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{{#seo:

|title=Nidra

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|keywords=carakasamhitaonline, charak samhita, caraka samhita, ~~Ayurved~~, Nidra, Nidra in Ayurveda, Nidra meaning, sleep, Ashtauninditiya Adhyaya

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|keywords=carakasamhitaonline, charak samhita, caraka samhita, Ayurveda, Nidra, Nidra in Ayurveda, Nidra meaning, sleep, Ashtauninditiya Adhyaya, sleep hygiene, sleep disorders, insomnia, shirodhara, panchakarma, deprivation of sleep, excess sleep causes, treatment, Indian system of medicine, alternative medicine, health

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|description=sleep~~. Synonyms: Swapna~~

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|description= Nidra (sleep) is essential for health

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=carak samhita

|type=article

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The term ‘Nidra’ means sleep (SAT-J.3) . It is a natural physiological process that occurs in all living beings usually during the nights. It is essential for resting the body and mind after the day-long exertion. Sleep (nidra) is equally essential like food (ahara) and following the path of ultimate reality (brahmacharya). These three are three sub-pillars of life. [Cha. Sa. [[Sutra Sthana]] 11/35]

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The term ‘Nidra’ means sleep (SAT-J.3).<ref>Available from http://namstp.ayush.gov.in/#/sat</ref> It is a natural physiological process that occurs in all living beings usually during the nights. It is essential for resting the body and mind after the day-long exertion. Sleep (nidra) is equally essential like food (ahara) and following the path of ultimate reality (brahmacharya). These three are three sub-pillars of life. [Cha. Sa. [[Sutra Sthana]] 11/35]

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{{Infobox

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|label1 = Section/Chapter

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|data1 = [[Sharira]] / Nidra

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|data1 = [[Sharira]] / Nidra (sleep)

|label2 = Authors

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|data2 = ~~Deole Y~~.S.<sup>1</sup>, Anagha S.<sup>1</sup>, ~~Resmi B~~.G.<sup>2</sup>

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|data2 = Resmi B.G.<sup>1</sup>, Anagha S.<sup>2</sup>, Deole Y.S.<sup>2</sup>

|label3 = Reviewed by

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|data3 = Basisht G.<sup>1</sup>

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|data3 = Basisht G.<sup>2</sup>

|label4 = Affiliations

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|data4 = <sup>1</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar ~~<sup>2</sup> Department of Kriya Sharir, Govt. Ayurveda College, Thiruvananthapuram, Kerala, India.~~

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|data4 = <sup>1</sup> Department of Kriya Sharira, Govt. Ayurveda College, Thiruvananthapuram, Kerala, India.

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<sup>2</sup> [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:

|data5 = carakasamhita@gmail.com

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|label6 = Date of first publication:

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|label6 = Publisher

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|~~data6~~ = June 25, 2021

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|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

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|~~label7~~ = DOI

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|~~data7~~ = ~~In process~~

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|label7 = Date of first publication:

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|data7 = June 25, 2021

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|label8 = DOI

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|data8 = 10.47468/CSNE.2021.e01.s09.061

}}

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==Importance of sleep in the preservation of health==

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Sleep is an important part of lifestyle. It is estimated that an average individual spends nearly one third part of life in sleeping. Sleep is a basic human need. It is essential for good health, good quality of life and performing well during the day. Sleep deprivation can lead to various physical effects like sleepiness, fatigue, hypertension. It can cause cognitive impairments like deterioration of performance, attention, and motivation; diminishment of mental concentration, intellectual capacity, and mental health complications. Inadequate rest impairs the ability to think, handle stress, maintain a healthy immune system, and moderate emotions.

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Sleep is an important part of lifestyle. It is estimated that an average individual spends nearly one third part of life in sleeping. Sleep is a basic human need. It is essential for good health, good quality of life and performing well during the day. Sleep deprivation can lead to various physical effects like sleepiness, fatigue, hypertension. It can cause cognitive impairments like deterioration of performance, attention, and motivation; diminishment of mental concentration, intellectual capacity, and mental health complications. Inadequate rest impairs the ability to think, handle stress, maintain a healthy immune system, and moderate emotions.<ref>Report on WHO technical meeting on sleep and health at Bonn Germany, 22-24 January 2004. Available from https://www.euro.who.int/__data/assets/pdf_file/0008/114101/E84683.pdf accessed on 22/06/2021 </ref>

The sleeping urge is one among non-suppressible natural urges. [Cha. Sa. [[Sutra Sthana]] 7/ 3] Sleep is a function of the mind. All kinds of perception or connections with the external world are blocked in sleep. The mind is disconnected from all sensory and motor organs during sleep. [Patanjali Yoga Sutra 1/20]

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The normal sleep is responsible for happiness, nourishment, strength, virility, knowledge and liveliness. On the contrary, abnormal sleep can cause miseries, malnutrition, weakness, impotence, ignorance, and death. Untimely sleep, excessive and deprived can take away the good fortunes of life. Properly observed sleep can provide happiness. [Cha. Sa. [[Sutra Sthana]] 21/36-38] Those who resort to proper sleep are free from diseases, have pleasant attitudes, and are endowed with strength, complexion and virility. They are not too obese or too lean and have a longer lifespan with all prosperity. [Su. Sa. Sharira Sthana 4/39, 40]

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The normal sleep is responsible for happiness, nourishment, strength, virility, knowledge and liveliness. On the contrary, abnormal sleep can cause miseries, malnutrition, weakness, impotence, ignorance, and death. Untimely sleep, excessive and deprived can take away the good fortunes of life. Properly observed sleep can provide happiness. [Cha. Sa. [[Sutra Sthana]] 21/36-38] Those who resort to proper sleep are free from diseases, have pleasant attitudes, and are endowed with strength, complexion and virility. They are not too obese or too lean and have a longer lifespan with all prosperity. [Su.Sa. Sharira Sthana 4/39, 40]

Food and sleep are the determinants of obesity and emaciation. [Cha. Sa. [[Sutra Sthana]] 21/51] Night vigil causes dryness in body, while day sleep causes unctuousness. This leads to the aggravation of [[vata]] [[dosha]] and [[kapha]] [[dosha]] respectively. Sleeping in a sitting posture does not influence [[dosha]] equilibrium. It causes neither too dryness nor unctuousness. [Cha. Sa. [[Sutra Sthana]] 21/50]

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==Etymology and derivation==

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The word is derived from the Sanskrit word root “Nidi kutsyaayaam” by adding the suffix “rak”. It means sleep, sleepiness, sloth, dream, shutting, budding state, dead, dull, drowsiness etc.

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The word is derived from the Sanskrit word root “Nidi kutsyaayaam” by adding the suffix “rak”.<ref name=jha >Jha Srujan. Amarkosha online application</ref> It means sleep, sleepiness, sloth, dream, shutting, budding state, dead, dull, drowsiness etc.

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==Synonyms==

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Shayanam, swapa, swapna/ swapnam, samvesha, tandra, supti, vaishnavi [Su. Sa. Sharira Sthana 4/33]

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Shayanam, swapa, swapna/ swapnam, samvesha, tandra, supti,<ref name=jha/> vaishnavi [Su. Sa. Sharira Sthana 4/33]

==Physiology of sleep==

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When the mind and body are tired, [[kapha]] [[dosha]] and inertia (tamas guna) are increased in the body. In this state, the sensory organs are unable to function. This state leads to sleep (nidra). [Cha. Sa. [[ Sutra Sthana]] 21/35] Inertia (tamas) is the prime factor responsible for sleep (nidra). [Su. Sa. [[Sharira Sthana]] 4/34]

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When the mind and body are tired, [[kapha]] [[dosha]] and inertia (tamas guna) are increased in the body. In this state, the sensory organs are unable to function. This state leads to sleep (nidra). [Cha. Sa. [[ Sutra Sthana|Sutra Sthana]] 21/35] Inertia (tamas) is the prime factor responsible for sleep (nidra). [Su. Sa. [[Sharira Sthana]] 4/34]

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The interplay of two significant processes regulates the sleep-wake system.

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The interplay of two significant processes regulates the sleep-wake system.<ref>Gillette M, Abbott S. Sleep Research Society. SRS Basics of Sleep Guide. Westchester, IL: Sleep Research Society; 2005. Fundamentals of the circadian system; pp. 131–138.</ref>

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'''a) Process S''' is the homeostatic drive for sleep. It is regulated by the neurons found in the preoptic area of the hypothalamus of the brain. These neurons contain molecules that inhibit neuronal communication and turn off the arousal systems during sleep.

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'''a) Process S''' is the homeostatic drive for sleep. It is regulated by the neurons found in the preoptic area of the hypothalamus of the brain. These neurons contain molecules that inhibit neuronal communication and turn off the arousal systems during sleep.<ref>Saper CB, Cano G, Scammell TE. Homeostatic, circadian, and emotional regulation of sleep. Journal of Comparitive Neurology. 2005a;493(1):92–98.</ref>

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'''b) Process C''' promotes wakefulness and alertness. The circadian system regulates it. Wakefulness is generated by an ascending arousal system from the brainstem. This activates forebrain structures by transmitting sensory information to the cerebral cortex and activating the nerve cells to interpret and analyze the sensory inputs.

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'''b) Process C''' promotes wakefulness and alertness. The circadian system regulates it. Wakefulness is generated by an ascending arousal system from the brainstem. This activates forebrain structures by transmitting sensory information to the cerebral cortex and activating the nerve cells to interpret and analyze the sensory inputs.<ref>Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature. 2005c;437(7063):1257–1263.</ref>

Through the synchronization of the circadian system, process C assists in keeping sleep-wakefulness cycles coordinated with environmental light-dark cycles.

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Process S is similar to the functions of [[kapha]] [[dosha]] and [[tamas]] [[guna]] that promotes sleep. Process C is similar to functions of [[vata]] [[dosha]] and [[rajo]] [[guna]] that promotes wakefulness.

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===Role of the mental constitution:===

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===Role of the mental constitution===

The mental constitution of a person can influence natural sleep patterns variably.

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===Dreams (swapna)===

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The dreams are seen due to the association of the mind with [[~~rajo~~]] [[guna]]. It perceives both auspicious and inauspicious objects of senses based on previous experiences in the form of dreams. [Su.Sa.Sharira Sthana 4/36-37]

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The dreams are seen due to the association of the mind with [[rajas]] [[guna]]. It perceives both auspicious and inauspicious objects of senses based on previous experiences in the form of dreams. [Su.Sa.Sharira Sthana 4/36-37]

When the mind continues to cognize, the sleeping person experiences different kinds of dreams. The sense organs are not receptive to their perceptions in this state. [A.S. Sutra Sthana 9/21]

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A dream is a conscious experience that occurs during sleep. Although it may happen in any sleep phase, it prevails during the desynchronized phase (REM type). Like any information consciously identified, a dream triggers a specific behavior, that we call an oneiric behavior. It comprises two types of identifiable manifestations:

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A dream is a conscious experience that occurs during sleep. Although it may happen in any sleep phase, it prevails during the desynchronized phase (REM type).<ref>Cesar Timo-Iaria (in memorian); Angela Cristina do Valle, Physiology of dreaming,Sleep Science, Vol.2 Issue 2 / 2009 ,Available from: http://sleepscience.org.br/details/145/en-US/physiology-of-dreaming</ref> Like any information consciously identified, a dream triggers a specific behavior, that we call an oneiric behavior. It comprises two types of identifiable manifestations:

'''a) Motor:''' These components are usually weak and poorly expressed movements during a dream.

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'''b) Vegetative:''' Phasic increases heart rate, blood pressure, respiration, pupillary diameter, and metabolic adjustments, which are expressed more consistently during a dream, as they are during attentive wakefulness.

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'''b) Vegetative:''' Phasic increases heart rate, blood pressure, respiration, pupillary diameter, and metabolic adjustments, which are expressed more consistently during a dream, as they are during attentive wakefulness.<ref>Cesar Timo-Iaria (in memorian); Angela Cristina do Valle, Physiology of dreaming,Sleep Science, Vol.2 Issue 2 / 2009 ,Available from: http://sleepscience.org.br/details/145/en-US/physiology-of-dreaming

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Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 2, Sleep Physiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19956 </ref>

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'''b) Rapid eye-movement (REM) sleep.'''

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NREM sleep is divided further into four stages based on variations in brain wave patterns, eye movements, and muscle tone. In the course of a period of sleep, NREM and REM sleep alternate cyclically. A normal sleep episode begins with a short period of NREM stage 1, progressing through stage 2, followed by stages 3 and 4, and finally to REM. The individuals do not remain in REM sleep throughout the night. The cycle between the stages of NREM and REM continues. NREM sleep constitutes about 75 -80% of the total duration of sleep, and REM sleep constitutes the remaining 20 – 25%. The function of cyclic change between these two types of sleep is not yet understood.

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NREM sleep is divided further into four stages based on variations in brain wave patterns, eye movements, and muscle tone. In the course of a period of sleep, NREM and REM sleep alternate cyclically. A normal sleep episode begins with a short period of NREM stage 1, progressing through stage 2, followed by stages 3 and 4, and finally to REM. The individuals do not remain in REM sleep throughout the night. The cycle between the stages of NREM and REM continues. NREM sleep constitutes about 75 -80% of the total duration of sleep, and REM sleep constitutes the remaining 20 – 25%.<ref>Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 2, Sleep Physiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19956/</ref> The function of cyclic change between these two types of sleep is not yet understood.

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However, irregular cycling or absent sleep stages are associated with sleep disorders. E.g. Individuals with narcolepsy enter sleep directly into REM sleep instead of entering sleep through NREM.

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However, irregular cycling or absent sleep stages are associated with sleep disorders.<ref>Zepelin H, Siegel JM, Tobler I. Mammalian sleep. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier/Saunders; 2005. pp. 91–100</ref> E.g. Individuals with narcolepsy enter sleep directly into REM sleep instead of entering sleep through NREM.<ref>Carskadon M, Dement W. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005. pp. 13–23.</ref>

There are seven types of sleep based on the causes of sleep.

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*Parasomnias

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*Sleep-related movement disorders and other sleep disorders.

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*Sleep-related movement disorders and other sleep disorders.<ref>Michael J. Sateia , MD, International Classifi cation of Sleep Disorders-Th ird Edition Highlights and Modifications, Contemporary Reviews in Sleep Medicine, 146#5 CHEST NOVEMBER 2014 :1387-1394</ref>

As per Ayurveda, the clinical presentations of sleep disorders may be broadly classified into two types.

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'''a)Excessive sleep (~~ati nidra~~)'''

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'''a) Excessive sleep (atinidra)'''

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'''b)Loss of sleep/insomnia (anidra)'''

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'''b) Loss of sleep/insomnia (anidra)'''

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===Causes of excessive sleep===

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Excess consumption of fats in the diet causes excess accumulation of fat (medas) and [[kapha dosha]]. This leads to obstruction in body channels, heaviness in the body and lethargy.This causes excessive sleep or hypersomnolence. [A. S. Sutra Sthana 9/30-33]

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Excess consumption of fats in the diet causes excess accumulation of fat (medas) and [[kapha dosha]]. This leads to obstruction in body channels, heaviness in the body and lethargy. This causes excessive sleep or hypersomnolence. [A. S. Sutra Sthana 9/30-33]

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Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy have excessive, uncontrollable daytime sleepiness. They may also suddenly fall asleep at any time, during any kind of activity. The exact cause of narcolepsy is unknown in contemporary sciences. People with type 1 narcolepsy have low levels of the chemical hypocretin, which is an important neurochemical that regulates wakefulness and REM sleep.The relation between high-fat diet and narcolepsy needs further research.

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Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. People with narcolepsy have excessive, uncontrollable daytime sleepiness. They may also suddenly fall asleep at any time, during any kind of activity. The exact cause of narcolepsy is unknown in contemporary sciences. People with type 1 narcolepsy have low levels of the chemical hypocretin, which is an important neurochemical that regulates wakefulness and REM sleep.<ref>Available from : https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497</ref>The relation between high-fat diet and narcolepsy needs further research.

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*Old age

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*Excess administration of procedures like therapeutic purgation ([[virechana]]), emesis ([vamana]]), nasal errhines ([[nasya]]), blood-letting ([[raktamokshana]])

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*Excess administration of procedures like therapeutic purgation ([[virechana]]), emesis ([[vamana]]), nasal errhines ([[nasya]]), blood-letting ([[raktamokshana]])

*[[Vata dosha]] predominant diseases, [[vata dosha]] dominance in basic body constitution ([[prakriti]]), aggravation of [[vata]] / [[vata]] along with [[pitta]] in the body due to any cause[Cha.Sa.[[Sutra Sthana]]21/55-57], [A. S. Sutra Sthana 9/34-36]

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Research shows an increased prevalence of insomnia in women and older adults. In women, insomnia is more prevalent during menarche and menopause.Comorbid medical disorders, psychiatric disorders, and night duties or rotating shifts are significant risks for insomnia.

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Research shows an increased prevalence of insomnia in women and older adults.<ref>National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005.</ref> In women, insomnia is more prevalent during menarche and menopause.<ref>Johnson EO, Roth T, Schultz L, Breslau N. Epidemiology of DSMIV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference. Pediatrics. 2006;117:e247–56</ref>Comorbid medical disorders<ref>Clinical correlates of insomnia in patients with chronic illness.Katz DA, McHorney CA,Arch Intern Med. 1998 May 25; 158(10):1099-107.</ref>,psychiatric disorders<ref>Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?Ford DE, Kamerow DBJAMA. 1989 Sep 15; 262(11):1479-84.</ref>, and night duties or rotating shifts<ref>Insomnia: epidemiology, characteristics, and consequences.Roth T, Roehrs T, Clin Cornerstone. 2003; 5(3):5-15.</ref> are significant risks for insomnia.

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Loss of sleep causes body ache, heaviness in the head, frequent yawning, stiffness, tiredness, giddiness, impaired digestion, stupor, and other [[vata]] predominant diseases. [A.S. Sutra Sthana 9/37] Suppression of natural sleep urge causes frequent yawning, body ache, stupor, diseases of head, and heaviness of eyes. [Cha. Sa. [[Sutra Sthana]] 7/23]

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The persons with insomnia can develop the conditions causing hypoxemia and dyspnoea, gastroesophageal reflux disease, pain conditions, and neurodegenerative diseases. Among the primary sleep disorders, restless legs syndrome (RLS), periodic limb movement disorders (PLMD), and sleep-related breathing disorders (snoring, dyspnoea, sleep apnoea) often present with an insomnia symptom.

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The persons with insomnia can develop the conditions causing hypoxemia and dyspnoea, gastroesophageal reflux disease, pain conditions, and neurodegenerative diseases.<ref>Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-S10.</ref> Among the primary sleep disorders, restless legs syndrome (RLS), periodic limb movement disorders (PLMD), and sleep-related breathing disorders (snoring, dyspnoea, sleep apnoea) often present with an insomnia symptom.<ref>The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness.Ancoli-Israel S, Am J Manag Care. 2006 May; 12(8 Suppl):S221-9.</ref>

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Research shows a relationship between inadequate sleep and medical conditions like hypertension, obesity and type-2 diabetes, cardiovascular disease and arrhythmias,mood disorders,neurodegeneration and dementia,and impaired immune functioning.

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Research shows a relationship between inadequate sleep and medical conditions like hypertension<ref>Grandner M, Mullington JM, Hashmi SD, et al. Sleep duration and hypertension: Analysis of > 700,000 adults by age and sex. J Clin Sleep Med. 2018;14(6):1031–1039. doi: 10.5664/jcsm.7176.</ref>, obesity and type-2 diabetes<ref>Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes Metabolism. 2018;84:56–86. doi: 10.1016/j.metabol.2018.02.010.</ref>, cardiovascular disease and arrhythmias <ref>Gottlieb DJ, Somers VK, Punjabi NM, Winkelman JW. Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med. 2017;31:10-17. doi:10.1016/j.sleep.2016.08.008</ref> <ref>May AM, Van Wagoner DR, Mehra R. OSA and cardiac arrhythmogenesis: mechanistic insights [published online September 29, 2016] Chest. 2017;151(1):225–241. doi: 10.1016/j.chest.2016.09.014.</ref>,mood disorders<ref>Lyall LM, Wyse CA, Graham N, et al. Association of disrupted circadian rhythmicity with mood disorders, subjective wellbeing, and cognitive function: a cross-sectional study of 91 105 participants from the UK Biobank Lancet Psychiatry. 2018;5(6):507–514. doi: 10.1016/S2215-0366(18)30139-1.</ref>,neurodegeneration and dementia<ref>Pillai JA, Leverenz JB. Sleep and neurodegeneration: a critical appraisal Chest. 2017;151(6):1375–1386. doi: 10.1016/j.chest.2017.01.002</ref> <ref>Sprecher KE, Koscik RL, Carlsson CM, et al. Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults. Neurology. 2017;89(5):445-453. doi:10.1212/WNL.0000000000004171</ref>,and impaired immune functioning.<ref>Watson NF, Buchwald D, Delrow JJ, et al. Transcriptional Signatures of Sleep Duration Discordance in Monozygotic Twins. Sleep. 2017;40(1):zsw019. doi:10.1093/sleep/zsw019</ref>

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Diseases of head, giddiness, disorientation, obstruction in body channels, hampered digestion, edema, nausea, nasal discharge, pain in one side of head, itching, pain and eruptions over skin, stupor, throat diseases, augmented activity of poisons are the untoward effects of improper and untimely sleep. [A.S. Sutra Sthana 9/30-33]

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The International Classification of Sleep Disorders (ICSD-2) includes “excessive daytime sleepiness” (EDS) as an essential feature for three diagnostic categories: narcolepsy, hypersomnia and ~~behaviourally~~ induced insufficient sleep syndrome. It is also associated with various diseases, including psychiatric and neurological disorders, pulmonary and cardiac conditions.

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The International Classification of Sleep Disorders (ICSD-2) includes “excessive daytime sleepiness” (EDS) as an essential feature for three diagnostic categories: narcolepsy, hypersomnia and behaviorally induced insufficient sleep syndrome. It is also associated with various diseases, including psychiatric and neurological disorders, pulmonary and cardiac conditions.<ref>Slater G, Steier J. Excessive daytime sleepiness in sleep disorders. J Thorac Dis. 2012;4(6):608-616. doi:10.3978/j.issn.2072-1439.2012.10.07</ref>

===Indications of day time sleep===

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== Current researches==

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In the conventional management of insomnia, non-benzodiazepine hypnotics are the first line pharmacotherapeutic agents, followed by benzodiazepines, amitriptyline and antihistamines.

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In the conventional management of insomnia, non-benzodiazepine hypnotics are the first line pharmacotherapeutic agents, followed by benzodiazepines, amitriptyline and antihistamines.<ref>Saddichha S. Diagnosis and treatment of chronic insomnia. Ann Indian Acad Neurol.2010;13(2):94-102. doi:10.4103/0972-2327.64628</ref>

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!Compound/ single drug !! Ingredients !! Dose/duration/ vehicle

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|Mamsyadi ghrita ||Ghee processed with Nardostachys jatamansi(jatamamsi), Convulvulus pluricaulis (shankhapushpi), Withania somnifera(ashwagandha),Valeriana wallichii (tagara) || 20 g twice a day orally with luke warm water for 6 weeks.

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|Mamsyadi ghrita<ref>Anil Kumar Singh; A clinical study of manasika bhavas in anidra w.s.r to stress

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induced chronic insomnia and its management with mamsyadi ghrita and dashamula kwatha shirodhara, (MD thesis),IPGT & RA, Jamnagar, 2007; 204-9

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</ref> ||Ghee processed with Nardostachys jatamansi(jatamamsi), Convulvulus pluricaulis (shankhapushpi), Withania somnifera(ashwagandha),Valeriana wallichii (tagara) || 20 g twice a day orally with luke warm water for 6 weeks.

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|Tagaradi Kwatha ||Nardostachys jatamansi (jatamamsi), Convulvulus pluricaulis (shankhapushpi), Withania somnifera (ashwagandha), Valeriana wallichii (tagara), Bacopa monnieri (brahmi),Vitis vinifera (draksha), Picrorhiza kurrooa (katuki), Hedyotis corymbosa (parpataka), Aegle marmelos(bilwa),Premna Serratifolia/integrifolia(agnimantha), Oroxylum indicum(shyonaka), Stereospermum suaveolens(patala), Gmelina arborea (gambhari), Solanum indicum(bruhati), Solanum xanthocarpum(kantakari),Desmodium gangeticum(shalaparni), Uraria picta(prushniparni), Tribulus terrestris(gokshura), Cyperus rotundus (musta), Pterocarpus santalinus (raktachandana), Cassia fistula(aragwadha) || 40gm/day (In two divided doses each of 20 gms) in decoction form for 6 weeks

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|Tagaradi Kwatha<ref>Vansh bina ,A clinical study on Manasika Bhavas in AnidraW.S.R to stress induced insomnia

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and its management with Tagaradi kwatha and Mahishi Dugdha Shirodhara, MD thesis, IPGT & RA, Jamnagar, 2008.

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</ref> ||Nardostachys jatamansi (jatamamsi), Convulvulus pluricaulis (shankhapushpi), Withania somnifera (ashwagandha), Valeriana wallichii (tagara), Bacopa monnieri (brahmi),Vitis vinifera (draksha), Picrorhiza kurrooa (katuki), Hedyotis corymbosa (parpataka), Aegle marmelos(bilwa),Premna Serratifolia/integrifolia(agnimantha), Oroxylum indicum(shyonaka), Stereospermum suaveolens(patala), Gmelina arborea (gambhari), Solanum indicum(bruhati), Solanum xanthocarpum(kantakari),Desmodium gangeticum(shalaparni), Uraria picta(prushniparni), Tribulus terrestris(gokshura), Cyperus rotundus (musta), Pterocarpus santalinus (raktachandana), Cassia fistula(aragwadha) || 40gm/day (In two divided doses each of 20 gms) in decoction form for 6 weeks

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|Parasikayavani capsule || Hyoscyamus niger (parasikayavani)-1/4 part and Nardostachys jatamansi (Jatamansi)-1 part, triturated 7 times in juice of Convulvulus pluricaulis (shankhapushpi) and 7 times in juice of Benincasa hispida (kushmanda)||5 Capsules, with luke warm water, at bed time, for 1 month.

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|Parasikayavani capsule<ref>M.P.S.K.R. Muthugala ,Evaluation of Parasikayavanyadi capsule in the management of Anidra W.S.R. to insomnia, MD thesis, IPGT & RA, Jamnagar, 2013.</ref> || Hyoscyamus niger (parasikayavani)-1/4 part and Nardostachys jatamansi (Jatamansi)-1 part, triturated 7 times in juice of Convulvulus pluricaulis (shankhapushpi) and 7 times in juice of Benincasa hispida (kushmanda)||5 Capsules, with luke warm water, at bed time, for 1 month.

|-

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|Apamargadi vati || Achyranthes aspera (apamarga), Asteracantha longifolia (kokilaksha), Perstrophe bicalyculata Linn (kakajangha), Psoralia corylifolia (bakuchi) ||1 gm trice a day, with buffalo milk, for 8 weeks.

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|Apamargadi vati<ref>Nirmal Dhamini, Role of Manasa Bhavas in Anidra and its management withcertain indigenous drugs and Shirodhara,(MD thesis), IPGT & RA, Jamnagar, 2004;143-7.</ref> || Achyranthes aspera (apamarga), Asteracantha longifolia (kokilaksha), Perstrophe bicalyculata Linn (kakajangha), Psoralia corylifolia (bakuchi) ||1 gm trice a day, with buffalo milk, for 8 weeks.

|-

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|Powder of root of Piper longum(pippali moola) || -- ||2 gm twice a day with jaggery (guda), after food , for 4 weeks

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|Powder of root of Piper longum(pippali moola)<ref>Krutika joshi , A pharmaco clinical evaluation of Pippalimoola (root of piper longum) W.S.R to insomnia, , (PhD thesis), IPGT & RA, Jamnagar,2014</ref> || -- ||2 gm twice a day with jaggery (guda), after food , for 4 weeks

|-

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|Leaf powder of Nardostachys jatamansi (Jatamansi) || -- || 3 gm powder with honey (5g), ½ hour before bed time for 4 weeks.

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|Leaf powder of Nardostachys jatamansi (Jatamansi)<ref name=kal>Kalpesh panara , A pharmaco clinical evaluation of Beejapoorapatra (leave of citrus medica linn.) W.S.R to insomnia, (PhD thesis), IPGT & RA, Jamnagar,2014</ref> || -- || 3 gm powder with honey (5g), ½ hour before bed time for 4 weeks.

|-

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|Powder of Citrus medica Linn(beejapura) leaves || -- || 3 gm powder with honey (5g), ½ hour before bed time for 4 weeks

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|Powder of Citrus medica Linn(beejapura) leaves<ref name=kal/> || -- || 3 gm powder with honey (5g), ½ hour before bed time for 4 weeks

|-

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|Insomrid tablet || Withania somnifera (ashwagandha), Rauvolfia serpentina (sarpagandha), Nardostachys jatamansi (jatamamsi), Valeriana wallichii (tagara), Hyoscyamus niger (parasika yavani)|| 2 tab (each of 500 mg) in the morning after breakfast and night after the dinner with luke warm milk for 30 days.

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|Insomrid tablet<ref>Pokharel S, Sharma AK. Evaluation of Insomrid Tablet and Shirodhara in the management of Anidra (Insomnia). Ayu. 2010;31(1):40-47. doi:10.4103/0974-8520.68209</ref> || Withania somnifera (ashwagandha), Rauvolfia serpentina (sarpagandha), Nardostachys jatamansi (jatamamsi), Valeriana wallichii (tagara), Hyoscyamus niger (parasika yavani)|| 2 tab (each of 500 mg) in the morning after breakfast and night after the dinner with luke warm milk for 30 days.

|}

'''Therapeutic procedures:'''

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Apart from oral medications, the local procedures like pouring of the medicated liquid on the forehead (shirodhara), application of medicated oil on head (shiro abhyanga and shiro pichu) have shown significant results in the management of insomnia.

The liquids used for Shirodhara in clinical trials are as follow:

−

*Oil processed with Nardostachys jatamansi (jatamamsi taila)

+

*Oil processed with Nardostachys jatamansi (jatamamsi taila)<ref>joshi chinmay-,Comparative study on the effect of Sneha Dhara and Jala Dhara in Anidra,( MD Thesis), IPGT & RA, Jamnagar 2013</ref>

−

*Decoction of 10 medicinal plant roots known as “Dashamoola” [Aegle marmelos(bilwa),Premna Serratifolia/integrifolia(agnimantha), Oroxylum Indicum(shyonaka), Stereospermum Suaveolens(patala), Gmelina Arborea(gambhari), Solanum Indicum(bruhati), Solanum Xanthocarpum(kantakari),Desmodium gangeticum(shalaparni), Uraria Picta(prushniparni), Tribulus Terrestris(gokshura)]

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*Decoction of 10 medicinal plant roots known as “Dashamoola”<ref>Anil Kumar Singh; A clinical study of manasika bhavas in anidra w.s.r to stress

+

induced chronic insomnia and its management with mamsyadi ghrita and dashamula kwatha shirodhara, (MD thesis),IPGT & RA, Jamnagar, 2007; 204-9</ref> [Aegle marmelos(bilwa),Premna Serratifolia/integrifolia(agnimantha), Oroxylum Indicum(shyonaka), Stereospermum Suaveolens(patala), Gmelina Arborea(gambhari), Solanum Indicum(bruhati), Solanum Xanthocarpum(kantakari),Desmodium gangeticum(shalaparni), Uraria Picta(prushniparni), Tribulus Terrestris(gokshura)]

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*Buffalo’s milk (mahisha dugdha)

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*Buffalo’s milk (mahisha dugdha)<ref>Vansh bina ,A clinical study on Manasika Bhavas in AnidraW.S.R to stress induced insomnia

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and its management with Tagaradi kwatha and Mahishi Dugdha Shirodhara, MD thesis, IPGT & RA, Jamnagar, 2008.</ref>

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*Ksheerabala taila

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*Ksheerabala taila<ref>Nirmal Dhamini, Role of Manasa Bhavas in Anidra and its management withcertain indigenous drugs and Shirodhara,(MD thesis), IPGT & RA, Jamnagar, 2004;143-7.</ref>

−

The duration of the procedure done in the clinical trials ranges from 30-45 minutes daily for 2-3 weeks, preferably in morning. The temperature range of liquid was 38-40 degree Celsius. A clinical trial showed efficacy of lukewarm water as equal to medicated oil in shirodhara procedure. The combined therapy with oral medication and local procedures shows appreciable results in the management of insomnia.

+

The duration of the procedure done in the clinical trials ranges from 30-45 minutes daily for 2-3 weeks, preferably in morning. The temperature range of liquid was 38-40 degree Celsius.<ref>Pokharel S, Sharma AK. Evaluation of Insomrid Tablet and Shirodhara in the management of Anidra (Insomnia). Ayu. 2010;31(1):40-47. doi:10.4103/0974-8520.68209</ref> A clinical trial showed efficacy of lukewarm water as equal to medicated oil in shirodhara procedure.<ref>joshi chinmay-,Comparative study on the effect of Sneha Dhara and Jala Dhara in Anidra,( MD Thesis), IPGT & RA, Jamnagar 2013</ref> The combined therapy with oral medication and local procedures shows appreciable results in the management of insomnia.

==Theses works ==

−

1) Nirmal Dhamini A (2004): Role Manasa Bhavas in Anidra and its management with certain indigenous drugs and Shiro-Dhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

+

−

2) Anil Kumar Singh (2007): A Clinical Study Of Manasika Bhavas In Anidra W.S.R To Stress Induced Chronic Insomnia And Its Management With Mamsyadi Ghrita And Dashamula Kwatha Shirodhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

+

1) Nirmal Dhamini A (2004): Role Manasa Bhavas in Anidra and its management with certain indigenous drugs and Shiro-Dhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

−

3) Bina H Vansh(2008) : clinical study on Mansika Bhavas in Anidra w.s.r. to stress induced insomnia & its management with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

+

−

4) M P S K R Muthugala (2013): Evaluation of Parasikayavanyadi Capsule in the management of Anidra w.s.r. to Insomnia, Department of Kayachikitsa, IPGT &RA, Jamnagar.

+

2) Anil Kumar Singh (2007): A Clinical Study Of Manasika Bhavas In Anidra W.S.R To Stress Induced Chronic Insomnia And Its Management With Mamsyadi Ghrita And Dashamula Kwatha Shirodhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

−

5) Chinmay P Joshi(2013) : Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia), Department of Panchakarma, IPGT &RA, Jamnagar.

+

−

6) Hapaliya Sunilkumar Babulal (2014): A Clinico Comparative Study of Madhukadi Taila Shiropichu and Pippalimoola Churna in the Management of Anidra with special reference to Insomnia, Department of Panchakarma, IPGT &RA, Jamnagar.

+

3) Bina H Vansh(2008) : clinical study on Mansika Bhavas in Anidra w.s.r. to stress induced insomnia & its management with Tagaradi Kwatha & Mahishi Dugdha Shirodhara, Department of Kayachikitsa, IPGT &RA, Jamnagar.

−

7) Kalpesh panara (2014): A pharmaco clinical evaluation of Beejapoorapatra (leave of citrus medica linn.) W.S.R to insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

+

−

8) Krutika joshi (2014) : A pharmaco clinical evaluation of Pippalimoola (root of piper longum) W.S.R to insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

+

4) M P S K R Muthugala (2013): Evaluation of Parasikayavanyadi Capsule in the management of Anidra w.s.r. to Insomnia, Department of Kayachikitsa, IPGT &RA, Jamnagar.

−

9) Mithilesh Kumar Sah (2015): Study On Concept Of Nidra (Sleep) And Diva-Swapna With Applied Aspect Of Snigdham Praswapnam Diva, Department of Basic Principles, IPGT &RA, Jamnagar.

+

−

10) Rawal Priyanka Manipal (2017) : A Critical Study On Trividha Aushadha And Applied Aspect Of Ahitebhyo Arthebhyo Manonigraha In The Management Of Anidra, Department of Basic Principles, IPGT &RA, Jamnagar.

+

5) Chinmay P Joshi(2013) : Comparative study on the effect of Sneha Dhara & Jala Dhara in Anidra (Insomnia), Department of Panchakarma, IPGT &RA, Jamnagar.

−

11) Goti Keval Kalubhai (2017): Pharmaco-Clinical Evaluation Of Nidrajanana Karma(Sedative Activity) Of Bijapuradi Yoga W.S.R. To Anidra( Insomnia), Department of Dravyaguna, IPGT &RA, Jamnagar.

+

−

12) Parth K Barad(2017): Pharmacognostical-Clinical Study Of Ikshurak Mool Kwath On Anidra W.S.R. To Insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

+

6) Hapaliya Sunilkumar Babulal (2014): A Clinico Comparative Study of Madhukadi Taila Shiropichu and Pippalimoola Churna in the Management of Anidra with special reference to Insomnia, Department of Panchakarma, IPGT &RA, Jamnagar.

−

References

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7) Kalpesh panara (2014): A pharmaco clinical evaluation of Beejapoorapatra (leave of citrus medica linn.) W.S.R to insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

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8) Krutika joshi (2014) : A pharmaco clinical evaluation of Pippalimoola (root of piper longum) W.S.R to insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

+

9) Mithilesh Kumar Sah (2015): Study On Concept Of Nidra (Sleep) And Diva-Swapna With Applied Aspect Of Snigdham Praswapnam Diva, Department of Basic Principles, IPGT &RA, Jamnagar.

+

10) Rawal Priyanka Manipal (2017) : A Critical Study On Trividha Aushadha And Applied Aspect Of Ahitebhyo Arthebhyo Manonigraha In The Management Of Anidra, Department of Basic Principles, IPGT &RA, Jamnagar.

+

11) Goti Keval Kalubhai (2017): Pharmaco-Clinical Evaluation Of Nidrajanana Karma(Sedative Activity) Of Bijapuradi Yoga W.S.R. To Anidra( Insomnia), Department of Dravyaguna, IPGT &RA, Jamnagar.

+

12) Parth K Barad(2017): Pharmacognostical-Clinical Study Of Ikshurak Mool Kwath On Anidra W.S.R. To Insomnia, Department of Dravyaguna, IPGT &RA, Jamnagar.

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