and sensory functions.

Even though the mastishka is the main seat of Vata, to execute the two main functions

viz., gati and gandhana, the Vata has to move through the vatavaha srotasses to reach the

target organs throughout the body. These vatavaha srotases can be divided into two varieties

according to the function viz. 1) Chestravaha srotases – to conduct motor function and 2)

Sanjnavaha srotases – to conduct sensory function.

Management of Anidra with Nidra caps – Discussion104


Manas, is sarvendriyapara, therefore both two varieties of srotases relay in the Manas.

So Manas is stated as ubhayatmaka. While describing the Anidra Samprapti, we have seen

that both daihika and manasika nidanas leads to Vata vriddhi and tama kshaya i.e., kshaya of

Kapha and tama avarana to the chetana hrudaya/sanjnavaha srotas. Vatavriddhi indicates the

involvement of mashtishka. Even the modern theories say the involvement of sleep centers at

brain.

When we go through Sensory functions of Vata as Vata stimulates all sensations. The

information about the artha from sense organ is carried to the Manas and Buddhi (cortical

centers) for nischayatmikajnana. The receptive impression of the artha on the sense organs is

transformed into the nerve impulse in the organ and carried through the sanjnavaha srotas via

the manas to the indriya Buddhi (receptive cortical centers).

In Charaka Samhita for induction of sleep it is said that when the mind gets exhausted

or becomes inactive, the sensory and motor organs become inactive then the individual gets

sleep. When Vata gets increased the above told phenomena will not takes place leading to

Anidra.

Somnus Rasayana

Previously it was believed that reticular activating system (RAS) located in upper

brain stem is the main area responsible for sleep. When the person remains active the area

within RAS remains excited and long continued excitation produces fatigability in that area,

when the RAS becomes fatigued, at the same time it becomes inactive and sleep manifests.

But it has been proved that an active inhibitory process causes sleep and stimulation of some

specific areas of brain can produce sleep with characteristics near to those of natural sleep.

These areas are -

Management of Anidra with Nidra caps – Discussion105


a) Raphe nucleus in the lower half of the pons and medulla

b) Nucleus of tractus solitorious

c) Rastral part of hypothalamus and

d) An area in the diffuse neclei of thalamus.

Among the neurohormonal substances, serotonin plays an important role in the

mechanism of sleep and catecholamines are considered to be responsible for wakefulness. The

blood concentration of serotonin becomes lower during sleep than awakefullness cholinergic

neurotrasmitters also play an important role in REM sleep generation. A variety of sleeps

promoting substances have been identified. They are prostaglandin D2 delta sleep inducing

peptide, maramyl dipeptide interleukin -1, fatty and primary amides and melatonin. The

peptide increases the REM sleep, the prostaglandin D2 and interlukin -1 acts immunologically

to induce sleep. This fact suggests a link between immune function and sleep wake state.

Evaluation of Tamas in terms of RATR

The ancient Greeks endorsed the sleep to God Hypnos (sleep), the child of darkness

and night and the brother of death, whose power as he swept across humanity was so great

that even the gods succumbed to him. Even in our mythology we found the “Nidra Devata” as

sister of “Yama” who is simulating the death.

As we understand, the Sleep is a periodic functional state of man and higher animals,

characterized by specific changes in vegetative and motor systems by the absence of

purposeful activity and sensory interaction with the environment and the Sleep is

characterized by the inhibition of conscious mental activity.

Satva, Rajas and Tamas are the three major or universal attributes that pervade the

universe. Onset of sleep is related to the increases of Tamas always. These said principles

Management of Anidra with Nidra caps – Discussion106


affect inertia on general. Sleep usually occurs at night as the surroundings are dark and are

predominated by Tamas. This dark environment naturally increases the Tamas in human

beings according to the theory of generality.

Sleep is a physiologic state of relative unconsciousness and inaction of the voluntary

muscles, the need for which recurs periodically. The stages of sleep have been variously

defined in terms of depth (light, deep), EEG characteristics (delta waves, synchronization),

physiological characteristics (REM, NREM), and presumed anatomical level (pontine,

mesencephalic, rhombencephalic, Rolandic, etc.).

Here, tamo-abhava is reticular activity transmission and tamobhava is RATR. We see

that, the satvika purusha with less tamas, who wants achievement in life, thinks that “If I

sleep, the world will move front, leaving me behind”. But dear, friends to maintain both

physical and mental health sleep in time for required period.

III) Discussion on probable mode of action of Nidra cap

For extreme diseases, extreme staidness of treatment is most efficacious. A normal

person spends approximately 1/3 of his life in sleep. Adequate sleep is a necessity of life. A

significant number of individuals complain of lack of sleep, insomnia; and the use of

hypnotics and sedatives is therefore, on the increase often indiscriminately as evidenced by

the availability of large number of such preparations in the market and the high incidence of

addiction and acute poisoning due to hypnotic drugs.

To discuss about Chikitsa, as Anidra is a pscycosomatic disease, the ubhayatmaka

Chikitsa i.e., which acts over both mind and body such a medicament has to be involved. Both

abhyantara and bahya Chikitsa and the manasika upacharas play an important role.

Management of Anidra with Nidra caps – Discussion107


Here the drugs the Jatamamsi having bhutaghna prabhava (manasadoshahara) and

nidrajanana quality, Tagara which is vtahara and mastishkashamaka. Ashwagandha, a tonic

or adaptogen is also mastishkashamaka and acts as Rasayana. Compound known as

withanolides are believed to account for the multiple medicinal applications, stimulates the

immune system and also been shown to inhibit inflammation and to improve memory.

Pippalimoola is a Vata hara and deepaniya. Thus the four rational drugs made combination

(Nidra cap) is able to subside the symptoms of Anidra and induces the good sleep.

IV) Statistical discussion of parameters

The parameters show High Significance in both the groups. Among the subjective

parameters the Nidra cap group shows more High Significance than the placebo group.

Among the objective parameters the Nidra cap group shows High Significance than the

placebo group in all the parameters by comparing the t-values. The parameter efficiency of

sleep is High Significant in Nidra cap group than placebo group with more mean effect and

less variation, by comparing t-value, mean and S.D.

V) Limitations of the study and suggestions

ƒ The polysomography studies are not with in reach.

ƒ The study sample is minimal.

ƒ Ayurvedic herbal alkaloid extractions require Animal experiments for sleep patterns

ƒ This combination has to evaluate in different combinations and permutations for

isolating the active herb of sleep induction

ƒ The same combination may be tried over a large sample.

Management of Anidra with Nidra caps – Discussion108


Chapter – 7
Conclusion

On the basis of the study “Management of Anidra with Nidra caps - a placebo

comparative study”, the conclusions can be drawn as follows:

I won’t sleep . . . . . . . Another sleepless night began . . . .

Nidra is an essential phenomenon for maintenance and restoration of the life, which is

considered under Trayopastambha. Adequate sleep is critical to good health, yet many adults

have sleep related problems that prevent them from getting adequate sleep. Many Foundations

working for sleep disorders say that at least 1/3rd people of the world suffer from sleep

disorders. Insomnia is the most common of sleep related symptoms.

Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.

sleep often becomes less restful as age progresses. But, a lack of restful sleep is not normal

consequence of aging. It is physiological; often it results as Anidra with reduction in sleep

time and associated symptoms of Anidra. Some simple changes in your daily routine and

habits may result in better sleep.

How much sleep is enough varies from person to person. Although 7 1/2 hours of

sleep is about average, some people do well on four to five hours of sleep. Other people need

nine to 10 hours of sleep each night. Nearly everyone has occasional sleepless nights, perhaps

due to stress, heartburn, or drinking too much caffeine or alcohol.

Patients may either sleep too much or have trouble sleeping if they're depressed.

Prescription drugs, including some antidepressants, high blood pressure and corticosteroid

medications, can interfere with sleep. Most people with this condition sleep better when

Management of Anidra with Nidra caps – Conclusion109


they're away from their usual sleep environment or when they don't try to sleep, such as

when they're watching TV or reading.

Activity helps to promote a good night's sleep. Sleep occurs during the sensory and

motor faculties are fatigued by day work. Even the modern theories say the involvement of

sleep centers at brain. Proper sleep provides balance of the body constituents, alertness, good

vision, good complexion, fired digestive power as well as happiness, vigor, virility, nutrition

and long life. According to modern science, sleep is said to nourish and repair the damages to

the tissues caused by various catabolic activities of the body.

When we go through Sensory functions of Vata as Vata stimulates all sensations. The

blood concentration of serotonin becomes lower during sleep than wakefulness’ cholinergic

neuron-transmitters also play an important role in REM sleep generation. A variety of sleep

promoting substances has been identified. The peptide increases the REM sleep, the

prostaglandin D2 and interlukin -1 acts immunologically to induce sleep. This fact suggests a

link between immune function and sleep wake state.

Insomnia can affect not only patients’ energy level and mood, but also patient’s health

as well because sleep helps bolster patient’s immune system. Fatigue, at any age, leads to

diminished mental alertness and concentration.

Here in the study, out of the 30 patients of Anidra studied exhibits each 26.7%

patients belong to 50 to 60 and 20 to 30 years age group. 50 to 60 age group data denotes

the age stage of Vata. Increased efforts to obtain sleep can it self induce sleep with timely

suggestions and placebo. Consequently, Charaka gave importance to Vata in the

management of Anidra. Religion is not a marker of the sleep disturbances. Occupation has a

good role in the induction of sleep naturally. People who are well tired gets sleep well. The

Management of Anidra with Nidra caps – Conclusion110


Nidra cap result implication over these exhibited 80% success. Vata and Rajasa play a key

role in the pathogenesis of Anidra. Manasika Nidanas as well as Psychic stress are the main

causative factors of the disease.

All the patients (100%) have complained of sleeplessness, followed by 96.66%

patients having Difficulty in initiating sleep and Reduction in sleep time. Out of 80% were

having Wakefulness during sleep as complaint. It is not necessary to have all associated

symptoms in Anidra patient, sometimes without these symptoms only there is disturbed

sleep or sleeplessness.

Study observes that the administration of Ayurvedic herbal formulation containing

the drugs having tranquilo-sedative and muscle relaxant effects provided added beneficial

results to get good sleep.

Onset of sleep is related to the increases of Tamas always. A normal person spends

approximately 1/3 of his life in sleep. Adequate sleep is a necessity of life. Among the

subjective parameters the Nidra cap group shows High Significance than the placebo group.

Management of Anidra with Nidra caps – Conclusion111


Chapter – 8
Summary

The present study is entitled “Management of Anidra with Nidra caps - a placebo

comparative study” is summarized as under.

Who needs sleep?” every body! I won’t sleep is a complaint of many patients at

clinics. Adequate sleep is a necessity of life. Sound restorative sleep is the foundation of a

healthy life among three sub-pillars diet, sleep and celibacy. According Ayurveda sleep is

induced by the increase of the inert universal attribute called Tamas. Sleep is characterized by

the inhibition of conscious mental activity. Onset of sleep is related to the increase of Tamas

and Kapha. This stage is called sleep, even in sleep mind maintains its connection with the

soul. Achara Rasayana gives rise regularized sound sleep and vice versa the regularized sleep

patterns induce Rasayana effect.

Naturally the night is described as a proper time for sleep. During sleep most bodily

functions are reduced their basal levels. Sleep does have moderate physiological effects on the

peripheral body. Gastric secretion is increased or little altered during sleep. Many disorders

are associated with abnormal patterns of sleep. Sleep depends upon the utilization of oxygen.

Theories state that there is a sleep center in the hypothalamus, the stimulation of which is

responsible for sleep. According to Howell, sleep is due to cerebral ischemia. NREM sleep is

a peaceful state relative to waking state. In NREM type of sleep the brain waves are very

slow, so it is also called slow-wave sleep. Most sleep during each night is of slow-wave

variety and it is deep, restful type of sleep. Deep sleep is dreamless, dreams occur only during

light sleep and chiefly in the period, which just precede waking. The consumption of oxygen

is lowest during slow wave sleep. It has been postulated that slow wave sleep being more

Management of Anidra with Nidra caps – Summary112


important for macromolecular synthesis and REM sleep for removing the synthetic products

of slow wave sleep to maintain synaptic connections which is necessary to maintain cognitive

function. Conversely, during slow-wave sleep, sympathetic activity decreases while

parasympathetic activity increases. Probably the most distinctive feature of REM sleep is

dreaming. The depth of sleep is not constant throughout the sleeping period, but varies from

hour to hour.

Nidra is inversely proportional to the age, as age advances the sleep decreases, i.e.

sleep often becomes less restful as age progresses. Although 7 1/2 hours of sleep is about

average, some people do well on four to five hours of sleep. Patients may either sleep too

much or have trouble sleeping if they're depressed. Activity helps to promote a good night's

sleep. The peptide increases the REM sleep, the prostaglandin D2 and interlukin -1 acts

immunologically to induce sleep.

Any derangement of above can cause Anidra. Present study Anidra compared to

insomnia is difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening

with difficulty resuming sleep or un-refreshing sleep. The study is incomplete if a

comparative clinical Trial of sleep inductive effect of the Nidra caps (trial drug) internally to

pacify the Dosha in Anidra and placebo to overcome the psychosomatic origin of the disease

Anidra is not compared. Anidra means less or no sleep.

All the patients (100%) have complained of sleeplessness, followed by 96.66%

patients having Difficulty in initiating sleep and Reduction in sleep time.

The results in group A placebo study doesn’t show any well and moderate response

except one patient of well responded in general. The result is mainly poor responded with 7

(46.66%) patients and 7 (46.66%) patients of not responded. Increased efforts to obtain sleep

Management of Anidra with Nidra caps – Summary113


can it self induce sleep with timely suggestions and placebo. Thus it is a clear and evidential

that the placebo doesn’t induce sleep. The placebo psychological effect of inducting sleep is

mere chance i.e., One in 15 patients of the study.

The group B Nidra caps study results are well and moderate response only but not of

either poor or no response categories. The result is mainly moderate responded with 11

(73.33%) patients and 4 (26.66%) patients of well responded. Thus it is a clear and evidential

that the Nidra caps has induced sleep. The Nidra caps effect is not only psychological but also

has drug effect in inducting sleep is not mere a chance.

To compare the effectiveness of drugs in two different groups, with statistical analysis

is highly significant as P value <0.05. In the placebo group except the parameter difficulty is

initiating sleep all parameters are not significant. The parameter efficiency of sleep is highly

significant in Nidra cap group than placebo group with more mean effect and less variation.

All subjective parameters of the Nidra cap group shows high significance than the placebo

group in all the parameters. All objective parameters of Nidra cap group show highly

significance than the placebo group in all the parameters by comparing the t-values.

Management of Anidra with Nidra caps – Summary114


Bibliographic
References

1) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 11/35, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 160
2) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/68, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 235
3) Kashinatha Sastri ed, Charaka Samhita, vol-1, Nidana 6/9, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 652
4) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 234
5) http://www.holosticonline.com/her_home.htm
6) http://www.printgoogle.co.in/print%3Fq%3Dprimary%2Binsomnia%260i%3DprintG
sig=QaxNvyEgrDQMVssbgb
7) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 399
8) Vaidya Baghel MS, Researches in Ayurveda, 2005, Mridu Ayurvedic Publication and
Sales, Jamnagar, pp 117, 20, 46, 43
9) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-64
10) Ibid, pp 31
11) Ibid pp 763
12) Ibid, pp 275
13) Kashinatha Sastri ed, Charaka Samhita, vol-1, Nidana 8/23, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 541
14) Ibid, Sutra, 11/35, pp 160
15) Ibid, 21/36, pp 283
16) Satyapal Bhishagacharya, Kashyapa Samhita Khila, 5/7, 2nd ed. 1976, Choukhambha
Sanskrit Samsthan, Varanasi, pp 256
17) Bhanoji Dikshit ed, Amarakosha, 1/7/36, 1st ed. Reprint, 2006, Choukhambha Sanskrit
Samsthan, Varanasi, pp 110
18) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003,
Choukhambha Sanskrit Samsthan, Varanasi, pp 40
19) Srirama Sharma ed, 108 Upanishad, jnanakhanda, Mandukyopanishat, 5, 4th ed.
2005, Parimala Publication, New Delhi, pp 362
20) Ibid, Chandyogyopanishad, 8/6/3, pp 188
21) Srikantha Murthy KR ed, Susruta Samhita, vol -1, shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
22) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/35, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283
23) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
24) Yadavji Trikamji Acharya ed, Susruta Samhita, Dalhana Nibandha Sangraha, Sutra,
1/25, 4th ed, 1980, Chaukhambha Orientalia, Varanasi, pp 7
Management of Anidra with Nidra caps – Bibliographic References i
25) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/39, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 197
26) Srikanta Murthy KR ed, Sharangadhara Samhita, Poorva, 6/24, 1st ed. 1984,
Chaukhambha Orientalia, Varanasi, pp-30
27) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 6/24, 3rd ed.
1983, Chaukhambha Orientalia, Varanasi, pp-74-75
28) Srirama Sharma ed, 108 Upanishad, jnanakhanda, Chandyogyopanishad, 6/8/1, 7th
ed. Parimala Publication, New Delhi, pp 162
29) Ibid, Bruhadaranyakopanishad, 2/1/17, pp 268
30) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003,
Choukhambha Sanskrit Samsthan, Varanasi, pp 40
31) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34-5, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
32) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/65 3rd ed. 1996, Chaukhambha
Krishnadas Academy, Varanasi, pp-121
33) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/36, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283
34) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
35) Ibid, pp 63
36) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68
37) Arthur C gyton & John E Hall, Medical Physiology, 10th ed. 2001, Harcourt Asia PTE
Ltd, Singapore, pp 690
38) Ibid, pp 690
39) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/58, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 287
40) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/58, 1st ed. Reprint, 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp
119
41) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/37, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 284
42) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
43) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/68, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 201
44) Harishastri Paradkar ed, astanga Hrudayam, Sutra, 7/54, 7th ed, 1982,
Choukhambha Orientalia, Varanasi, pp 141
45) Kashinatha Sastri ed, Charaka Samhita, vol-1, Vimana 6/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 602
46) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
47) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain
Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930
Baghel), pp 35

Management of Anidra with Nidra caps – Bibliographic References ii


48) Satyanarayana Sastri, Charaka Samhita, Part II, Chikitsa 1-4/32, 1st ed. Reprint,
2001, Chaukhambha Bharati Academy, Varanasi, pp- 58
49) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 19/37, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 370
50) AS Fauci, Harison principles of internal medicine, Vol-1, 14th ed. 1998 India: Mcgraw
Hill co, Singapore, pp 151
51) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain
Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930
Baghel), pp 33
52) Ibid, pp 34
53) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/57, 1st ed. Reprint 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp
119
54) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
55) Gopala Sastri Nene ed, Manusmruti, 1/65, 7th ed. 2003, Chaukhambha Sanskrit
Samsthan, Varanasi, pp 21-22
56) Indradev Tripathi & Dayashankar tripathi ed, Yoga Ratnakara, Poorva, Nitya
Pravrutti Parkaran, 259, 1st ed. 1998, Krishnadas Academy, Varanasi, pp-66
57) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 7/112, 3rd ed.
1983, Chaukhambha Orientalia, Varanasi, pp-103
58) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/36, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283
59) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 234
60) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737
61) Arthur C gyton & John E Hall, Medical Physiology, 10th ed. 2001, Harcourt Asia PTE
Ltd, Singapore, pp 689
62) Ibid, pp 693
63) Kashinatha Sastri ed, Charaka Samhita, vol-1, Sutra 21/35, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 283
64) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68
65) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/34, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
66) Chatterjee CC, Human Physiology, Vol 2, 9th ed. 1983, Medical allied Agency,
Calcutta, pp 5-267-68
67) Dhamini Nirmal, Role of Manasa bhavas in Anidra and its management with certain
Indigenous drugs and shiro dhara, 2004, Manasa Roga Vibhaga, Jamnagar (L-2930
Baghel), pp 29
68) Ibid, pp 30
69) Satyanarayana Sastri, Charaka Samhita, Part II, 1st ed. Reprint 2001, Chikitsa
15/241, 2001, Chaukhambha Bharati Academy, Varanasi, pp- 485
70) AS Fauci, Harison principles of internal medicine, Vol-1, 14th ed. 1998 India:
Mcgraw Hill co, Singapore, pp 151

Management of Anidra with Nidra caps – Bibliographic References iii


71) Indradev Tripathi & Dayashankar tripathi ed, Yoga Ratnakara, Poorva, Nitya
Pravrutti Parkaran, 191, 1st ed. 1998, Krishnadas Academy, Varanasi, pp-61
72) Brahma Sankara Misra ed, Bhavaprakasha, Poorva khanda, 5/315, 5th ed, 1969,
Chaukshambha Sanskrit series office, Varanasi, pp-146
73) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 234
74) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/36, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 418
75) Ibid, pp 416
76) Ibid, 20/11, pp 399
77) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/33, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 63
78) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/39, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 197
79) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/65 3rd ed. 1996, Chaukhambha
Krishnadas Academy, Varanasi, pp-121
80) Parashurama sastri ed, Sharangadhara Samhita, Poorva, Adhamalla, 7/112, 3rd ed.
1983, Chaukhambha Orientalia, Varanasi, pp-103
81) Raja Radhakanta dev Bahadur, Shabdakalpadruma, vol-1, 3rd ed, 1967,
Chaukhambha Sanskrit series, Varanasi, pp-1
82) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary
insomnia, 2000, GAMC, Mysore, pp 11
83) Monier Williams, Sanskrit English dictionary, 1st ed reprint, 1993, Oxford university
press, Delhi, pp-95
84) Ibid, pp 417
85) Ibid, pp 60
86) Ibid, pp 327
87) Ibid, pp 744
88) Ibid, pp 407
89) Ibid, pp 769
90) Ibid, pp 957
91) Ibid, pp 532
92) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737
93) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/55-57, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 421
94) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani Ayurveda Deepika,
Sutra, 21/57, 1st ed. Reprint 2004, Chaukhambha Sanskrit Samsthan, Varanasi, pp
119
95) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/57, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 421
96) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/42, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 65
97) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/324, 5th ed, 1988,
Chaukshambha Sanskrit sansthan, Varanasi, pp-74

Management of Anidra with Nidra caps – Bibliographic References iv


98) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/53-54, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 199
99) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Shareera 4/42, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 65
100) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 7/23, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 157
101) Srikantha Murthy KR ed, Susruta Samhita, vol -3, Uttara 55/17, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 364
102) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/56, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 200
103) Srikanta Murthy KR ed, Astanga Hridaya, Sutra, 7/64 3rd ed. 1996, Chaukhambha
Krishnadas Academy, Varanasi, pp-121
104) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 399
105) Brahmalinamuni ed, Patanjali Yoga Darshan, Samadhi pada, 10, 6th ed. 2003,
Choukhambha Sanskrit Samsthan, Varanasi, pp 40
106) K. R Shrikanta Murthy ed, Sharangdhara samhita, 7/112-119, 1st ed, Chaukambha
Orientalia ,Varanasi, 1984, pp 40-1
107) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 21/59, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp 422-3
108) Srikantha Murthy KR ed, Susruta Samhita, vol -2, Chikitsa 24/88, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 234
109) Ravidutt Trippathi ed, Astanga Sangraha, Sutra, 9/56, 1st ed. Reprint 2001,
Choukhambha Sanskrit Pratistan, Varanasi, pp 200
110) Brahma Shankar Mishra ed, Bhaisajya Ratnavali, 15/162-66, 18th ed, 2005,
Chaukhambha Sanskrit Bhavan, Varanasi, pp-455
111) Ayurvedic formulary of India, part-1, 1st ed. 1978, 18/21, Govt. of India, controller of
publications Delhi, pp 193
112) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary
insomnia, 2000, GAMC, Mysore, pp 28
113) Ayurvedic formulary of India, part-1, 1st ed. 1978, 819, Govt. of India, controller of
publications Delhi, pp 107
114) Ramavalamba Sastri, Harita Samhita, Truteeya, 15/5, 1st ed, 1985, Prachya
Prakashan, Varanasi, pp 297-8
115) Ibid, 15/6, pp297-8
116) Pujar MP, effect of Shirovasti in the management of Nidranasha wsr to primary
insomnia, 2000, GAMC, Mysore, pp 28
117) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/325, 5th ed, 1988,
Chaukshambha Sanskrit sansthan, Varanasi, pp-74
118) Brahma Shankar Mishra ed, Bhaisajya Ratnavali, 21/9, 18th ed, 2005, Chaukhambha
Sanskrit Bhavan, Varanasi, pp-498
119) Brahma Sankara Misra ed, Bhavaprakasha, madhyama khanda, 1/327, 5th ed, 1988,
Chaukshambha Sanskrit sansthan, Varanasi, pp-74
120) Ramavalamba Sastri, Harita Samhita, Truteeya, 15/4, 1st ed, 1985, Prachya
Prakashan, Varanasi, pp 297-8

Management of Anidra with Nidra caps – Bibliographic References v


121) Tiwari PV ed, Kashyapa Samhita Khila, 4/30-31, 1st ed. Reprint 2002, Chaukhambha
Vishwa Bharati, Varanasi, pp-472
122) Ibid, 4/56, pp 476
123) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737
124) Sainani GS ed, API textbook of medicine, 6th ed, 1999, Association of Physicians of
India, Mumbai, pp 745
125) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-64
126) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 199-200
127) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 1260
128) Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, 1985, Chaukambha Bharati
Academy, Varanasi, pp 374
129) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-31
130) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 840
131) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 240
132) Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, 1985, Chaukambha Bharati
Academy, Varanasi, pp 731
133) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-763
134) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 240
135) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 1292
136) Bapalal .G. Vaidya, Nighantu Adarsha, volume 2, 1st ed , Chaukambha Bharati
Academy, Varanasi, 1985, page no. 134
137) Ibid, pp 345
138) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati
Academy, Varanasi, pp-275
139) K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, 1982, Popular
Prakashan, Bombay, pp 965
140) G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary, 2004
Chaukambha Bharati Academy, Varanasi, pp 16
141) Kashinatha Sastri ed, Charaka Samhita, vol-1, sutra 20/11, Vidyotini Hindi
commentary, 18th ed, 2004, Choukhambha Sanskrit Samsthan, Varanasi, pp
142) Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi, pp737
143) http://www.mayoclinic.com/health/sleep/SL99999
144) http://www.sjo.org/MainServices.aspx?pageId=114
145) Ibid

Management of Anidra with Nidra caps – Bibliographic References vi


Demographic Data of Group – Placebo
SNo OPD Gender Religion Occupation Economical Result

V/Mx
Food
Age
No Condition
M F H M C O S A L P Md Hg Hc
1 2534 + 28 V + + + NR
2 2656 + 30 V + + + PR
3 2676 + 52 V + + + PR
4 2757 + 23 MX + + + PR
5 2821 + 58 V + + + PR
6 2869 + 32 MX + + + WR
7 2874 + 22 V + + + PR
8 3933 + 43 MX + + + PR
9 3842 + 27 MX + + + NR
10 3866 + 59 V + + + NR
11 3865 + 34 V + + + NR
12 3863 + 33 V + + + NR
13 5038 + 50 V + + + PR
14 2509 + 29 V + + + NR
15 2812 + 45 V + + + NR
10 5 V=11 12 2 0 1 1 11 3 4 10 1 0 NR=7
Total MX=4 PR=7
WR=1

Demographic Data of Group – Nidra cap


SNo OPD Gender Religion Occupation Economical Result
V/Mx
Food
Age

No Condition
M F H M C O S A L P Md Hg Hc
1 2210 + 69 V + + + MR
2 2515 + 65 V + + + MR
3 2368 + 55 V + + + MR
4 2472 + 40 MX + + + MR
5 2843 + 43 V + + + MR
6 3125 + 62 MX + + + MR
7 3001 + 28 MX + + + MR
8 2568 + 40 V + + + MR
9 3864 + 28 MX + + + MR
10 3882 + 50 MX + + + MR
11 4624 + 58 V + + + WR
12 4812 + 56 V + + + WR
13 5027 + 45 V + + + WR
14 2618 + 40 V + + + MR
15 2853 + 28 V + + + WR
8 7 V=10 9 5 1 0 1 12 2 3 8 4 0 MR=11
Total MX=5 WR=4

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 1
Subjective Statistical Assessment Data of Group – Placebo
S.No OPD Difficulty in Body ache Yawning Vitality after Performance of
initiating sleep (Angamarda) (Jrumba) morning daily activities
awakening
B A B A B A B A B A
1 2534 2 2 1 1 2 2 0 0 0 0
2 2656 1 0 3 3 1 1 1 1 1 1
3 2676 2 0 2 0 1 1 1 1 1 1
4 2757 2 1 1 1 1 1 1 0 1 0
5 2821 2 0 1 1 1 1 2 1 2 1
6 2869 3 0 1 0 2 0 2 0 2 0
7 2874 1 0 0 0 0 0 2 0 2 0
8 3933 3 2 2 1 2 1 1 1 1 1
9 3842 2 2 1 1 1 1 1 1 1 1
10 3866 1 1 1 1 1 1 1 1 1 1
11 3865 2 2 0 0 1 1 0 0 0 0
12 3863 2 2 1 1 1 1 0 0 0 0
13 5038 2 2 1 1 1 1 1 1 1 1
14 2509 2 2 1 1 1 1 1 1 1 1
15 2812 2 2 0 0 1 1 1 1 1 1
Total 29 18 16 12 17 14 15 9 15 9

Subjective Statistical Assessment Data of Group – Nidra caps


S.No OPD Difficulty in Body ache Yawning Vitality after Performance of
initiating sleep (Angamarda) (Jrumba) morning daily activities
awakening
B A B A B A B A B A
1 2210 3 1 1 0 2 1 3 1 2 1
2 2515 2 1 1 0 1 0 1 0 1 0
3 2368 2 1 2 1 2 1 1 0 1 0
4 2472 2 0 3 1 3 1 3 1 3 1
5 2843 2 1 0 0 1 0 1 0 1 0
6 3125 3 0 1 1 1 1 2 0 2 0
7 3001 2 0 2 0 1 0 2 0 2 0
8 2568 2 1 0 0 1 1 1 0 1 0
9 3864 2 0 1 0 1 0 1 0 1 0
10 3882 2 0 2 0 2 0 1 0 1 0
11 4624 2 0 1 0 1 0 1 0 1 0
12 4812 2 0 1 0 1 0 1 0 1 0
13 5027 2 0 1 0 1 0 1 0 1 0
14 2618 3 1 1 0 1 0 1 0 1 0
15 2853 2 0 1 0 1 0 1 0 1 0
Total 33 6 18 3 20 5 21 2 20 2

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 2
Objective Statistical Assessment Data of Group – Placebo
S.No OPD Total sleep Sleep onset Number of Efficiency of sleep Sleep
time (hrs) latency (min) awakens (TST/TTSR * 100) Fragmental
Time (TST/ #
Awk)
B A B A B A B A B A
1 2534 6.5 6.5 120 120 2 2 70.2 70.2 3.25 3.25
2 2656 6 7.5 60 30 2 2 75 93.75 3 3.75
3 2676 3.75 5.5 120 30 3 1 62.5 91.66 1.25 5.5
4 2757 4 6 120 30 3 1 50 75 1.33 6
5 2821 4.25 6 120 60 3 1 60.71 85.71 1.41 6
6 2869 5.5 8 150 30 3 1 64.7 94.11 1.83 8
7 2874 5.75 6.5 60 30 3 2 82.14 92.85 1.91 3.25
8 3933 5.25 6.25 180 120 3 3 61.76 73.52 1.75 2.08
9 3842 5 5 120 120 2 2 62.5 62.5 2.5 2.5
10 3866 4.75 4.75 60 60 2 2 79.16 79.16 2.37 2.37
11 3865 5.25 5.25 120 120 3 3 65.62 65.62 1.75 1.75
12 3863 5 5 120 120 0 0 71.42 71.42 5 5
13 5038 4.5 5.5 120 60 3 3 64.28 78.57 1.5 1.83
14 2509 5 5 120 120 2 2 62.5 62.5 2.5 2.5
15 2812 4.75 4.75 60 60 2 2 79.16 79.16 2.37 2.37
Total 75.25 87.5 1650 1110 36 27 1011.65 1175.73 33.72 56.15

Objective Statistical Assessment Data of Group – Nidra caps


S.No OPD Total sleep Sleep onset Number of Efficiency of sleep Sleep
time (hrs) latency (min) awakens (TST/TTSR * 100) Fragmental
Time (TST/ #
Awk)
B A B A B A B A B A
1 2210 0.5 3 60 30 3 0 7.1 42.85 0.1 3
2 2515 5 6 180 60 3 2 55.55 66.66 1.6 3
3 2368 5.75 7 120 60 3 1 71.87 87.5 1.9 7
4 2472 5.25 7 180 30 3 0 65.62 87.5 1.75 7
5 2843 5 6.5 120 60 3 2 62.5 81.25 1.6 3.25
6 3125 4 5.5 150 30 2 0 50 68.75 2 5.5
7 3001 5.5 8 180 90 5 2 55 80 1.1 4
8 2568 5 7 120 60 4 1 52.5 87.5 1.25 7
9 3864 5 6 180 60 3 2 55.55 66.66 1.66 3
10 3882 5.5 8 180 90 5 2 55 80 1.1 4
11 4624 3.75 5.5 120 30 2 1 62.5 91.66 1.87 5.5
12 4812 5 7 150 30 2 1 66.66 93.33 2.5 7
13 5027 4 6 120 30 2 1 50 75 2 6
14 2618 4 6.5 120 60 3 2 50 81.25 1.3 3.25
15 2853 5.25 7 120 30 3 1 65.62 87.5 1.75 7
Total 68.5 96 2100 750 46 18 825.47 1177.41 23.48 75.5

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 3
Chief & Associated complaints of Placebo
Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 T

1 Difficulty in initiating sleep + + + + + + + + + + + + + + +


2 Reduction in sleep time + + + + + + + + + + + + + + +
3 Wakefulness during sleep + + + + + + + + + + +
4 Body ache (Angamarda) + + + + + + +
5 Yawning (Jrumba) + + + +
Associated Complaints
1 Tandra (Stupor) + + +
2 Klama (Fatigue) + + + + + + + +
3 Shirogourava (Head + + + + + + + + + + + +
Heaviness)
4 Shirasoola (Headache) + + + + + + + + + + + +
5 Akshi Jadya (heaviness in + + + + + + + + + + +
eyes)
6 Deha Jadya (Body heaviness) + + + + + + + + + + + +
7 Glani

8 Bhrama (Giddiness) + + + + +
9 Apakti (Indigestion) + + + +
10 Aruchi (Anorexia) + + + +

Chief & Associated complaints of Nidra cap


Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 T

1 Difficulty in initiating sleep + + + + + + + + + + + + + +


2 Reduction in sleep time + + + + + + + + + + + + + + +
3 Wakefulness during sleep + + + + + + + + + + + + +
4 Body ache (Angamarda) + + + + + + + + +
5 Yawning (Jrumba) + + + +
Associated Complaints
1 Tandra (Stupor) + + + + + +
2 Klama (Fatigue) + + + + + + + + +
3 Shirogourava (Head + + + + + + + + +
Heaviness)
4 Shirasoola (Headache) + + + + + + + + +
5 Akshi Jadya (heaviness in + + + + + + + + +
eyes)
6 Deha Jadya (Body heaviness) + + + + + + + + +
7 Glani + + + + +
8 Bhrama (Giddiness) + + + +
9 Apakti (Indigestion) + + + +
10 Aruchi (Anorexia) + + +

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 4
Examination of Sleep Data of Group – Placebo caps
S.No OPD History of sleep Sleep Bahya Manasika
Upashaya
points (11) Examination Karana karana
points (48) (Ahara-
Vihara)
B A B A B A B A B A
1 2534 1 1 5 0 5 1 2 2 0 2
2 2656 1 1 14 6 3 1 2 2 0 2
3 2676 1 1 5 0 5 1 2 2 0 2
4 2757 2 2 8 3 0 0 4 1 0 2
5 2821 1 1 3 0 0 0 3 1 0 2
6 2869 1 1 11 0 4 0 1 0 0 4
7 2874 1 1 22 0 0 0 5 2 0 2
8 3933 1 1 13 10 0 0 4 2 0 3
9 3842 1 1 4 4 0 0 4 4 0 2
10 3866 2 2 7 5 0 0 2 2 0 5
11 3865 2 2 4 4 1 1 3 3 0 3
12 3863 2 2 3 3 3 1 3 1 0 2
13 5038 2 2 5 5 0 0 3 3 0 2
14 2509 2 2 13 10 0 0 4 2 0 1
15 2812 1 1 3 0 0 0 3 1 0 2
Total 21 21 120 50 21 5 45 28 0 36

Examination of Sleep Data of Group – Nidra caps


S.No OPD History of sleep Sleep Bahya Karana Manasika
points (11) Examination Upashaya
(Ahara- karana
points (48) Vihara)
B A B A B A B A B A
1 2210 2 2 15 2 1 0 5 3 0 5
2 2515 2 2 8 2 0 0 6 3 0 3
3 2368 1 1 6 0 0 0 3 1 0 1
4 2472 2 2 8 0 2 0 5 2 2 1
5 2843 1 1 10 3 0 0 5 4 0 1
6 3125 1 1 6 0 0 0 5 1 0 2
7 3001 1 1 7 2 0 0 5 2 0 2
8 2568 1 1 4 0 0 0 6 2 2 2
9 3864 2 2 2 0 0 0 3 1 0 2
10 3882 1 1 18 4 0 0 2 0 0 4
11 4624 1 1 10 3 0 0 3 1 0 2
12 4812 1 1 3 0 0 0 0 0 0 2
13 5027 2 1 10 2 0 0 2 0 0 2
14 2618 2 2 2 0 0 0 3 1 0 2
15 2853 1 1 4 0 0 0 6 2 2 2
Total 21 20 113 18 3 0 59 23 6 33
Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 5
History of present Illness of placebo cap
S.No OPD Mode of Course Freque Duration Preceded by Change of
onset of ncy of of Regulariti
Anidra Anidra Anidra es
1 2 3 1 2 1 2 1 2 3 1 2 3 4 5 1 2 3
1 2534 + + + + + + +
2 2656 + + + + + + + +
3 2676 + + + + + + + + +
4 2757 + + + + + +
5 2821 + + + + + + + +
6 2869 + + + + +
7 2874 + + + + +
8 3933 + + + + + + +
9 3842 + + + + + +
10 3866 + + + + + + +
11 3865 + + + + + + +
12 3863 + + + + + + +
13 5038 + + + + + + +
14 2509 + + + + + + + +
15 2812 + + + + + + + +
Total 2 11 2 5 10 9 6 8 7 0 11 1 9 6 4 8 4 2
*

History of present Illness of Nidra cap


S.No OPD Mode of Course Freque Duration Preceded by Change of
onset of ncy of of Anidra Regulariti
Anidra Anidra es
1 2 3 1 2 1 2 1 2 3 1 2 3 4 5 1 2 3
1 2210 + + + + + + + + +
2 2515 + + + + + + + +
3 2368 + + + + +
4 2472 + + + + + + + + + + +
5 2843 + + + + + + + + + +
6 3125 + + + + + + + + + + +
7 3001 + + + + + + + + + +
8 2568 + + + + + + + + +
9 3864 + + + + +
10 3882 + + + + + + +
11 4624 + + + + + + +
12 4812 + + + +
13 5027 + + + + + + + +
14 2618 + + + +
15 2853 + + + + + + + + +
Total 2 8 5 8 7 4 11 6 6 5 9 7 4 4 7 9 8 6

Mode of onset = 1-sudden /2- Gradual / 3- Insidious; Course of Anidra = 1-Transient / 2-continuous/; Frequency of Anidra
= 1-few days / 2- few weeks; Duration of Anidra = 1-continuous / 2- intermittent / 3- sleeps with medication; Preceded by=
1-Anxiety / 2-Anger / 3-Fear /4- restlessness / 5-pain / ; Change of Regularities = 1-Place / 2-Bed / 3-Environmental

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1 6
Group –A (Placebo caps)
SN OPD.No Difficulty Body ache Yawning Vitality Performance Total Sleep Number Efficiency Sleep Total
in (Angamarda) (Jrumba) after of daily sleep onset of of sleep Fragmental mean %
initiating % % morning activities % time latency awakens (TST/TTSR Time (TST/
sleep % awakening (hrs (min % * 100) % # Awk) %
%) %)
%
1 2534 0 0 0 0 0 0 0 0 0 0 0
2 2656 100 0 0 0 0 20 50 0 10.8 21.5 21.05
3 2676 100 100 0 0 0 31.9 75 66.7 29.2 77.3 48
4 2757 50 0 0 100 100 33.4 75 66.7 25 76.7 40.2
5 2821 100 0 0 50 50 29.2 50 66.7 25 76.5 44.8
6 2869 100 100 100 100 100 31.3 80 66.7 29.5 77.5 78.5
7 2874 100 0 0 100 100 11.6 50 33.4 10.8 41.2 44.7
8 3933 33.4 50 50 0 0 16 33.4 0 11.8 14.3 20.9
9 3842 0 0 0 0 0 0 0 0 0 0 0
10 3866 0 0 0 0 0 0 0 0 0 0 0
11 3865 0 0 0 0 0 0 0 0 0 0 0
12 3863 0 0 0 0 0 0 0 0 0 0 0
13 5038 0 0 0 0 0 18.2 50 0 14.3 18 19.2
14 2509 0 0 0 0 0 0 0 0 0 0 0
15 2812 0 0 0 0 0 0 0 0 0 0 0
Total 583.4 250 150 350 350 191. 463.4 300.2 156.4 403 317.35
6
Mean 12.7 30.893 20.0133
38.89333 16.66667 10 23.33333 23.33333 7333 33 3 10.42667 26.86667 21.15667

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
7
Group –B (Nidra caps)
SN OPD.No Difficulty Body ache Yawning Vitality Performance Total Sleep Number Efficiency Sleep Total
in (Angamarda) (Jrumba) after of daily sleep onset of of sleep Fragmental mean %
initiating % % morning activities % time latency awakens (TST/TTSR Time (TST/
sleep % awakening (hrs (min % * 100) % # Awk) %
%) %)
%
1 2210 66.7 100 50 66.7 50 83.4 50 100 35.8 96.7 67.95
2 2515 50 100 100 100 100 16.7 66.7 33.4 11.1 46.7 62.5
3 2368 50 50 50 100 100 17.8 50 66.7 15.7 72.9 57.35
4 2472 100 66.7 66.7 66.7 66.7 25 83.4 100 21.9 75 67.25
5 2843 50 0 100 100 100 23 50 33.4 18.8 50.8 52.6
6 3125 100 0 0 100 100 27.3 80 100 18.8 63.7 59.3
7 3001 100 100 100 100 100 31.3 50 60 25 72.5 73.9
8 2568 50 0 0 100 100 28.6 50 75 25 82.1 51.05
9 3864 100 100 100 100 100 16.7 66.7 33.4 11.1 44.7 67.3
10 3882 100 100 100 100 100 31.2 50 60 25 72.5 73.9
11 4624 100 100 100 100 100 31.9 75 50 29.2 66 75.25
12 4812 100 100 100 100 100 28.6 80 50 26.7 64.3 74.55
13 5027 100 100 100 100 100 33.4 75 50 25 66.7 75
14 2618 100 100 100 100 100 38.5 50 33.4 31.2 60 71.35
15 2853 100 100 100 100 100 25 75 66.7 21.9 75 76.4

Management of Anidra with Nidra caps – Master Charts data of Trial- Annex-1
8
Special case sheet for “Management of Anidra with Nidra caps
- a placebo comparative study”
POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA)
D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide: Scholar:
Dr. K. Shiva Rama Prasad Kamalaxi. M. Angadi
1) Name of the Patient Sl.No

2) Gender Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM
Date Month Year Time
Hours Minutes PM

9) Selection Included Excluded

10) Schedule dates Initiation completion

11) Result Well Moderately Not Discontinued


Responded Responded responded
INFORMED CONSENT
I Son/Daughter/Wife of
am exercising my free will, to participate in above study as a subject. I have been informed to
my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of
the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any
time during the course of the treatment.
EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ
PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ
0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature

“Management of Anidra with Nidra caps- a placebo comparative study” 1


12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters)
Complaints Duration Remarks

1 Difficulty in initiating sleep


2 Reduction in sleep time
3 Wakefulness during sleep
4 Body ache (Angamarda)
5 Yawning (Jrumba)
13) ASSOCIATED COMPLAINTS
Associated Complaints Duration Remarks

1 Tandra (Stupor)
2 Klama (Fatigue)

3 Shirogourava (Head Heaviness)


4 Shirasoola (Headache)

5 Akshi Jadya (heaviness in eyes)


6 Deha Jadya (Body heaviness)
7 Glani
8 Bhrama (Giddiness)
9 Apakti (Indigestion)
10 Aruchi (Anorexia)
14) HISTORY OF PRESENT ILLNESS
Mode of onset sudden / Gradual / Insidious
Course of Anidra Transient / continuous/
Frequency of Anidra few days / few weeks
Duration of Anidra continuous / intermittent / sleeps with medication
Preceded by Anxiety / Anger / Fear / restlessness / pain /
Change of Regularities Place / Bed / Environmental
History of sleep
Hearing soft Music before going to bed Yes No
Perfume applications before going to bed Yes No
Having Bath Before going to Bed Yes No
Massage of feet etc before going to bed Yes No
Passing Urine before going to bed Yes No
Passing Stools before going to bed Yes No
Masturbation before going to bed Yes No
Prayers before going to bed Yes No
Reading before going to bed Yes No
Consuming alcohol before going to bed Yes No
Sexual Intercourse before going to bed Yes No
15) Occupational History if any

“Management of Anidra with Nidra caps- a placebo comparative study” 2


16) PERSONAL HISTORY
Food habits Vegetarian Mixed diet
Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna


Kosta Mrudu Madhyama Krura
Nidra Day Night Sound Disturbed
Addictions Tobacco Alcohol Drugs
Bowel habits Normal Loose Constipated
Menstrual History Regular Irregular Amenorrhea Menopause
Family history – Specify if any has the same disease
Treatment Other system medications (Anti depressants) Since how long
history Tranquillisers Hypnotics Sedatives
History of past illness corresponding
to sleep disturbances
17) EXAMINATION
a) Vitals

Temperature ºF Pulse / min Respiration rate / min

Height Cms Weight Kg Blood pressure mmHg

b) Examination of sleep
B A
1. Do you wake frequently during the night and feel un-refreshed in the morning?
2. Do you have difficulty staying awake during the day?
3. Do you have diabetes, hypertension or another health problem that affects your sleep?
4. Are you overweight? Do you find it difficult to lose weight?
5. Do you wake up with a dry mouth, sore throat or headache in the morning?
6. Do you have difficulty concentrating during the day?
7. Do you need to take naps during the day?
8. Does your snoring bother you or your spouse enough for you to consider treatment?
9. Doze off or fall asleep in Sitting and reading position
10. Doze off or fall asleep while Watching TV
11. Doze off or fall asleep in Sitting inactive in a public place
12. Doze off or fall asleep as a passenger for 1 hour without a break
13. Doze off or fall asleep in Lying down to rest in the afternoon
14. Doze off or fall asleep in Sitting & talking to someone
15. Doze off or fall asleep while Sitting quietly after lunch without alcohol
16. Doze off or fall asleep while stopping for a few minutes in traffic
0 = Never, 1= .Slight Chance 2 = Moderate Chance 3 = High Chance

“Management of Anidra with Nidra caps- a placebo comparative study” 3


c) Dosha Examination (Ayurvedic)
Desham (Deha) Ð Bhumi Jangala Anupa Sadharana
(a) Dosha Vata B A Pitta B A Kapha B A
Vruddhi
P eet a
K ars hy a A gni s adana
m o ot rat a
K ars hnya P eet anet ra P ras ek a

Us hna k ami t wa P eet av it A las ya

Kampa P ee t at wak S wet a n g a t a

A naha Adhiks hudha Sheetangata

S hak rudgraha Adhi daha Gowrav a

B a l ab hr m s h a S l at h an ga t a

Nidrabhr a ms ha S was a

Pralapa K as a

B h r am a At i ni dr a
(b) Dosha Vata B A Pitta B A Kapha B A
Kshaya
Angasada Mandagni Bhrama
Alpabhashite Shareera Urah
ahitam sheetatwam shoonyata
Shira
Chesta heenata Prabha hani
soonyata
Vyamoha Hridrava
Sandhi
Sleshma vruddhi
saidhilya
Nadi V P K VP VK PK VPK
Prakruti V P K VP VK PK VPK
Sara Pravara Avara Madhyama
Samhanana Susamhita Asamhita Madhyma samhita
Pramana Height in Cms Weight in Kgs
Satmya Ekarasa Sarvarasa Ruksha Sneha
Satwa Pravara Avara Madhyama
Ahara Shakti Abhyavaharana Jarana
Vyayam Shakti Pravara Avara Madhyama
Vaya Balya Yauvana Vardhakya
Nadi Dosha Mutra
Pravrutti
Gati
Varna
Astasthana

Purnata
Gandha
Spandana
Kathinya
Jihwa Ardra Sushka Mala Sama Nirama
Lepa Nirlepa
Shabda Sparsha Sheeta Ushna
Drik Akruti

“Management of Anidra with Nidra caps- a placebo comparative study” 4


d) Examination of Sleeplessness effect on systems
System (Srotas) Observations Remarks
Gastrointestinal (Anna)
Respiratory (Prana)
Cardiovascular (Rasa)
Hemopoietic (Rakta)
Musculoskeletal (Mamsa / Asti)
Neurological (Majja)
Genital (Sukra)
Urinary (Mootra)
Lower GIT (Pureesha)
18) Anidra Nidana
Ahara Vihara Manasika Anya
Yavanna Dhooma Bhaya Virechana
Rookshanna Vyayama Chinta Vamana
Upavasa Krodha Shirovirechana
Asukhashayya Manastapa Raktamokshana
Kshudha Vyatha Kshaya
Mithuna Harsha Abhighata

19) Upashaya and Anupashaya in Anidra

Upashaya Abhyanga Tarpana


Utsadana Sneha sevana
Ksheera panam Mamsarasa sevana
Anupashaya Rooksha ahara Manasika vikara
20) Investigations in routine
Haemoglobin %
Erythrocyte sedimentation Rate
Differential count Lymphocytes
Neutrophils
Eosinophils
Basophils
Monocytes
21) Assessment
a) Subjective parameters Before After Follow-up Comment

1 Difficulty in initiating sleep

2 Body ache (Angamarda)

3 Yawning (Jrumba)

4 Vitality after morning awakening

5 Performance of daily activities

“Management of Anidra with Nidra caps- a placebo comparative study” 5


b) Objective parameters Before After Follow-up

1 Total sleep time (hrs)


2
Sleep onset latency (min)
3 Number of awakens
4 Efficiency of sleep (TST/TTSR * 100)
5 Sleep Fragmental Time (TST/ # Awk)

22) Treatment schedule of NIDRA CAPS / PLACEBO


Schedule Investigator’s observation
Day 1
Day 7
Day 14
Day 21
Day 28 1st Follow up
Day 42 (Final Follow up)
Sleep worksheet
S.No

TST = TTSR
Compleation

Awakenings
Duration of
Awakening
Number of

– (Daw +
Going to

Latency
Falling
asleep

TTSR
Sleep

Sleep
Bed

SL)
1
before

2
3
1
After

2
3
1
Follow up

2
3

Investigators Note:

Signature of Guide Signature of Scholar


(Dr. K. Shiva Rama Prasad) (Kamalaxi. M. Angadi)

“Management of Anidra with Nidra caps- a placebo comparative study” 6


Group –A (Placebo caps)
SN OPD.No Difficulty Body ache Yawning Vitality Performance Total Sleep Number Efficiency Sleep Total
in (Angamarda) (Jrumba) after of daily sleep onset of of sleep Fragmental mean %
initiating % % morning activities % time latency awakens (TST/TTSR Time (TST/
sleep % awakening (hrs (min % * 100) % # Awk) %
%) %)
%
1 2534 0 0 0 0 0 0 0 0 0 0 0
2 2656 100 0 0 0 0 20 50 0 10.8 21.5 21.05
3 2676 100 100 0 0 0 31.9 75 66.7 29.2 77.3 48
4 2757 50 0 0 100 100 33.4 75 66.7 25 76.7 40.2
5 2821 100 0 0 50 50 29.2 50 66.7 25 76.5 44.8
6 2869 100 100 100 100 100 31.3 80 66.7 29.5 77.5 78.5
7 2874 100 0 0 100 100 11.6 50 33.4 10.8 41.2 44.7
8 3933 33.4 50 50 0 0 16 33.4 0 11.8 14.3 20.9
9 3842 0 0 0 0 0 0 0 0 0 0 0
10 3866 0 0 0 0 0 0 0 0 0 0 0
11 3865 0 0 0 0 0 0 0 0 0 0 0
12 3863 0 0 0 0 0 0 0 0 0 0 0
13 5038 0 0 0 0 0 18.2 50 0 14.3 18 19.2
14 2509 0 0 0 0 0 0 0 0 0 0 0
15 2812 0 0 0 0 0 0 0 0 0 0 0
Total 583.4 250 150 350 350 191. 463.4 300.2 156.4 403 317.35
6
Mean 12.7 30.893 20.0133
38.89333 16.66667 10 23.33333 23.33333 7333 33 3 10.42667 26.86667 21.15667
Group –B (Nidra caps)
SN OPD.No Difficulty Body ache Yawning Vitality Performance Total Sleep Number Efficiency Sleep Total
in (Angamarda) (Jrumba) after of daily sleep onset of of sleep Fragmental mean %
initiating % % morning activities % time latency awakens (TST/TTSR Time (TST/
sleep % awakening (hrs (min % * 100) % # Awk) %
%) %)
%
1 2210 66.7 100 50 66.7 50 83.4 50 100 35.8 96.7 67.95
2 2515 50 100 100 100 100 16.7 66.7 33.4 11.1 46.7 62.5
3 2368 50 50 50 100 100 17.8 50 66.7 15.7 72.9 57.35
4 2472 100 66.7 66.7 66.7 66.7 25 83.4 100 21.9 75 67.25
5 2843 50 0 100 100 100 23 50 33.4 18.8 50.8 52.6
6 3125 100 0 0 100 100 27.3 80 100 18.8 63.7 59.3
7 3001 100 100 100 100 100 31.3 50 60 25 72.5 73.9
8 2568 50 0 0 100 100 28.6 50 75 25 82.1 51.05
9 3864 100 100 100 100 100 16.7 66.7 33.4 11.1 44.7 67.3
10 3882 100 100 100 100 100 31.2 50 60 25 72.5 73.9
11 4624 100 100 100 100 100 31.9 75 50 29.2 66 75.25
12 4812 100 100 100 100 100 28.6 80 50 26.7 64.3 74.55
13 5027 100 100 100 100 100 33.4 75 50 25 66.7 75
14 2618 100 100 100 100 100 38.5 50 33.4 31.2 60 71.35
15 2853 100 100 100 100 100 25 75 66.7 21.9 75 76.4
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DESERTAION

0.1 NAME OF THE CANDIDATE : KAMALAXI. M. ANGADI.

ADDRESS(in block letters) : D/o. MALLAPPA. S. ANGADI.

OPP. J. T. KALLYANAMANTAPA,

GADAG.

DIST: GADAG. – 582 101

0.2 NAME OF THE INSTITUTION : SRI. D. G. MELAMALGI AYURVEDIC

MEDICAL COLLEGE, GADAG.

0.3 COURSE OF STUDY & SUBJECT : AYURVEDA VACHASPATHI(MD)

KAYACHIKITSA

0.4 DATE OF ADMISSION : APRIL – 2005.

0.5 TITTLE OF THE TOPIC :

“MANAGEMENT OF ANIDRA WITH NIDRA CAPS

- A PLACEBO COMPARATIVE STUDY”

0.6 RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

How the food, water and air are essential for life, like that Nidra is also very much

essential. Sound restorative sleep is the foundation of a healthy life. A good night’s sleep is

undoubtedly one of the most precious gifts we can enjoy. It provides rest our needs. Rest is

the basis of activity. Hence, the Ayurvedic Acharya’s explained Nidra one of the

trayopasthambhas1. As health is the first muse and sleep is the condition to produce it.

Improper sleep leads to disease both physical and mental.


Insomnia is ‘The inability to fall asleep or to stay asleep’. The onset of primary

insomnia is usually in young adulthood and middle age. It tends to increase with age and

affects about 40% of women and30% men 2 and about 25% of elderly people and 15 % of
3.
the general population suffer from this complaint This Nidranasha became a major

problem nowadays, due to altered life styles, busy schedule and stressful living conditions,

struggle for existence etc.

The management of Nidranasha in contemporary sciences mainly depends on most

commonly available antidepressant drugs, sedatives, tranquillisers and hypnotic drugs. The

drawback with this approach is drug dependence, tolerance towards the drugs and

reoccurrence of the symptoms on withdrawal of the drug. Apart from these internal

medication, counselling, cognitive therapy, physiotherapy and meditation have also been

advised. Still we find no satisfactory and safe measures for Nidranasha in contemporary

medical science.

So, it is forbidden moral responsibility of Ayurveda scholar to search for effective

and ideal remedy from Ayurvedic treasure of therapeutics. A several herbs have been

described in Ayurvedic literature which have beneficial effect in the management of

Nidranasha, among them Tagar (Valerian wallichii), Jatamamshi (Nordostachys

jatamamshi), Ashwaganda (Withania somnifera), and Pippali (Piper longum). At present

study an attempt will be made to evaluate the efficacy of this drug preparation in Nidranasha

with a view to find out a therapeutically efficacious, safer, cost effective and easily available

drug 16,17,18.19,20.

2
6.2Review of literature

Sleep is defined as unconsciousness from which the person can be aroused by


4.
sensory or other stimuli Nidranasha is not discussed as a disease anywhere in the

classical texts, only referred as one among the 80 types of vatavyadhi, 5,6 and mentioned as

a symptom in many diseases7. They have mentioned the relation of the doshas to Nidra. .

Nidra it is swabhavaj or swabhavik.8 Nidra is induced due to Kapha and tamobhav.9,10

. Classical text mentioned the symptoms angamarda, shirogourava, jrumbha, jadya, glani,

bhrama and apakti11,12.

While telling about merits and demerits of Nidra carak has mentioned, Happiness

and misery, obesity and leanness, strength and weakness, sexual vigour and impotence,

consciousness and loss of sensory activity, even life and death depend on the quantity of

sleep13. Nidranasha or insomnia may be defined as a condition of inadequate quantity and

quality of sleep, difficulty in getting sound sleep and early awakening14.

Primary insomnia is difficulty in initiating or maintaining sleep for at least 1 month

to 5 years and is characterised by difficulty in initiating sleep, wakefulness, during normal

sleep, daytime fatigue etc15.

A number of herbal preparations and plant extracts have been used with varying

degree of success in the management of Nidranasha. Among them Tagar (Valerian

wallichii), Jatamamshi (Nordostachys jatamamshi) Ashwaganda (Withania somnifera)

Pippalimoola (Piper longum), when taken in combination induces sleep. Which are taken on

basis of rasa, guna, veerya, and vipak, and karma and their Nidrajanakatwa prabhav16,
17,18,19,20.
Vangasen has mentioned to give pippalimoola in Nidranasha due to jwara21.

3
6.2 Objectives of the study

a) To evaluate the Nidrajanaka prabhava (sedation) of Nidracap in Anidra

b) To evaluate the Nidrajanaka prabhava (sedation) of placebo in Anidra

c) To compare the Nidrajanaka prabhava (sedation) of placebo and Nidra cap in Anidra

Materials and methods

7.1 Source of data .

a. Patients : Patients suffering from Nidranasha are selected from P.G.S and R.C

O.P.D of Shri D.G.M.A.M.C and Hospital, Gadag.

b. Literary : Literary aspects of the study will be collected from classical Ayurvedic

and modern texts, medical journals and information regarding the study will be

updated from internet search along with above said.

c. Trial drug: the trial drugs will be collected from the area where it is available

abundantly and identification will be confirmed by botanist

Rational combination has been formulated based on the pharmacological

properties and pharmacokinetics of individual drugs included in Nidracap are

individually scrutinised for its Nidrajanakatwam , Nidraprabhav from the essential

texts. To check the appropriativeness of rational combination limited no. of herbs are

included in Nidracap. Based on rasa, guna, veerya, vipak the rational combination is

formed16,17,18,19,20,21.

Each 500 mg Nidra cap consists of -

Drugs Botanical Names Quantity


Tagar Valeriana wallichii 125mg
Jatamanshi Nordostachys jatamamshi 125mg
Ashwaganda Withania somnifera 125mg
Pippalimoola Piper longum 125mg

4
7.2 METHOD OF COLLECTION OF DATA

a) Study Design: A comparative placebo control single blind clinical study

b) Sample: A minimum of 60 patients with Nidranasha disease will be selected

30 patients will be treated in each group

c) Grouping: Group A: Control 30 patients with placebo

Group B: Trial 30 patients with Nidracap.

d) Study duration: 21 days

e) Follow up: 21 days

f) Exclusive criteria:

1. Nidranasha due to other conditions like madatyaya,


2. Nidranasha due to abhighata
3. Pregnant women
4. Lactating mothers
5. Associated with any other systemic and metabolic disorders
g) Inclusive criteria:
1. Patients complaining of reduction in sleep time any of these or all of these
will be included
2. Difficulty in initiating sleep.
3. Wakefulness during normal sleep
4. Any of above or all of the above will be included
5. Along with Nidranasha patients complaining of angamarda, shirogourava,
jrumbha, jadya glani, bhrama and apakti will be included.
6. Patients already diagnosed for primary insomnia with the duration of 1
month to 5 years will be included.
h) Posology:

2 caps of 500mg or 15mg /kg body weight/24 hours, 1 hour before to retiring

5
i) Assessment of results:

Subjective and objective parameters of base line data to the after treatment data

comparison are done for the assessment of results.

j) Subjective parameters:

1. Angamarda
2. Shirogourava
3. Jrumbha
4. Jadya
5. Glani
6. Bhrama
7. Apakti
k) Objective parameters

1. Total sleep time (hrs)


2. Sleep onset latency (min)
3. Quality of sleep (mm)
4. Vitality after morning awakening (mm)
5. Performance of daily activities (mm)
6. Sleep quality evaluation (mm)
l) Statistical analysis:

The parameters going to be compared are (subjective parameters) and (objective

parameters). The paired and unpaired T – test and non parametric test used for the

testing of hypothesis if p < 0.05, the test is highly significant.

7.2 Ethical clearance: Obtained and certificate attached

8. References:

1. Satyanarayan shastri ed, carak samhita, volume 1 sutra 11/35, vidyotini hindi
commentary, 22nd ed, Choukamba Bharati Academy, Varanasi, 1996, page no.227.
2. http://www.printgoogle.co.in/print%3Fq%3Dprimary%2Binsomnia%260i%3Dprint
Gsig=QaxNvyEgrDQMVssbgb
3. http://www.holistic-online.com/Remedies/Sleep/Sleep insomnia-herbs.htm
6
4. Guyton, Human physiology and mechanism of disease, 5th ed, W. B. Saunders
Company, Tokyo, 1992,page no.453.
5. Satyapal Bhishagacharya, ed, Kashyap samhita, sutra 27/28, Chaukambha Sanskrit
Samsthan , Varanasi, page no. 42.
6. Prof. K. R Shrikanta Murthy etd,Sharangdhara samhita, 7/112, 1st ed, Chaukambha
Orientalia ,Varanasi, 1984, page no. 40.
7. Kavivar Shri Shali Gramoji Vaishya ed, Vangasen hindi tika samhita 1/718,
Khenraj Krishnaadas prakashan, Bombay, 1996, page no. 64
8. Vaidya Jadavaji Trikamji Acharya ed, Susruta samhita ,sutra 1/25, 4th ed,
Chaukambha Orientalia, Varanasi,1980, page no.
9. Kaviraja Ambikadutta shastri, ed, Susruta samhita, sharira 4/32, part 1, 11th ed ,
Chaukamba Sanskrit Samsthan,Varanasi, 1996, pag no.34.
10. Prof. K.R Shrikanta Murthy ed,Sharangdhara samhita, 6/24, , 1st ed, Chaukambha
Orientalia ,Varanasi, 1984, page no. 30
11. P.V. Sharma ed, Astanghridayam, sutra 7/52, Sarvangsundara commentaryand
Vidyotini hindi commentary, 1st ed, Chaukambha Orientalia, Varanasi,1978 page
no. 116
12. Ravidutta Tripathi ed, Astang sangraha sutra 9/56, Saroj hindi commentary, 6th ed,
Chaukambha Bharati Academy, Varanasi, 2001 page no.200
13. Satyanarayan shastri ed, carak samhita, sutra 21/36, vidyotini hindi commentary
22nd ed, Choukamba Bharati Academy, Varanasi, 1996, page no. 418
14. Christopher Haslett ed, Davidson’s Principles and Practice of Medicine 18th ed,
Livingstone International, page no. 1093.
15. htpp//www.google.com/primary insomnia.
16. Dr. G. S. Pandey ed, Bhavaprakash Nighantu, Dr. K.C. Chunekar commentary,
Chaukambha Bharati Academy, Varanasi 2004 page no. 200, 240, 393, 16.
17. Dr. K. M. Nadakarni, Indian Metria Medica, volume 1, 3rd ed, Popular Prakashan,
Bombay, 1982, page no. 1260, 840, 1292, 965.
18. Bapalal .G. Vaidya, Nighantu Adarsha, volume 1, 1st ed, Chaukambha Bharati
Academy, Varanasi, 1985, page no. 737, 731.
19. Bapalal .G. Vaidya, Nighantu Adarsha, volume 2, 1st ed , Chaukambha Bharati
Academy, Varanasi, 1985, page no. 134, 345.
20. P.V Sharma, Dravyaguna Vijnana. Volume 2, 16th ed, Chaukambha Vishvabharati,
1995, page no.31,64,275,763.
21. Kavivar Shri Shali Gramoji Vaishya ed, Vangasen hindi tika samhita, 1/718, Shri
Khenraj Krishnadasa Prakashan, Bombay,1996, page no. 64.
22. Kaplon and Sadock’s , Synopsis of Psychiatry, 8th ed, 1998, B.I Waverly Pvt. Ltd,
New Delhi,page no.737 for sleep and its disorders.`

7
External application :
Kushtha, being exhibited through the skin, external application
are also advocated. For the external application drug should be applied
after elimination of the Doshas from the body by Shodhana Karma and
Raktamokshana. Various forms of local application are prescribed like
Udvartana, Pralepa, Parisheka, Abhyanga, etc. Kshara Karma and Agada
Karma are also prescribed in special condition of Kushtha.
1. SOMNUS RASAYANA
(NIDRA EFFECT IN INDUCTING THE RASAYANA EFFECT)
Author: Dr. K. Shiva Rama Prasad, M.D.(Ay), C.O.P.(German), M.A, Ph.D (Jyotish) 1
Co-Author & Presentation: Dr. Kamalaxi. M. Angadi2

Rasayana (Achara) gives rise regularized sound sleep and vice versa the regularized
sleep patterns induce Rasayana effect. Health is a first muse and sleep is the condition to
produce it. The goal of the Ayurvedic approach is to create more potent individuals through
increased Ojas (immunity), which is the finest end product of digestion & metabolism that
provides energy, enthusiasm, happiness, clarity of thinking, better coordination between the
body and mind. Only the sound most restful (stage IV) sleep generates Ojas. A sound quality
sleep provides ultimate rest to the mind and senses, with enhanced capacities of mental and
physical work ability forthe next day. On the other hand, lack of sleep vitiates & initiates Vata,
Ama (endo toxins), etc in the body.
Human requires the three fundamental objective fulfillments in his entire lifetime, “Trayo
Upasthambha” (Trayo upasthambha iti swapnoahara brahmacharyamiti) viz. Ahara (Food),
Brahmacharya (regularized sex act) and Nidra (Sleep) (cha.su11/35). Sleep is function of all
living beings. It is definite to say that “The best bridge between despair and hope is a good
night’s sleep”. As like the all essentials of life it is evidential that the Nidra is also very much
needed to attain the fulfillments of the individuals. Sound restorative sleep is the foundation for
healthy living, there by to construct a progressive society. A good night’s sleep is undoubtedly
one of the most precious gifts of the nature ever we are enjoying to give rise next days energy
boosted levels. Sleep is the basis of our day-to-day activity, hence, the Ayurveda explains
physiological and pathological Nidra in detail.

1
Professor, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic Medical
College, Gadag, BOS member, Calicut University, Kerala (+91-9448746450), doctorksrprasad@gmail.com
2
Final PG scholar, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic
Medical College, Gadag

1
In Shakespeare’s words the sleep is - indeed a positive thing, a reactive process, a
winding up of the vital clock, a recharging of life’s battery and “Chief nourisher at life’s feast”.
Three sub-pillars are diet, sleep and celibacy. If these three are fulfilled properly, the body is
supported well by these pillars, it continues well endowed with strength, complexion and
developments till the complexion of life span provided one abstains from harmful practices
which will be explained here itself (Cha. Su. 11/35)
Ahara
Ahara, partaking food confers satisfaction and immediate strength supports the body,
increases span of life, radiance, enthusiasm, memory, valiance and digestive capacity. (Su.Chi
24/38)
Nidra
Sleep enjoyed at the proper time bestows nourishment, good color (Complexion), and
strength, enthusiasm, keenness of digestive power, wakefulness and maintains normalcy of
tissues (Su.Chi 24/88).
Brahmacharya
The end product of ahara rasa is said as the shukra dhatu. Loss of shukra cause
marana i.e. death on the other hand dharana of sukra gives life. So the shukra is the bala
(strength) for purusha (human) (Su.Chi 24).
Hence, these three trayopasthmbha exhibits the importance of life and necessity of the
induction of the Rasayana effect in to the life. As we know that satisfaction alone is the cause of
Rasayana and the satisfaction of the Nidra gives raise the Rasayana effect.
Rasayana
Rasayana is the food, medicine or therapy, which nourishes Rasa and other Dhatu or
the medicine with the effect of its taste, potency or special properties bestows long life, strength
and retards ageing.
Charaka has opined the ‘Nidra’ (Ch. Su. 11/35) along with Chakrapani as ‘Upastambha’
as sub-post, which promotes the Rasayana. Posts mainly support a house, but sub posts add to
the supporting strength of such posts. In the same way, body is mainly supported by the acts
performed in the previous life, which determined the intake of food, sleep and Bramhacharya.
So they are known as secondary supports of life. It is observed that all the living creatures must
enjoy the sleep in quality and quantity to keep them fit. From the very birth the amount in hours
of sleep of newborn is maximum, it is because at sleep the baby grows. Bhavamishra has
mentioned that during the pregnancy, when the mother sleeps, the baby in womb enjoys better
rest and comfort - (B. P. 1st part, S.No. 317).

2
Susruta commenter Dalhana classifies Rasayana is as follows. Mainly Rasayana into
two folds as –
1. Kutipravesika Rasayana – residing in a specially built house and undergoing therapy.
2. Vatatapika Rasayana - undergoing therapy while moving about in wind and sunlight.
Further it is again of three kinds as-
1.Kamya Rasayana – desiring benefits such as long life, great intelligence, wealth etc
2.Naimittika Rasayana – consequent to diseases (either for treatment or for resuscitation)
Such as, use of recipes of Shilajatu, Bhalltaka, Tuvaraka etc in diseases like diabetes piles,
leprosy etc
3.Ajasrika Rasayana – habitual to be consumed daily such as milk, ghee etc.
Again it is of two kinds- Samshodhana (purification)-producing vomiting, purgation etc and
Samsamana- mitigates/alleviating the aggravated doshas or diseases.
NIDRA
In fact, Nidra looks like a glimpse of Pralaya, which carries peace but in darkness. After
this glimpse of Pralaya – man awakens fresh like Srujana. For the living beings in the world, it is
an essential phenomenon for maintenance and restoration of both – body and mind.
Since the dawn of the civilization the thinker of various countries in the world have tried
to study the sleep, its nature and causes. In India, from the Vedic and Upanishad period, the
Yogis have studied the Yogic phenomena pertaining to various stages associated with Atma.
They have termed these stages as Jagritavastha (waking state), Svapnavastha (dream state),
Sushuptavastha (sleep state) and Samadhi Avastha (the conscious sleep phase having
Detachment from the external world in different degrees).
In the Patanjali Yoga Sutra, the physiology of Nidra has been described as: Sleep is the
non-deliberate absence of thought waves or knowledge. Dreamless sleep is an inert state of
consciousness in which the sense of existence is not felt. In sleep, the senses of perception rest
in the mind, the mind in the consciousness and the consciousness in the being in the deep
sleep, the senses of perception cease of function because their king, the mind, is at the rest.
This is Abhava, a state of void, a feeling of emptiness (Samadhi Pada – 10 Yogasutras of
Patanjali).
The onset and progress of sleep as described in Brahmanopanishad, pertaining to Yoga
sutra runs as under: when the Chitta becomes exhausted, it goes inward the sense impulses
from worldly objects; hence the sleep is a resting phase of mind. At that time, there is absence
of the knowledge about the orientation of time and place. In this condition, it is believed that the
Chitta resides in the Medhya Nadi. When a person awakens from the deep sleep, it is the sense

3
of pleasure and sense of satisfaction. In Mandala Brahmanopanishad, the sleep is considered
as one of the five unwanted activities (Ma.Br.Up.pp274).
According to Lord Swaminarayana, Nidra is made for the rest of physical and mental
bodies, which get tired after the whole day’s work. Lord Shri Krishna have explained the
importance of proper sleep for a Dhyana Yogi in Bhagwadgita. According to him, excessive
sleep and ceaselessly awakening are also not good. (Shrimad Bhagvadgita).
Sleeping for six hours in the middle of the night and keeping awake during the first and
last quarters as well as during daytime, are generally considered as regulated sleep and
wakefulness. In the Ayurvedic classics and the later literature, the usefulness of sleep and its
role in the maintenance of health is elaborately discussed.
Similarly the botanists have observed that not only animals but plants also enjoy
recreation in the night by attracting the petals and leaves and flowers etc., at the time of sunset
and in the next morning relaxing and reopening (Sa. Ni. Page1142). The sleep is an indicator of
good health because it brings the normalcy in body tissue and relaxes the person. (B. P. Pu.
5/315; Y.R. Pu. 88). Untoward effects of various pathogenic conditions do not harass persons
residing in unhygienic locality but obeying the rules of diet, sleep and exercises. (Ka. Sam. Khi.
5/7).
Generally, the sleep comes during the night and at about the same time for a particular
duration everyday and as such in Ayurveda Nidra has been said to be Ratrisvabhava Prabhava
(Ch. Su. 21/58). According to Susruta, Nidra is provoked due to nature and considered as
Svabhavika Roga (Su. Su.24/8). Therefore, Ayurvedic authors have advised that a man should
not suppress this natural urge (Ch. Su. 7/4).
According to Charaka, the sleep occurring at night, as a natural phenomenon is a
nourishing phenomenon so it is termed as Bhutadhatri – that nurses all the living beings (Ch.
Su. 21/59). It is also called the ‘Vaishnavi Maya’ in a metaphoric language, which means that
Nidra provides the nutrition to the living body and maintains the health like Lord Vishnu, who is
the nourisher and maintainer of the world (Su. Sha. 4/32).
Though, the role and importance of sleep are very wider accepted even then if the sleep
is not taken appropriately and in appropriate quantity and irregularly, it may have adverse
effects on the body. Therefore, sleep should be watchfully enjoyed because the excessive sleep
causes various sins (Papma).
The control over sleep and wakening for the meditation is useful for the uplift of Atma.
The saints always prefer to keep awake at night for meditation, conversely person having

4
antisocial attachment do sleep during the daytime, which considered as one of the root causes
of many evils (Su. Sha.4/32).
Natural Instincts of life
In Shaligram Nighantu, four natural instincts of the living organisms are mentioned,
which are as under –
1) Desire to take the food
2) Desire to take the water
3) Desire to take the sleep and
4) Desire to take the sexual contact for pleasure.
These four are considered as the pioneers of the health (Bri.Ni.Ra.pp2&164).
Independently but an all-round rest for the entire organism is possible only when it goes to
sleep. The ancient seers of India have not only recognized the natural constructive power of
sleep, but have also attributed to it, a super natural power which beneficial for the health,
happiness and longevity. The modern science also confirming the function and physiology etc.
told by our ancient sages but still not come for any conclusion as sleep is concerned.
Finally, Manu, the great lawmaker of the world has ever produced, after describing the
small divisions of time, remarks that 30 Muhurta period (24 hours), are divided by the sun into
day and night; the day time is intended the activities and the night time is designed for the rest
and repose. The daily (Bio) rhythm of the life is thus a natural instinct related to the rhythm of
night and day existing in nature (Manu Smriti). By all above explanation it is said that proper
sleep induces the effect of Rasayana.

Proper sleep

Proper agni

Proper nourishment

Proper dhatu sequence

Ojus
Hence, here it shows the effect of Nidra in inducting the effect of the Rasayana. In this
paper an attempt is made to evaluate the effect of Nidra in inducting the effect of Rasayana.

5
Many researchers claim that the sleep is psychosomatic in origin, thus a simple randomized
placebo clinical trial is studied. The results are as follows-
Rasayana effect assessment by Dhatu karma Lakshana
Dhatu karma Lakshana as told by Charaka emphasises the effect any drug involvement
over the dhatu. The lakshana with the effect of Nidra as Rasayana is as follows.

Lakshanas Effect of Nidra Effect of Rasayana


Dheergha ayu ++++ ++++
Smruti ++++ ++++
Medha ++++ ++++
Aroghya ++++ ++++
Tarunya ++++ ++++
Vaya ++++ ++++
Vak-siddhi & Kanti ++++ ++++

Samyak Dhatu Karya Effect of Nidra Effect of Rasayana


Preenana ++++ ++++
Jeevana ++++ ++++
Lepa ++++ ++++
Snehana ++++ ++++
Dharana ++++ ++++
Poorana ++++ ++++
Garbhotpadana ++++ ++++

S.No Sleep efficiency Effect of Rasayana


(Effect of placebo)

1 55.5 55.5
2 82.14 82.14
3 85.71 85.71
4 62.5 62.5

6
5 73.52 73.52
6 53.33 53.33
7 42.85 42.85
8 53.33 53.33
9 62.5 62.5
10 53.1 53.1
Total 624.48 624.48
Mean 62.43 62.43
Nidra – an essential phenomenon for maintenance and restoration of the life, which is
considered under Trayopastambha. Proper sleep provides balance of the body constituents,
alertness, good vision, good complexion, fired digestive power as well as happiness, vigor,
virility, nutrition and long life. According to modern science, sleep is said to nourish and repair
the damages to the tissues caused by various catabolic activities of the body.

7
Evaluation of Tamas in terms of RATR (Reticular Activity
Transmission Retardation) in Sleep patterns
Author: Dr. K. Shiva Rama Prasad, M.D.(Ay), C.O.P.(German), M.A, Ph.D (Jyotish) 1
Co-Author & Presentation: Dr. Kamalaxi. M. Angadi2

Introduction

Ayurveda describes the genesis of Universe in detailed with 25 dimensions. Out of

narration it aspires the understanding of “Triguna” in terms of biological explorations. Here at

this juncture an attempt is made to understand the “Tamas” as retardate product of

biorhythms. Human requires the three fundamental objective fulfillments in his entire life

span, “Trayo Upasthambha” (§ÉrÉ EmÉxiÉqpÉÉ CÌiÉ AÉWûÉUÈ xuÉmlÉÉå oÉë¼cÉrÉïÍqÉÌiÉ|) viz. Ahara (Food),

Brahmacharya (regularized sex act) and Nidra (Sleep).

It is definite to say that “The best bridge between despair and hope is a good night’s

sleep”. As like the all essentials of life, even the Nidra is also very much, and that is evidential

even. Sound restorative sleep is the foundation of a healthy life, there by to have a

constructive and progressive society. A good night’s sleep is undoubtedly one of the most

precious gifts of the nature we are enjoying freely. Sleep provides rest there by the energy for

our needs. Sleep is the basis of our day-to-day activity, hence, the Ayurveda explained

physiological and pathological Nidra in detail. As the health is a first muse and sleep is the

condition to produce it. Improper sleep leads to disease both physical and mental. Such sleep

is not emphasized on par with the present day available knowledge for better understanding

what our ancient Indian scientists notified through their tenets.

1
Professor, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM Ayurvedic
Medical College, Gadag (+91-9448746450)
2
Final PG scholar, Department of Kayachikitsa (PG), Postgraduate Studies and Research Center, DGM
Ayurvedic Medical College, Gadag
What is Nidra (sleep)?

The ancient Greeks endorsed the sleep to God Hypnos (sleep), the child of darkness

and night and the brother of death, whose power as he swept across humanity was so great

that even the gods succumbed to him. Even in our mythology we found the “Nidra Devata” as

sister of “Yama” who is simulating the death.

Sleep is defined as a regular, recurrent, easily reversible state that is characterized by

relative quiescence and by a great increase in the threshold of response to external stimuli

relative to the waking state. The definition is still far from being satisfactory; an absolute

definition is not yet available it is very much need of the hour to evaluate the facts related to

the sleep under the lime light of available science. Sleep is defined as unconsciousness from

which the person can be aroused by sensory or other stimuli. (Guyton). Sleep is a state of

altered consciousness or partial unconsciousness from which the person can be aroused.

(Tortora).

As we understand, the Sleep is a periodic functional state of man and higher animals,

characterized by specific changes in vegetative and motor systems by the absence of

purposeful activity and sensory interaction with the environment and the Sleep is

characterized by the inhibition of conscious mental activity.

Sleep is a physiologic state of relative unconsciousness and inaction of the voluntary

muscles, the need for which recurs periodically. The stages of sleep have been variously

defined in terms of depth (light, deep), EEG characteristics (delta waves, synchronization),

physiological characteristics (REM, NREM), and presumed anatomical level (pontine,

mesencephalic, rhombencephalic, Rolandic, etc.).


According Ayurveda, the sleep is induced by the increase of the inert universal

attribute called Tamas. The term Tamas literally means darkness. Satva, Rajas and Tamas are

the three major or universal attributes that pervade the universe. These three attributes or

dimensions play an important role in the functioning of the mind and even body, of them rajas

and Tamas are capable to vitiate mind (Manas). Because of their predominance’s affects and

afflicts the mind the mental diseases are resultant. On the other hand the satva increase cause

the conducive to mental health and rajas represents its action.

Onset of sleep is related to the increases of Tamas always. These said principles affect

inertia on general. Sleep usually occurs at night as the surroundings are dark and are

predominated by Tamas. This dark environment naturally increases the Tamas in human

beings according to the theory of generality. Apart from this the bioelectrical cells, which are

in the body, sustain the energy for activity in the day light by getting charged through Sun

light. At the night the Human is the only capable to generate Bioelectricity through the

activity of digestion (Jatharagni). At the darkness the person reserves the energy and wish to

retire as the activities are restricted and energy levels are inhibited.

The sensory and motor faculties are fatigued by day’s work. The fatigued faculties

become sluggish in their work and will loose their activity. They gradually withdraw from

their objects 1. The functions of the mind also blocked by the increase and influence of

Tamas. Mind gets detached from the faculties and its action of enjoying the faculties ceases.

This stage is entitled as sleep. But even in the sleep also mind maintains its connection with

the soul, as it is “Ubhayendriya” – dualistic organ 2.

Sleep is a natural function of Tamas where in both satva and rajas acts against the

sleep induction. Apart from sleep Tamas causes of fear, ignorance, depression and laziness
also. Satva represents cognition and enlightenment. It is the cause of awakening; Nevertheless

sleep is included among any natural diseases 3. Hence, the Satva is against the ignorant and

inert sleep. Rajas on par with satva represent action and hence, it is also a factor against to

sleep induction, where the physical and mental activities are subdued or restrained.

Types of sleep (Cha. Su 21/58)

Ayurveda has different opinions regarding the types of sleep. Basically Nidra can be

classified into types viz. Svabhavika (natural) and Asvabhavika (abnormal). Out of the former

Svabhavika Nidra is regularly every night, which offers beneficial effects for the living

beings, whereas the later Asvabhavika is one can be due to different causes of pathological in

origin.

Charaka classifies the sleep condition into seven folds. He agrees with the ancient

authors who considered the sleep is Bhutadhatri. Sleep comes at night, spontaneously and

regularly as a natural instinct and that the other categories were either due to sin or the

disease. The seven types described by Charaka run as under -

1. Tamobhava Nidra

2. Sleshma Samudbhava Nidra

3. Manah Shrama Sambhava Nidra

4. Sharira Shrama Sambhava Nidra

5. Agantuki Nidra

6. Vyadhyanuvartini Nidra

7. Ratri Svabhava Prabhava Nidra

Brief descriptions of these types of Nidra are as follows -


1) Tamobhava Nidra:

Generally the sleep is due to the effect of Tamas, but the Tamobhava Nidra as

particularly due to the excessive Tamas causing sleep. When Satva and Rajasa are diminished

in excess and the seat of Atma and Mana i.e. Hridaya is covered by the vitiated Tamas, then

the organization become inert or inactive. According to some scholars, the Tamodbhava Nidra

resembles with Sanyasa condition described by Charaka, which is the comatose state. The

sleep caused by Tamas is also the root cause for all sinful acts. Tamas always causes

excessive sleep. Thus, the individual is unable to perform the virtuous files and so he subjects

himself to sinful behavior.

2) Sleshma Samudbhava Nidra:

Sleshma is the material state of Tamas and as such the Sleshma and the Tamas are

having identical properties. When the Sleshma increases in the body the sleep ensues.

Therefore, it is called Sleshma Samudbhava Nidra.

3) Manah Shrama Sambhava Nidra:

The person also gets the sleep as the result of exertion. Due to excessive mental stress

and strain, the mind gets tired and unable to perform its activities, as a result the animal gets

sleep.

4) Sharira Shrama Sambhava Nidra:

The person also gets the sleep due to physical exertion. When a person indulges in

excess physical activities he feels too much tired. The body and mind desire to take rest and

agitate to work further and the person gets sleep.

5) Agantuki Nidra:
Sometimes the cause of sleep remains obscure and the cause is not explainable.

However, the sleep is followed by the death and as such Chakrapani has termed this sleep as a

death signal (Arishta) 1

6) Vyadhyanuvartini Nidra:

There are some diseases like Sannipata Jwara where severe weakness of the patient

and follows the condition just similar to coma. This type of sleep is termed as

Vyadhyanuvartini Nidra.

7) Ratri Svabhava Prabhava Nidra:

As has been stated earlier the sleep is a natural phenomenon and it comes at a

particular time in the night. There is no particular reason for this sleep and it is also termed as

Bhutadhatri. It has been observed that even the individual who has slept during the daytime

would also feel sleepiness in the night, which is quite a natural phenomenon.

Astanga Sangraha Vagbhata followed the Charaka’s view with a slight change in the

names. He also mentioned seven types. The commentator Indu opined that the Tamobhva is

Antya i.e. comes at the time of death and Agantuka means Shastra Praharadina (due to injury)

and considered these are due to Vyadhis.

Astanga Hridaya Vagbhata considered only four types of Nidra and included the all

seven types in these viz. Akale sevitha , Ati prasangath sevitha, Nacha sevitha and Nishevitha.

The commentator Hemadri considered them as – The properly taken sleep brings happiness,

nourishment, strength, virility, knowledge and life to the individual. The improperly taken

other three types may kill the individual like the Kalaratri, who killed all demons. Acharya

Charaka also mentions these while explaining the effects of sleep.


Susruta described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi and

Vaikariki Nidra.

1) Svabhaviki Nidra:

Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the

power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached from the

worldly sensory objects on account of the tiredness of Manasa; and the seat of Manasa and the

Sleshma and Tamas cover Atman. This mostly happens in the night and individual gets sleep.

The Tamoguna dominant persons may go to sleep at any time i.e. day or night. But a person

having Rajoguna in excess may get sleep sometimes in the day or in the night, because of

Chalatva of Rajasa. The person having qualities dominated by Satva Guna sleeps at the

midnight. Because, at this time Tamas is excess and Satva will be decreased (Dalhana)

The term Papma has been used to describe the Tamobhava of Nidra and also to

mention the sinful activities.

2) Tamasi Nidra:

It is the lack of consciousness preceding the death. Tama dominant Kapha induces this

due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individual.

3) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of

Vayu and also due to mental and physical pain, distress etc. the person doesn’t enjoy the
2,3
sufficient and sound sleep in quantity and quality . Disturbed sleep is also a type or

Vaikarika Nidra.

Instead of above seven fold classification we can make three types of classifications in

terms of tamas. As we seen that sleep is due to manodosha tamas, but here tamas means not

alone, the other manasika doshas are there i.e. according to Charaka vimansthana Dosha

anubhandhya anubhandha concept the nidra can be made into mainly three types.

™ Tamasika nidra

™ Rajayukta tamasika nidra

™ Satvayukta tamasika Nidra

According to Susruta (shareera 4/32) another sets of Nidra viz. Tamasika Nidra is sleeps

both day & night, Rajayukta tamasika Nidra get sleeps either in the day or night and

Satvayukta tamasika nidra sleep at midnight.

Contemporary theories of sleep (Nidra)

Until some time back, it was held that the condition of a sleeping man (or animal) may

be compared to an individual deprived of cerebral hemispheres and capable only of the most

elementary sensory motor acts. This view has since been shown to be inaccurate largely

because the decorticated animal exhibits sleep wake rhythm. In addition there is also evidence

that in sleep several areas of the nervous system are in a quiescent state and such functions as

still are carried out on in a modified manner. The question is if certain parts of the nervous

system exercise a control over sleep awake rhythm or does the nervous system, as a whole,

respond merely to some outside influence, such as a toxin on to be reduced blood flow, has
been sought to be answered thus; there are neural structure in the tagmentum of the mid brain

which maintains a state of wakefulness, somnolence lasting several weeks has been produced

in monkeys by causing lesions between the posterior hypothalamus and the mid brain. The

structure in the tagmentum of the mid brain has been shown to be activated by collaterals of

afferent sensory neurons which in turn excite a wide spread effect on the cerebral cortex. The

existence of a corticofugal influence on the mid brain, by which afferent valleys of nerve

impulses may be prevented from having there influence on the cortex is considered to be a

possibility.

No satisfactory answer has, as yet been found to the question if assuming that, this or

neighboring parts of the nervous system is essential to the sleep-wake rhythm by what means

it periodically subsides into tranquity? In the view of authorities entitled to an opinion there is

a growing measure of support to the view postulated by parkinjee that sleep represents “a

physiological interruption of afferent pathways at a central point”. It is of importance to note

that the cerebral blood flow does not appear to be reduced during sleep. This observation

should clear the prevalent notion that sleep is the outcome of cerebral ischaemia.

The sleep center:

Several clinical and experimental observations point to the existence of a center

concerned with sleep, in the hypothalamus, which is also the center for the sympathetic and

parasympathetic. It has been shown that drugs, which suspend the activity of the sympathetic

center, caused apreponderance of parasympathetic effects including sleep. The view that sleep

is the function of the parasympathetic has, therefore been advanced.

The validity of this view, apart, which according to other authorities needs further

experimental corroboration the evidence for the participation of the hypothalamus, is the
causation of sleep is seen to be very strong. Nonetheless, contrary to the view, that sleep is

caused by the excitation of some part of the hypothalamus, some authorities hold that it

results from the depression of the hypothalamus. Thus the hypothalamus is considered to

contain a waking center, the inhibition of which is stated to follow by sleep.

Cortical theory of sleep:

Reticular activating system (RAS) is a physiological term denoting that part of the

brainstem reticular formation that plays a central role in the organism's bodily and behavioral

alertness; it extends as a diffusely organized neural apparatus through the central region of the

brainstem into the sub-thalamus and the intra-laminar nuclei of the thalamus; by its ascending

connections it affects the function of the cerebral cortex in the sense of behavioral

responsiveness; A Proactive or Retroactive inhibition of sleep patterns can be assessed

through behavioral responsiveness.

Yet another theory, the one advanced by Kleitman- holds that sleep is due to the

inactivity of the cerebral cortex, which arises from the reduction in the number of affarent

impulses, especially from the muscles, reaching the sensory areas. The factor which is

considered to bring about the reduction in the number of afferent impulses, especially from

the muscles due to fatigue of the neuromuscular mechanism which latter mediates muscle

tone & the consequential suppression of impulses from the proprioceptors of the muscles is

stated to be important.

Secondly, the exclusion of stimuli from the visual auditory and cutaneous receptors is

also an important factor, which is stated to lead to sleep. Not withstanding the above, it has

been recognized that cortical activity due to psychic causes viz. anxiety, worry, excitement

etc, may prevent sleep with those of the hypothalamus.


Looking at all the above theories of contemporary about the mechanism of sleep, a

review of the concept of Nidra is essential. None of them are truly sufficient to explain their

phenomenon undoubtedly. However each one of them has contributed some facts, based on

either experimental or clinical observations. These are of values added studies along with the

concept of Nidra vividly described by Charaka, Susruta and Dalhana. The concepts of sleep

are –

1) Initially, in view of the fact finding the portion of Mastiska that is known as

the cerebra cortex is essential for sensory appreciation and voluntary movements in

the body. As both these capacities are reduced during sleep, recent investigators

looked in to the cortex for an explanation of sleep. Sleep results from a decrease in the

number of impulses flowing to the cerebral cortex. It is an important factor responsible

for impulses reduction has been attributed to the fatigue of the neuromuscular

function, which in turn is unable to pass on proprioceptive impulses, would lend

support klama of Charaka, reference to fatigue of the mind. The klama or the fatigue

of body and senses leading especially to divorce of the sense objects from the senses

by implication. The affarent pathways are unable to conduct different kinds of external

and internal stimuli due to fatigue.

2) It is well known that sleep usually requires a reduction in external disturbing

agents such as light and sound, which also reduces the sensory barrage to the cerebral

cortex, is the Tamas described as Ratri swabhavaja (Night habituations).

3) Anxiety, fear, worry and elation of spirits, which tends to excite the cerebral

cortex and prevent sleep are also stated to be due to Tamas 5.


“The important factor responsible for reduction of sleep has been shown to be the fatigue

of neuromuscular function which in turn unable to pass on proprioceptive impulses may be

the Tamas.” This is proved with the sleep efficiency and sleep fragmented time calculations of

10 patients who underwent the insomnia and sleep pattern disturbances. The data is as

follows.

In this paper an attempt is made to evaluate the quantity and quality of Tamas in terms of

sleep efficiency and the Tamo-abhava (vitiation of tamas ) in terms of sleep fragmented

time,i.e. disturbed sleep, awakening during normal sleep.

Tamas = sleep efficiency

Vitiation of Tamas = Sleep fragmented time

S.No Sleep efficiency Sleep fragmented Tamas


time
1 55.5 1.66 55.5
2 82.14 1.91 82.14
3 85.71 3.0 85.71
4 62.5 1.25 62.5
5 73.52 2.13 73.52
6 53.33 2.0 53.33
7 42.85 1.5 42.85
8 53.33 1.0 53.33
9 62.5 1.66 62.5
10 53.1 1.4 53.1
Total 624.48 17.51 624.48
Mean 62.43 1.9 62.43

100
10 80 2
60
Sleep 40
9 3
efficiency 20
Sleep 0
fragmented
time 8 4
Conclusion:

Sleep is considered as one of the supporting pillars of life. Hence, Ayurveda offers

importance to proper sleep at the most. Its importance is equal to that of food and daily

routines along with regulated sexual act. Food and sex may mainly require maintaining one’s

own health and pleasure satisfaction but the sleep imparts both at once with relaxation. as

sex is essential for the continuity of human race. Ayurvedic treatises advocate various norms

for practicing sleep in proper manner. Acharyas (A.H.Su 7/53 & C.S.Su 21/36) even told that

sleep is the root cause of pleasure, pain, proper nutritional status, emaciation, strength,

weakness, sexual power, impotency, knowledge, ignorance, life and death. It is interesting to

note that sleep can produce favorable and unfavorable results even. Favorable results are

caused by proper practice of sleep, whereas unfavorable results produced by improper

practice of sleep. One should sleep in time for the required period, lest he may fall victim to

diseases (C.Su.21/37). So, one should not indulge excessive sleep and should resort to

untimely sleep.

Here, tamo-abhava is reticular activity transmission and tamobhava is RATR. We see

that, the satvika purusha with less tamas, who wants achievement in life, thinks that “If I

sleep, the world will move front, leaving me behind”. But dear, friends to maintain both

physical and mental health sleep in time for required period.

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