Journal of Dental Science and Medicine
Open Access

Sleep is the best phase for relaxation. It is important in every individual for being fit and fine. It not only relaxes but also rejuvenates for next day chores. Ayurveda has included sleep that is nidra in three pillars of life namely Aahar (diet), Bramhacharya (abstinence) and nidra (sleep). Nidranash i.e insomnia is the commonest complaint heard in OPDs after pain [1].

There are various reasons behind having insomnia. Senility, diseases related to respiratory system, painful conditions, certain drugs like propanol, steroids, mental conditions like mania, anxiety causes sleeplessness [2]. The prevalence rate of insomnia is 10-30% [3]. Idiopathic insomnia, Psychophysiologic insomnia, Paradoxical insomnia, Inadequate sleep hygiene insomnia, Physiological insomnia, Insomnia NOS, Insomnia due to mental illness, Insomnia due to medical illness, Insomnia due to substance use/abuse or withdrawal [4]. There are various medicaments which are used in modern medicine for Insomnia but the drugs used in insomnia causes various other sides - effects like cancer of various origins and harm to the indwelling foetus [5]. There is description of each and every disease in Ayurveda. Nidranash is also described by Charak Acharya under the heading vatajnanatmajvyadhi (different diseases of vata origin) [6]. Happiness, sadness, nourishment, undernourishment, Strongness, weakness, fertility, infertility, sanity, insanity, life and death depends on appropriate and inappropriate sleep [7]. Acharya Charak said that when mind and soul get tired, they get distracted from sensory as well as motor sensations and person sleeps. According to Acharya Sushruta, when the seat of chetas (mind) that heart gets covered with Tamoguna (Mode of ignorance), an individual goes to sleep. According to Acharya Vaghbhata, Manovahastrotas (channels of intellectuals) gets filled up with Kaphadosha and blocks sensations due exhaustion, an individual sleeps. Acharya Charak has given seven types of nidra namely Tamodbhava (Due to increase in mode of ignorance), Shleshmasamodbhava (due to increase in kapha dosha), Mana shramasambhava (dur to exhaustion of mind), Sharirshramasambhava (due to exhaustion of body), Agantukinidra (acquired), Vyadhinuvartininidra (due to illness), Ratriswabhavaprabhavanidra (physiological sleep induced at night) [8]. There are various treatment modalities in Ayurveda to combat with Nidranash. Acharya Charak has given Abhyanga (massage), Utsadana (massage with powdered drugs), Samvahana (pressing body parts), Akshi-tarpana (instillation of oil in eyes), Shiro- Lepa (Head pack), Karna-Purana (instillation of oil in ears), Shiro-Basti (keeping oil over head with special type of taping), Shiro- Dhara (dripping medicated oil on forehead), Moordhni Taila (dripping of oil) as bahyaupacharas (external application). Charaka mentioned Manonukulavishayagrahana (Desired conditions), Manonukula Shabdagranaha (desired words), Manonukulagandhagranaha (desired perfumes), as Manasikaupacharas (mental treatment) [9]. There are many patients who have Anidra or Nidranash. Insomia causes lack of interest in surrounding, lack of interest in work and other activities.

Here we have a case report of female patient having insomnia which was treated with simple line of treatment of Ayurveda.

A 38 year old female patient came to outdoor patient department of Kayachikitsa, MGACH & RC, Salod (H), Wardha with complain of disturbed sleep pattern since six months. She had problem of hyperacidity since 3-4 years. She felt lethargic from 5-6 months. She has a feeling of loss of interest in everything. Body pain since 2 months.

Family history

Mother- No history of illness

Father- No significant history

Siblings-No significant history

Past history

She lost her husband in an accident four years back.

History of HTN and DM.

Personal history

Patient has addiction of Tea, Tobacco, betel nuts, betel leaf occasionally.

Diet: Non-Vegetarian, Junk food, stale food, consumed on daily basis, timing of meal are not fixed. Dry food like Snacks, Farsan, Chiwda

Sleep: Disturbed sleep.

Bowel: Not satisfactory goes 3-4 times for defecation.

Clinical findings

The patient was apparently good and healthy 8 months back. Her husband met with an accident and died. After that event she has disturbed sleep pattern, slight depression, hyperacidity. She felt lethargic and loss of interest in surrounding. She has taken modern treatment for insomnia but it is of no use.

When the patient came to OPD, he was thoroughly examined and complete history was taken. Patient was supportive, oriented to time and place.

Vitals: Temperature=99.3, Pulse=94/min, Respiratory rate=20/ min, Blood pressure=140/90 mm of Hg.

Asthavidhaparisha (Eight vitals according to Ayurveda)

Nadi – 94/ min

Mutra – No complaints

Mala – malabadhhata

Jivha – Sama

Shabda – Ksheen (due to lack of sleep)

Sparsha – Normal

Drik – Normal

Akruti – madhyam

Diagnostic assessment

Insomnia severity scale (ISI) [10]

Treatment

(Table 1)

Table 1: Diagnostic Assessment.

Assessment criteria

(Table 2)

Table 2: Assessment criteria.

Interpretation

0-7: No clinically significant insomnia

8-14: Sub threshold insomnia

15-21: Clinical insomnia (moderately severe)

22-28: Clinical insomnia (severe)

Sleep is the most important aspect of an individual according to Ayurveda. There are various treatment modalities in Ayurveda also for insomnia. In this case we just treated a case of Insomnia with Jatamansifanta, Gandharvaharitaki as internal medicine and Padabhyanga as external. The patient was also advised to avoid overthinking.

In this case, the patient was assessed on Insomnia severity index. The severity of sleeplessness is scored 3 before treatment. After treatment it got reduced to 0. The score of satisfaction after sleep was 4 before treatment and after treatment it reduced to 1.  Due to the lack of sleep, there was interference in the daily routine of 4 score which is reduced to 0 after treatment. His score of noticing the people about sleeplessness of this lady was 3 which were reduced to 0 after the management. The patient was worried about her sleep issue which was scored about 3 and reduced to 0 after the treatment of 30 days. There are specific consequences which takes place when Jatamansifanta, gandharvaharitaki and Padabhyanga is advised to the patient. Jatamanasi is Tikta (bitter), Kashay (astringent), Madhur (sweet) rasa (taste) Pradhan (chiefly) drug. It has Laghu (light) and snigdha (oily) property. The veerya (potency) of jatamansi is sheet (cold). The vipak (end product of digestion) is Katu (pungent). The prabhav (effect) is manasdoshhar (mental disorder) [11]. According to Ayurveda it is nidrajanana (promotes sleep) and promotes good digestion. It has tranquilizer effect [12]. Bitter, Astringent and sweet taste drugs are pittashamakrasa (antagonist effect on bile properties) [13]. In pitta vruddhilakshanas there is symptom called alpanidrata (less sleep). The cold property of Jatamansi alleviates the hot property of bodily biles. So the three rasa present in jatamansi may alleviate the problem of insomnia. Fanta (hot infusion) is the one of the panchvidhakashay Kalpana (Ayurveda formulation). In this, powdered drug is kept in hot water over night and then it is filtered with cotton cloth and advised to consume it. It helps to resume the volatile constituents [14]. The hot infusion is given in mild disorders. So the patient got relief from this Jatamansi hot infusion. Gandharvahartaki is anulomak (purgative drug) in property. It contains haritaki (Chebula terminalis), eranda tail (Castor oil), Sunthi (gingiber officinalis), Saidhav and Suvarchalalavana (types of salts). Mrudu Virechan (purgation) is the first line of treatment for pitta related diseases. There are two types of purgation, ruksha (dry) and snigdha (oily) [15]. Here snigdhavirechan is used as vata is having ruksha (dry) guna. Along with this, Vatavriddhi causes Anidra (insomnia) [16]. Mruduvirechan (mild purgation) is best treatment for vata vyadhi [17]. This patient was advised to do Padabhyanga (foot massage) on daily basis before sleep at night. Foot massage is given in Dincharya (daily routine) by Acharya. In this case, simple til tail (sesame oil) is used for massage. Tail (oil) is well known treatment to alleviate vata dosha. Massage alleviates fatigue, stress. Massage increases kaphadosha which helps in elevation of tamoguna. As we discussed early tamoguna is important in sleep induction. Massage also causes secretion of serotonin and dopamine Melatonin is formed from dopamine which is secreted due to massage. It gives the feeling of wellbeing [18]. This patient was advised to do this foot massage with Kasavati (bronze bowl). Bronze is combination of brass and tin. It is observed that it has beneficial effect in induction of sleep from ages [19-22].

In this case the patient got relief from insomnia with the simple and less number of drugs. For the management, we just used Jatamanasifanta, Gandharvaharitaki and foot massage with bronze bowl.

Insomnia is just simple disorder which can be alleviated by managing the dosha avastha (condition) in an individual. Works on Vata, pitta and kapha dosha give noticeable effect. It can be treated by using a single drug like Jatamansi which has sedative effect and Gandharvaharitaki which is mruduvirechan. A simple routine procedure like foot massage can be advised to the patient. These drugs do not cause lethargy and sedation as an after effect.

As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.

I would like to express my sincere gratitude to Dr. Vaishali Kuchewar, Dean, Dr. Amol Deshpande (Assistant professor), Department of Rachana sharir, MGACH & RC, salod, Wardha.

Authors have declared that no competing interests exist.