Kavitha S

“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE
STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN
PRIMARY INSOMNIA”
By
Dr. Kavitha S. B.A.M.S.
Dissertation submitted to the

Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore.
In the partial fulfillment of the requirements for the degree of
DOCTOR OF MEDICINE (AYURVEDA)

in
AYURVEDA SIDDHANTA
Under The Guidance of

Dr. Bala Krishna D. L. M.D. (Ayu)
Professor
Head of the Department,
Department of Panchakarma,
G.A.M.C., Mysore-21.
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA

SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE,
MYSORE. 2010
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ACKNOWLEDGEMENTS
I bow to the sacred feet of Almighty, without the blessings of whom this study would
not have been completed.
I am extremely thankful to Dr. Naseema Akthar, HOD, Department of PG Studies in
Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for her
constant guidance and support.
I sincerely express my indebtedness and profound gratitude to my Guide
Dr. Balakrishna D. L., Professor, Head of the Department of Panchakarma,
Government Ayurveda Medical College, Mysore for his valuable guidance &
encouragement through out my PG studies.
I am grateful to Principal Dr.Ashok D. Satpute, Professor and Head, Department of
Rasashastra and Bhaishajya Kalpana, Government Ayurveda Medical College,
Mysore for his support and encouragement.
I am highly thankful to (Late) Dr.G.N.Shakuntala, former HOD, Department of PG
Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for
her constant guidance, continuous supervision and help at every stage of this study.
I sincerely express my indebtedness and profound gratitude to Dr.N.Anjaneya
Murthy, Joint Director of AYUSH, Professor and former HOD, Department of PG
Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for
his ever lasting support and inspiration.
I owe my deep sense of gratitude to all my teachers Dr. T. D. Ksheera Sagar,
Dr. Shanthala Priyadarshini, Dr.H.M.Chandramouli, Dr. Gopinath,
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Dr. Shantaram, Dr.Rajendra, Dr.Shreevathsa, Dr.Mythreyi, Dr.V.A.Chate and
Dr. Anand Katti and all other teachers and hospital staff for their support in this
study.
I also thank Dr.Ramchandra Naik, Senior Physician, GAMCH, Mysore for his
constant support. I also convey my special thanks to Dr. Raveesh, Professor & HOD,
Dept. of Psychiatry, MMC, for this valuable guidance and support during my study.
I thank Dr.Lancy D’souza for his valuable help and guidance in the statistical
analysis and interpretations.
I express enormous amount of thanks to my senior Colleague Dr.Soubhagya Bilagi,
my colleague Dr.Aparna.K and My junior colleague Dr.Rekha.A.R for their timely
suggestion, support and encouragement through out my study.
I am thankful to my senior colleagues Dr.Savita Shenoy, Dr. Vijayalakshmi,
Dr.Yogesh and Dr.Kedar Sharma. I owe my special thanks to my classmates
Dr.Annapoorani, Dr.Pankaj Pathak and Dr.Rajesh Bhat.
I thank my colleagues Dr. Ranjith, Dr. Kalyani, Dr.Ramesh and Dr.Geetha for
their help. I also thank my Kayachikitsa colleagues Dr. Parveen, Dr. Kiran,
Dr. Ranjini, Dr. Vyas Raj, Dr. Anatha Sayena, Dr. Sameena and Dr. Pallavi for
their support.
I also thank our junior colleagues Dr. Athika Jan, Dr. Pallavi and Dr.Aravind for
their help. I thank Kayachikitsa juniors Dr. Shridhar Murthy, Dr. Shubha,
Dr. Geeta, Dr. Soumya, Dr. Aditya , Dr. Mahesh and Dr. Vidya for their help
I also thank our Department employee Annaiahachar.
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I also owe my heart felt gratitude to my Teachers of Under Graduation at GAMC,
Bangalore, who initiated and instilled in me the knowledge of this holy science.
This acknowledgement would not be complete without paying obeisance to my
parents Sri S. Subramanyam and Smt. S. Saroja. Their constant encouragement and
guidance propelled me to achieve my goal.
I am especially indebted to my in-laws Sri T. Muralikrishna and Smt. T.
Varalakshmi for all their support and taking care of my daughter during my study.
I convey my special thanks to my beloved husband Dr. T. Sundar Raj Perumall for
his valuable timely help and support and also to my little daughter Sai Krishna priya
for allowing me to complete my study.
I also thank my sister Jyothi Nandi, brother-in-law Gopal S. Nandi(CA) brother
S. Venkatesh, sister-in-law Dr. Susheela Murthy her husband Commander
M.S.N.Murthy( Indian Navy) and brother Prof. S. D. Prasad for their support.
I wish to convey my thanks to U.G. and P.G. Librarian Mrs. Varalakshmi and
Mr. Somasundar for providing library facilities. I also thank library employee Raju.
I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in a
documented form.
Last but not the least, I express my thanks to all persons who helped me directly or
indirectly in my studies with apologies for my inability to identify and thank them
individually.
Date:
Place: Mysore Dr. Kavitha S.
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ABSTRACT
Background of the Study
Our treatises emphasized the importance of Trayopastambhas viz. Aahara, Nidra and
Brahmacharya as the pillars of a healthy life. Nidra is the most neglected part of
modern life style where one gives least importance to the timing, duration, and quality
of sleep with stress playing an important role in inducing insomnia. This negligence is
leading to Vata prakopa and in turn causing various physical and psychiatric illnesses.
Recent studies have shown that about 40 percent of women and 30 percent of men are
suffering from insomnia. Considering this, Insomnia has become a major health
hazard, drawing the attention of professionals and researchers all over the world.
Primary insomnia, where the cause of sleeplessness is obscure, is normally treated
with antidepressants, sedatives, tranquilizers, hypnotic drugs, etc. Slowly people are
getting addicted to these drugs, and also experiencing the side effects of these strong
chemicals. Other modalities of treatments such as relaxation therapy and psycho-
therapy also have their own limitations. When insomnia is neglected or wrongly
treated it leads to impaired mental functioning, accidents, headaches, increase in
mortality rates, stress, depression and heart diseases.
Holistic management of Nidranasha is the need of the day and Ayurvedic
professionals need to re evaluate the management of nidranasha. Nidranasha has been
described in detail by all our acharyas. Nidranasha is mentioned in various contexts
like vataja nanatmaja vikaras, vataja jwara, vataja hridroga etc. Various drugs are also
mentioned to be highly effective in Nidranasha. Diet and life style modifications have
a great role to play in assisting patients of primary insomnia as per our treatises. Many
promising formulations have been described and one such yoga has been selected.
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Guda-pippalimula yoga is described to be effective in Nidranasha in Bhaishajya
Ratnavali.
Hence there is a need for a detailed study of physiological, pathological and curative
aspects of Nidranasha. The present study is aimed at studying concepts of Nidranasha
and evaluating the importance of diet and comparing it with a simple yoga on primary
insomnia patients.
Objectives of the Study
To systematically review & study the literature on Nidranasha, available in all
Ayurvedic classics.
To review literature on Nidrajanaka Ahara and modifications suggested to
prevent and manage Nidranasha.
To clinically evaluate the efficacy of Guda Pippalimula yoga in Nidranasha by
comparing with Ayurvedic diet suggested in Nidranasha (Primary Insomnia).
Method: A Comparative Single Blind Clinical Study with pre and post design.
Intervention:
As it is a comparative study, the patients are divided in to three Groups consisting of
15 patients in each Group.
Group A: 2g Pippalimula choorna along with 2g of Guda was administered with
milk, in the evening after meals; along with Diet chart for Nidranasha created as per
our classics, for a period of 48days.
Group B: 2g Pippalimula choorna along with 2g of Guda was administered with
milk, in the evening after meals, for a period of 48days.
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Group C: Only advised to follow Diet chart for Nidranasha created as per our
classics, for a period of 48days.
The follow up period was for 48days.
Statistical Analysis to assess Individual and Comparative effects of the groups was
done using Chi- Square test, One Sample t- test, Contingency Co-efficient Test and
Repeated Measures ANOVA.
Results: All the patients with Nidranasha considered for the study showed
improvement in all the Parameters in all three Groups. However in Groups A and B
the improvement is Highly significant. Changes within the group were also found to
be highly significant.
Interpretation and Conclusion
After treatment period good result was observed in group A followed by group
B and in group C Mild improvement was observed. After follow up period, also good
result was observed in Group A followed by Group B and Mild improvement was
seen in Group C. Overall result was good in Groups A and B
Keywords
Nidra
Nidra nasha
Primary insomnia
Guda Pippali mula Yoga
Nidra Janaka Ahara
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CONTENTS
1
Introduction
Review of Literature
Historical Review 3
Concept of Nidra 5
Concept of Sleep 26
Nidranasha 34
Nidana Panchaka 36
Nidana 36
Poorvaroopa 40
Roopa 40
Upashaya 41
Samprapti 42
Upadrava 47
Arista lakshana 47
Modern Review 48
Chikitsa 58
Pathya apathy 64
Modern Treatment 66
Drug review 76
Previous works 94
Materials and Methods 95
Observation 109
Results 126
Discussion 143
Conclusion 176
Summary 177
Bibliographic References 179
Annexure I
Master Chart X
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List of Tables
Table Particulars Page

No No.
1 Showing the Synonyms of Nidranasha 35
2 Showing the different Nidanas of Nidranasha 38
3 Showing the Ahara-viharajanya nidana of Nidranasha 38
4 Showing the Upacharajanya Nidanas 39
5 Showing the Manasika Nidana 39
6 Showing the Anya Nidanas 39
7 Showing Rupa of Nidranasha 40
7a Differential Diagnosis 54
8 Showing Bahya upacharas in Nidranasha 59
9 Showing the Manasika Upacharas in Nidranasha 59
10 Showing Aahara Upacharas in Nidranasha 60
11 Showing Different Ahara vargas used in Nidra nasha 61
12 Showing Anya upachara in Nidranasha 61
13 Showing the Pathya ahara in Nindranasha 64
14 Various viharas promoting Nidra mentioned in Brihattrayee 65
15 Hypnotic Drugs and their Hypnotic Effect 72
16 Showing the properties of Pippalimoola 77
17 Showing the properties of Guda 80
18 Showing the Nutrient content of Jaggery (per 100 gms) 81
19 Showing the Rasa panchaka of Ksheera 82
20 Showing nutritive value of milk (per 100 gms) 83
21 Showing the Properties of Masha 84
22 Showing the Properties of Ikshu 85
23 Table showing Properties of Ghrita 86
24 Showing the Properties of Upodika 87
25 Showing the properties of Godhuma 88
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26 Showing the properties of Shali Dhanya 89
27 Showing the Properties of Dadhi 90
28 Showing the Properties of Palandu 90
29 Showing the Properties of Draksha 91
30 Showing the Properties of Tila 92
31 Showing Different varieties of mamsa used in Nidranasha 93
32 Showing the diet chart given to the Groups A and C 104
33 Showing Component 1: Subjective sleep quality—question 9 105
34(a) Showing the response to C2/Q2 subscore 105
34(b) Showing the response to C2/Q5a subscore 105
34(c) Showing the sum of Q2 and Q5a subscores (C2) 105
35 Showing Component 3: Sleep duration—question 4 106
36 Showing Component 4: Sleep efficiency—questions 1, 3, and 4 106
37(a) Showing Component 5: Sleep disturbance—questions 5b-5j 106
37(b) Showing the sum of 5b to 5j scores 107
38 Showing Component 6: Use of sleep medication—question 6 107
39(a) Showing the response to C7/ Q7 subscore 107
39(b) Showing the respone to C7/Q8 subscore 107
39(c) Showing the sum of Q7 andQ8 subscores(C7) 108
40 Distribution of Age Group among the 45 patients 109
41 Distribution of Sex among the 45 patients 109
42 Distribution of Marital Status among the 45 patients 110
43 Distribution of Religion among the 45 patients 110
44 Distribution of Location among the 45 patients 111
45 Distribution of Occupation among the 45 patients 111
46 Distribution of Socio-Economic Status among the 45 patients 112
47 Distribution of Education among the 45 patients 112
48 Distribution of Nature of Work among the 45 patients 113
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49 Distribution of Diet among the 45 patients 113
50 Distribution of Chronicity among the 45 patients 114
51 Distribution of Habits among the 45 patients 114
52 Distribution of Prakruti among the 45 patients 115
53 Distribution of Sara among the 45 patients 115
54 Distribution of Samhanana among the 45 patients 115
55 Distribution of Pramana among the 45 patients 116
56 Distribution of Satmya among the 45 patients 116
57 Distribution of Sattva among the 45 patients 116
58 Distribution of Agni among the 45 patients taken for Study 117
59 Distribution of Koshta among the 45 patients 117
60 Distribution of Vyayama Shakti among the 45 patients taken for Study 117
61 Distribution of Onset among the 45 patients taken for Study 118
61a Associated symptoms complained by 45 patients of Nidranasha 118
62 Showing Global PSQI in Group A 126
63 Showing Global PSQI in Group B 126
64 Showing Global PSQI in Group C 126
65 Showing the Mean Global PSQI values in Group A,B and C 126
66 General Linear Model-Descriptive Statistics of Global PSQI score 127
67 Showing total scores of C1 in Group A in Subjective sleep quality 128
68 Showing total scores of C1 in Group B in Subjective sleep quality 128
69 Showing total scores of C1 in Group C in Subjective sleep quality 128
70 Symmetric Measures in Component 1: Subjective sleep quality 128
71 Showing Significance Symmetric Measures in Component 1 129
72 Showing total scores of C2 in Group A in Sleep latency 129
73 Showing total scores of C2 in Group B in Sleep latency 130
74 Showing total scores of C2 in Group C in Sleep latency 130
75 Showing results of Component 2: Sleep latency 130
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76 Symmetric Measures in Component 2: Sleep latency 130
77 Showing total scores of C3 in Group A 131
78 Showing total scores of C1 in Group B 131
79 Showing total scores of C1 in Group C 131
80 Showing results of Component 3: Sleep duration 132
81 Symmetric Measures in Component 3: Sleep duration 132
85 Showing results of Component 4: Sleep efficiency 133
86 Symmetric Measures in Component 4: Sleep efficiency 134
90 Showing results of Component 5: Sleep disturbance 135
91 Symmetric Measures in Component 5: Sleep disturbance 135
95 Showing results of Component 6: Use of sleep medication 136
96 Symmetric Measures in Component 6: Use of sleep medication 137
100 Showing results of Component 7: Daytime dysfunction 138
101 Symmetric Measures in Component 7: Daytime dysfunction 138
102 Showing the similarities in types of sleep by Charaka and Vagbhata 148
103 Similarities of the types of sleep in Brahatrayis 149
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List of Illustrations
1 Showing age wise distribution of 45 patients in Nidranasha 119

2 Showing sex wise distribution of 45 patients in Nidranasha 119
3 Showing marital status wise distribution of 45 patients in Nidranasha 119
4 Showing religion wise distribution of 45 patients in Nidranasha 119
5 Showing Occupation wise distribution of 45 patients in Nidranasha 120
6 Showing Education wise distribution of 45 patients in Nidranasha 120
7 Showing socio economic status wise distribution of 45 patients 120
8 Showing diet wise distribution of 45 patients in Nidranasha 120
9 Showing locality wise distribution of 45 patients in Nidranasha: 121
10 Showing mode of onset wise distribution of 45 patients in Nidranasha 121
11 Showing Nature of work distribution of 45 patients 121
12 Showing prakruti wise distribution of 30 patients in Vataja Kasa 121
13 Showing Sara wise distribution of 45 patients in Nidranasha 122
14 Showing Samhanana wise distribution of 45 patients in Nidranasha 122
15 Showing Samhanana wise distribution of 45 patients in Nidranha 122
16 Showing Satmya wise distribution of 45 patients in Nidranasha 122
17 Showing Sattva wise distribution of 45 patients in Nidranasha 123
18 Showing agni wise distribution of 45 patients in Nidranasha 123
19 Showing koshta wise distribution of 45 patients in Nidranasha 123
20 Showing Vyayama wise distribution of 45 patients in Nidranasha; 123
21 Showing chronicity distribution of 45 patients in Nidranasha 124
22 Showing Component 1(Subjective Sleep Quality) Score distribution 139
23 Showing Component 2( Sleep Latency) Score distribution 140
24 Showing Component 3( Sleep Duration) Score distribution 140
25 Showing Component 4 ( Sleep Efficiency) Score distribution 140
26 Showing Component 5( Sleep Disturbance) Score distribution 141
27 Showing Component 6( Use of Sleep Medication) Score distribution 141
28 Showing Component 7( Daytime Dysfunction) Score distribution 141
29 Showing Global PSQI Score distribution in 45 patients of Nidranasha 142
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List of Abbreviations
1. A H Ut - Astanga Hridaya Uttaratantra
2. A H Ni - Astanga Hridaya Nidanasthana
3. AH - Astanga Hridaya
4. AS - Astanga Sangraha
5. A H Su - Astanga Hridaya Sutrasthana
6. A S Su - Astanga Sangraha Sutrasthana
7. BS - Bhela Samhita
8. BP - Bhavaprakasha
9. B P M Kh - Bhavaprakasha Madhyama Khanda
10. B R & Bh Rat - Bhaishajya Ratnavali

11. Ch. Sam - Charaka Samhita
12. Ch Chi - Charaka Samhita Chikitsasthana
13. Ch Vi - Charaka Samhita Vimana sthana
14. DN - Dhanwantari Nighantu
15. HS - Hareeta Samhita
16. KS - Kashyapa Samhita
17. MPN - Mandanapala Nihantu
18. NA - Nightantu Adarsh
19. RN - Raja Nighantu
20. Sha U Kh - Sharangadhara Uttara Khanda
21. Su Su - Sushruta Samhita Sutrasthana
xviii
22. Sha P Kh - Sharangadhara Poorva Khanda
23. Su Ni - Sushruta Samhita - Nidanasthana
24. SS - Sushruta Sauhita
25. SY - Sahasra Yoga
26. YR - Yogaratnakara.
27. PSQI - Pittsburgh Sleep Quality Index
28. G PSQI - Global PSQI Score
28. C1-C7 - Component 1 to Component 7 of Global PSQI Score
xix
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA
PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
INTRODUCTION
Human beings in their eternal efforts to triumph over nature, are finding themselves
engulfed in the day-tight compartments of concrete jungle called modern life. In their
every quest filled with emotional stress and physical strain humans are encountering
an enormous army of diseases which is highly successful in creating major hurdles in
the human journey. Sometimes these problems become so intense that humans often
find themselves entangled in the web of solving and creating problems into a vicious
circle, which makes them forget their real purpose in life deprives them their basic
right, the perfect health. Among the web of diseases, Sleeplessness is the most
common problem which is often neglected, until it becomes an irreversible hazard.
Gelder. M. etal ( 1990 ) have estimated that atleast 10 – 20 % of the population is
suffering from Insomnia, among them 15% are suffering from this condition, where
the cause is not known. i.e., Primary Insomnia.
The condition of Insomnia may not be a life threatening illness, but it has a tendency
to damage the person’s daily life, including his social and occupational life. If it is
very chronic, the person may devolop varieties of Psychiatric illness also. Considering
this, Insomnia is considered to be a major health hazard, drawing the attention of
professionals and researchers all over the world.
Nidranasha is not explained as a separate disease in any of classical text books of
Ayurveda. The minimum descriptions that are available are also scattered and
mentioned incidentally in the context of Vatajananatmaja Vikara, Vatajajwara, Vataja
hridroga etc.
Dr Kavitha S 1
Primary Insomnia, where the cause of sleeplessness is obscure, is normally treated
with anti depressant drugs, sedatives, tranquilizers and hypnotic drugs etc. But these
drugs may lead to many complications such as hang-over, tolerance towards the drug,
reoccurance of the symptoms on the withdrawal of the drug, etc. Other modalities of
treatment such as Relaxation therapy and Psychotherapy also have their limitations.
In the above situation, we need an alternative therapy which is useful and deviod of
the hazards of modern drug therapy. Fortunately we find a ray of hope in treating the
patients of Insomnia with an age old therapy of Ayurveda.
Guda Pippalimula yoga was indicated in the management of Nidranasha in
Bhaishajya Ratnavali, Bhava prakasha, etc. So the study was undertaken to evaluate
the efficacy of Guda Pippalimula yoga in the management of Nidranasha.
A large group of aharas are mentioned in various classics which are useful in
promoting sleep. So a diet chart was prepared using the references with an intention
of relieving insomnia with a healthy diet. This diet regimen alone was given to one
group of patients and to another group diet regimen along with guda pippalimula yoga
was advised
The duration of study was one Mandala (48 days). Pittsburg sleep Quality Index was
used to assess the effect of study before and after the treatment.
Post therapy follow-up was conducted after 48 days.
The study contains two parts. First part deals with conceptual study of Nidra nasha
and drug review. In second part the materials and methods, observation and results,
discussion and conclusion with summary are dealt. The results obtained are now
being presented before the scholars for evaluation and acceptance.
Dr Kavitha S 2
CHAPTER-1 CONCEPT OF NIDRA
Historical review
Ayurveda regards Nidra as one of the most essential factors responsible for a healthy
and fulfilled life. It is one of the trayopastambhas or three great supporting pillars on
which the health of a person is firmly balanced. Every country has had great scientists
who have tried to study the sleep, its nature and causes.
Vedic and Upanishad period
In India, from the Vedic and Upanishad period, the Yogis have studied the Yogic
phenomena pertaining to various stages associated with Atma. They have termed
these stages as Jagritavastha (waking phase), Svapnavastha (dream phase),
Sushuptavastha (sleep phase) and Samadhi Avastha (the conscious sleep phase having
detachment from the external world in different degrees). In Atharvaveda
Shounakeeya shakha, the reference is available of Nidrajanana as Karma, while
explaining the Moulika Sidhanta in Dravya-Guna In the Patanjali Yoga Sutra, the
physiology of Nidra has been described as:
Sleep is the non-deliberate absence of thought waves or knowledge. Dreamless sleep
is an inert state of consciousness in which the sense of existence is not felt. In sleep,
the senses of perception rest in the mind, the mind in the consciousness and the
consciousness in the being. In deep sleep, the senses of perception cease to function
because their king, the mind, is at rest. This is Abhava, a state of void, a feeling of
emptiness.1
The onset and progress of sleep as described in Brahmanopanishad, pertaining to
Yogasutra runs as under:
Dr Kavitha S 3
When the Chitta becomes exhausted, it goes inward, away from the sense impulses of
worldly objects; hence the sleep is a resting phase of mind. At that time, there is
absence of the knowledge about the orientation of time and place. In this condition, it
is believed that the Chitta resides in the Medhya Nadi. When a person awakens from
the deep sleep, it is a sense of pleasure and sense of satisfaction.2
Lord Shri Krishna has explained the importance of proper sleep for a Dhyana Yogi in
Bhagwad Gita. According to him, both excessive sleep and ceaselessly awakening are
not good.
Yuktaahaara vihaarasya yukta cheshtasya karmasu | yukta svapnaava bodhasya yogo
bhavati duhkhahaa || 3
Samhita kala.
In Samhita kala, the books written were Charaka Samhita, Sushruta Samhita, Bhela
Samhita and Hareeta Samhita. All of these are having the descriptions of Nidranasha.
Although Charaka and Sushruta Samhita have not explained this separately, Bhela
and Hareeta have mentioned special chapters on Nidra. In this context they have also
explained the nidana and chikitsa of Nidranasha.
In Kashyapa Samhita
Nidranasha is explained as the lakshanas of some disease and in some Grahadushta

lakshanas. Various oushadhis for chikitsa of Nidranasha are available.
Sangrahakala
In Sangrahakala Astanga Sangraha, Astanga Hridaya and Madhava Nidana

were written. Nidana and chikitsa of Nidranasha are available in Astanga
Dr Kavitha S 4
Hridaya and Astanga sangraha. In Madhava Nidana, Nidranasha is mentioned

as a lakshana in some diseases.
Adhunika Kala
In Adhunikakala i.e., 13th to 16th century AD two more texts were written. They
are Bhavaprakasha of Bhavamishra and Yogaratnakara, In Bhavaprakasha,
Nidranasha has been explained as the lakshana in some diseases such as
vatajajwara, Nidana and Chikitsa of nidranasha have also been explained in
some contexts. In Yogaratnakara the reference is available of Nidranasha as a
Lakshana in some diseases along with the Chikitsa of Nidranasha.
In Bhaishajya Ratnavali of Govindadas, the Oushadhi yogas are explained for

nidranasha, and the author mentions some drugs like Potaki shaka, Sura,
Masha, Ikshu vikara, etc., which induce sleep.
Concept of Nidra
Sleeping for six hours in the middle of the night and keeping awake during the first
and last quarters as well as during day time, are generally considered as regulated
sleep and wakefulness. In the ayurvedic classics and the later literature, the usefulness
of sleep and its role in the maintenance of health is elaborately discussed. Acharya of
Charaka Samhita has considered ‘Nidra’ as one among the three Upastambhas (sub-
pillars).4
Commentator Chakrapani has explained ‘Upastambha’ as sub-post. Posts mainly
support a house, but sub- posts add to the supporting strength of such posts. In the
same way, body is mainly supported by the acts performed in the previous life, which
determine the intake of food, sleep and bramhacharya. So they are known as
Upastambhas- secondary supports of life.
Dr Kavitha S 5
It is observed that all the living creatures must enjoy the sleep in quality and quantity
to keep themselves fit. From the very birth, the amount of sleep (in hours) of a new
born is maximum. Bhavamishra has mentioned that during pregnancy, when the
mother sleeps, the baby in the womb enjoys better rest and comfort5.
Similarly the botanists have observed that not only animals but plants also enjoy
recreation in the night by contracting the petals of the flowers, leaves etc., at the time
of sunset and in the next morning relaxing and reopening.
The sleep is an indicator of good health because it brings the normalcy in body tissue
and relaxes the person. 5,6
Persons residing in unhygienic locality but obeying the rules of diet, sleep and
exercises are not harassed by untoward effects of various pathogenic conditions.7
Generally, sleep occurs during the night and at about the same time for a particular
duration everyday and as such in Ayurveda, Nidra is said to be Ratrisvabhava
Prabhava.8
According to Sushruta Samhita, Nidra is provoked due to nature and considered as
Svabhavika Roga.9
Therefore, our Acharyas have advised that a man should not suppress this natural
urge.10
In Charaka Samhita, it has been explained that the sleep occurring at night is a natural
& nourishing phenomenon so it is termed as Bhutadhatri – that which nurses all the
living beings.11
Dr Kavitha S 6
In metaphoric language it is also called the ‘Vaishnavi Maya’, which means that
Nidra provides the nutrition to the living body and maintains the health like Lord
Vishnu, who is the nourisher and sustainer of the world.12
The role and importance of sleep are very widely accepted. Even if sleep is not taken
appropriately, in appropriate quantity and irregularly, it may have adverse effects on
the body. Therefore, sleep should be watchfully enjoyed because excessive sleep
causes various sins (Papma).The control over sleep and wakening for the meditation
is useful for the upliftment of Atma. The saints always prefer to keep awake at night
for meditation, conversely person having antisocial attachment do sleep during the
day time, which is considered as one of the root causes of many evils.12
Natural instincts
Four natural instincts of the living organisms are mentioned In Yoga Ratnakar Pu. 64,
which are as under:
1) Desire to take food
2) Desire to take water
3) Desire to sleep and
4) Desire to have sexual contact for pleasure.13
These are considered as the pioneers for health.
It is quite evident from the above discussion that the sleep is a fundamental need of
every living being. When people are deprived of this sleep for too long a period, they
find it hard to concentrate or remember what was said or done a moment earlier.
Dr Kavitha S 7
Any living organism of whatever nature always feels the need for resting after a
period of activity. The various organs and the parts of the body can be given rest
independently but complete rest for the entire organism is possible only when it goes
to sleep.
The ancient seers of India have not only recognized the natural constructive power of
sleep, but have also attributed to it, a super natural power which is beneficial for
health, happiness and longevity. The modern science also confirms the function and
physiology etc., told by our ancient sages, but still has not come to any conclusion as
far as sleep is concerned.
Finally, Manu, the great law maker of the world, after describing the small divisions
of time, remarks that 30 Muhurta period (24 hours), are divided based on the sun’s
rise and fall, into day and night; the day time is intended for activities and the night
time is designed for rest and repose.
The daily rhythm of the life is thus a natural instinct related to the rhythm of night and
day existing in nature.14
Etymology:
Derivation of the word ‘Nidra’
The term ‘Nidra’ is feminine gender. It is derived from the root ‘Dra’ with suffix ‘Ni’
and the root ‘Dra’ means undesired, ‘Gatu’ to lead, it is a state which is hated,
therefore, it is termed as ‘Nidra’.
Nidra is formed by Sutra ‘Ataschopasarge.’15
Dr Kavitha S 8
Also it is derived as “Ityuktam hetuke vishayebhyo karmendriyanam
vyaparoparmaroope jeevasya avasthabhedaha”, means nidra is the state of life
where, gnanendriyas and karmendriyas are not doing their functions.16
Definition:
It is a question from time immemorial as to what sleep is and how it occurs and what
is the role of sleep in health and in the treatment of diseases. Scientists have tried to
think over the phenomena of sleep. The great sages of India had the perfect
knowledge regarding the sleep. In Upanishad and Ayurvedic literature, it is
considered as one of the essential functions of the living organism.
Maharshi Patanjali has given the perfect definition that Sleep is the mental operation
having the absence of cognition for its grasp. The commentator Vyas made it clear
that sleep is a state of unconsciousness, but the consciousness remains about his own
unconsciousness.1
According to Chanda Kaushika, the maintenance of the body is caused by the sleep.
In Mandukya Upanishad, sleep is described as a condition in which the Atma doesn’t
have desire for anything and also doesn’t dream anything and this condition is called
Sushuptavastha or Nidra.2
The young sage Shankaracharya in his Brahmasutra Bhasya, while explaining the
position of Atma during Nidra, also collectively mentioned the different opinions
regarding sleep.17
In Chhandogya Upanishad, the role in which the mind is unaware about its
surroundings and does not see any dream is called Supta or Nidra.18
Dr Kavitha S 9
Collectively the above verses from Brihadaranyaka Upanishad and Kaushika Sutra
refer that, sleep is such a state where Atman for the time being enjoys Brahmananda
and only the vital functions of body are carried out through Prana. 19,20
Vachaspatyam explains Nidra as “ Sarvalokaha Samakshudha yada yamena
ratrishu”. Ie, Ratrishu yogena samanyena means Nidra is the phenomenon,
which occurs usually with Samyoga of Ratri.21
Kashiraja, Goodarthadeepikakara defines Nidra as “Nidradayopi Shareera
shramasambhabaha, tamokaphabhyam nidrasyat bhavet”.
Means Nidra is the resultant state of Shareerashrama, predomenance of Tamas
and kapha dosha & Swabhava.22
Definitions from Ayurveda
Acharya of Charaka Samhita and commentators Chakrapani and Gangadhar explained

that when the mind as well as the soul gets exhausted or becomes inactive and the
sensory and motor organs become inactive, then the individual gets sleep.
Yada Tu Manasi Klanti Kamatmana Klamanvita
Vishayebhyo nivartante Tada Swapati Manava 4
In Sushruta Samhita, it is described that sleep occurs when Hridaya the seat of
Chetana is covered by Tama.19
According to Acharya Vagbhatta, the Srotas become accumulated with Sleshma and
the mind is devoid of sense organs because of fatigue, hence the individual gets
sleep.20
Dr Kavitha S 10
Nidra can be defined as “Nidra medhya manasamyogaha” which means Nidra

is the stage of mind and intellect are at rest.23
Nidra can be defined as “Tamakaphabhyam Nidra”, it is the state where
predominance of kapha and tamas is seen.24
Adhamalla defines Nidra as “Nidra Swapnechcha Sa Tamakaphabhyam syat
Tamoguna kaphasamsargena Bhavati Ityarthaha”. Means Nidra is the stage in
which the Tamoguna combines with Kaphadosha.24
Adhamalla further says “Nidra Indriyamanomohaha” which means the
Mohavastha of Indriya and Manas is called as Nidra.
Dalhanacharya defines nidra in Sushruta Samhita Sutrasthana 1st chapter,
“Nidra Medhyamanasamyogat Dehendriya Sukhabhogaha”. Nidra is that state
of combination of mind and intellect, in which the person feels happy.
Synonyms of Nidra :
The prefix “Ni” is the Sanskrit root of the English word “nether” or down, as in
“nether world”(underworld) while the suffix ‘dra” may be cognated with the English
“drowsy” “to be half sleep, to be inactive or present an appearance of peaceful
inactivity or isolation.”25
In Amarkosha, four synonyms have been mentioned-
1) Shayanam
2) Svapah
3) Svapnah
Dr Kavitha S 11
4) Samvesh 26
Similarly, in Vaidyaka Shabda Sindhu, three synonyms are available.
1) Sambhashah
2) Suptih
3) Svapanam27
In Charaka Samhita, Bhutadhatri has been used as a synonym and in Sushruta
Samhita the word Vaishnavi Maya is used.
Concept of the phenomenon of Nidra
Different Interpretations:
There is a natural relation of sleeping and waking. During the24 hour cycle of day and
night, sleep comes naturally during the night but it is not a necessary consequence of
darkness, as is proved by those people working at night, who sleep during the day,
and they readily adopt themselves to this condition.
Our ancient sages and Acharyas had crystal clear view regarding the physiology of
sleep, but explained it in different ways, according to their working field. The
different explanations regarding the phenomena of Nidra may be classified under the
following four groups.
1) Upanishad Theories
2) Yogic Theories
3) Ayurvedic Theories
4) Recent Concept
Dr Kavitha S 12
1) Upanishad Theories
The sleep is only a palliated form of death. The discussion about sleep is one of the
important concepts of the Upanishads. The seers of antiquity have enunciated many
interesting theories on this subject.
a) The fatigue theory of sleep is just in the pattern of modern physiology. The concept
has been explained by citing an example in which a falcon or any other bird after
having flown in the sky, becomes tired and folding his wings repairs to his nest, so
does a person hasten to reach to that state where, he does not have any desires or
dreams, called sleep.
b) Another view holds that sleep is caused by the senses being absorbed in the highest
‘sensorium’ or in the mind just similar to the rays of sun,which become collected in
the bright disc at the time of sunset. This is the reason why a man is not able to hear,
to see or to smell in deep sleep and the people say about him, that he has slept.
c) The above statement can be further exemplified. Accordingly, the reason for sleep
is that the mind is merged into the ocean of life. When he is over-powered by light,
then the soul sees no dreams and at that time great happiness arises in the body.
d) One another theory says that sleep is caused by the soul, which gets lodged in the
Nadis. The same idea is elaborated elsewhere. It states that the heart sends forth about
72,000 arteries to the Puritata. Deussen translates Puritata as the ‘pericardium’ and
Maxmullar as ‘the surrounding body’. This Puritata corresponds to the pineal gland so
far as the function is concerned. The ancient seers imagined that the soul moves from
the heart by means of the arteries and gets lodged inside the Puritata and then the
sleep follows.
Dr Kavitha S 13
e) Ancient Rishis gave another explanation. They say that sleep occurs when the mind
is merged in Prana. It is a breath or energy, “As a bird when tied by a string flies first
in every direction and finding no rest anywhere, settles down at last on the very spot,
from where, it is fastened, exactly in the same manner, mind after flying in every
direction, rests in the breath, for indeed mind is fastened to breath.”
f) Still one another explanation says that sleep occurs when the soul goes to rest in the
space inside the heart. In order to prove this to Gargya – an experimental inquiry was
done by Ajatashatru. He took him to a sleeping man by the hand. He called him by his
name very loudly but he didn’t rise. Then he rubbed him with his hand, the man got
up. Then Ajatashatru said, “When this man was asleep, then the soul, full of
intelligence lay in the space inside the heart. The sleep is only a parallel form of
death.” The fatigue theory states that during sleep a man restores his lost energy. Then
the senses are all absorbed in the mind itself. The mind merges into the ocean of light.
Under its power there is sound sleep and the man derives real happiness in the body.
At this time the soul gets its lodgement in the arteries. The soul moves then inside the
Puritat. During sleep the mind merges into Prana and the soul goes to rest in the heart.
Here, the soul is one with the Brahman.
2) Yogic Theories
The Yogic philosophers of India have given explanation regarding sleep and have also
explained the Samadhi state which resembles the sleep, but is entirely opposite to that.
a) Lord Shri Krishna, while discussing the Dhyana Yoga has said that the Yogi should
be regulated in sleep and wakefulness. He has also said that seeing, smelling etc., are
the functions of five sense organs, whereas breathing points to the function of five
vital airs and that sleeping denotes the function of inner sense or mind.28
Dr Kavitha S 14
b) There is another opinion of Yogis that the Upavayu Devadatta controls the Nidra of
the individual.
c) Maharshi Patanjali mentioned that:
Sleep is a state in which all activities of thought and feeling come to an end. In sleep,
the senses of perception rest in the mind, the mind in the consciousness and
consciousness in the being. In deep sleep, the senses of perception cease to function
because their king, the mind, is at rest. After awakening the consciousness or mind
will be aware about its unconsciousness.
d) It is also mentioned that the Tamoguna is responsible for sleep.
e) Yoga Nidra – A Yogic sleep process
Upanishadic doctrine, describes the existence of four levels of consciousness, they
are:
1. Waking consciousness – Jagritavastha
2. Dreaming consciousness – Svapnavastha
3. Dreamless sleep – Sushuptavastha
4. Conscious dreamless sleep – Turiya / Turiyavastha
3) Ayurvedic Theories
Several theories have been explained by our ancient seers to explain the phenomenon
of natural sleep. They are as under-
a) Tamoguna Theory: This is the Darshanika theory of sleep. In Darshanas, Tamas
has been held responsible for ignorance, loss of consciousness, inattention, sloth and
Dr Kavitha S 15
sleep. The theory states that at night the Tamas being powerful, the higher psychic
centers being overpowered by it, the living organisms go to sleep.29
In Sushruta Samhita, it is said that Hridaya is the seat of consciousness, when it is
covered by Tama, the person goes to sleep. Tamas is hence the cause for sleep and the
Satva for consciousness.19
Acharya Kashyapa has mentioned that the Satva is Prakashaka, the Rajoguna is
Pravartaka while the Tamoguna is Niyamaka and Moha Sambhava. Therefore, the
Tamoguna is more predominant than the Satva and Rajasa. And hence it causes the
sleep.
According to Harita, the centre of sleep is in the upper half part of nose, between the
two eyebrows in the cerebrum or brain. When the Tamas reaches this sleep center, the
knowledge and activity get diminished and sleep occurs.
b) Kapha Dosha Theory: This is the ancient medical theory of sleep. In fact, it is just
a modification of the Tamoguna theory. Kapha is supposed to be composed mostly of
Tamas. Therefore, increased Kapha has been related with more or less qualities of
Tamas.
According to this theory, whenever the Chetana is overpowered by the accumulation
of Tamas, the sensation conveying channels of the body are blocked or checked by
the Sleshma. When this Sleshma is over saturated with Tamasika quality, the living
being gets sleep. 19,20
Acharya Sushruta also clearly mentioned the role of Sleshma and Tamas in Nidra.30
By the above verses it is clear that during the commencement of sleep the body and
mind are interrelated.
Dr Kavitha S 16
b) Depression Theory: Charaka Samhita propagated this theory. Both the Vagbhatas
followed this view. When the mind and the organs of sense become so tired that they
cannot be stimulated to activity, the person goes to sleep.31 The modern chemical
theories can be correlated to these Ayurvedic concepts to some extent, where our
concepts are perfect and treatment is also based on that, while the modern theories are
changing every time.
c) Svabhava :
Just after describing the role of Tamas in sleep, Acharya of Sushruta Samhita has said
that it is the natural instinct, which is the most powerful cause for sleep. Hence, he has
also considered it as a Svabhavika Vyadhi. 32
At one another place, where diseases are classified, sleep is included in the list of
natural diseases, along with hunger, thirst, ageing, death etc.12
Types of Nidra
Our Acharyas have given different opinions regarding the types of sleep. Basically
Nidra can be classified into two types viz. Svabhavika (natural) and Asvabhavika
(abnormal).The Svabhavika Nidra comes regularly every night, which is having
beneficial effects for the living beings, whereas Asvabhavika one may be due to
different causes.
Charaka Samhita classifies the sleep condition into seven categories and agrees with
the ancient sages who have considered that sleep is Bhutadhatri, which comes on at
night, spontaneously and regularly as a natural instinct and that the other categories
are either due to sin or the disease. The seven types described by Charaka run as
under-
Dr Kavitha S 17
1) Caused by Tamas
2) Caused by Kapha (vitiated)
3) Caused by Manasika Shrama
4) Caused by Sharirika Shrama
5) Agantuki – indicative of bad prognosis leading to imminent death.
6) Caused as a complication of diseases like Sannipata-jwara etc.
7) Caused by the very nature of night.8
A brief description of these different types of Nidra may be produced as under -
1) Tamobhava Nidra :
Generally, sleep is due to the effect of Tamas, but the Tamobhava Nidra is
particularly due to the excessive Tamas, causing sleep. When Satva and Rajasa are
diminished in excess and the seat of Atma and Mana i.e. Hridaya is covered by the
vitiated Tamas, then the organism become inert or inactive. According to some
scholars, the Tamobhava Nidra resembles with the Sanyasa condition, described in
Charaka Samhita which is the comatose state. The sleep caused by Tamas is also the
root cause for all sinful acts. Tamas always causes excessive sleep. Thus, the
individual is unable to perform the virtuous deeds and so he subjects himself to sinful
behavior.33
2) Sleshma Samudbhava Nidra:
Sleshma is the material state of Tamas and as such the Sleshma and the Tamas are
having identical properties. When the Sleshma increases in the body, sleep ensues.
Therefore, it is called Sleshma Samudbhava Nidra.
Dr Kavitha S 18
3) Manah Shrama Sambhava Nidra:
Sleep is also said to be produced as a result of exertion. Due to excessive mental
stress and strain, the mind gets tired and is unable to perform its activities; as a result
the individual gets sleep.
4) Sharira Shrama Sambhava Nidra:
The sleep has also been stated to be caused due to physical exertion. When a person
indulges in excess physical activities he feels very much tired. The body and mind
desire to take rest, and refuse to work further and the person gets sleep.34
5) Agantuki Nidra:
Sometimes the cause of sleep remains obscure and the cause is not explainable.
However this sleep is followed by death and as such Chakrapani has termed this sleep
as a sign of death (Arishta).
6) Vyadhyanuvartini Nidra:
There are some diseases like Sannipata Jwara where in along with severe weakness,
the patient goes into this condition just similar to coma. This type of sleep is termed
as Vyadhyanuvartini Nidra.
7) Ratri Svabhava Prabhava Nidra:
As has been stated earlier sleep is a natural phenomenon and it comes at a particular
time in the night. There is no particular reason for this sleep and it is also termed as
Bhutadhatri. It has been observed that even the individual who has slept during the
day time would feel sleepy in the night also, which is quite a natural phenomenon.
The author of Ashtanga Sangraha followed the Charaka Samhita’s view with a slight
change in the names. He has also mentioned seven types. The commentator Indu has
Dr Kavitha S 19
opined that Tamobhva is Antya i.e., comes at the time of death and Agantuka means
Shastra Praharadina (due to injury) and considered that they are due to Vyadhis 35. In
Ashtanga Hridaya, Acharya Vagbhata considered only four types of Nidra and
included all the seven types in these.36The commentator Hemadri considered them as
1. Sleep taken in wrong manner
2. Excessively taken sleep
3. Inadequately taken sleep
4. Properly taken sleep
The properly taken sleep brings happiness, nourishment, strength, virility, knowledge
and life to the individual. The improperly taken sleep i.e., other three types may kill
the individual like the Kalaratri, who killed all demons. Charaka Samhitakara also
mentions these while explaining the effects of sleep.37
Acharya of Sushruta Samhita described only three types of Nidra:
1) Vaishnavi or Svabhaviki
2) Tamasi
3) Vaikari 19
1) Svabhaviki Nidra:
This has been stated to be caused due to the Maya or illusion attached to the power of
Vishnu. Here, Maya is a desire of the Manas to get detached from the worldly sensory
objects on account of the tiredness of Manasa ; and the seat of Manasa and Atma is
overpowered by the Sleshma and Tamas. This mostly happens at night and the
individual gets sleep. This can be correlated with Charaka’s Ratri Svabhava Prabhava
Dr Kavitha S 20
Nidra. The Tamoguna dominant persons may go to sleep at any time i.e. day or night.
But a person having Rajoguna in excess may get sleep sometimes in the day or in the
night, because of Chalatva of Rajas. The person having qualities dominated by Satva
Guna sleeps at the midnight. Because at this time Tamas will be in excess and Satva
will be decreased38. But practically it is observed that the time of onset of sleep differs
from individual to individual and place to place according to the age, nature,
occupation, constitution etc. The term Papma has been used to describe the
Tamobhava of Nidra and also to mention the sinful activities of night.
2) Tamasi Nidra :
It is the lack of consciousness preceding the death. This is induced due to the
blockage of Sanjnavaha Srotasa by Tama dominant Kapha, and from this Nidra, the
individual cannot be awakened.12
This can be correlated to Tamobhava and Agantuki Nidra mentioned by Charaka.
3) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of
Vayu and also due to mental and physical pain, distress etc. The person does not
enjoy sufficient and sound sleep in quantity and quality. Disturbed sleep is also a type
of Vaikariki Nidra.12
This Nidra may be correlated with Manaha-Sharira Shrama Sambhava,
Vyadhyanuvartini and Sleshma Samudbhava Nidra varieties described in Charaka
Samhita.
Dr Kavitha S 21
Physiology of Nidra
When Manah is exhausted, then sleep occurs. This phenomenon can be understood in
the following manner: According to Howell, sleep is due to cerebral ischaemia.
Cerebral cortex is the seat of higher centers like pre and post central gyrus,
association area etc., which have the correlation with mental activities described in
Ayurveda. So due to the reduction in cerebral blood supply Manah becomes Klanta,
this causes sleep. Further, during sleep, Indriyas (Jnanendriya and Karmendriya -
both) become inactive by the detachment from their sense organs or from their work.
Kleitman explains that due to the reduction of muscle tone and discharge of less
afferent impulses, the cerebral cortex remains inactive. This can be interpreted in
terms of ‘Guru’ and ‘Varanaka’ properties (according to Sankhya theory) of Tamas.
Fatigue of the muscles with consequent reduction of transmission of afferent impulses
to the cerebral cortex and thereby keeping it inactive seems to be a plausible factor in
the production of sleep.
Physiological effects of Sleep
Charaka Samhita explains that in the night, the Hridaya gets contracted, the Srotasa as
well as the Koshtha are contracted and the body elements get softened. 39
According to modern view, sleep causes two major types of physiological effects:
1) Effects on the Nervous System itself.
2) Effects on the other structures of the body.
The first one seems more important because lack of sleep-wakefulness cycle in the
nervous system at any point below the brain, causes neither harm to the bodily organs
nor any deranged function. On the other hand, lack of sleep certainly does affect the
Dr Kavitha S 22
functions of the central nervous system. Prolonged wakefulness is often associated
with progressive malfunction of the mind and sometimes even causes abnormal
behavioral activities of the nervous system. So, in the absence of any definitely
demonstrated functional value of sleep, we might postulate that the principle value of
sleep is to restore the natural balance among the neuronal centers.
Sleep does have moderate physiological effects on the peripheral body. For instance,
during wakefulness, there is enhanced sympathetic activity and hence increases the
muscle tone. Conversely, during slow-wave sleep, sympathetic activity decreases
while parasympathetic activity increases. Therefore, a ‘restful’ sleep ensues – fall in
blood pressure, respiratory rate and pulse rate, skin vessels dilate, activity of GIT
sometimes increases, muscles fall into a mainly relaxed state, and the overall basal
metabolic rate of the body falls by 10 to 30 percent.
Functions of Nidra
Sleep at night time makes for the balance of the body constituents (Dhatusamya),
alertness, good vision, good complexion and good digestive power5,6. Sushruta
Samhita describes that, those who take proper sleep at proper time will not suffer
from disease, their mind will be peaceful, they gain strength and good complexion,
good virility, their body will be attractive, they won’t be lean or fatty and they live a
good hundred years.40
Importance of Nidra
Ahara, Nidra and Brahmacharya are the three factors, which play an important role in
the maintenance of a living organism. In the Ayurvedic literature, these factors i.e.
Ahara, Nidra and Brahmacharya have been compared with the three legs of sub-
Dr Kavitha S 23
support and have been termed as the three Upastambhas4. The inclusion of Nidra in
the three Upastambhas proves its importance. While discussing about Nidra, the
ancient Acharyas have stated that happiness and sorrow, growth and wasting, strength
and weakness, virility and impotence and the knowledge and ignorance, as well as the
existence of life and its cessation depend on the sleep.41 According to Acharya
Kashyapa, getting good sleep at proper time is one of the characteristics of a healthy
man7.
Nidra and Prakriti :
The sleep according to Prakriti may be divided into two groups i.e.
1) According to Deha Prakriti and
2) According to Manasa Prakriti.
According to the individual’s Prakriti and Vayoavastha the sleep requirement varies:
1) Nidra- according to Sharirika Prakriti : The sleep is produced by Tamoguna and
Sleshma. So according to the Prakriti of a person the quality and quantity of sleep
varies. An individual of Kapha Prakriti gets more sleep, which is sound also; while a
person of Vata Prakriti gets less sleep and may be disturbed also. Similarly, sleep is
related to the age or Vayah. In Balyavastha, Kapha is predominant, so a child sleeps
for more time than the youth. In Vriddhavastha, Vata is predominant, so the aged
people get very less sleep. Apart from the Deha Prakriti, some naturally get less
sleep.42
2) Nidra- According to Manasa Prakriti: Mind is always flickering by virtue of it
being governed by Prana Vayu. It is subjected to moods, principally the Rajas and
Tamas. The former is a state of emotions while the latter is a state of inhibition.
Dr Kavitha S 24
Devoid of the two is a pure state of mind, the Satva. Rajasa surpasses even this and
Tamasa however remains restrained. Hence, people who have an excess of Tamasa in
their system tend to sleep heavily. They sleep both during day and night. Those with
Rajasa as the dominant trait sleep either during daytime or during night and their sleep
is light and disturbed. Persons with Satva as the main trait, sleep peacefully, but never
before midnight.
During sleep, the Jivatma (soul), which never sleeps, may convey the glimpses of the
events and experiences of previous happenings to the Rajasika element of the mind.
This Rajasika element does not completely loose its consciousness during sleep
(person experiences dreams), but is unable to come back immediately to the normal
state of consciousness. The normal consciousness is restored after sometime and the
person awakens from sleep, only through the agency of the Satvika element. In
Tamasika Nidra, the accumulation of Tamasa may be so great that the Satvika
principle may find it difficult to perform the restoring function. If the Satvika
principle is ultimately unable to overcome the Tamasika principles, then
unconsciousness (coma) or death occurs 43, 44
Nidra and Kala :
Manu, the great law maker has described the divisions of time, and then has remarked
that the thirty Muhurta periods of 24 hours, is divided based on the sun’s rise and fall,
into day and night; the day being intended for activities and the night is designed for
rest and repose.
Naturally, night is described as a proper time for sleep. The person should not awake
at night and should not sleep in day time because both are Dosha Prakopaka.
Dr Kavitha S 25
It is advised to take sleep avoiding the first and last parts of night. As the sleep is one
among five Varjyas of Sandhya Kala, if taken the person becomes needy or sparse45.
As it is a well known concept that early morning awakening is good for health and
also to get Bramhajnana.
Modern Concept of sleep:
Sleep is one of the body's most mysterious processes. It is a state of unconsciousness
in which the brain is relatively more responsive to internal than to external stimuli.
The predictable cycling of sleep and the reversal of relative external unresponsiveness
are features that assist in distinguishing sleep from other states of unconsciousness.
The brain gradually becomes less responsive to visual, auditory, and other
environmental stimuli during the transition from wake to sleep.
Historically, sleep was thought to be a passive state that was initiated through
withdrawal of sensory input. Currently, withdrawal of sensory awareness is believed
to be a factor in sleep, but an active initiation mechanism that facilitates brain
withdrawal also is recognized.
Necessity of sleep
Sleep helps to restore and rejuvenate many body functions:
Memory and learning - Sleep seems to organize memories, as well as to recover
memories. After something new is learnt, sleep may solidify the learning in the brain.
Mood enhancement and social behaviors - The parts of the brain that control
emotions, decision-making, and social interactions slow down dramatically during
sleep, allowing optimal performance when awake. REM sleep seems especially
Dr Kavitha S 26
important for a good mood during the day. Tired people are often cranky and easily
frustrated.
Nervous system - Some sleep experts suggest that neurons used during the day repair
themselves during sleep. When we experience sleep deprivation, neurons are unable
to perform effectively, and the nervous system is impaired.
Immune system - Without adequate sleep, the immune system becomes weak, and the
body becomes more vulnerable to infection and disease.
Growth and development - Growth hormones are released during sleep, and sleep is
vital for proper physical and mental development.
Sleep rhythm:
Animals and man show one sleep period in 24 hours. Night, commonly being the
period of rest, is used for sleep.
Physiological changes during sleep:
During sleep somatic activity is greatly decreased. Threshold of many reflexes is
elevated and responsiveness is also lessened. Basic metabolic rate being least; all
organs and tissues perform the least work. The changes are
Cirulatory system – Pulse rate, cardiac output, vasomotor tone and blood pressure
reduced.
Dr Kavitha S 27
Respiratory system – Tidal volume, rate of respiration and, therefore pulmonary
ventilation-lowered (sometimes rate may be unchanged or even high due to shallow
breathing).
Basal metabolic rate – reduced by 10-15%
Urine – Volume less, reaction variable, specific gravity and phosphates – raised.
Secretions – salivary and lacrimal – reduced, gastric- unaltered or raised, sweat –
raised.
Muscles – relaxed (tone minimum)
Eyes – Eyeballs roll up and out, due to flaccid external ocular muscles, eyelids come
closer, specially due to the drooping of the upper lids, pupils are contracted.
Blood – volume increased. (plasma diluted)
Nervous system – deep reflexes are reduced, babinski, extensor, superficial reflexes-
unchanged, vasomotor reflexes – more brisk, light reflex- retained.
Theories of sleep:
There are several theories for explaining the cause of sleep, but none is quite
competent.
1. Cerebral ischaemia – Sleep is due to cortical ischaemia. The drowsiness after food
is due to splanchnic vasodilatation, fall of blood pressure and consequent
cerebralischaemia. Vulpian has shown that after stimulation of the cervical
Dr Kavitha S 28
sympathetic in animals, cerebral ischaemia was produced but no sleep was
induced.
2. Pavlov’s theory – Sleep is a special manifestation of conditioned inhibition. It
is due to spread of an internal inhibitory process and is considered to be
concomitant sleep, as a symptom of the cortical inhibition.
3. Biochemical aspects: a) Acetylcholine – Since acetyl choline is closely related
to the functional integrity of nervous system, sleep is claimed to be due to
accumulation of acetylcholine in the cerebral cortex.
b) Lactic acid – sleep is due to accumulation of lactic acid in the tissues during
fatigue. Lactic acid depresses the acivities of the cerebral cortex. But in fatigue
there is often sleeplessness and oxidation of lactic acid occurs which supplies
energy to the brain tissue. So this theory is not acceptable.
c) Hypnotoxin – According to some physiologists hypnotoxin which is liberated
from the brain tissue, produces sleep.
d) Bromhormone – Sleep is induced by the bromhormone liberated from the
pituitary. There is no evidence in support of this theory.
4. Kleitman’s theory – Due to reduction of muscle tone and discharge of less
afferent impulses, the cerebral cortex remains inactive. Fatigue of the muscle with
consequent reduction of transmission of afferent impulses to the cerebral cortex
and thereby keeping it inactive seems to be a plausible factor in the production of
sleep. Kleitman also observed that reticular formation plays an important role in
the production of sleep.
Dr Kavitha S 29
Stages of sleep: Sleep is a periodic state of rest during which consciousness of the
world is interrupted. Additionally, sleep is marked by:
• decreased movement of the skeletal muscles;

• a relaxed posture, usually lying down;
• reduced response to stimulation, such as sounds and touch;
• slowed-down metabolism; and
• complex and active brain wave patterns.
Usually sleepers pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement)
sleep. These stages progress cyclically from 1 through REM then begin again with
stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. The first sleep
cycles each night have relatively short REM sleeps and long periods of deep sleep but
later in the night, REM periods lengthen and deep sleep time decreases.
Stage 1 is light sleep where one drifts in and out of sleep and can be awakened easily.
In this stage, the eyes move slowly and muscle activity slows. During this stage, many
people experience sudden muscle contractions preceded by a sensation of falling.
In stage 2, eye movement stops and brain waves become slower with only an
occasional burst of rapid brain waves.
In stage 3, extremely slow brain waves called delta waves are interspersed with
smaller, faster waves.
In stage 4, the brain produces delta waves almost exclusively. Stages 3 and 4 are
referred to as deep sleep, and it is very difficult to wake someone from them. In deep
sleep, there is no eye movement or muscle activity. This is when some children
experience bedwetting, sleepwalking or night terrors.
Dr Kavitha S 30
In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk
rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage
increase to levels experienced when a person is awake. Also, heart rate increases,
blood pressure rises, males develop erections and the body loses some of the ability to
regulate its temperature. This is the time when most dreams occur, and, if awoken
during REM sleep, a person can remember the dreams. Most people experience three
to five intervals of REM sleep each night. Infants spend almost 50% of their time in
REM sleep. Adults spend nearly half of sleep time in stage 2, about 20% in REM and
the other 30% is divided between the other three stages. Older adults spend
progressively less time in REM sleep.
The waveform during REM has low amplitudes and high frequencies, just like the
waking state. Early researchers actually called it "paradoxial sleep".
Neuronal centers, Neurohumoral substances and mechanisms that cause sleep:
Stimulation of several specific areas of the brain can produce sleep with
characteristics very near those of natural sleep. Some of these are the following:
1. The most conspicuous stimulation area for causing almost natural sleep is the
raphe nuclei in the lower half of the pons and in the medulla. These are a thin
sheet of nuclei located in the midline. Nerve fibers from these nuclei spread
widely in the reticular formation and also upward into the thalamus, neo-cortex,
hypothalamus, and most areas of the limbic system. In addition, they extend
downward into the spinal cord, terminating in the posterior horns where they can
inhibit incoming pain signals. It is also known that many of the endings of fibers
Dr Kavitha S 31
from these raphe neurons secrete serotonin. Also, when a drug that blocks the
formation of serotonin is administered to an animal, the animal often cannot
sleep for the next several days. Therefore, it is assumed that serotonin is the
major transmitter substance associated with production of sleep.
2. Stimulation of some areas in the nucleus of the tractus solitarius, which is the
sensory region of the medulla and pons for the visceral sensory signals entering
the brain via the vagus and glosso-pharyngeal nerves, will also promote sleep.
However, this will not occur if the raphe nuclei have been destroyed. Therefore,
these regions probably act by exciting the raphe nuclei and the serotonin system.
3. Stimulation of several regions in the diencephalons can also help promote sleep,
including the rostral part of the hypothalamus, mainly in the suprachiasmal area
and an occasional area in the diffuse nuclei of the thalamus.
Characteristics of REM sleep
During REM sleep, a person dreams actively, but limb muscles are immobile.
Breathing is rapid, irregular, and shallow. Heart rate increases, blood pressure rises,
brain is at least as active during REM sleep as it is when the person is awake.
The major muscles do not move during REM sleep. (Sleepwalking occurs during
NREM sleep.)
Infants spend about 50 per cent of their sleep time in REM sleep; after infancy, fifteen
to twenty per cent of sleep time is spent in REM sleep..
Dr Kavitha S 32
Waking usually transitions into NREM sleep. REM follows NREM sleep and occurs
4-5 times during a normal 8 to 9 hour sleep period. The first REM period of the night
may be less than 10 minutes in duration, while the last may exceed 60 minutes.
For the purpose of analysis, overnight sleep has been divided into 3 equal time
periods: sleep in the first third of the night, which comprises the highest percentage of
NREM; sleep in the middle third of the night; and sleep in the last third of the night,
the majority of which is REM. Awakening after a full night's sleep is usually from
REM sleep.
Sleep in adults: In adults, sleep of 8-8.4 hours is considered fully restorative. In
some cultures, total sleep often is divided into an overnight sleep period of 6-7 hours
and a mid afternoon nap of 1-2 hours.
Sleep in infants: Infants have an overall greater total sleep time than any other age
group; their sleep time can be divided into multiple periods. In newborns, the total
sleep duration in a day can be 14-16 hours.
Sleep in elderly persons: In elderly persons, the time spent in stages III and IV sleep
decreases by 10–15% and the time in stage II increases by 5% compared to young
adults, representing an overall decrease in total sleep duration. Latency to fall asleep
and the number and duration of overnight arousal periods increase. Thus to have a
fully restorative sleep, the total time in bed must increase. If the elderly person does
not increase the total time in bed, complaints of insomnia and chronic sleeplessness
may occur.
Knowledge of the mechanism and importance of sleep helps us in understanding and
treating insomnia in a better way.
Dr Kavitha S 33
Chapter-2
Nidra Nasha and Insomnia
In the ancient texts of Ayurveda we find several references for insomnia in the form
of Nidra Nasha and Anidra. In Charaka Samhita, Nidra and Nidranasha are explained
in the context of Astauninditiya Adhyaya. According to Charaka Samhita, Nidra is
pushtida, while jagarana does the Karshana of the body; it is also stated that happiness
and sorrow, growth and wasting, strength and weakness, virility and impotence, the
knowledge and ignorance as well as existence of life and its cessation depend on
sleep. Untimely and excessive sleep and prolonged vigil take away both happiness
and longevity like the Kaala ratri.46
In Charaka Samhita, Nidranasha is included under the 80 Nanatmaja vata vikaras.
Sushruta Samhita has explained this under the chapter Garbha Vyakarana Shaariram,
as Nidra plays a vital role in nutrition and development of the foetus. In the same
chapter along with chikitsa, Vaikariki Nidra has been explained which can be
correlated to sleep disorders.
Astanga Sangraha has mentioned this in Viruddhanna vijnaniya Adhyaya, where the
Trayopastambhas are explained. It states that Manda Nidra is due to Vata, and the
term Asvapna has been used in Vataja Nanatmaja vikaras.
In Astanga Hridaya Nidra, Nidra Vikaras and its chikitsa are mentioned under Anna -
rakshadhyaya, where Trayopastambhas are explained.
Sharangadhara Samhita has considered Nidranasha in Vataja Nanatmaja vikara, Alpa
Nidra in Pittaja Nanatmaja vikara and Atinidra under Kaphaja Nantmaja Vikara. By
observing these descriptions regarding Nidra and Nidranasha, it can be concluded that
all the texts have considered the importance of Nidranasha, hence Nidranasha has
Dr Kavitha S 34
been explained along with the physiology of Nidra. Nidranasha or Alpanidra is seen
in many diseases as a Laksana and it may be Upadrava or Arista Lakshana also.
Hence, the Nidana, Samprapti and Chikitsa are explained regarding nidranasha, the
Acharyas considered its independent manifestation too as a disease.
The derivation of word Nidranasha:
Nidranasha is composed of two words ‘Nidra’ + ‘Nasha’. Nidra is ‘Ni’ + ‘Dra’, Drayi,
Santi, i.e. Dadrushu Naish, means to fall asleep. Sleep, Slumber, Sleepiness. The
suffix ‘Nasha’ provides negative meaning to the act of Nidra.47
Nidranasha means less or no sleep.
In Ayurvedic texts the term ‘Nidranasha’ is used indicating a pathological condition
in which the patient is devoid of sleep.
Table No. 1: showing the Synonyms of Nidranasha:
• Aswapna • Alpanidra
• Akala nidra • Avyavahita Nidra
• Ratri jagarana • Prajagarana
• Manda nidra • Nashta nidra
• Nidra nasha • Nidra bhanga
• Nidraghata • Nidra vighata
• Nidra viparyaya • Nidrabhighata
• Jagaruka, Jagarth, Jagrya, Jagriya, Jag etc.
Dr Kavitha S 35
NIDANA
Charaka Samhita has mentioned the specific cause for nidranasha like atiyoga of
virechana, shirovirechana, vamana, bhaya, krodha, dhumrapana, ati vyayama and
rakta mokshana48 and also, Upavasa, uncomfortable bed, predominance of Satva and
suppression of Tamasa –These check the unwholesome and excessive occurrence of
sleep.
49,50
The cause for nidranasha are the Karya, Kala, Vikara, Prakriti and Vayu which
can be elaborated as under:
1) Karya – Absorption in the work: When an individual is deeply involved in any
work, either mental or physical, his mind would be deviated from the sleep, or he
would not get the sleep. This happens in persons who are having a heavy load of
mental work.
2) Kala – It is another factor which plays an important role in the Nidra and
Nidranasha both. Everyone experiences in day to day life, that as soon as the night
comes, he feels the desire for sleep. This type of feeling, under normal circumstance
is never seen during the day time except in the summer. It indicates that the sleep has
got a relationship with the time factor.
3) Vikara –There are various diseases in which sleep is disturbed or they may be
causative factors for sleeplessness. The list of diseases is given in the foregone pages.
4) Prakriti –The Vata Prakriti persons have been described as Jagaruka i.e., those who
sleep very less or who practically don’t sleep. The Satvika persons also sleep for less
time. The individuals of Rakshasa kaya and Pashava kaya get excessive sleep.
5) Vata –Vata Dosha is considered mainly as sleep dispeller. Vata is having ‘Chala’
Guna and by virtue of this Guna, it does not allow the Manas to take rest and
Dr Kavitha S 36
therefore, it doesn’t allow the individual to sleep well or have a sound sleep.
Hence, we can consider all Vata Prakopaka Hetus as the causative factors for
Nidranasha also.
According to Sushruta Samhita, Nidranasha is caused by aggravated Anila and Pitta,
manastaapa, dhatu kshaya and abhighata.51
The loss of sleep is not only found in all Vata rogas, but it is also found in those
diseases where Shula exists, viz. Pindikodveshtana, Gridhrasi, Udavarta, Akshepaka.
Astanga Hridaya has mentioned the manasika cause for Nidranasha, it is stated that
due to excess of Kama, Nidrakshaya occurs52.
Both Ashtanga Hridaya and Sangraha, have followed Charaka Samhita, but have
added some other factors also.53
The excessive hunger, thirst, mental and physical misery, excessive happiness,
sadness, coitus, fear, anger, worry, eagerness and excessive use of dry dietetics are the
extra causes mentioned for sleeplessness. The Vata and Pitta provoking Ahara and
Vihara also cause sleeplessness. In Ashtanga Hridaya, the edge of Tikshna Anjan and
Dwadashavidha Langhana are also mentioned as the causes for Nidranasha 54.
Bhavamishra mentioned the same things which are mentioned in previous texts.
Nasya, fasting, worry, excess exercise, sadness, fear, Kaphakshaya etc. are the causes
of Nidranasha55.
By going through the above description, it is quite evident that Nidranasha may be
due to a variety of causes and these may also act so effectively as to keep the person
awake altogether or may serve, when present in a less degree to produce one of the
forms of dreaming and unrefreshing slumber mentioned above.
In Garuda Purana it is stated that poor men, servants, men infatuated with woman and
thieves cannot get good sleep.
In Skanda Purana it is mentioned that due to anxiety, arising out of frailness of a
Dr Kavitha S 37
person, occupied and afflicted by the innumerable hopes and expectations, may not
get proper sleep.
Finally all the above causes of Nidranasha can be listed under four categories
Table No 2: showing the different Nidanas of Nidranasha
Ahara & viharajanya Manasika Chikitsajanya Anya
Yavanna Bhaya Virechana Kshaya
Rookshanna Chinta Vamana Abhighata
Dhooma Krodha Shirovirechana
Vyayama Manastapa Raktamokshana
Upavasa Vyatha Sweda
Asukhashayya Harsha Anjana
Kshudha Lobha Langhana
Mithuna Shoka
Table No.3: showing the Ahara-viharajanya nidana of Nidranasha
NIDANA CS SS AS AH BS HS BP
- - - + - - -
Rookshanna Sevana
Yavanna Sevana - - - - + - -
Dhoomapana + - - + + - -
Vyayama + - - + + - +
Upavasa + - - + - + -
Asukhashayya + - + - - - -
Kshudha - - + - - - -
Maithuna - - + - - - -
Trit - - + - - - -
Dr Kavitha S 38
Table No. 4: showing the Upacharajanya Nidanas
NIDANA CS SS AS AH BS BP
Vamana + - + + - -
Virechana + - + - + -
Shirovirechana + - + + + +
Raktamokshana + - + - - -
Sweda - - - + - -
Anjana - - - + - -
Langhana - - - + + -
Table No. 5: showing the Manasika Nidana
NIDANA CS SS AH AS BS HS BP
Bhaya + - - - - + +
Chinta + - + + - + +
Krodha + - + - - - +
Manastapa - + - - - - -
Shoka - - + + - - +
Vyatha - - - + - - -
Harsha - - - + - - -
Lobha - - - - - + -
Goodarthaparichitana - - - - + - -
Table No.6: showing the Anya Nidanas
NIDANA SS
Abhighata +
Kshaya +
Dr Kavitha S 39
PURVARUPA:
Purva Rupa of Nidranasha is not mentioned in Ayurvedic classics.
RUPA:
In Ayurvedic classics some symptoms are mentioned due to restraint of sleep.
Charaka Samhita has described the following symptoms. Suppression of sleep, causes
jrumbha, anga marda, tandra, shiro roga, akshi gaurava.56
Sushruta Samhita has described following symptoms due to restraint of sleep:
Jrumbha, anga marda, Jadya in the anga, shiro and akshi, along with tandra are the
symptoms caused by restraint of sleep.57
Astanga Sangraha and Hridaya have mentioned that due to Nidranasha, anga marda,
shiro gaurava, jrumbha, jadya, glani, bhrama, apakti, tandra and Vataja rogas will be
manifested. 58,59
Table No. 7: Showing Rupa of Nidranasha
Rupa Cha.Sam. Su.Sam A.H. A.S.

Jrumbha + + + +
Angamarda + + + +
Tandra + + + +
Shiroroga + _ _ _
Shirogaurava _ + + +
Akshigaurava + + _ _
Jadya _ _ + +
Glani _ _ + +
Bhrama _ _ + +
Apakti _ _ + +
Vataroga _ _ + +
Dr Kavitha S 40
UPASHAYA AND ANUPASHAYA
Goodhalinga Vyadheenam Upashayanupashayabhyam Pareekshet
If disease is not diagnosed properly, Upashaya and Anupashaya can help in
diagnosing the disease. As Nidranasha is not explained as a separate disease,
obviously the references of Upashaya & Anupashaya is not available in Ayurvedic
texts.
However Upashaya for Nidranasha can be evolved. Mamsa sevana, Ksheerasevana,
Ksheeravikarasevana, Madyasevana, Abhyanga, Utsadana, Tarpana, Snehasevena can
be considered as Upashaya for Nidranasha.
In Anupashaya, Rookshannasevana, Yavannasevana, Dhoomapana, Krodha, Shoka
can be considered, other nidanas explained previously can also be considered as
Anupashaya for Nidranasha.
Dr Kavitha S 41
SAMPRAPTI
Relation of various Manasika Bhavas on the Sharirika Doshas is well known. Hence
Charaka Samhita has mentioned it as:
The interplay between the body and mind is the core of Samprapti of every Manasa
roga.60 Though, nidranasha is considered under Vataja Nanatmaja roga, here it is
better to consider it as Vataja Manasika Nanatmaja roga. Even though, it is Vataja
Vikara, in the pathogenesis of nidranasha, the Manasika Dosha ‘Rajas’ plays an
important role.
Broadly, the etiological factors of nidranasha can be categorized into two headings,
viz. Sharirika and Manasika. The former category comprises Shodhana Atiyoga,
Vyayama, Upavasa, ahaara and vihara causing Vata-pitta vitiation etc. On account of
mental dispositions such as Chinta, Krodha, Bhaya and Shoka, Vata Prakopa takes
place in addition to the physical factors. The Vata vitiation occurs, due to both kinds
of etiological categories.
Fundamental functions of Vata, in connection with mental operations are Activation
(Pravartakaha), Controlling (Niyantrana) and Motivation (Preraka). These basic
functions are impaired, when Vata aggravation takes place on account of specific
Nidanas.
Impairment of Basic Functions of Vata:
Activation function is altered due to a more hightened state of activity.
This results in over indulgence of Karmendriya, leading to the absence of exhausted
Karmendriya state. Consequently, Mano-nivritti, a necessary requisite for Nidra, is
not at all ensued. An abnormality in the controlling function leads to a very active
mind. This implies that, the Rajoguna, universal motivator of everything must have
Dr Kavitha S 42
been overwhelming. In addition to this, over activity of mind, causes over activation
of Gyanendriya and Karmendriya, because Manas is an Ubhayendriya and it is
juxtaposed to both. As seen earlier, this again renders a state of Manas without
exhaustion. This prevents revoking of mind from its objects. Constant perception of
Vishaya by the sense organs can be reckoned, as an impact of perseverant motivation
function. Following, detachment of mind from its corresponding sense organs is not
likely to occur. All the three psychosomatic functions of mind, when impaired,
restricts the detachment of Manas from Indriyas of both kind, seeking rest in
Nirindirya Pradesha (Chakrapani), results in the pathological state Nidranasha
Another View: The aetilogical factors of nidranasha results in gunatah vrudhi of
rooksha, laghu and chalaguna of vata, ushnaguna of pitta and its kshaya of sasneha
guna. Gunataha kshaya of guru, sheeta, manda and snigdha of kaphadosha and
tamogunakshaya, which seems to be similar to kapha.
The kaphadosha and tamoguna are responsible to get sleep. When kaphadosha and
tamoguna fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya. Due
to kshayavastha of kaphadosha and tamoguna are unable to fillup the
samgnavahasrotas. On the other hand vitiated vatadosha gets lodged in majjadhatu.
Mastulunga has been explained as shiromajja, as a part of samgnavahasrotas is not
filled with kapha and tamoguna, it results in nidranasha.
On the other hand the manasika karanas enlisted in hetus of nidranasha, vitiates rajas
and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiates
them, thus results in nidranasha
Dr Kavitha S 43
Schematic presentation of nidranasha samprapti
NIDANA SEVANA
VATAVRUDHI PITTAVRUDHI
Rooksha Laghu Chala Ushna
Takes Ashraya in Asthi
Enters majja Rajogunavrudhi
KAPHAKSHAYA
Snigdha Sheeta Guru Manda Tamogunakshaya
KAPHA WILL NOT ABLE TO FILL UP SAMGNAVAHASROTAS

( which is responsible for Nidra )
NIDRANASHA
Types of Samprapti:
Sankhya: According to our ancient Acharyas, Asvapna is of two types viz.,
Nidranasha due to Vataprakopa and Nidralpata due to Pittaprakopa61. So Sankhya
Samprapti of Nidranasha can be two in number.
Vikalpa: In nidranasha, mainly Vata Prakopa occurs, due to its Chala and Laghu
Guna , which keeps the mind active, causing Nidranasha.
Dr Kavitha S 44
Pradhanya : In Pradhanya Samprapti, the predominance of morbid humors are
described in terms of the comparative and superlative degrees but here as nidranasha
is a Vataja Nanatmaja Vyadhi, vitiation of Vata only takes place. So there would not
be Pradhanya Samprapti in the case of nidranasha.
Bala: Bala of Asvapna can be determined by the strength of manifestation of its
symptoms, severity, duration etc.
Kala: It is an important factor, while considering Nidra as well as Nidranasha.
Charaka Samhita has mentioned Kala under the causative factors of Nidranasha,
which indicates that Kala or time factor has an influential effect on it.
Samprapti Ghataka:
Dosha: Vata & Pitta (Vriddhi), Kapha (Kshaya)
Dushya: Rasa
Agni: Jatharagni
Srotasa: Manovaha, Rasavaha
Srotodushti Prakara: Atipravritti (Over indulgence)
Adhisthana: Hridaya
Udbhavasthana: Hridaya
Dosha: Doshas involved in nidranasha are Vata, Pitta and Kapha. But the deviation
from the normal level is to be considered with due importance. Vata and Pitta are in
increased state, while in case of the Kapha, Kshaya is usually observed.
Dushya: Rasa Dhatu has its role in the Dhatu level of Samprapti. Because it provides
Tushti, Prinana- both functions are evaluated by Acharyas in the psychic level.
Agni: Here, vitiation of Jatharagni takes place, because Nidra is said to enhance the
Agni.62 Apakti - one symptom of Nidranasha also indicates its vitiation.
Dr Kavitha S 45
Srotasa: The role of Manovaha Srotas can be understood without any controversy.
Rasavaha Srotasa, in this context, too has a pivotal role in the pathogenesis. Root of
Manovaha Srotasa is Hridaya and Hridaya is substantiating to the seat of Mana.
Moreover, etiological factor, responsible for Rasavaha Dushti, includes mental cause
such as Chintyanam Chatichintanat.
Srotodushti Prakara: The main mode of vitiation is Atipravritti. Since, the over
indulgence of Manasa is a common feature of the disease.
Adhisthana and Udbhavasthana: Hridaya is the abode for these two factors. It is the
place form where the whole Samprapti process is supposed to be eventualised. As
seen earlier, Hridaya is the seat for Manas and its role in nidranasha is already defined
by Acharyas.
The etilogical factors of nidranasha results in gunataha vrudhi of rooksha, laghu and
chalaguna of vata, ushnaguna of pitta and its kshaya of sasneha guna. Gunataha
kshaya of guru, sheeta, manda and snigdha of kaphadosha and tamogunakshaya,
which is seems to be similar as kapha.
The kaphadosha and tamoguna are responsible to get sleep. When kaphadosha and
tamoguna will fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya.
Due to kshayavastha of kaphadosha and tamoguna are unable to fillup the
samgmavahasrotas. On the other hand vitiated vatadosha get lodged in majjadhatu.
Mastulunga has been explained as shiromajja, is a part of samgnavahasrotas is not
filled with kapha and tamoguna and results in nidranasha.
and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiates
them and results in nidranasha
Dr Kavitha S 46
UPADARVA
In Ashtanga Sangraha, it is mentioned that increased Vayu due to Nidranasha
produces Kaphakshaya, this decreased and dried Kapha sticks in the walls of
Dhamanis and causes Srotorodha. This, results in so much exhaustion that eyes of the
patient remain wide open with watery secretion from eyes. This dangerous exhaustion
is Sadhya up to three days then becomes Asadhya 63
Having a detailed knowledge of Nidra Nasha helps us in understanding and
diagnosing the condition of patient which leads to correct treatment.
ARISHTA LAKSHANA
Arishta lakshanas are indication of imminent death. Specific arishta lakshanas are told
in the classics for particular disease. A disease with Arishta lakshanas is very difficult
to treat. Death may occur after the appearance of Arishta lakshanas.
As such there is no specific Arishta lakshanas mentioned in Nidranasha. Sushruta
stated that Nidranasha ( complete loss of sleep ) itself is Arishta lakshana which
denotes definite death.
Dr Kavitha S 47
INSOMNIA MODERN REVIEW
Insomnia is the complaint of difficulty initiating or maintaining sleep, waking too
early and not being able to get back to sleep, or waking feeling unrefreshed and
lethargic.
Data available on chronic insomnia suggest that about 30 percent of the general
population have complaints of sleep disruption, while approximately 10 percent have
associated symptoms of daytime functional impairment. The effects of insomnia can
include daytime fatigue, impaired mood and judgment, poor performance, and an
increased likelihood of accidents at home, in the workplace, and while driving.64
Types of insomnia:
1.Transient - It can last up to one month and may be caused by many things, among
them jet lag, stress, a major life change such as a new job or loss of a relationship,
environmental factors like noise, or even consuming too much caffeine.
2. Intermittent - Short term insomnia which happens from time to time.
3. Chronic insomnia - Occurs when a person has insomnia a minimum of three
nights a week for a month or longer. Chronic insomnia is present in either the primary
or secondary forms.
Primary - It is not directly associated with any other health condition or
problem.
Secondary - It is associated with health condition such as depression, heartburn,
cancer, asthma, or arthritis, or as a result of medications or drugs, including alcohol
and caffeine. In the secondary forms it usually is caused by a medical condition or
medication taken for other disorders, or by alcohol consumption.
Patients with chronic insomnia should be evaluated to ensure the sleep problem is not
Dr Kavitha S 48
due to an underlying medical or psychiatric condition that may require treatment.
Primary insomnia is sleeplessness that is not attributable to any medical, psychiatric,
or environmental cause. The diagnostic criteria for primary insomnia (307.42) from
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision (DSM-IV-TR) are as follows:
• The predominant symptom is difficulty initiating or maintaining sleep, or non-
restorative sleep, for at least 1 month.
• The sleep disturbance (or associated daytime fatigue) causes clinically
significant distress or impairment in social, occupational, or other important
areas of functioning.
• The sleep disturbance does not occur exclusively during the course of
narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder,
or a parasomnia.
• The disturbance does not occur exclusively during the course of another
mental disorder (eg, major depressive disorder, generalized anxiety disorder, a
delirium).
• The disturbance is not due to the direct physiological effects of a substance
(eg, drug abuse, medication) or a general medical condition.65
The International Classification of Sleep Disorders (ICSD-2) diagnostic and coding
manual66 consists of 3 primary insomnia categories:
• Psychophysiological insomnia
• Idiopathic insomnia
• Paradoxical insomnia
Dr Kavitha S 49
Pathophysiology
The pathophysiology of primary insomnia is not well understood and essential
features assist with diagnosis. The focus of management is on symptoms.
Psychophysiological insomnia
The essential features include learned or behavioral insomnia and heightened arousal.
The primary components involved are intermittent periods of stress that result in poor
sleep and maladaptive behaviors. These include (1) a vicious cycle of trying harder to
sleep and becoming tenser (ie, patients “trying too hard to sleep”) and (2) bedroom
habits and routines (eg, brushing teeth) that actually condition the patient to become
frustrated and aroused. Patients often report "racing thoughts" and sensitivity to their
environment.
Bad sleep habits such as those naturally acquired during periods of stress are
occasionally reinforced. These are therefore not resolved and become persistent.
Insomnia continues for years after the stress is abated and is labeled persistent
psychophysiological insomnia.
Idiopathic insomnia
The essential feature of idiopathic insomnia is lifelong sleeplessness with onset in
infancy or childhood. Lifelong sleeplessness is attributed to an abnormality in the
neurologic control of the sleep-wake cycle for many areas of the reticular activating
system (which promotes wakefulness) as well as in areas such as supra nuclei, raphe
nuclei, and medial forebrain areas (which promote sleep).
Dr Kavitha S 50
Possibly, a so-called neuroanatomic, neurophysiologic, or neurochemical lesion exists
in the sleep state that patients tend to be on the extreme end of the spectrum toward
arousal.
Paradoxical insomnia
Paradoxical insomnia is also called sleep state misperception. The essential feature is
reports of severe insomnia without supporting objective evidence such as daytime
sleepiness.
Frequency
Primary insomnia is diagnosed in approximately 15-25% of patients with insomnia
who are referred to sleep disorder centers following exclusion of other predisposing
conditions. However, true incidence is not known. Primary insomnia is estimated to
occur in 25% of all patients with chronic insomnia.
Mortality/Morbidity
Whether the consequences associated with chronic insomnia outweigh the costs of
treatment remains debatable. Despite that, the following associations have been noted:
• Increased risk of mortality is associated with short sleep lengths.
• Insomnia is the best predictor of the future development of depression.
• Catastrophic worry about the consequences of not sleeping is common among
patients with chronic insomnia and serves to maintain the sleep disturbance.
• Increased risk exists of developing anxiety, alcohol and drug use disorders,
and nicotine dependence.
Dr Kavitha S 51
• Poor health and decreased activity occur.
• Onset of insomnia in older patients is related to decreased survival.
Sex
Primary insomnia is more common in women than in men.
Age
Persons of any age may be affected, although primary insomnia is more common in
the older population.
Clinical History
A thorough clinical interview with the patient and his or her sleep partner is critical in
making the correct diagnosis of primary insomnia.
Psychophysiological insomnia
Sleep disturbance varies from mild to severe.
Insomnia may manifest as difficulty falling asleep or as frequent nocturnal
awakenings.
Patients often find that they can sleep well anywhere else but in their own bedroom.
Patients with this type of insomnia tend to be more tense and dissatisfied compared to
people who sleep well. Emotionally, they typically are repressors, denying problems.
Idiopathic insomnia
Insomnia is long-standing, typically beginning in early childhood.
Patients often present with other hard-to-localize neurologic signs and symptoms such
as difficulties with attention or concentration, hyperactivity, and mild nonfocal
electroencephalographic abnormalities.
Dr Kavitha S 52
Emotionally, persons with childhood-onset insomnia are often repressors, denying
and minimizing emotional problems.
These individuals often show atypical reactions, such as hypersensitivity or
insensitivity, to medications.
Insomnia tends to persist over the entire life span and can be aggravated by stress or
tension.
Sleep state misperception: Patients report insomnia subjectively, while sleep duration
and quality are completely normal.
Physical Findings.
Physical findings that indicate sleep deprivation and fatigue may include features such
as eye redness. Depending on the origin of the sleep dysfunction, other
physical findings would be included to rule out secondary causes (ie, weight, neck
circumference, thyroid). A complete neurologic examination is included in the
evaluation of insomnia to assess for comorbid conditions. Recognition of mental
disorders that may be contributing to insomnia is key to effectively manage
symptoms.
When performing a complete Mental Status Examination, drowsiness and mood
changes such as irritability, anxiety, and sad feelings from underlying depression may
be noted. The clinician should also note the patient's orientation, memory, judgment,
insight, and the presence of any hallucinations or delusions.
As with any mental status (but especially with the concern about depression), assess
the patient's suicide potential. For completeness, assess the patient's homicidal
potential as well.
Dr Kavitha S 53
Causes
Exclusion of other common causes is required to make the diagnosis of primary

insomnia.
Medical causes
Chronic pain, especially neuropathic pain
Primary sleep disorders (eg, sleep apnea, periodic limb movements, restless legs
syndrome)
Dyspnoea from any cause
Pregnancy
Differential Diagnoses
Adjustment Disorders Major Depression

Alcohol-Related Psychosis Obstructive Sleep Apnea-Hypopnea Syndrome
Amphetamine Abuse Parasomnias
Anxiety Disorders Postpartum Depression
Apnea, Sleep Posttraumatic Stress Disorder
Bipolar Affective Disorder Schizophrenia
Caffeine-Related Psychiatric DisordersSleep Disorder, Geriatric
Cocaine-Related Psychiatric Disorders Depression
Other Problems to Be Considered
A number of occult medical, psychiatric, and substance abuse disorders can cause
sleep disturbance. Also consider other sleep-related disorders, such as circadian
rhythm sleep disorder and parasomnias, in the differential diagnosis. Substance abuse
can cause insomnia during the intoxication phase, during the sustained use phase, and
during withdrawal.
Dr Kavitha S 54
Psychiatric and/or psychological causes
Mood disorders (eg, depression, mania): Recent findings have strengthened the
evidence that primary insomnia may be linked with mood disorders and is associated
with hypothalamic-pituitary-adrenal (HPA) axis overactivity and excess secretion
of corticotropin-releasing factor (CRF), adrenocorticotropin-releasing hormone, and
cortisol.
Anxiety disorders (eg, generalized anxiety, panic attacks, obsessive–compulsive
disorder)
Substance abuse (eg, alcohol or sedative/hypnotic withdrawal)
Major life stressors and/or events
Environmental causes
Noise
Jet lag or shift work
Bedroom too hot or cold
Laboratory Studies
Laboratory studies essentially are not required for the diagnosis of primary insomnia.
Tests required to exclude other causes of insomnia include the following:
¾ Thyroid function tests (hyperthyroidism)
¾ Blood alcohol levels (alcohol-related psychosis)
Imaging Studies
Neuroimaging studies may be helpful if a structural lesion is suspected to cause
insomnia.
Dr Kavitha S 55
Other Tests
Sleep diary
This is a questionnaire completed by the patient each morning to describe the
previous night's sleep. Data from the sleep diary may help minimize distortions in
sleep information recalled in the physician's office.
Actigraphy: This is a recently developed technique that makes use of an activity
monitor to record activities during sleep and waking. It is useful in the diagnosis of
circadian rhythm sleep disorders, sleep state misperception, and other types of
primary insomnia. In older adults treated for chronic primary insomnia, the clinical
use of actigraphy is still suboptimal in detecting wakefulness.
Procedures
Full-night polysomnography (PSG) is indicated when suspicion of sleep apnea or
movement disorders arises, when initial diagnosis is uncertain, when treatment fails,
or when precipitous arousal occurs with violent or injurious behavior.
Multiple sleep latency test
Psychophysiological insomnia and idiopathic insomnia manifest as increased sleep
latency, reduced sleep efficiency, and increased number and duration of awakenings.
Sleep state misperception manifests as normal sleep latency (15-20 min), normal
number of arousals and awakenings, and normal sleep duration (6.5 h). The multiple
sleep latency test shows normal daytime vigilance. Sleep state misperception can be
diagnosed only in the laboratory because of the need to document that sleep duration
and quality are normal when a person claims to have poor sleep
Dr Kavitha S 56
Drug use or withdrawal (eg, selective serotonin reuptake inhibitors, stimulants,
antihistamines, caffeine, diet pills, herbal preparations containing ma huang,
anticonvulsants, steroids)
Dr Kavitha S 57
Chapter-3
CHIKITSA AND PATHYAPATHYA IN NIDRANASHA
Vaidya is considered next to God owing to his unquestionable ability to treat the
disease. This ability is a result of his indepth shastraadhyayana coupled with practical
experience. Maharshi Atreya has mentioned the qualifications of a good physician,
that along with so many other things he should also know well about the wholesome
and the unwholesome sleep, sleeplessness and excessive sleep including their
causation and treatment67. Charaka Samhita has recommended the following
measures for insomnia.
Abhyanga, utsadana, snana, intake of mamsa rasa of gramya, anupa and audhaka
animals, shali rice with dadhi, ksheera, sneha, madhya, manah sukham, smell of
scents and hearing of sounds of one’s taste (manaso anugunaa gandhah, shabdah),
samvahana, Netra Tarpana, shiro lepa, vadana lepa, comfortable bed and home and
proper time brings sleep, to those who are suffering from sleeplessness.68
Astanga Sangrahakara has narrated the following regimens for sleeplessness:
Milk, sugarcane juice, mamsa rasa of gramya, anupa and audhaka animals, foodstuffs
prepared from jaggery and rice, Alcoholic beverages,masha, kilata and curd of
buffallow’s milk, abhyanga and bath, shiro-abhyanga, Sravana purana and Netra
tarpana, application of ointments on head and face, kneading of body by beloved
ones, sleeping in the hands of beloved, sexual intercourse, fantasysing the mind with
blissful things gives sleep and makes the person happy.69,70
Sushruta Samhita also mentions the same regimens.71
Bhavaprakash Samhita mentions the following treatment for insomnia:
Abhyanga, Udvartana, Snana, Akshitarpana, Samvahana.
Dr Kavitha S 58
Panchakarma chikitsa
Abhyanga, Utsadana, Chakshu Tarpana, Shiro Lepa, Vadana Lepa, Murdha Taila,
Karna Purana, Shiro Basti, Shirodhara.
Table No. 8: Showing Bahya upacharas in Nidranasha
Upachara CS SS AH AS YR BP KS HS BS BR
Abhyanga + + + + + + - - + -
Utsadana + - - - - - - - - -
Samvahana + + - + + + - - - -
Akshitarpana + - + + + - - - - +
Moordhnitaila + + - - - - - - - -
Udvartana - + + + - + + - - -
Shirobasti - - + + - - - - - -
Shirastarpana - - + - - - - - - -
Moordhnapoorana - - - + - - - - - -
Karnapoorana - - - + - - - - - -
Padabhyanga - - - - + + - - - -
Angamardana - - - - - - - - - -
Mardana - - - - - - - - + -
Karnatarpana - - - - - - + - - -
Table No. 9: showing the Manasika Upacharas in Nidranasha
Upacharas CS SS AH AS HS BP
Manonukula Vishaya grahana + - - - - -
Manonukula Sabda granaha + - - - - -
Manonukula Gandha granaha + - - - - +
Mrudu shayya - + - - - -
Sukha shayya - - - + - -
Sukha sparsh - - - + - -
Nischinta - - + - - -
Nityatrupti - - + - - -
Dr Kavitha S 59
Bhaya tyaga - - - - + -
Chintatyaga - - - - + -
Lobha tyaga - - - - + -
Swasteerna Sayana + - - - - -
Sukhavartalapa - - - - + -
Santosha - - - - - +
Table No. 10: showing Aahara Upacharas in Nidranasha
Upacharas CS SS AH YR BP KS HS BR DN RN
Gramya mamsa rasa + - - - - - - - - -
Anupa mamsa rasa + - - - - - - - - -
Jaleeya mamsa rasa + - - - - - - - - -
Mahisha ksheera + - + + - - + + + +
Peeyusha + - + + - - - - - -
Morata + - - + - - - - - -
Goodhooma - + - - + + - - - -
Varahamamsa - - - - - - - - + +
Guda - - - - - + - + - -
Matsya - - - - + + - + - -
Dadhi - - - - - + - - - -
Koorchika - - - + - - - - - -
Masha - - - - + - - + - -
Sita - + - - - - - - - -
Yoosha - - - - + - - - - -
Sneha - - - - + - - - - -
Kilata + - + + - - - - + +
Madhya - - + - - - - - - -
Dr Kavitha S 60
Table No. 11: showing Different Ahara vargas used in Nidra nasha
Mamsa varga Ksheeravarga Madyavarga Dhanyavarga Anya
Gramyamamsarasa Mahishaksheera Paistikamadaya Godhooma Guda
Anoopamamsa Dadhisevana Goudamadya Masha Sneha
Udakamamsa Koorchika Shastikashali Snigdhabhojana
Bileshayaprani Morata
Vishkarimamsa Kilata
Peetanamatsya Peeyoosha
Roheetakamatsya
Mahishamamsa
Varahamamsa
Table No. 12: showing Anya upachara in Nidranasha
Upacharas CS AH AS BP KS HS YR
Snana + + + - - - -
Shirolepa + + + - - - -
Varsa sevana in Varsa Ritu - - - + - - -
Lehana karma - - - - + - -
Vastra kruta vayu sevana - - - - - + -
Kamsya patrakruta vayu sevana - - - - - + -
Talapatra kruta vayu sevana - - - - - + -
Kadali patrakruta vayu sevana - - - - - + -
Viewing dance and hearing humorous voice - - - - - + -
For somatic management several medicines are mentioned.
¾ Pippali Moola Churna with Jaggery 72,73
¾ Loknath Rasa 74
Dr Kavitha S 61
¾ Ashwagandha Churna with Sharkara & Ghee75
¾ Decoction of Jeevaniya Gana with milk 76
¾ Roasted Vijaya powder with honey 77
¾ Decoction of root and bark of Kakamachi with Jaggery 78
¾ Nidrodaya Rasa79
¾ Kalyanaka Guda80
¾ Indumareechadi vati (musta, yasti, ahiphena, badarasthimajja)81
¾ Mamsa rasa, shaka, sarpi, yoosha, ksheera- all mixed with Palandu.82
¾ Aragwadha, vacha, nimbi, patola, usheera, kutaja, kakamachi, ativisha, moorva,
triphala, duralabha, bala, patha, madhooka, rohini should be taken in equal
quantity and quatha is to be prepared.83
¾ Kantakaridwaya, vasa, kakamachi, punarnava, vartakimoola- all in equal
quantity, quatha is to be prepared.84
¾ Kakajangha, apamarga, kokilaksha shooraparnika- all in equal quantity, quatha
is to be prepared.85
¾ Ghrita + Taila, Yamaka krutha yoosha.86
¾ Kambalika is prepared from boiled roheetakamatsya blended with kanji and
dadhi mastu is to be consumed along with kutaja beeja and 5 pala of guda.87
¾ Ghrita bharjita nagara.88
¾ Ghrita bharjita bhanga with madhu.89
¾ Kakajangha twak quatha with madhu.90
¾ Shalmalee niryasa + kiratatikta91
¾ Swarna makshika bhasma92
¾ Tungadrumadi taila93
Dr Kavitha S 62
Some external treatments are also described- Harita Samhita also states that sleep is
induced by fanning with the help of cloth, Bamboo-chip (fan) or use of bronze vessel
and the use of banana leaf.94 It is also mentioned that the sleep can be achieved by
hearing the sounds produced by the animals like ox, horse etc., and by viewing dance
and hearing humorous words.95 Hareeta Samhita in Nidra Chikitsa Adhyaya advices
the application of Dadhi Mastu to the soles of the feet to get sleep. In the same context
it is said that by keeping the roots of Kakajangha, Apamarga, Kokilaksha, Suparnika
in the hair/plait, causes sleep95. Bhaishajya Ratnavali in Murcha roga Adhyaya,
advices the application of Bhanga lepa to the soles of the feet to promote sleep in
those who have not slept since long. Bhava Prakasha advices to keep the roots of
upodika and Kakamachi in the hair/plait to get sleep.
Adravya Chikitsa:
Pleasant smell and sound96
Gentle rubbing97
To listen good music and news98
To keep the mind in a calm and happy state99
Living without worry100
To remain always satisfied 100
Dr Kavitha S 63
PATHYAAPATHYA
Pathya is the wholesome regimen which does not impair the body system and which
is pleasant to the mind101. If one follows certain principles and controls the activities
and makes changes in the regimen, he can get a sound, normal and good sleep.
Pathye sati gadartasya kimoushadha nishevanam Pathye asati gadartasya
kimoushadha nishevanam says Lolimbaraja . He simply states that there is no point in
planning a treatment regimen if one is not following Pathyaapathya. This is especially
true in the case of Nidranasha where diet and life style play an important role in its
treatment. The following table is a collection of all food items promoting nidra in
various Ayurvedic text.
Table No.13: Showing the Pathya ahara in Nindranasha
Pathya Ahara Ch. Su. A.H. A.S. B.P

Mamsa rasa of gramya, anupa and audaka + - - - -
animals
Shali anna + + - + -
Dadhi + - + + -
Ksheera + + + + -
Godhuma - + - - -
Ikshu - + - + +
Pishta - + - + -
Mamsa rasa - + + - +
Madhura - + - - -
Mamsa of Bila and Vishkira animals - + - - -
Draksha - + - - -
Sita - + - - -
Sura - - + + +
Mamsa of Anupadeshiya animals and birds - - - + -
Masha - - - + +
Kilata - - - + -
Shaka - - - - +
Dala - - - - +
Ghrutha - - - - +
Yusha - - - - +
Tila - - - - +
Matsya - - - - +
Dr Kavitha S 64
Life Style: Pathya viharas in nidranasha mentioned in classics are given below:
Table No. 14: The following table is a collection of various viharas promoting
comfortable nidra mentioned in Brihattrayee.
Vihara Ch. Su. A.H. A.S.

Comfortable bed + + - +
Comfortable room + - - -
Proper time + - - -
To wear clean clothes - + - -
To speak softly - + - -
To take bath - - + +
To observe celibacy - - + -
To lay down in fragrant and airy place - - - +
Apathya
Apathya –– those which adversely affect the body and mind are considered to be
unwholesome (Apathya)
All the ahara viharas mentioned as nidana for nidra nasha can be considered as
Apathya and their parivarjana forms an important aspect of treatment.
Dr Kavitha S 65
CONTEMPORARY MEDICAL TREATMENT FOR INSOMNIA
In many cases, insomnia is caused by another disease, side effects from medications,
or a psychological problem. It is important to identify or rule out medical and
psychological causes before deciding on the treatment for the insomnia. Attention to
sleep hygiene is an important first line treatment strategy and should be tried before
any pharmacological approach is considered.
Non-pharmacological
Non-pharmacological strategies are superior to hypnotic medication for insomnia
because tolerance develops to the hypnotic effects. In addition, dependence can
develop with rebound withdrawal effects developing upon discontinuation. Hypnotic
medication is therefore only recommended for short term use, especially in acute or
chronic insomnia. Non pharmacological strategies however, have long lasting
improvements to insomnia and are recommended as a first line and long term strategy
of managing insomnia. The strategies include attention to sleep hygiene, stimulus
control, behavioral interventions, sleep-restriction therapy, paradoxical intention,
patient education and relaxation therapy.
Stimulus control therapy is a treatment for patients who have conditioned themselves
to associate the bed, or sleep in general, with a negative response. As stimulus control
therapy involves taking steps to control the sleep environment, it is sometimes
referred interchangeably with the concept of sleep hygiene. Examples of such
environmental modifications include using the bed for sleep or sex only, not for
activities such as reading or watching television; waking up at the same time every
morning, including on weekends; going to bed only when sleepy and when there is a
high likelihood that sleep will occur; leaving the bed and beginning an activity in
Dr Kavitha S 66
another location if sleep does not result in a reasonably brief period of time after
getting into bed (commonly ~20 min); reducing the subjective effort and energy
expended trying to fall asleep; avoiding exposure to bright light during nighttime
hours, and eliminating daytime naps.
A component of stimulus control therapy is sleep restriction, a technique that aims to
match the time spent in bed with actual time spent asleep. This technique involves
maintaining a strict sleep-wake schedule, only sleeping at certain times of the day and
for specific amounts of time to induce mild sleep deprivation. Complete treatment
usually lasts up to 3 weeks and involves making oneself sleep for only a minimum
amount of time that they are actually capable of on average, and then, if capable (i.e.
when sleep efficiency improves), slowly increasing this amount (~15 min) by going to
bed earlier as the body attempts to reset its internal sleep clock.
Paradoxical intention is a cognitive reframing technique where the insomniac, instead
of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially
stops trying to fall asleep). One theory that may explain the effectiveness of this
method is that by not voluntarily making oneself go to sleep, it relieves the
performance anxiety that arises from the need or requirement to fall asleep, which is
meant to be a passive act. This technique has been shown to reduce sleep effort and
performance anxiety and also lower subjective assessment of sleep-onset latency and
overestimation of the sleep deficit (a quality found in many insomniacs).
Cognitive behavior therapy
A recent study found that cognitive behavior therapy is more effective than hypnotic
medications in controlling insomnia. In this therapy, patients are taught improved
sleep habits and relieved of counter-productive assumptions about sleep. Common
Dr Kavitha S 67
misconceptions and expectations that can be modified include: (1) unrealistic sleep
expectations (e.g., I need to have 8 hours of sleep each night), (2) misconceptions
about insomnia causes (e.g., I have a chemical imbalance causing my insomnia), (3)
amplifying the consequences of insomnia (e.g., I cannot do anything after a bad
night's sleep), and (4) performance anxiety after trying for so long to have a good
night's sleep by controlling the sleep process. Hypnotic medications are equally
effective in the short term treatment of insomnia but their effects wear off over time
due to tolerance. The effects of cognitive behavior therapy have sustained and lasting
effects on treating insomnia long after therapy has been discontinued. The addition of
hypnotic medications with CBT adds no benefit in insomnia. The long lasting benefits
of a course of CBT shows superiority over pharmacological hypnotic drugs. Even in
the short term when compared to short term hypnotic medication such as zolpidem
(Ambien), CBT still shows significant superiority. Thus CBT is recommended as a
first line treatment for insomnia.
Medications
Many insomniacs rely on sleeping tablets and other sedatives to get rest, with research
showing that medications are prescribed to over 95% of insomniac cases. Certain
classes of sedatives such as benzodiazepines and newer nonbenzodiazepine drugs can
also cause physical dependence which manifests in withdrawal symptoms if the drug
is not carefully tapered down. The benzodiazepine and nonbenzodiazepine hypnotic
medications also have a number of side effects such as day time fatigue, motor
vehicle crashes, cognitive impairments and falls and fractures. Elderly people are
more sensitive to these side effects. Review of the literature regarding benzodiazepine
hypnotic as well as the nonbenzodiazepines concluded that these drugs caused an
Dr Kavitha S 68
unjustifiable risk to the individual and to public health and lack evidence of long term
effectiveness.
The risks include dependence, accidents and other adverse effects. Gradual
discontinuation of hypnotics in long term users leads to improved health without
worsening of sleep. Preferably hypnotics should be prescribed for only a few days at
the lowest effective dose and avoided altogether wherever possible in the elderly.
Benzodiazepines
The most commonly used class of hypnotics prescribed for insomnia are the
benzodiazepines. Benzodiazepines bind unselectively to the GABAA receptor. These
include drugs such as temazepam, flunitrazepam, triazolam, flurazepam, midazolam,
nitrazepam and quazepam. These drugs can lead to tolerance, physical dependence
and the benzodiazepine withdrawal syndrome upon discontinuation, especially after
consistent usage over long periods of time. Benzodiazepines while inducing
unconsciousness, actually worsen sleep as they promote light sleep whilst decreasing
time spent in deep sleep such as REM sleep. A further problem is with regular use of
short acting sleep aids for insomnia, day time rebound anxiety can emerge.
Benzodiazepines can help to initiate sleep and increase sleep time but they also
decrease deep sleep and increase light sleep.
Non-benzodiazepines
Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone
and eszopiclone, are a newer classification of hypnotic medications. They work on the
benzodiazepine site on the GABAA receptor complex similarly to the benzodiazepine
class of drugs. Some but not all of the nonbenzodiazepines are selective for the α1
subunit on GABAA receptors which is responsible for inducing sleep and may
Dr Kavitha S 69
therefore have a cleaner side effect profile than the older benzodiazepines. However,
there are controversies over whether these non-benzodiazepine drugs are superior to
benzodiazepines. These drugs appear to cause both psychological dependence and
physical dependence though less than traditional benzodiazepines and can also cause
the same memory and cognitive disturbances along with morning sedation.
Alcohol
Alcohol is often used as a form of self-treatment for insomnia and to induce sleep.
However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of
alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as
suppression of REM sleep and REM sleep fragmentation. Frequent moving between
sleep stages occurs, with awakenings due to headache, polyurea, dehydration and
diaphoresis. Glutamine rebound also plays a role as when someone is drinking,
alcohol inhibits glutamine, one of the body's natural stimulants. When the person
stops drinking, the body tries to make up for lost time by producing more glutamine
than it needs. The increase in glutamine levels stimulates the brain while the drinker is
trying to sleep, keeping them from reaching the deepest levels of sleep.
Opioids
Opioid medications such as hydrocodone, oxycodone, and morphine are used for
insomnia which is associated with pain due to their analgesic properties and hypnotic
effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By
producing analgesia and sedation, opioids may be appropriate in carefully selected
patients with pain-associated insomnia.
Dr Kavitha S 70
Antidepressants
Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can
often have a very strong sedative effect, and are prescribed off label to treat insomnia.
The major drawback of these drugs is that they have properties which can lead to
many side effects,. Some also alter sleep architecture. As with benzodiazepines, the
use of antidepressants in the treatment of insomnia can lead to withdrawal effects;
withdrawal may induce rebound insomnia.
Mirtazapine is known to decrease sleep latency, promoting sleep efficiency and
increasing the total amount of sleeping time in patients suffering from both depression
and insomnia.
Melatonin and melatonin agonists
The hormone and supplement melatonin is effective in several types of insomnia.
Melatonin has demonstrated effectiveness equivalent to the prescription sleeping
tablet zopiclone in inducing sleep and regulating the sleep/wake cycle. One particular
benefit of melatonin is that it can treat insomnia without altering the sleep pattern
which is altered by many prescription sleeping tablets. Melatonin agonists, including
ramelteon (Rozerem) and tasimelteon, seem to lack the potential for misuse and
dependence. This class of drugs have a relatively mild side effect profile and lower
likelihood of causing morning sedation.
Antihistamines
The antihistamine diphenhydramine is widely used in nonprescription sleep aids such
as Benadryl. Its effectiveness may decrease over time and the incidence of next-day
sedation is higher. Anticholinergic side effects may also be a draw back of these
particular drugs. Dependence does not seem to be an issue with this class of drugs.
Dr Kavitha S 71
Cyproheptadine is a useful alternative to benzodiazepine hypnotics in the treatment of
insomnia. Cyproheptadine may be superior to benzodiazepines in the treatment of
insomnia because cyproheptadine enhances sleep quality and quantity whereas
benzodiazepines tend to decrease sleep quality.
Atypical antipsychotics
Low doses of certain atypical antipsychotics such as quetiapine, olanzapine and
risperidone are also prescribed for their sedative effect but the danger of neurological,
metabolic and cognitive side effects make these drugs a poor choice to treat insomnia.
Over time, quetiapine may lose its effectiveness as a sedative.
Eplivanserin is an investigational drug with a mechanism similar to these
antipsychotics, but probably with less side effects.
Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but
this has not yet been proven. A healthy diet containing magnesium can help to
improve sleep in individuals without an adequate intake of magnesium.
Table No. 15: Hypnotic Drugs and their Hypnotic Effect
Hypnotic drugs Effect on Effect on REM Effect on Stage 3-4(Slow

Serotonin Sleep wave) Sleep
L-Tryptophan +++ +++ +++
Doxepin ++++ + +++
Amitriptyline ++++ + +++
Imipramine +++ ++ ++
Phenobarbital -- --- -
Flurozepam -- 0 ---
Diazepam --- -- --
Chlorpromazine 0 +++ 0
Desipramine 0 +++ 0
These are the presently available treatment procedures in modern medicine.
Dr Kavitha S 72
FOOD AND DIET ACCORDING TO CONTMPORARY SCIENCE
Diet is especially important when treating sleep disorders, and it is essential to rule
out food intolerances as a cause.
Foods to Eat
Chlorophyll-rich foods, such as leafy, green vegetables, steamed or boiled.
Microalgae, such as chlorella and spirulina.
Oyster shell can be taken as a nutritional supplement.
Whole grains: Whole wheat, brown rice, and oats have a calming and soothing effect
on the nervous system and the mind. Carbohydrates also boost serotonin, which
promotes better sleep.
Mushrooms (all types)
Fruits especially mulberries and lemons, which calm the mind.
Seeds: jujube seeds are used to calm the spirit and support the heart. Chia seeds also
have a sedative effect.
Foods such as bread, and crackers that are high in complex carbohydrates have a mild
sleep-enhancing effect because they increase serotonin, a brain neurotransmitter that
promotes sleep.
Milk contains tryptophan which, when converted to seratonin in the body, induces
sleep and prevents waking.
Vitamins for Insomnia: Vitamin B is important as it plays a vital role in treating
insomnia. When our body does not get sufficient amount of this vitamin it finds it
difficult to calm down and relax hence one cannot sleep. This vitamin is found in
Dr Kavitha S 73
foods such as whole grains, cereals, pulses and nuts. A decoction made of lettuce
seeds is used and proved to be very helpful. Lettuce has a long-standing reputation for
promoting healthy sleep. This is due to an opium-related substance combined with
traces of the anticramping agent hyoscyarnin present in lettuce. The meal should also
include legumes, peanuts, nutritional yeast, fish or poultry. These foods contain
vitamin B3 (niacin). Niacin is involved in seratonin synthesis and promotes healthy
sleep. Mixed with a little lemon juice for flavor, lettuce juice is an effective sleep-
inducing drink highly preferable to the synthetic chemical agents in sleeping pills
Foods to Avoid
Coffee, Tea, Spicy foods, Cola, Chocolate, Stimulant drugs, Alcohol, refined
carbohydrates (They drain the B vitamins.), Additives, Preservatives, Non-organic
foods containing pesticides. Canned foods or any source of toxicity or heavy metals.
Sugar and foods high in sugar and refined carbohydrates. These raise blood-sugar
levels and can cause a burst of energy that disturbs sleep.
Foods that are likely to cause gas, heartburn, or indigestion, such as fatty or spicy
foods, garlic-flavored foods, beans, cucumbers, and peanuts.
Foods such as meat that are high in protein can inhibit sleep by blocking the synthesis
of serotonin, making us feel more alert.
Monosodium glutamate (MSG), often found in Chinese food. This causes a stimulant
reaction in some people.
One should avoid cigarettes and tobacco. While smoking may seem to have a calming
effect, nicotine is actually a neurostimulant and can cause sleep problems.
Dr Kavitha S 74
Alcohol and caffeine are two beverages/food that you must avoid for a healthy sleep.
One should avoid caffeine in all forms (tea, coffee, cola, chocolate)
The sensitivity to the stimulant effects of caffeine varies greatly from one person to
the next. This is largely a reflection of how quickly the body can eliminate caffeine.
Even small amounts of caffeine such as those found in decaffeinated coffee or
chocolate, may be enough to cause insomnia in some people.
Alcohol produces a number of sleep-impairing effects. In addition to causing the
release of adrenaline, alcohol impairs the transport of tryptophan into the brain, and,
because the brain is dependent upon tryptophan as the source for serotonin (an
important neurotransmitter that initiates sleep), alcohol disrupts serotonin levels.
One should avoid too many ingredients in a meal and too much food late at night.
One should avoid bacon, cheese, chocolate, eggplant, ham, potatoes, sugar, sausage,
spinach, tomatoes, and wine close to bedtime. These foods contain tyramine, which
increases the release of norepinephrine, a brain stimulant.
Our digestive system slows at night. So, it is harder to digest late meals. Heavy meals
before bedtime must be avoided.
Dr Kavitha S 75
DRUG REVIEW
The term Drug is derived from the French word ‘drogue’ i.e. dry herb. A Drug is
defined as any substance used for the purpose of diagnosis, prevention, relief or cure
of a disease in man or animals. According to W.H.O., the Drug is “A substance used
in the diagnosis, treatment, or prevention of a disease or as a component of a
medication”.
A Drug is any substance or product that is used or intended to be used to modify or
explore physiological systems or pathological states for the benefit of the recipient.
Drug is one of the chief factors of Chikitsa Chatushpada. Acharya Charaka has
emphasized, the awareness of therapeutic Drug by considering it as one among
‘Trisutra’ i.e. Hetu, Linga and Ausadh of Ayurveda.102
Bheshaja is the key ingredient for a successful chikitsa and understanding the virtues
of the bheshaja forms an important part of research which helps the researcher to
discuss why the pirticular bheshaja is acting in a specific way in treating the problem ,
what properties and components make the drug act in a pirticular fashion, and what
difference is seen in the action of drug with and with out dietary regulations. This
section is divided into two to study the properties of two ingredients of Guda
Pippalimoola in one section and the properties of the food items included in the diet
chart in the second section.
Guda Pippalimula Yoga was described to be effective in the following texts
1. Bhava Prakasha Samhita
2. Bhaishajya Ratnavali
3. Yoga ratnakaram
4. Vangasena
Dr Kavitha S 76
PIPPALI MULA
Pippali moola is the root of the plant pippali, which is a key ingredient of many
formulations. However pippalimoola is attributed with a special property of releiving
nidranasha when it is used along with guda.
Table No. 16: showing the properties of Pippalimoola.
Latin Name Piper longum

Family Piperaceae
Vernacular Hindi- Pipal ki mool
Name: English- Roots of Long pepper
Telugu- Modi
Malyalam-Tippali moola
Kannada- Hippali beru
Tamil- Tippali moola
Synonyms Granthikam, Ushanam, Catakasira moola, Kanamoola.Katu granthi,
Kolamoolam, Katumoolam, Katushanam,sarvagranthi, Chavika sira,
Patradyam, virupam,shonasambhavam, Granthilaam.103
Gana Dipaniya, Shulaprashamanam (Ch.)
Pipalyadi Varga(Pr. Ni) (Su.) ( Ad. Ni)(R.Ni)
Panchkola, Haritakyadi Varga (B.P.)
Satapushpadi vargam (Dh. Ni)
Rasa Katu
Vipaka Katu
Guna Laghu, Snigdha, Tikshna
Virya Anushna
Chemical It contains Essential oil, Resin, Volatile oil, starch, gum, fatty oil,
Composition inorganic matter and an alkaloid, Piperine- 0.15-0.18%, Pipalartin-
0.13-0.20%, Piperleguminin ,Glyosides, Beta-Sitosterol, Cepharadiones
sesamin, piplasterol, piperronguminin, steroid etc.
Parts Used Mula (root)
Dr Kavitha S 77
Doshaghnata Kapha-vata shamaka,

Karma Deepana, Pachana, Bhedana Krimighna, Kasahara, Swasahara,
Hiccanigrahana, Triptighna Roghaghnata Vatavyadhi, Aruchi, Pandu,
Gulma, Swasa, Kasa
Indications Udara, Anaha, Pliha roga, Gulma, Krimi, Svasa, Ksaya, Nidra nasha104
In Paniniya gana patha (4/2/90) we come across the reference of Pippalimoola. It is
also extensively described in the Vedic literature.
Morphology: It is an aromatic tender climber, stems creeping, jointed, attached to
other plants while climbing, leaves- 5-9 cm X 3-5 cm, sub-acute, entire, glabrous,
cordate at the base, flowers in pendulate spikes straight, fruits yellowish-orange in
fleshy spike. The roots are noded and brownish in colour
Different Varieties: Dymock (1885) reported that there are three kinds of
Pippalimoola viz.,
a. Mirzapuri
b. Bengali and
c. Malva varieties
Guda (Jaggery):
Guda and its vikara are indicated in nidranasha as promotive of sleep in various
classical texts like Astanga Sangraha, Bhaishajya Ratnavali, Bhava Prakasha and
Kashyapa Samhita
Jaggery is a dark, course, unrefined sugar made either from sugar-cane juice. It is
primarily used in India, where many categorize sugar made from sugar-cane as
Dr Kavitha S 78
jaggery and that processed from palm trees as "gur". Jaggery has a sweet, wine-like
fragrance and flavor that lends distinction to whatever food it embellishes.
Ayurvedic Review:
Sweetening substances are being used in the Ayurvedic formulations to increase it’s
palatability, for preservation and also to have, tonic effect. They are responsible for
the generation of alcohol in Asavarishtas and serve as base in Avaleha Kalpana.
In our Ayurvedic formulation, various sweetening agents used are Guda, Sita,
Sharkara etc. Among these Guda (Jaggery), Sita (Purified sugar candy), Sharkara
(sugar) are very commonly used the preparation of different Kalpanas i.e. Avaleha,
Gutika, Asava-Arishta, Sharkara, Panaka, etc. But in Asava-Arishta, percentage of
Jaggery (Guda) found is more in comparison to others. Jaggery is explained under the
heading of “Ikshuvarga” in all Samhitas and Nighantus. It is prepared by the juice of
sugarcane.
According to Cha. Su. 27/239 - Before formation of Jaggery, the sugarcane juice
undergoes four stages i.e.
(i) Chaturbhagavasheshita - 1/4th remain
(ii) Tribhagavasheshita - 1/3rd remain
(iii) Ardhabhagavasheshita - ½ remain
All these three varieties are called “Kshudraguda” and they are light for digestion in
their ascending order.
(iv) Dhauta Guda: The finally formed Guda will be clean and of good quality, it is
called as Dhauta Guda and used for medicinal purpose as well as dietetic purpose.105
Dr Kavitha S 79
Properties of Navaguda (New Jaggery):
Newly prepared jaggery is Kapha, Shwasa-Kasakrita, Krimikara and Agnideepaka.106
Properties of Purana Guda (Old Jaggery):
It is Laghu, Pathya, Anabhishyandi, Agnivardhaka, Vata Pittaghna, Madhura,
Vrishya, Raktaprasadana.107
Guda with different Anupana having Trisodhashashamaka activity:108
With Ardraka - Kaphaghna
Haritaki - Pittaghna
Sunthi – Vatghna108
Table No.17: showing the properties of Guda.
Vernacular Hindi - Guda

Names English - Treacle/Jaggery
Marathi – Gula
Kannada – Bella
Synonyms Sishupriya, Sitadih, Arunorasaja, Rasapakajah109
Rasa Madhura
Vipaka Madhura
Guna Guru, Snigdha
Virya Ushna
Chemical It contains sharkara, albumine, calcium oxelate.
Composition
Doshaghnata Tridoshashamaka
Karma Deepana, Pachana, Anulomana, Vrishya, Hridya, Mutra-Rakta
shodhaka, Increase Medodhatu, Kapha and Krimi,
Pittaghna,Vatashamaka110
Dr Kavitha S 80
b. Modern Review:
Jaggery is nutritious. It improves digestion, prevents fatigue,purifies blood and
provides strength to the muscles. Jaggery is rich in minerals, iron and instant glucose.
It is not only easily digestible, but also has various minerals and vitamins in right
proportion, which is extremely useful for our body.
Jaggery and sugar not only differ in their composition but also in their effect on the
human metabolism. Carbohydrate, which is prominently present in sugar, need B-
vitamins for their proper utilization by the body and the nature has so arranged it that,
in their natural states, both cereals and natural sugar items (like, cane-juice, fruits,
nuts etc.), and also protein foods, have more than enough of the B-vitamins needed
for the assimilation of all the carbohydrate present. If excess of refined sugar is eaten,
it is likely to lead to some degree of B-vitamin deficiency. Symptoms of B-vitamin
deficiency include irritability, nervous exhaustion, sleeplessness, heart trouble,
digestive disorders and mental trouble.
On the other hand, one hundred gm. of jaggery provides 200 calories and so requires
about 0.1 mg of vitamin B and, it contributes many times this amount itself.
Table No.18: showing theNutrient content of Jaggery (per 100 gms)
Moisture 3.80 gm
Protein 0.40 gm
Fat 0.10 gm
Carbohydrate 95.00 gm
Energy 183 k. Cals
Calcium 80.20 mg
Phosphorous 40.20 mg
Iron 11.4 mg
Total Minerals 0.60 gm
Carotine 168 mcg
Thiamine 0.02 mg
Riboflavin 0.05 mg
Vitamin C 0.50 mg
Dr Kavitha S 81
REVIEW OF AHARA DRAVYAS SELECTED IN DIET CHART
Some of the ahara dravyas mentioned in the context of nidranasha were selected to
prepare the diet chart for one of the groups. Following are those dravyas and their
properties.Bhaishajya Ratnavali states sone of the dravyas as Nidrakara viz., Ikshu,
Pothaki, Masha, Sura, Mamsa, Ghritha, Payah, Godhuma, Guda and Matsya in the
21st Chapter (Murcha Roga Chikitsa)
Iksvaha potaki mashaah suraa maamsam ghrutham payah |
Godhuma guda matsyaascha nidraam kurvanti dehinaam ||
KSHEERA
Snighdam ruchikaram cha tandraanidraakaram vrushyatamam shramaghnam||
Balapradam pustikaram kaphasya sanjeevanam chaasti peyo mhishayaah |111
Ksheera is considered as complete diet. It is indicated for all, right form the child to
the aged. Among all the jeevaneeya dravyas ksheera is said to be superior. The regular
consumption of ksheera brings rasayana effect in the body. Charaka samhita describes
ten qualities of ksheera which are similar to that of ojus. It is the pathyatama dravya,
especially in debilitating conditions.
Synonyms: Dugdha, soumya, dhari, satmya, paya, prasravana, asraja, jeevana,
ksheera, peeyusha, udhasya and amruta.
Table No. 19 – showing the Rasa panchaka of Ksheera
Rasa Madhura
Guna Snigdha, guru, mrudu, shlakshna, picchila, manda.
Veerya Sheeta
Vipaka Madhura
Dosha karma Vatapitta hara, shleshma kruth.
Dr Kavitha S 82
The quality of milk varies depending upon the nature of animal, duration of boiling,
time of consumption etc.Dharoshna ksheera is amrutatulya. Kwathitha dugdha is said
to be sarva rogahara, balapushtikari and ojoprada.If it is taken in the morning it acts as
balya, bruhmana and agnivardhana. It is ruchikara and baladayaka when taken in the
afternoon. The consumption of milk at night acts as tridoshahara. In balyavastha, it
improves agni and bala. In vardhakya, it acts as virya vardhaka.
MILK
Milk is a fine blend of all the nutrients necessary for growth and development of the
young ones. Milk is a good source of proteins, fats, sugars, vitamins and minerals.
Milk is being used throughout the world for feeding infants and as a supplement to the
diets of children and adults.
Table No. 20: Showing nutritive value of milk (per 100 gms)
Sl.No. Nutrients Nutritional value

1 Fat 4.1g
2 Protein 3.2g
3 Lactose 4.4g
4 Calcium 120mg
5 Iron 0.2mg
6 Vitamin C 2mg
7 Minerals 0.8gm
8 Water 87%
9 Energy 67 kcal
Masha: Masha is said to be nidrajanaka in Sushrutha Samhita, Astanga Sangraha,
Bhava Prakasha and Bhaishajya Ratnavali.
(Ch. Su.25, Ch.Su. 27/24, Su. Su. 46, A.H.Su.6. R.N. Bh.P.)
Dr Kavitha S 83
Table No. 21: showing the Properties of Masha
Latin Name: Phaseolus radiatus
Family: Leguminoseae
Sub family: Papilonaceae
Gana: Palashadi Varg (Bh.P.)
Synonyms: Mansala, Baladhya, Vrushtakar, Kuruvinda, Dhanyavir, Pitrya,
Pitrujyottama.
Rasa Madhura
Guna Guru, Snigdha
Veerya Ushna
Vipaka Amla112
Doshaghnata Vatashamak, Kaphapitta Vardhak
Part used Bija
Rogaghnata: Gudakila, Ardita, Swasa, Paktishula, Vata Roga.
Chemical Compsition
It contains minerals like Ca, P, Mg. Cu and K; and Vitamins like carotene, thiamine,
riboflavin, niacin, choline, folic acid, Vit B12 is present in minute quantity. A
suceinoides with properties similar to those of muscle enzyme has been obtained.
Globulin, albumin, prolamin and glutelin are the proteins found. Allantoin,
glutathione is also present. It’s a good source of lysine, valin, amino acids, leucines,
etc. (Wealth of India – Raw materials Vol. X). It contains albuminoids 22.7%, starch
55.8%, oil 2.2%, fibre 4.8% and Ash 4%. An analysis of some samples grown in
Bombay presidency shows moisture 6.05 to 11.95, Ether extract 1.25 to 2.60,
Dr Kavitha S 84
Albuminoids 19.81 to 27.50; soluble carbohydrates 50.05 to 60.69, woody fibres –
4.25 to 5.90 and Ash 3.45 to 5.35. (Bombay Govt. Agri. Bulletin).
Actios and uses
It is used in rheumatism, affection of nervous system and disease of liver. In Indo-
China countries black gram is considered as diuratic and is used in dropsy and
cephalagia. (Kirt. & Basu. I).
It is the most demulcent cooling as well as nutritious of all pulses, also aphrodisiac,
lactogene and nervine tonic. The pulses shows marked cholesterole lowering effect (in
serum, liver and aorta) when fed to rats receiving normal hypercholesterolemic diet,
serum phospholipids levels are also lowered. (Chem, Abstr. 1971, 74, 10942) Also
used in gastric catarrh, dysentry, diarrhoea, cystitis, paralysis, piles, rheumatism and
affections of liver and of nervous system. (Indian Meteria Medica).
IKSHU: Ikshu and its vikara are considered as Nidrajanaka in Sushrutha Samhita,
Astanga Sangraha, Bhava Prakasha and Bhaishajya Ratnavali.
Table No. 22: showing the Properties of Ikshu
Latin Name: Saccharum officinarum

Family: Gaminae
Sub family: Papilonate
Gana: Shukrashodhan ( Cha) Trinapanchamula (Su)
Synonyms: Madhutruna, Bhuriras, Gudadara, Gudamula, Trinaraj, Maharas.
Rasa Madhura
Guna Guru
Veerya Shita
Vipaka Madhura
Dr Kavitha S 85
Doshaghnata Vatapittahara
Part used Stem
Karma: Balya, vrishya, Kaphaprada, Mutrala, Brimhana
Rogaghnata: Gudakila, Ardita, Swasa, Paktishula, Vata Roga.
Sugar cane is sweet oleginous, indigestible, diuretic, tonic, cooling, aphrodisiac.
Chemical Constituents: It contains sugar, watre, resin, fat, albumin, guanine,
calcium oxalate.
GHRITA: Ghrita is considered as Nidrakara in Bhava Prakasha and Bhaishajya
Ratnavali. Ghrita is one among the Ajasrika Rasayanas. It is Ayuvardhaka,
Balavardhaka, Ojovardhaka, Vayasthapaka, Dhatu poshaka and is supreme in snehana
Dravyas. By virtue of Yogavahitwa, as per its ingredients the medicated Ghrita will
be attaining different properties.
Table No. 23: Table showing Properties of Ghrita
Rasa Madhura
Guna Snigdha, guru, Sara
Veerya Sheeta
Vipaka Madhura
Doshaghnata Vata-Pitta Shamaka
Karma Medhya, Agni vardhaka, Pandu, Kamala, Netra Rogahara
Chemical Ghee contains 8% lower saturated fatty acids which makes it
composition easily digestible. Due to having 4-5% lenoleic acid, an essential
fatty acid, it promotes proper growth of human body. Ghee also
contains vitamin A,B,E and K. vitamin A and E are anti oxidant
Dr Kavitha S 86
and are helpful in preventing oxidative injury to the body. Ghee
is lipophilic and this action of ghee facilitates the transportation
of ingredients of formulation to target organ and final delivery
inside the cell, because cell membrane is highly lipophilic.
Upodika: Upodika or Pothaki is said to be Nidrajanak in various texts like Bhava
Prakasha, Bhaishajya Ratnavali and Vangasena.
Pothakyupodika saa tu maalvaa amrutavallari | pothaki sheetala snighdha
sleshmalaa vaatapittanut || Akantya pichillaa nidrashukradaa raktapittajit | Baladaa
ruchikrut pathyaa brumhanee truptikaarinee |113
Upodikaa himaa snigdha swaadu paaka rasaa saraa sakshaaraa sleshmalaa balyaa
nidraa shukraatipushtidaa akantyaa picchilaa hanti raktapittamadaanilaan|114
Table No. 24: showing the Properties of Upodika
Latin Name: Basella rubra Linn.

Family: Chenopodiaceae (vastuka kula)
Sanskrit Name Upodika
Vernacular Hindi: Poi, Poy, Poi shak
Names English: Indian Spinach
Telugu: Batsala
Kannada: Basale
Synonyms Amruta vallari,upodaka, Kantaki,Urdhvaga valli, Upodika, pothaki, Malva,
vrittapatra, pichilachadana, mathsyakata, turangi, kalambika, rakta danda,sthira.
Rasa Madhura
Guna Guru, Snigdha, Picchila
Veerya Shita
Vipaka Madhura
Dr Kavitha S 87
Doshaghnata Kapha vardhaka, Vata-Pitta shamaka

Part used Leaves and Stem
Karma Balya, vrishya, Kaphaprada, Mutrala, Brimhana
Rogaghnata Anulomana, Balya, Vrusya, Brumhana, Mada nashaka, Nidrajanana, vrana
pachana ,vimlapana,sara, bhedana, daha prashamana.
Chemical Protein-1.2%,calcium-15%,Iron-1.4mg/100g,vitamin-A-3.250I.U.,VitaminB1-
composition 40 I.U.,VitaminB2-10 I.U., Leaves contain high amount of mucilage, red
variety contains colouring matter and the fruits contain deep violet colouring
matter.
Godhuma: Godhuma is considered to be Nidrajanaka according to Sushrutha
Samhita, Kashyapa Samhita, Bhava Prakasha and Bhaishajya Ratnavali.
Godhumako yavanakah sumanashchamaddo matah ||
Godhumo madhuro vrushyo guruh snigdho himah sarah | jeevano brumhano varnyo
balyo asyandi ruchipradah||
Sthyairya sandhana krud vaatapittaghnah kaphakrunna cha.115
Table No. 25: showing the properties of Godhuma
Latin Name Triticum sativum Lam.
Family Gramineae
Vernacular names Hindi-gehu, Eng-wheat, Telugu-Godhuma,Kannada- Godhi.
Synonyms Godhuma, Yavanaka, Sumana, chamada
Rasa Madhura
Guna Guru, snigdha, hima
Virya Sheeta
Vipaka Madhura
Karma Vrushya, sara, jeevana, brumhana, Varnya, balya,

asyandi, ruchiprada, Sthairya sandhana krut
Doshagnata Vatapittaghna, Kaphakara
Dr Kavitha S 88
Shali Dhanya: Shali anna is said to be Nidrajanaka in the classical texts like Charaka
Samhita, Sushrutha Samhita and Astanga Sangraha.
Table No. 26: showing the properties of Shali Dhanya
Latin Name Oryza sativa Linn.
Family Gramineae
Vernacular Hindi-Dhaan, Chaval, English-Paddy,rice,Telugu-

names Vari,Biyam,Kannada-Batta,akki.
Rasa Madhura,
Anurasa Kashaya
Guna Laghu, Snigdha,
Virya Sheeta
Vipaka Madhura
Karma Brumhana, Vrushya,Hrudya, Ruchya, Ati mutrala, Balya,

Swarya, Jwarahara
Doshagnata Pittaghna, Vata-Kaphakara
Dadhi: Dadhi is considered as Nidrakara in texts like Charaka Samhita, Astanga
Sangraha, Astanga Hridaya and Kashyapa Samhita.
Dr Kavitha S 89
Table No. 27: showing the Properties of Dadhi116
Vernacular Hindi-Dahi, English-Yogurt,Curd,Telugu-

names Perugu,Kannada-Mosaru
Rasa Madhura, Amla
Guna Guru, abhishyandi, Ushna, Snigdha,
Virya Ushna
Vipaka Amla
Karma Snehana, Agnideepanam, grahi, abhishyandi,

Sristamutravit
Doshagnata Vatahara, Pitta-Kaphakara
Indications Aruchi, Pratishyaya, Shitajwara, Vishama jwara,

kasa, krushata, Mutrakrucchra
Palandu: Palandu is said to be Nidrajanaka in Bhava Prakash Samhita.
Table No. 28: showing the Properties of Palandu117
Botanical Name Alium cepa

Family Liliaceae
Vernacular Names Hindi- Pyaz
English- onion
Telugu: ullipaya
Tamil: vengayam
Synonyms youvana eshta, mukha dushaka
Chemical constituents cycloallin,quercetin,oleanolic acid,etc.
Dr Kavitha S 90
Draksha: Draksha is considered as Nidrajanaka in Sushrutha Samhita.
Table No. 29: showing the Properties of Draksha118
Botanical name Vitis vinifera Linn.

Family Cyperaceae
Gana Charaka- kanthya, virechanopaga, kasahara, sramahara.
Sushruta- Parusakadi gana
Vagbhata- Parusakadi gana
Synonyms Mridwika, Gostani, Charuphala, Kapisha,
Harahura, Swadophala
Part used Fruit, Leaf, Stem, Flower
Rasa Madhura
Guna Snigdha,Guru,Mridu
Veerya Sheeta
Vipaka Madhura
Doshaghnata Vata-Pitta Shamaka
Karma Trishnanigrahana, Kaphanissaraka, Kanthya, Vata-Pittahara,
Vrusya, Brimhana, Caksusya, Virechanopaga Jwaraghna, Balya,
Brimhana, Raktaprasadana, Raktapittashamaka, Anulomana,
Hridya, Medhya etc.
Indications Jwara, Raktapitta, Kamala, Rajayakshma,Daha, Trsna.
Chemical 3 – monoglucosides of delphinidin, cyaniding, petunidin,
constituents peonodin, malvidin, acetyl and coumaryl glycosides, biflavonoids,
malic acid, tannic acid, glucose, fructose, galactose, mannose,
amino acids like alanine, arginine and proline (fruit) etc. Catechin,
epicatechin, Betasitosterol, ergosterol, jasmanic acid.
Pharmacological Antioxidant, Hepatoprotective, Antifungal,
actions Anti bacterial, Anti ulcer, Cardio protective etc.
Dr Kavitha S 91
Tila: Tila is considered be Nidrajanaka in Bhava Prakasha Samhita.
Table No. 30: showing the Properties of Tila119
Latin name Sesamum indicum
Family Pedaliaceae
Gana:Charaka Svedopaga, Purisa virajaniya
Vernacular Names Hindi: Til, English: Sesamum seeds, Telugu: Nuvvulu, Tamil:
Ellu, Kannada :Ellu
Rasa Madhura, Kashaya and Tikta
Guna Snigdha, Tikshna, Guru, Vyavayi, Ushna, Sara
Veerya Ushna
Vipaka Madhura
Action VataShamaka Tvachya, Balya, Kesya, Sukrala
Indication Vata roga, Grahani, Agnimandya, Yoni-roga
Chemical Neutral lipids, glycolipids and phospholipids, sesamose,
constituents sesamolin, sesamolinol, sesamol, pinoresinol.
Mamsa: Various vargas of Mamsa are considered as Nidrajanaka in different texts.
Gramya, Anupa and Jaleeya mamsa rasa is said to be Nidrajanaka in Charaka
Samhita, Astanga Hridaya and Bhava Prakasha.Mamsa of Bila and Vishkira animals
is said to be Nidrajanaka in Sushrutha Samhita. Mamsa of Anupa deshiya animals and
birds is considered as Nidrajanaka in Astanga Sangraha. Matsya is considered as
Nidrajanaka in Kashyapa Samhita, Bhava Prakash and Bhaishajya Ratnavali. Varaha
Mamsa is considered as Nidrajanaka in Dhanvantari Nighantu and Raja Nighantu.
Dr Kavitha S 92
Table No. 31: showing Different varieties of mamsa used in Nidranasha120
Rasa Guna Karma Indication

Gramya Madhura, Laghu, Ruksha Dipana, Balya, Vata Vyadhi,
mamsa Kashaya Brumhana, Vrushya Prameha, Slipada,
Galaganda.
Anupa Madhura Snighdha, Kapha vardaka, Krisatva. Nidra
Mamsa Guru, Picchila, Agnishamaka and nasha
Abhishyandi, Brumhana.
Aja Mamsa Madhura Na atisheeta, Adoshakaraka Shosha roga.
Guru, Snighda, Brumhana. tridoshanut, it Rajayakshma
Abhishyandi, is adaahi, Param Nidra nasha.
Balakaram, Ruchyam,
Virya Vardhanam.
Avi Mamsa Madhura Sheeta Brimhana Nidra nasha.
Mahisha Madhura Snighda, Guru, Tarpana, Vrushya, Nidra nasha.
Mamsa Ushna Brumhana, Nidrajanana.
Varaha Madhura Guru, Snighda, Vata shamaka, Swedana,
Mamsa Shramagna, Balya,
Rochana, Vrushya,
Brumhana.
Kukkuta Madhura Guru, Vata shamaka, Kapha Nidra nasha.

Mamsa Snighdha, karaka, Balya, Vrushya,
Ushn virya Brumhana, Chakshushya,
Sasha Madhura, Laghu, Tridoshagna Nidra nasha.

Mamsa Kashaya, Ruksha,
Katu Sheeta virya
vipaka
Dr Kavitha S 93
Previous works done:
1. Pujari Muralidhar.P. The Effect of Shiro Basti in the management of Nidra
Nasha w.s.r. to Primary Insomnia. Dept. of Kayachikitsa; Govt. Ayurveda
Medical College, Mysore: 1999.
2. Sahoo Srinibash. A Compararitive Study on the Effect of Jala Dhara and Taila
Dhara. Dept. of Manasa roga; S.D.M.College of Ayurveda, Hassan: 2002.
3. Chaudary Vinay. A Study on Nidranasha vis-a-vis Insomnia and Effect of
Amalaki Shirolepa against Amalaki Shirodhara. Dept. of Manasa Roga; Govt.
Ayurveda College, Kottakal: 2005.
4. Todkar Swati. Study of the Effect of Abhyanga Karma in Nidranasha. Dept. of
Swasthavritta; Tilak Ayurveda Mahavidyalaya, Pune: 2005.
Dr Kavitha S 94
MATERIALS
The materials used for the study is categorized in to following three headings.
1. Literary source
2. Drugs
3. Assessment tools
Collection of Material
Literary source
Literary source for the present study was obtained from Vedic scriptures, classical
texts of Ayurveda, Sanskrit dictionaries, books related to western science, Articles
published in reputed journals and also from the various media like Internet etc
followed by retrospective study of related research works.
Drugs
1. Sookshma churna of Pippalimoola was purchased from sri Anjaneya herbals
Vijayawada, Andhra Pradesh
2. Guda was purchased from More mega store Mysore.
Assessment tools
1. Pittsburgh Sleep Quality Index (PSQI)
The Pittsburgh Sleep Quality Index (PSQI) (Buysse et al. 1989a) was developed to
measure sleep quality during the previous month and to discriminate between good
and poor sleepers. Sleep quality is a complex phenomenon that involves several
dimensions, each of which is covered by the PSQI. The covered domains include
Subjective Sleep Quality, Sleep Latency, Sleep Duration, Habitual Sleep Efficiency,
Sleep Disturbances, Use of Sleep Medications, and Daytime Dysfunction.
Dr Kavitha S 95
DESCRIPTION
The PSQI is composed of 19 self-rated questions and 5 questions rated by a bed
partner or roommate (only the self-rated items are used in scoring the scale). The self-
administered scale contains 15 multiple-choice items that inquire about frequency of
sleep disturbances and subjective sleep quality and 4 write-in items that inquire about
typical bedtime, wake-up time, sleep latency, and sleep duration. The 5 bed partner
questions are multiple-choice ratings of sleep disturbance. All items are brief and easy
for most adolescents and adults to understand. The items have also been adapted so
that they can be administered by a clinician or research assistant. Sample self-rated
items are provided in Example 30 –1.
The PSQI generates seven scores that correspond to the domains listed previously.
Each component score ranges from 0 (no difficulty) to 3 (severe difficulty). The
component scores are summed to produce a global score (range of 0–21). A PSQI
global score >5 is considered to be suggestive of significant sleep disturbance. Cutoff
scores are not available for component scales.
PRACTICAL ISSUES
It takes most patients 5–10 minutes to complete the PSQI. No training is needed to
administer and score it. Scoring time is less than 5 minutes.
PSYCHOMETRIC PROPERTIES
Reliability
Internal consistency was demonstrated in a sample of healthy control subjects (n =
52), patients with sleep disorders (n = 62), and depressed patients (n = 34);
Cronbach’s alpha was 0.83 for the global score. Correlations between the component
Dr Kavitha S 96
scales and the total score ranged from 0.35 to 0.76. Correlations of items with the total
score ranged from 0.20 to 0.66. Test-retest reliability (average interval of 28 days)
with a subset of 91 of the patients and control subjects described earlier (43 control
subjects, 22 depressed patients, and 26 patients with sleep disorders) was 0.85 for the
global score and 0.65–0.84 for component scales. A small sample of elderly patients
(n = 19) evaluated over an average interval of 19 days revealed similar findings
(global reliability = 0.82; component scale score = 0.45–0.84).
Validity
Patients with sleep disorders (n = 62) or psychiatric disorders associated with sleep
disturbances (e.g., depressive and anxiety disorders) (n = 34) scored significantly
higher than healthy control subjects (n = 52) on global and component scales.
Component scales
significantly differentiated diagnostic groups. A post hoc cutoff score of 5 on the
PSQI produced a sensitivity of 89.6% and a specificity of 86.5% of patients versus
control subjects. This cutoff score correctly identified 84% of patients with disorders
of initiating or maintaining sleep, 89% of patients with disorders of excessive
sleepiness, and 97% of depressed patients. Group differences on the PSQI between
patients and control subjects were substantiated by comparable group differences in
polysomonographic measures for sleep latency, sleep efficiency, sleep duration, and
number of arousals. However, PSQI component scale scores were not significantly
correlated with corresponding polysomnographic measures (in the same sample of
148 patients and control subjects), with the exception of sleep latency (r = 0.33). The
Dr Kavitha S 97
global PSQI score was correlated with sleep latency (r = 0.20) but not with any other
polysomnographic measures.
In studies that compared patients with anxiety disorders with control subjects, those
with panic disorder and those with social phobia exceeded the control group on global
PSQI scores and on Subjective Sleep Quality, Sleep Latency, Sleep Disturbances, and
Daytime Dysfunction subscales.
CLINICAL UTILITY
The PSQI was designed to provide a reliable, valid, and standardized measure of sleep
quality. Preliminary results with the scale suggest that it is successful on all three
counts.
Within sleep disorder treatment settings, the test should be useful in providing initial
indexes of the severity and nature of sleep disturbances. Within a general psychiatric
or medical setting, the PSQI appears to be useful as an initial screen to identify good
and poor sleepers. Furthermore, although not as psychometrically sound as the overall
score, the component scales appear to provide preliminary signs of specific types of
sleep disturbance. Although in theory the PSQI should be useful in identifying
patients for whom polysomnographic evaluation may be necessary, its actual
performance as a screening tool has not been reported (i.e., false-positive and false-
negative rates compared with results from the polysomnogram). The PSQI component
scales do not, by and large, reflect corresponding polysomnographic findings. In any
case, the PSQI is not sufficient to provide accurate clinical diagnoses of sleep
disorders. Furthermore, there are no data establishing its sensitivity to change; thus, it
is not known whether the scale is useful for monitoring treatment response.
Dr Kavitha S 98
PITTSBURGH SLEEP QUALITY INDEX (PSQI)
Name__________________________ Date________ Age___ After Treatment /
After Follow-up
1. During the past month, when have you usually gone to bed at night?
USUAL BED TIME_________________________
2. During the past month, how long (in minutes) has it usually taken you to fall asleep
each night?
NUMBER OF MINUTES_____________________
3. During the past month, when have you usually gotten up in the morning?
USUAL GETTING UP TIME__________________
4. During the past month, how many hours of actual sleep did you get at night? (This
may be different than the number of hours you spend in bed.)
HOURS OF SLEEP PER NIGHT______________
5. During the past month, how often have Not during the Less than Once or Three or
you had trouble sleeping because you. past month once a week twice a more
week times a
week
a. Cannot get to sleep within 30 minutes
b. Wake up in the middle of the night or
early morning
c. Have to get up to use the bathroom
d. Cannot breathe comfortably
e. Cough or snore loudly
f. Feel too cold
g. Feel too hot
h. Have bad dreams
i. Have pain
j. Other reason(s), please describe:
6. During the past month, how often have

you taken medicine to help you sleep
(prescribed or “over the counter”)?
Dr Kavitha S 99
7. During the past month, how often have

you had trouble staying awake while
driving, eating meals, or engaging in
social activity?
No problem at Only a very Some what A very
all slight of a big
problem problem problem
8. During the past month, how much of a
problem has it been for you to keep up
enough enthusiasm to get things done?
Very good Fairlygood Fairly bad Very bad
9. During the past month, how would you
rate your sleep quality overall?
No bed Partner/roo Partner in Partner in
partner or m mate in same room same bed
roommate other room but not
same bed
10. Do you have a bed partner or room
mate?
Not during the Less than Once or Three or
past month once a week twice a more
week times a
week
If you have a room mate or bed partner,
ask him/her how often in the past month
you have had:
a. Loud snoring
b. Long pauses between breaths while
asleep
c. Legs twitching or jerking while you
sleep
d. Episodes of disorientation or confusion
during sleep
e. Other restlessness while you sleep,
please describe:
Dr Kavitha S 100
METHODS
Aim: To evaluate the efficacy of Guda Pippalimula yoga on Nidranasha.
Objectives of the study:
¾ To systematically review & study the literature on Nidranasha, available in all
Ayurvedic classics.
¾ To review literature on Nidrajanaka Ahara and modifications suggested to
prevent and manage Nidranasha.
¾ To clinically evaluate the efficacy of Guda Pippalimula yoga in Nidranasha by
comparing with Ayurvedic diet suggested in Nidranasha (Primary Insomnia).
Source of data:
¾ Literary Sources: All the available data on Nidranasha collected from different
Vedic scriptures, Upanishads, Darshana shastras, Ayurvedic and Modern text
books.
b. Sample: 45 patients coming under inclusion criteria approaching the OPD & IPD of
Government Ayurveda Medical College & Hospital, Mysore and special camps
conducted in and around Mysore were selected for the study.
Methods of Collection of data:
Patients were selected on the basis of age, irrespective of sex, socio-economic status
and caste, having the signs and symptoms of Nidranasha.
Dr Kavitha S 101
Inclusion Criteria:
Patients of either sex between the age group of 30-50 years.
Patients with symptoms of Nidranasha (primary insomnia).
Primary Insomnia with a history of one to five years.
Exclusion Criteria:
Patients suffering from other systemic illnesses and on any medication.
Patients who have undergone any surgery within the past 6 months.
Diagnostic Criteria:
Normal sleep pattern-
6-8 hours of sleep will be considered as normal sleep.
15-30 minutes of duration to initiate the sleep without any disturbances will be
considered as normal.
Abnormal sleep pattern:
If the patient is having difficulty in initiating sleep even after one hour.
Reduction in sleep time for more than two hours.
Discontinuation of sleep for at least two to three times.
Parameters of the study:
*Pittsburgh Sleep Quality Index (PSQI)
Dr Kavitha S 102
Sampling Method
Purposive sampling was done. 45 patients coming under inclusion criteria
approaching the OPD & IPD of Government Ayurveda Medical College & Hospital,
Mysore and special camps conducted in and around Mysore were selected for the
study.
Research Design
After the Diagnosis, the selected patients were assigned to identical group of 15
patients in each of the 3 Groups. This is a Single Blind Comparative Clinical Study.
All the Patients were treated on O.P.D basis only and Pre- Treatment, Post- treatment
and Post Follow-Up readings were recorded to assess various parameters of this
study.
Statistical Analysis to assess Individual and comparative effects of the groups was
done using Chi- Square test, One Sample t- test, Contingency Co-efficient Test and
Repeated Measures ANOVA. Analysis was considered by SPSS for windows
(Statistical presentation system software) version 14 developed by SPSS, New York
(2005).
INTERVENTION:
Patients were assigned into three groups of 15 subjects each:
Group A: 2g Pippalimula choorna along with 2g of Guda was administered with
milk, in the evening after meals; along with diet suggested in Nidranasha as per our
classics, for a period of 48days.
For Group B: 2g Pippalimula choorna along with 2g of Guda was administered with
milk, in the evening after meals, for a period of 48days.
Dr Kavitha S 103
For Group C: Only diet suggested in Nidranasha as per our classics was prescribed in
the form of a Diet Chart, for a period of 48days.
The follow up period was for48days.
Table No. 32: showing the diet chart given to the Groups A and C
Sl. NO. Time Diet

1 6.00 AM One glass of Milk{150 ml} with jaggery.
2 8.00 AM Chapati/poori/Idli/Dosa/Uddin Vada/Paratha with
ghee/wheat upma with Ghee
3 11.00 AM Sugarcane juice/grape juice
4 1.00 PM Shastika Shali rice with curd and curry prepared
from fish,prawns,chicken,mutton,Beef,Pork,Basella
leaves,onion,Sesamum. Sweet prepared from
milk,jaggery, wheat,black gram laddu
5 4.00 PM Sweet Lassi /Sugar cane juice/grape juice/
6 7.30 PM Chapati or paratha with ghee and curry prepared
from fish,prawns,chicken,mutton,Beef,Pork,Basella
leaves,onion,Sesamum and Curd.
7 9.30 PM One glass of milk{150 ml } with jiggery
Assessment Criterion
In scoring the PSQI, seven component scores are derived, each scored 0 (no
difficulty) to 3 (severe difficulty). The component scores are summed to produce a
global score (range 0 to 21). Higher scores indicate worse sleep quality.
Dr Kavitha S 104
Table No. 33: showing Component 1: Subjective sleep quality—question 9
Response to Q9 Component 1 score

Very good 0
Fairly good 1
Fairly bad 2
Very bad 3
Component 1 score:_____
Table No.34: showing Component 2: Sleep latency—questions 2 and 5a
Table No. 34(a): showing the response to C2/Q2 subscore
Response to Q2 Component 2/Q2 subscore

< 15 minutes 0
16-30 minutes 1
31-60 minutes 2
> 60 minutes 3
Table No. 34(b): showing the response to C2/Q5a subscore
Response to Q5a Component 2/Q5a subscore

Not during past month 0
Less than once a week 1

Once or twice a week 2
Three or more times a week 3
Table No.34(c): showing the sum of Q2 and Q5a subscores (C2)
Sum of Q2 and Q5a subscores Component 2 score

0 0
1-2 1
3-4 2
5-6 3
Dr Kavitha S 105
Table No. 35: showing Component 3: Sleep duration—question 4
> 7 hours 0
6-7 hours 1
5-6 hours 2
< 5 hours 3
Table No. 36: showing Component 4: Sleep efficiency—questions 1, 3, and 4
Sleep efficiency = (# hours slept/# hours in bed) X 100%
# hours slept—question 4
# hours in bed—calculated from responses to questions 1 and 3
Sleep efficiency Component 4 score

> 85% 0
75-84% 1
65-74% 2
< 65% 3
Table No. 37(a): Showing Component 5: Sleep disturbance—questions 5b-5j
Questions 5b to 5j should be scored as follows:

Dr Kavitha S 106
Table No. 37(b): showing the sum of 5b to 5j scores
Sum of 5b to 5j scores Component 5 score

0 0
1-9 1
10-18 2
19-27 3
Table No. 38: showing Component 6: Use of sleep medication—question 6

Component 7: Daytime dysfunction questions 7 and 8
Table No. 39(a): showing theresponse to C7/ Q7 subscore

Table No. 39(b): showing the respone to C7/Q8 subscore

No problem at all 0
Only a very slight problem 1
Somewhat of a problem 2
A very big problem 3
Dr Kavitha S 107
Table No. 39(c): showing the sum of Q7 andQ8 subscores(C7)
Sum of Q7 and Q8 subscores Component 7 score
0 0
1-2 1
3-4 2
5-6 3
Global PSQI Score: Sum of seven component scores:__________
Dr Kavitha S 108
OBSERVATION
Total 30 patients coming under the inclusion criteria were randomly selected for the
clinical study and made into three groups. Observations in the present study were
done in following manner ;
General Observations
Observation during intervention
Observation on results
General observations
The present study was conducted on 45 patients who were divided into three groups
of 15 patients in each group. The following are the observations under different
aspects.
Age: Out of 45 samples, 15 patients (33.3%) were in the age group of 30-40 and 30
patients (66.7%) were in the age group of 40-50.
Table No. 40: Distribution of Age Group among the 45 patients taken for Study
Frequency Percent
30-40 15 33.3
AGE 40-50 30 66.7
Total 45 100.0
Sex: Table No.41 : Distribution of Sex among the 45 patients taken for Study
Frequency Percent
Male 14 31.1
SEX Female 31 68.9
Total 45 100.0
Out of 45 samples, 14 were Male (31.1%) & 31 were Female (68.9%).
Dr Kavitha S 109
Marital Status :
Table No. 42: Distribution of Marital Status among the 45 patients taken for
Study
Frequency Percent
Married 33 73.3
MARITAL Unmarried 5 11.1
STATUS Widow 7 15.6
Total 45 100.0
Out of 45 samples, 33 patients (73.3%) were Married and 5 patients (11.1%)
were unmarried and 7 patients (15.6%) were Widow.
Religion:
Table No. 43: Distribution of Religion among the 45 patients taken for Study
Frequency Percent
Hindu 38 84.5
RELIGION Muslim 5 11.1
Christian 1 2.2
Jain 1 2.2
Total 45 100.0
Out of 45 samples, 38 patients (84.5%) were Hindus, 5 patients (11.1%) were
Muslims, 1 patient was a Christian and 1 patient was a Jain.
Dr Kavitha S 110
Location: Table No. 44: Distribution of Location among the 45 patients
Frequency Percent
Rural 11 24.5
LOCATION Urban 34 75.5
Total 45 100.0
Out of 45 samples, 11patients (24.5%) were from Rural area and 34 patients (75.5%)
were from Urban area.
Occupation :
Table No. 45: Distribution of Occupation among the 45 patients taken for Study
Frequency Percent
Agriculturist 2 4.4
Shop-keeper 3 6.7
House-wife 30 66.7
OCCUPATION Salesman 3 6.7
Govt. Official 2 4.4
Teacher 4 8.9
Mason 1 2.2
Total 45 100.0
Out of 45 samples, 2 patients (4.4%) were Agriculturists, 3 patients (6.7%) were
Shopkeepers, 30 patients (66.7%) were House wives, 3 patients (6.7%) were
Dr Kavitha S 111
Salesmen, 2 patients (4.4%) were Government Officials, 4 patients (8.9%) were
Teachers and 1 patient (2.2%) was a Mason.
Socio-Economic Status:
Table No. 46: Distribution of Socio-Economic Status among the 45 patients taken
for Study
Frequency Percent
Poor 16 35.5
SOCIO- Lower Middle class 25 55.6
ECONOMIC
STATUS Upper middle class 4 8.9
Total 45 100.0
Out of 45 samples, 16 patients were Poor (35.5%), 25 patients (55.6%) belonged to
the Lower Middle Class and 4 patients (8.9%) belonged to the Upper Middle Class.
Education:
Table No. 47: Distribution of Education among the 45 patients taken for Study
Frequency Percent
Illiterate 13 28.9
Primary 7 15.5
Secondary 18 40.0
EDUCATION Graduate 4 8.9
Post graduate 3 6.7
Total 45 100.0
Dr Kavitha S 112
Out of 45 samples,13 patients (28.9%) were Illiterate, 7 patients (15.5%) had

completed their Primary Education, 18 patients (40%) had completed their Secondary
Education, 4 patients (8.9%) were Graduates and 5 patients (6.7%) were Post
Graduates.
Nature of Work :
Table No48: Distribution of Nature of Work among the 45 patients
Frequency Percent
Active 25 55.6
NATURE Sedentary 20 44.4
OF Total
45 100.0
WORK
Out of 45 samples, 25 patients (55.6%) were Active, whereas 20 patients (44.4%) had
Sedentary nature of work.
Diet:
Table No. 49: Distribution of Diet among the 45 patients taken for Study
Frequency Percent
Veg 18 40.0
DIET Mixed 27 60.0
Total 45 100.0
Out of 45 samples, 18 patients (40%) consumed Vegetarian Diet whereas 27 patients
(60.0%) consumed Mixed Diet (both vegetarian and non-vegetarian foods)
Dr Kavitha S 113
Chronicity: Table No. 50: Distribution of Chronicity among the 45 patients
Frequency Percent
12-24 months 33 73.3

CHRONICITY 25-60 months 12 26.7
Total 45 100.0
Out of 45 samples, 33 patients (73.3%) reported chronicity ranging between 12-
24 months, while 12 patients reported chronicity ranging between 25-60 months.
Habits:
Table No. 51: Distribution of Habits among the 45 patients taken for Study
Frequency Percent
No habits 1 2.2
Tea 16 35.6
Coffee 18 40.0
HABITS Tea & Coffee 9 20.0
Tea, Cigarette& Alcohol 1 2.2
Total 45 100.0
Out of 45 samples, 1 patient (2.2%) had no Habits, 16 patients (35.6%) had the
Habit of taking tea, 18 patients (40%) had the Habit of taking coffee, 9 patients (20%)
had the Habit of taking both tea and coffee, 1 patient (2.2%) had the Habit of taking
tea, cigarette and alcohol.
Dr Kavitha S 114
Prakruti:
Table No. 52: Distribution of Prakruti among the 45 patients taken for Study
Frequency Percent
Vata-Pitta 28 62.2
Pitta-Kapha 2 4.4
Kapha-Vata 15 33.4
PRAKRUTI Total 45 100.0
Out of 45 samples, 28 patients (62.2%) were of Vata-Pitta Prakruti, 2 patients (4.4%)

were of Pitta-Kapha Prakruti and 15 patients (33.4%) were of Kapha-Vata Prakruti.
Sara:
Table No. 53: Distribution of Sara among the 45 patients taken for Study
Frequency Percent
Pravara 2 4.4
SARA Madhyama 33 73.4
Avara 10 22.2
Total 45 100.0
Out of 45 samples, 2 patients had Pravara Sara (4.4%), 33 patients had
Madhyama Sara (73.4%) and 10 patient had Avara Sara (22.2%).
Samhanana: Table No. 54: Distribution of Samhanana among the 45 patients
Frequency Percent
Pravara 6 13.3
SAMHANANA Madhyama 30 66.7
Avara 9 20.0
Total 45 100.0
Out of 45 samples, 6 patient had Pravara Samhanana (13.3%), 30 patients had
Madhyama Samhanana (66.7%) and 9 patients had Avara Samhanana (20%).
Dr Kavitha S 115
Pramana: Table No. 55: Distribution of Pramana among the 45 patients
Frequency Percent
Pravara 4 8.9
PRAMANA Madhyama 39 86.7
Avara 2 4.4
Total 45 100.0
Out of 45 samples, 4 patients were of Pravara Pramana (8.9%), 39 patients were of
Madhyama Pramana (86.7%) and 2 patients were of Avara Pramana (4.4 %).
Satmya: Table No. 56: Distribution of Satmya among the 45 patients
Frequency Percent
Avara 21 46.6
SATMYA Madhyama 24 53.4
Total 45 100.0
Out of 45 samples, 21 patients had Madhyama Satmya (46.6%) and 24 patients had
Avara Satmya (53.4%).
SATTVA Table No. 57: Distribution of Sattva among the 45 patients
Frequency Percent
Pravara 1 2.2
SATTVA Madhyama 14 31.1
Avara 30 66.7
Total 45 100.0
Out of 45 samples, 1 patient had Pravara Sattva (2.2%), 14 patients had
Madhyama Sattva (31.1%) and 30 patients had Avara Sattva (66.7%).
Dr Kavitha S 116
Agni: Table No. 58: Distribution of Agni among the 45 patients taken for Study
Frequency Percent
Sama 33 73.4
AGNI Manda 7 15.5
Vishama 5 11.1
Total 45 100.0
Out of 45 samples, 33 patients had Samagni (73.4%), 7 patients had Mandagni and 5
patients had Vishamagni (11.1).
Koshta: Table No. 59: Distribution of Koshta among the 45 patients
Frequency Percent
Madhyama 30 66.7
KOSHTA Mridu 3 6.6
Kroora 12 26.7
Total 45 100.0
Out of 45 samples, 30 patients had Madhyama Koshtha (66.7%), 3 patients had

Mridu Koshta (6.6%) and 12 patients had Kroora Koshtha (26.7%).
Vyayama Shakti: Table No. 60: Distribution of Vyayama Shakti among the 45
patients taken for Study
Frequency Percent
Pravara 4 8.9
VYAYAMA SHAKTI Madhyama 32 71.1
Avara 9 20.0
Total 45 100.0
Out of 45 samples, 4 patients had Pravara Vyayama Shakti (8.9%), 32 patients had
Madhyama Vyayama Shakti (71.1%) and 9 patients had Avara Vyayama
Shakti(20%).
Dr Kavitha S 117
Onset: Table No. 61: Distribution of Onset among the 45 patients taken for
Study
Frequency Percent
Gradual 20 44.4
ONSET Sudden 25 55.6
Out of 45 samples, 20 patients (44.4%) had Gradual Onset of the disease whereas 25
patients had Sudden Onset of the disease.
Associated Symptoms : Associated symptoms like Shirogaurava was present in
46.6% of patients, Angamarda in 64.4%, Jrumbha in 60.0%, Shiroshula in 35.5%,
Apakti is 48.8%, Glani is 51.1%, Klama in 71.1%, Shrama in 24.4%, Bhrama is
22.2% and Aruchi is44.4% each in 38.46% of patients (Table No. 36).
Table No. - 61
Associated symptoms complained by 45 patients of Nidranasha
Associated symptoms No.of patients %
Angamarda 29 64.4
Apakti 22 48.8
Aruchi 20 44.4
Shirogaurava 21 46.6
Jrumbha 27 60.0
Glani 23 51.1
Bhrama 10 22.2
Shrama 11 24.4
Klama 32 71.1
Shiroshula 16 35.5
Dr Kavitha S 118
Illustration No. 1 – Showing age wise Illustration No. 3 – Showing marital
distribution of 45 patients in status wise distribution of 45 patients
Nidranasha in Nidranasha
Illustration No. 2 – Showing sex wise Illustration No. 4 – Showing religion
distribution of 45 patients in wise distribution of 45 patients in
Nidranasha Nidranasha
Dr Kavitha S 119
Illustration No. 5 – Showing Illustration No. 7– Showing socio
Occupation wise distribution of 45 economic status wise distribution of
patients in Nidranasha 45 patients inNidranasha;
Illustration No. 6 – Showing Illustration No. 8 – Showing diet
Education wise distribution of 45 wise distribution of 45 patients in
patients in Nidranasha Nidranasha
Dr Kavitha S 120
Illustration No. 9 – Showing locality Illustration No. 11 – Showing Nature
wise distribution of 45 patients in of work distribution of 45 patients
Nidranasha:
Illustration No. 10 – Showing mode Illustration No. 12 – Showing
of onset wise distribution of 45 prakruti wise distribution of 30
patients in Nidranasha patients in Vataja Kasa;
Dr Kavitha S 121
Illustration No. 13 – Showing Sara Illustration No. 15 – Showing
wise distribution of 45 patients in Pramana wise distribution of 45
Nidranasha patients in Nidranasha
Illustration No. 14 – Showing Illustration No. 16 – Showing
Samhanana wise distribution of 45 Satmya wise distribution of 45
patients in Nidranasha patients in Nidranasha
Dr Kavitha S 122
Illustration No. 17 – Showing Sattva Illustration No. 19 – Showing Koshta
wise distribution of 45 patients in wise distribution of 45 patients in
Nidranasha Nidranasha;
Illustration No. 18 – Showing Agni Illustration No. 20 – Showing
wise distribution of 45 patients in Vyayama shakti wise distribution of
Nidranasha 45 patients in Nidranasha;
Dr Kavitha S 123
Illustration No. 21 – Showing chronicity distribution of 45 patients in Nidranasha
Dr Kavitha S 124
OBSERVATIONS DURING INTERVENTION
It was observed that all most all the patients preferred and consumed pungent, hot and
spicy foods.
It was observed that most people had difficulty in initiating sleep
The palatability of the drug was not very good, due to the katu rasa of Pippalimoola.
Even the addition of Guda couldn’t make Pippalimula Palatable.
Most of them were eager to get rid of sedatives they were using.
Some of the patients observing the diet chart have complained difficulty in digesting
the frequent non vegetarian meal.
Dr Kavitha S 125

RESULTS
Table No. 62: showing Global PSQI in Group A
Sl.N 1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 Total
o Score
BT 16 15 13 19 16 16 15 19 18 17 20 16 19 17 14 250
AT 8 8 3 9 5 4 4 4 5 6 6 7 5 3 9 86
FU 13 11 12 12 6 11 5 7 6 12 11 9 8 8 14 131
Table No. 63: showing Global PSQI in Group B
Sl.No 1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 Total
Score
BT 14 17 13 15 16 19 18 19 19 17 19 18 18 16 15 253
AT 5 4 5 9 5 4 6 6 6 8 10 4 10 8 8 98
FU 9 8 7 15 6 6 9 7 13 12 15 11 15 13 15 161
Table No. 64: showing Global PSQI in Group C
Sl.No 1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 Total
Score
BT 18 18 19 17 19 18 19 16 20 15 16 17 19 15 16 262
AT 8 13 14 14 13 3 5 8 16 9 6 11 14 12 7 153
FU 13 16 17 16 15 8 11 12 19 15 16 15 19 15 14 221
Table No. 65: showing the Mean Global PSQI values in Group A, B and C
Group Before Treatment After Treatment After FollowUp
Group A 16.67 5.73 8.73
Group B 16.87 6.53 10.73
Group C 17.47 10.20 14.73
Total 17 7.49 11.40
Dr Kavitha S 126

Table No.66: Showing General Linear Model-Descriptive Statistics of Global
PSQI score
Std.
GROUP Mean Deviation N
PSQI Group A 16.67 2.024 15

BT Group B 16.87 1.959 15
Group C 17.47 1.598 15
Total 17.00 1.859 45
PSQI Group A 5.73 2.052 15

AT Group B 6.53 2.134 15
Group C 10.20 3.913 15
Total 7.49 3.395 45
PSQI Group A 9.67 2.845 15

AF Group B 10.73 3.494 15
Group C 14.73 2.890 15
Total 11.71 3.739 45
Table showing Tests of Within-Subjects Effects for Global PSQI
Source Type III Sum of Squares df Mean Square F Sig.
CHANGE 2043.911 2 1021.956 219.938 .000
CHANGE * GROUP 90.444 4 22.611 4.866 .001
Error(CHANGE) 390.311 84 4.647
Dr Kavitha S 127

C1 Component 1: Subjective sleep quality
Table No. 67: showing total scores of C1 in Group A
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 2 2 3 2 2 2 3 3 3 3 3 2 2 2 36
AT 1 0 0 1 1 0 1 0 0 1 1 1 0 0 1 8
FU 2 1 2 1 1 1 1 1 1 2 1 1 1 1 2 19
Table No. 68: showing total scores of C1 in Group B
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 2 2 3 2 3 3 3 2 2 3 2 3 2 2 36
AT 0 0 1 1 0 0 1 1 1 1 1 0 1 1 1 10
FU 1 1 1 2 0 1 1 1 1 2 2 1 2 2 2 20
Table No. 69: showing total scores of C1 in Group C
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 2 3 3 3 2 3 1 2 2 3 2 2 37
AT 1 2 2 2 1 0 1 1 2 0 1 1 2 1 1 18
FU 2 3 2 2 1 1 2 2 1 1 2 2 3 2 2 28
Table No.70: Showing results of Component 1: Subjective sleep quality
Group A 2.4 0.53 1.27
Group B 2.4 0.67 1.33
Group C 2.47 1.20 1.87
Dr Kavitha S 128

Table No. 71: Showing Symmetric Measures in Component 1: Subjective sleep
quality
Groups Value Approx. Sig
Group A Nominal by Nominal Contingency Coefficient .709 .000
Group B Nominal by Nominal Contingency Coefficient .670 .000
Group C Nominal by Nominal Contingency Coefficient .581 .001
The Mean score of Group A in Subjective Sleep Quality Before Treatment is 2.4,
After Treatment is 0.53 and After Follow up is 1.27.
The Mean Score of Group B in Subjective Sleep Quality Before Treatment is 2.4,
The Mean Score of Group C in Subjective Sleep Quality Before Treatment is 2.47,
The Improvement in Subjective Sleep Quality is statistically highly significant in
Group A and Group B; in Group C the Subjective Sleep Quality is statistically
significant
Component 2: Sleep latency
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45
AT 2 1 1 2 1 1 1 1 2 1 1 1 2 0 2 19
FU 3 2 3 3 2 2 1 2 1 2 2 2 2 1 3 31
Dr Kavitha S 129

Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45
AT 1 1 1 2 1 1 1 0 1 1 2 1 2 2 1 18
FU 3 1 2 3 1 1 2 1 3 2 3 2 3 3 3 33
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45
AT 2 2 3 2 3 1 0 1 2 2 2 2 2 3 1 28
FU 3 3 3 2 3 2 2 2 3 3 3 3 3 3 2 40
Table No. 75: Showing results of Component 2: Sleep latency
Group Before After Treatment After FollowUp

Treatment
Group A 3 1.27 2.07
Group B 3 1.20 2.20
Group C 3 1.87 2.67
Table No. 76: Showing Symmetric Measures in Component 2: Sleep latency
The Mean score of Group A in Sleep Latency Before Treatment is 3, After Treatment
is 1.27 and After Follow up is 2.07.
Dr Kavitha S 130

The Mean Score of Group B in Sleep Latency Before Treatment is 3, After Treatment
The Mean Score of Group C in Sleep Latency Before Treatment is 3, After Treatment
The Improvement in Sleep Latency is statistically highly significant in Group A and
Group B; in Group C the Sleep Latency is statistically significant.
C3 Component 3: Sleep duration
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 2 3 3 3 3 3 3 3 3 2 3 3 2 42
AT 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 17
FU 2 2 2 2 1 2 1 1 1 2 2 1 1 1 2 23
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 2 3 3 3 3 3 3 3 3 2 3 3 2 42
AT 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 17
FU 2 2 2 2 1 2 1 1 1 2 2 1 1 1 2 23
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 44
AT 1 3 2 2 2 0 1 1 3 2 1 2 3 1 1 23
FU 2 3 3 3 3 1 2 2 3 3 3 3 3 2 3 39
Dr Kavitha S 131

Table No. 80: Showing results of Component 3: Sleep duration
Group A 2.8 1.13 1.53
Group B 2.8 1.13 1.53
Group C 2.93 1.53 2.60
Table No. 81: Showing Symmetric Measures in Component 3: Sleep duration
The Mean score of Group A in Sleep duration
Before Treatment is 2.8, After Treatment is 1.13 and After Follow up is 1.53.
The Mean Score of Group B in Sleep duration Before Treatment is 2.8 , After
Treatment is 1.13 and After Follow up is 1.53.
The Mean Score of Group C in Sleep duration Before Treatment is 2.93, After
The Improvement in Sleep duration is statistically highly significant in Group A and
Group B; in Group C the Sleep duration is statistically significant.
Dr Kavitha S 132

C4 Component 4: Sleep efficiency
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 1 3 3 3 3 3 2 3 3 3 3 3 2 41
AT 1 3 0 1 0 1 0 0 0 0 0 1 0 1 1 9
FU 2 3 1 3 0 3 0 1 0 2 1 2 1 2 2 23
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 0 3 1 3 3 3 3 3 3 3 3 3 3 3 3 40
AT 0 1 0 2 0 0 1 1 0 1 2 1 2 1 1 13
FU 0 2 0 3 0 0 2 1 2 3 3 3 3 2 3 27
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45
AT 1 2 3 3 3 0 0 2 3 3 2 3 3 3 1 32
FU 2 3 3 3 3 1 1 3 3 3 3 3 3 3 3 40
Table No. 85: Showing results of Component 4: Sleep efficiency
Group A 2.73 0.60 1.53
Group B 2.67 0.87 1.80
Group C 3.0 2.13 2.67
Dr Kavitha S 133

Table No. 86: Showing Symmetric Measures in Component 4: Sleep efficiency
The Mean score of Group A in Sleep efficiency Before Treatment is 2.73, After
The Mean Score of Group B in Sleep efficiency Before Treatment is 2.67, After
The Mean Score of Group C in Sleep efficiency Before Treatment is 3.0, After
The Improvement in Sleep efficiency is statistically highly significant in Group A and
Group B; in Group C the Sleep efficiency is statistically significant.
C5 Component 5: Sleep disturbance
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 1 1 2 2 1 2 2 2 3 1 3 1 3 2 2 28
AT 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15
FU 1 1 2 1 1 1 1 1 1 2 2 1 1 1 2 19
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 2 2 1 1 2 1 2 2 1 2 3 1 2 1 25
AT 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 17
FU 2 1 1 2 3 1 1 1 2 1 2 2 1 1 1 22
Dr Kavitha S 134

Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 1 1 2 2 2 2 2 1 3 2 1 2 2 2 1 26
AT 1 1 2 2 2 1 1 1 3 1 1 1 1 2 1 21
FU 1 1 2 2 2 1 1 1 3 2 1 1 2 2 1 23
Table No. 90: Showing results of Component 5: Sleep disturbance
Group A 1.87 1,0 1.27
Group B 1.67 1.13 1.47
Group C 1.73 1.40 1.53
Table No. 91: Showing Symmetric Measures in Component 5: Sleep disturbance
The Mean score of Group A in Sleep disturbance Before Treatment is 1.87, After
The Mean Score of Group B in Sleep disturbance Before Treatment is 1.67, After
The Mean Score of Group C in Sleep disturbance Before Treatment is 1.73, After
Dr Kavitha S 135

The Improvement in Sleep disturbance is statistically highly significant in Group A,
in Group B and Group C the Sleep disturbance is statistically significant.
C6 Component 6: Use of sleep medication
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 2 2 3 3 2 2 3 2 3 3 2 3 2 2 37
AT 1 1 0 1 1 0 0 1 0 1 1 1 1 0 1 10
FU 2 1 1 1 1 1 1 1 1 2 2 1 1 1 2 19
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 2 2 3 3 3 3 3 3 3 3 3 3 2 2 40
AT 0 0 1 1 1 1 0 1 1 1 1 0 1 1 1 11
FU 1 1 1 2 1 1 1 1 2 1 2 1 2 2 2 21
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 3 3 3 3 2 3 2 3 3 3 3 3 2 2 40
AT 1 2 1 2 1 1 1 1 2 1 1 1 2 1 1 19
FU 2 2 2 3 2 1 2 1 3 2 3 2 3 2 2 32
Table No. 95: Showing results of Component 6: Use of sleep medication
Group A 2.47 0.67 1.27
Group B 2.67 0.73 1.40
Group C 2.67 1.27 2.13
Dr Kavitha S 136

Table No. 96: Showing Symmetric Measures in Component 6: Use of sleep
medication
The Mean score of Group A in ‘Use of sleep medication’ Before Treatment is 3, After
The Mean Score of Group B in ‘Use of sleep medication’ Before Treatment is 3, After
The Mean Score of Group C in ‘Use of sleep medication’ Before Treatment is 3, After
The Improvement in‘Use of sleep medication’ is statistically highly significant in
Group A and Group B; in Group C the ‘Use of sleep medication’ is statistically
significant.
Component 7: Daytime dysfunction
No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score
BT 1 1 1 2 1 1 0 2 2 1 2 1 2 2 1 20
AT 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 8
FU 1 1 1 1 0 1 0 0 1 1 1 1 1 1 1 12
Dr Kavitha S 137

Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 2 2 1 2 1 2 3 2 3 2 2 1 2 1 1 27
AT 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 11
FU 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14
Sl.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total Score

BT 3 2 2 1 2 2 2 2 2 0 1 1 2 1 2 25
AT 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 12
FU 1 1 2 1 1 1 1 1 2 1 1 1 2 1 1 18
Table No. 100 – Showing results of Component 7: Daytime dysfunction
Group A 1.33 0.53 0.80
Group B 1.80 0.73 0.93
Group C 1.67 0.80 1.20
Table No. 101 – Showing Symmetric Measures in Component 7: Daytime
dysfunction
Dr Kavitha S 138

The Mean score of Group A in ‘Daytime dysfunction’ Before Treatment is 1.33, After
The Mean Score of Group B in ‘Daytime dysfunction’ Before Treatment is 1.80,
The Mean Score of Group C in ‘Daytime dysfunction’ Before Treatment is 1.67,
The Improvement in ‘Daytime dysfunction’ is statistically highly significant in Group
A and Group B; in Group C the ‘Daytime dysfunction’ is statistically significant.
Illustration No. 22 – Showing Component 1(Subjective Sleep Quality) Score
distribution in 45 patients of Nidranasha
Illustration No. 23 – Showing Component 2( Sleep Latency) Score distribution
in 45 patients of Nidranasha
Dr Kavitha S 139

Illustration No. 24 – Showing Component 3( Sleep Duration) Score distribution
Illustration No. 25 – Showing Component 4 ( Sleep Efficiency) Score distribution
Dr Kavitha S 140

Illustration No. 26 – Showing Component 5( Sleep Disturbance) Score
Illustration No. 27 – Showing Component 6( Use of Sleep Medication) Score
Illustration No. 28 – Showing Component 7( Daytime Dysfunction) Score
Dr Kavitha S 141

Illustration No. 29 – Showing Global PSQI Score distribution in 45 patients of
Nidranasha
Dr Kavitha S 142

DISCUSSION
Discussion on title
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF
DIET AND GUDA PIPPALIMULA YOGA IN PRIMARY INSOMNIA”
Ayurveda has considered Nidra as one among the three Upastambhas,which bring
about maintenance of the living organism (Ch. Su. 11/35). While discussing about
Nidra and Nidranasha in the context of Astaunindaniya Adhyaya, Charaka has stated
that happiness & sorrow, growth & wasting, strength & weakness, virility &
impotence, the knowledge & ignorance as well as existence of life and its cessation
depend on the sleep. Moreover, Nidra is Pushtida whereas Jagarana or Nidranasha
does the Karshana of the body. Untimely sleep, excessive sleep and prolonged vigil
take away both happiness and longevity, like the night of destructions (Ch. Su. 21/36-
38). GudaPippalimoola is said to be very effective in treating Nidranasha in
BhavaPrakasha samhita and Bhaishajyaratnavali. Hence this study has been taken up
to evaluate the effect of Guda Pippalimula Yoga on Nidranasha. Diet is an important
part in the management of disease. Various ahara vargas have been explained to
promote sleep. A diet chart was made using these food items which was used to
measure the effect of diet on nidranasha. Hence here a conceptual study of
nidranasha was done along with a comparative study of the efficacy of Diet and Guda
Pippali mula was done in Primary Insomia patients.
Dr Kavitha S 143

Discussion on Nirukti, Paribhasha and Paryaya of Nidranasha:
Nidranasha is the commonest symptom encountered in clinical practice. However the
definition of Nidranasha is not mentioned in any of the popular dictionaries, such as
Monier Williams Sanskrit English dictionary. But a transalatory work of 20th century
authors, have termed Nidranasha as Insomnia.
Nidranasha can be defined as Insomnia in terms of Reduction in sleep time, Difficulty
in initiating sleep and disturbances while, sleeping.
Based on the available references, “Kshaya” can be considered as the synonym of
Nasha (Bhattacharya T.T. 1990). So, the disturbance in the quality and quantity of
sleep, in terms of decreased quantity & disturbed quality of sleep can be, considered
as Nidranasha. So the definition of Nidranasha is similar to the definition of Insomnia
in all regards.
Paryayas
i) Nidranasha
The term Nidranasha is constituted by two words viz., “Nidra” and “ Nasha”. The
term “nidra” means, the phenomenon, of resting of the body which occurs usually
during night. (Bhattacharya T.T. 1570). “Nasha” has many meanings, such as, being
lost, loss, elimination, disappearance, destruction, (Williams MM 1970). Apachaya,
Hrasa, Adarshana, Bhanga (Bhattachary TT 1970). Hence, the nidranasha can be
considered as the loss of sleep i.e. which refers to the reduction in sleep time.
Dr Kavitha S 144

ii) Anidra
Na Nidra or Anidra; Nan Tatpursha which means the loss of sleep, i.e the reduction of
sleep time.
iii) Jagarana
Jagarana means to awake, waking, or keeping awake, (Williams M.M. 1970).
Jagarana is said as Nidrarahita and Nidraabhava (Bhathacharya T.T. 1970). Here the
term awake refers to the disturbances during sleep. The term nidrarahita and
nidraabhava refers to the loss of sleep i.e. reduction in sleep time.
iv) Swapna adarshana
Swapna is the synonym of nidra. Adarshana means Na darshana, i.e. the “Abhava” or
absense. It is also a condition of the Reduction in sleep time.
v) Nashtanidra
The term ‘Nashta’ means Lost, disappeared, escaped, damage and deprived (Williams
MM 1970). Here the term Nashtanidra refers to loss of sleep, damage in normal
sleep, which refers to the Disturbances during sleep and Reduction in sleep time.
vi) Alpanidra
The term Alpa means small, minute, little (William MM 1970). Alpanidra means the
little quantity of sleep which refers to the reduction in sleep time.
viii) Nidrakshaya
Kshaya means Hrasa, Adarshana & Bhanga (Bhattacharya 1970). This term refers to
loss of sleep in terms of reduction in normal sleep time.
Dr Kavitha S 145

ix) Nidrabramsha
The term Bhramsha means ‘to drop’, ‘fall down’, cessation, and loss (William’s MM
1970). Bhramsha also means “Adhahapatana” (Bhattacharya TT 1970). So the term
Nidra bramsha refers to the reduction in sleep time.
x) Nidravighata
The term Vighata refers to the ‘breaking in to pieces’, destruction and interruption
(Williams MM 1970). So it refers to the disturbance during sleep.
xi) Nidradourbalya
Here the term Dourbalya means “wakefull” (William MM 1970). “Dourbalyam
Durbalasya Bhavam” (Bhattacharya TT 1970) i.e. the nidradourbalya refers to the
wakefull sleep i.e. the disturbances during sleep.
xii) Vigatanidra
The term Vigata means Gone, disappeared, ceased, (Willaims MM 1970).
Vigatanidra means the reduction in sleep time and disturbance during sleep.
Charaka Samhita has included Asvapna (Insomnia) in Nanatmaja Vata Vikaras.
Acharya Sushruta explained this under the chapter Garbha Vyakarana Shariram,
might be because, Nidra plays a vital role in nutrition and development of the body.
We also find the explaination of Vaikariki Nidra in the same chapter which can be
correlated to sleep disorders. Vagbhatta in Ashtanga Sangraha mentioned this in
Viruddhanna-vigyaniya Adhyaya, where he explained the Trayopastambhas. Here he
considered Manda Nidra due to Vata, but used Asvapna term in Vataja Nanatmaja
Vikaras. In Ashtanga Hridaya –– Nidra, Nidra Vikaras and its Chikitsa are mentioned
Dr Kavitha S 146

under Anna-rakshadhyaya where Trayopastambhas are explained. Sharangadhara,
included Anidra in Vataja Nanatmaja Vikara, Alpa nidra in Pittaja Nanatmaja Vikara
and Atinidra under Kaphaja Nanatmaja Vikara. By observing these descriptions
regarding Nidra and Anidra, it can be concluded that all Acharyas considered the
importance of Nidra, hence Nidranasha is explained along with physiology of Nidra
itself.
Discussion on Physiology of Nidra.
Charaka Samhita has stressed the importance of Klama (fatigue) in the causation of
normal sleep. It is also an accepted fact that, the fatigue of sensory and motor organs,
along with the inertness of the Manas, results in the liberation of lactic acid, which
induces sleep. The lactic acid liberated at the myoneural junction causes the muscle
fatigue, which inturn induces sleep.
Achary Sushruta has given the importance to the organ Hridaya, which is responsible
for the initiation and mantainance of Prakrutanidra and as the chetanasthana. In this
context, the Hridaya, mentioned by Sushruta is considered as Shirohridaya which
refers to brain i.e. the inhibition of the sleep centers situated in the brain, produces the
sleep.
Acharya Vagbhata has given the importance to Kapha dosha and Shareerashrama in
the causation of Prakruta nidra. These references says that, Klama (fatigue)
Shirohridaya (sleeping center in brain) and kapha dosha and shareerashrama are
responsible for sleep. Other references say that the Tamogana is also responsible for
the causation of normal sleep.
Dr Kavitha S 147

Hence, sleep is the phenomenon in which, the mind is inert, the sensory and motor
faculty are fatigued, increase in Kaphadosha, increase in Tamoguna and absence of
gnanotpatti are present.
Discussion on the types of Nidra

The classification of sleep, by Charaka Samhitakara and Vagbhata are similar.
Table No- 39 showing the similarities of sleep
Charaka Vagbhata
Tamobhava Tamobhava
Shleshmalamudbhava Kaphobhava
Manasharamajanya Chittakhedaja
Shareera shramaga Dehakhedaga
Agantuki Agantuka
Ratriswashava Kalaswashana
Vyadhayanuvartini Anayaja
Acharya Sushruta mentions three types of Nidra. Such as
1. Tamasi Nidra (papma)

2. Prakruta nidra
3. Vaikarika nidra.
Tamasi nidra is also called as Pampma, which occurs during the pralaya kala, due to
the acculmuation of Kapha and Tamoguna in the samgnavaha srotas.
Prakruta nidra is the normal sleep and vaikarika nidra is the abnormal stages of sleep.
Dr Kavitha S 148

Table No – 102 shows the similarities of the types of sleep in Brahatrayis

Sushruta Charaka Vagbhata
Tamobhava Tamobhava
Tamasi Nidra
Shleshmasamdhbhava Kaphobhava
Prakruta Nidra Manashramasambhava Chittakhedaja
Shareerashramasambhava Dehakhedaja
Ratriswabhava Kalaswabhava
Vaikrika Nidra Agantuki Agantuka
Vyadhyanuvartini Amayaja
The conditions of Atinidra and Nidranasha can also be considered under the heading
of Vaikarika nidra. Hence, Sushruta’s classification seems accurate, while Charaka’s
and Vagbhata’s classifications are very eloborate. Sushruta’s classification includes,
all the types of sleep, explained by Charaka and Vagbhata.
Discussion on Nidana
Ayurveda gives importance to the prakrutanidra in the maintenance of health.
Incidently the authors have, mentioned the physiology of sleep, management of
atinidra condition and the caustive factors for nidranasha and its management. In
Charaka samhita, Astanga Hridaya and Ashtanga sangraha, the nidana of Nidranasha
has been explained in the context of Atinidra chikitsa. Both the authors opine that the
therapeutic measures of atinidra itself will lead to nidranasha, by saying ‘Eva Eva Cha
Vigneyo nidranashaya Hetavaha’. On the other hand Sushruta mentions, other causes
of nidranasha, such as Manasika nidanas, Abhighata, Kshaya and Dosha (vata &
pitta).
Dr Kavitha S 149

The causitive factors, explained by different authors of Ayurveda, enlisted in the
review of literature plays an important role in the production of Nidranasha.
Nidranasha is also mentioned as a vatananatmaja vikara. In this context it is termed
as “Aswapna”. Hence the vata dosha is the dosha hetu for nidranasha. Nidranasha
has also been mentioned as a symptom in some diseases such as vataja jwara, pittaja
jwara, vataja trishna etc.
Primary Imomnia is that type of Insomnia, where the cause is obscure i.e. the
Insomnia is not related to any diseased condition (psychological or physical).
Nidranasha as a Vatananatmaja vikara is also not related to any secondary condition
such as shoola daha etc., it occurs only by vatadosha not from any other conditions.
So Nidranasha in the term of Aswapna explained as a Vatananatmaja vikara, is
considered as Primary Insomnia.
Broadly the nidanas of Nidranashs can be classified as
1. Aharajanya nidanas & viharajanya nidanas

2. Manasika nidanas
3. Chikitsajanya nidanas
4. Anya nidanas.
Discussion on aharasambandhi nidanas
Rookshana
Increases rookshaguna in the body, which will lead to the vataprakopa or vatavrudhi
and causes nidranasha.
Dr Kavitha S 150

Yavanna
It is having kashayarasa and rookshaguna. These gunas cause the vitiation of pitta
and vata,thus causing nidranasha.
Discussion on viharasambandhi nidanas
Dhooma
Excessive inhalation of dhooma causes the vitiation of vata and pitta by its teekshna,
ushnu and rooksha guna. The vitiated vata and pitta will cause nidranasha.
Vyayama
Performance of excessive exercise, increases the laghu guna and Rooksha guna in the
body, at the same time the snigdha guna decreases in the body leading to kaphakshya.
As per the classics, kapha is an important cause for nidra, when there is kaphakshaya
in the body, automatically it results in nidranasha.
Upavasa
It is one type of Dashavidhalanghana. Upavasa increases the laghuguna in the body,
which lead to the gunatahavrudhi of vatadosha, which results in nidranasha.
Asukhashayya
Means improper bedding. If the bedding arrangements are not made properly, the
person will not get sleep.
Kshudha
Due to vataprakopa in Kshudha avastha, nidranasha is often seen to occur.
Dr Kavitha S 151

Maithuna
Due to atimaithuna dhatukshaya will take place which leads to kaphakshaya and
results in vatavrudhi and in turn causing nidranasha.
Discussion on Chikitsajanya nidanas
Virechana
Atiyoga of virechana will lead to Vatavruddhi. The person will suffer from many vata
rogas, when there is atiyoga of virechana. Atiyoga of virechana causes the vitiation of
vata dosha, which in turn causes nidranasha.
Nasyakarma
Sukhaswapna is one of the lakshana seen in Samyak Nasya karma. In mithya yoga of
nasya karma, the sleep pattern will change. Mithyayoga of nasyakarma will result in
the vigunata of vata dosha, which increases the rookshaguna of vatadosha leading to
nidranasha.
In the mithyayoga of nasyakarma, the vatadosha takes its ashraya in Mastulunga,
which is explained as shiromajja. When vata takes its ashraya in shiromajja, it leads to
Nidranasha.
Raktamokshana
Atiraktasrava causes the kshaya of saptadhatu, which is also responsible for
kaphakshaya. Due to kaphakshaya and resultant Vatavruddhi nidranasha occurs.
Vamana
Dr Kavitha S 152

Nidranasha has been explained as an atiyogalakshana of vamanakarma. Chakrapani
comments on this as “Nidrahanihi anilaprakopena” means in vamanatiyoga
nidranasha occurs due to the vitiation of vata dosha.
Discussion on manasika karanas
Emotional disturbances play an important role in causing the disturbance of nidra.
These include different emotions such as fear, anxiety, sorrow anger, passion etc.
Bhaya
The meaning of bhaya is fear, alarm, dread or to have fear. Bhaya can be defined as
“Swanishta sambhavanuroope va chittavruttabhedhaaha”. In Bruhatrayee, in the
context of vataprakopaka karanas all the classical authors of Ayurveda have stated
that bhaya is also one of the nidana for vata prakopa. As a result of the emotional
disturbance due to bhaya, the individual suffers from nidranasha.
Shabdakalpadruma explains bhaya as “Chittavaikalyadam bhayam” i.e., the
deformities of intellect takes place due to bhaya. When chitta is engaged in
something, the person does not get sleep.
Chinta
It is also one of the manasika nidana which is responsible for vataprakopa and in turn
nidranasha. In Ayurveda it is told that the chinta is also one among the factors
responsible for vata prakopa. Chinta means to think too much, which is totally a
mental exercise. This view is supported by Charakasamhita’s opinion that over
indulgence {karyasakta} in mental work results to nidranasha. { Chakrapani }.
Dr Kavitha S 153

Manastapa
The person will not have peace of mind, if he has manastapa or anguish, which is
defined as “Manastapaha anutapaha anutape Manapeedayamcha”. Anguish results in
mental pain, which in turn causes Insomnia.
Krodha or anger, shoka or sorrow, Harsha or euphoria; all such emotional imbalances
have an impact on the normal psychosomatic state of an individual and have an
impact on the quantum and quality of sleep. If prolonged, they all act as causitive
factors for Nidranasha.
Discussion on anya karanas
Abhighata - Causes the Vitiation of vatadosha which lead to nidranasha. In
Abhighata, the shoola will develop because of vata, this shoola lead to nidranasha.
Kshaya - It can be considered as Dhatukshaya which is responsible for kapha kshaya
and vitiation of vatadosha, which results in Nidranasha.
Discussion on samprapti
As nidranasha is not explained as a separate disease in Ayurveda, the samprapti of
nidranasha is not available. Based on the physiology of swabhavika nidra, nidanas of
nidranasha, lakshanas of nidranasha and chikitsa of nidranasha, the samprapti of
nidranasha can be hypothised as follows,
From the nidanas, it is clearly evident that vatavruddhi and kaphakshaya is going to
occur. As tamogunapradhanakapha should fillup Sangnavaha srotas to induce nidra.
Here in nidranasha, due to the indulgence in various causitive factors, the kapha
Dr Kavitha S 154

which is in kshayavastha {gunataha, dravyataha and karmataha} cannot fillup the
samgnavahasrotas and so the result nidra does not occur.
The other set of enlisted causitive factors, vitiates vatadosha. The vitiated vatadosha
has antagonastic property of kaphadosha, which means that the aggravation of
vatadosha by its nidana is going to result in kapha kshaya. The vrudha vatadosha
enters in to the shirohridaya {chetanasthana, which is responsible in producing nidra
and tamas} is responsible for jagrutavasta, which is contrary to the concept of nidra
described by Sushruta.
In Ayurveda it has been explained that vataprakruti purushas are jagarookaha, ie.,
they will get less quantity and disturbed quality of sleep. Sushruta has explained that
Tamas is the cause for nidra and satva is the cause for jagrutavastha. These two
references suggest that when the satvaguna become more predominant, then there will
be kshaya in tamoguna, due to which the person remains awake.
The aetilogical factors of nidranasha results in gunataha vruddhi of rooksha, laghu
and chalaguna of vata, ushnaguna of pitta and kshaya of its sasneha guna. Gunataha
kshaya of guru, sheeta, manda and snigdha guna of kaphadosha, and tamogunakshaya.
The kaphadosha and tamoguna are responsible to get sleep, where the kaphadosha and
tamoguna will fillup the samgnavahasrotas by engulfing the chetanasthana Hridaya.
Due to kshayavastha of kaphadosha and tamoguna, they are unable to fillup the
samgmavahasrotas. On the other hand vitiated vatadosha get lodged in majjadhatu.
Mastulunga, which has been explained as shiromajja, is a part of samgnavahasrotas ,
if it is not filled with kapha and tamoguna, it results in nidranasha.
Dr Kavitha S 155

and tamas. These manasikadoshas produce an impact on shareerikadoshas and vitiate
them, thus resulting in nidranasha.
Discussion on lakshanas of nidranasha
1. Angamarda – It is because of Nidranasha, which occurs due to vruddhi of
vatadosha and ksheenata of kaphadosha in the body.
2. Shirogourava – By prakruta nidra, physiologically disturbed doshas come
into samanyavastha. In Nidranasha vatadosha is increased which is responsible
for utsaha. In the course of Nidranasha this will result in Shirogourava.
3. Jadya – If Nidranasha continues for a long time, there will be no rest to the
body, due to which the patient feels heavyness of the body.
4. Glani – It can be considered as exhausted state, or depression of the mind.
Persons suffering from Nidranasha, feel exhausted, an suffers from depression,
which leads to further Nidranasha.
5. Bhrama – The maintenance of the equilibrium of the body is the function of
vatadosha. Here in case of Nidranasha the vata is increased, causing Bhrama.
6. Tandra – Due to Nidranasha there will not be rest to the Indriyas. Due to this
Indriyas will not perform their proper function, which results in Tandra
Discussion on upashaya and anupashaya
In the classical text books of Ayurveda some substances, such as ksheera, sneha,
mamsa etc., are said to induce good sleep. The same can also be considered as
upashaya of nidranasha, because they have the properties, such as, Madhura rasa,
Dr Kavitha S 156

Sheetaveerya and Madhura vipaka and Gunas like sheeta, snigdha and Guruguna,
which helps to induce sleep in individuals. In the same way regular practicing of
dinacharya procedures such as Abhyanga, padabhyanga, maradana, samvahana etc.,
also act as upashaya and the factors which bring about psycological comforts and
tranquility such as manonokoolavishayagrahana and sukhashayya are also considered
as upashaya for nidranasha.
Dicussion on sadhyasadhyata
The diagnosis of nidranasha or Insomnia is made only if the symptoms persists for a
long time, for atleast one month. Usually the disorder persists, if it is not attended
properly. The course of disease is not predictable, usually it does not change its form.
However it may lead to many physical psychological disease, if prolonged for many
years. It usually waxes and vanes in response to life stressors.
Nidranasha otherwise known as Aswapna is a condition of vatananatmaja vikara. The
text books of Ayurveda call vatavyadhis as Daruna i.e. not easily managable.
However, there are many factors such as age, duration, prakruti, satwa and
occupation, which influence the sadhyasdhyata of the disease nidranasha.
Age & duration
If insomnia presented at an early age, and /or is of short duration, normally the
prognosis is good. On the other hand insomnia of an elderly man or /of a longer
duration has poor prognosis.
Dr Kavitha S 157

Prakruti
The people having predominatly vataprakruti lakshanas, usually does not respond
well to the treatment, when compared to pitta and kapha prakruti.
Satva
People having Avara satva, are having poor prognosis, as compared to pravara &
madhyama satva.
Occupation
The patients who involved in stressful jobs have poor prognosis. A stable personality
and good occupational support usually help in alleviating nidranasha.
Discussion on sapeksha nidana
Nidranasha has been explained as the lakshana in many of the diseases, mentioned in
Review of literature. On the basis of lakshanas of other conditions such as jwara, rise
in temperature in this condition, dravamala pravrutti in Atisara, shwasakruchrata in
Tamakashwasa, trishna in vatajatrishna, history of panchakarma chitista in
panchakarma chiksajanya nidranasha, Abhighata in abhighotajanya nidranasha and
manasika karanas, such as krodha, shoka etc.,
The primary insomnia have been differentiated with the secondary conditions, i.e.
when the nidranasha is presented as a symptom in other diseases, then the
differentiation has been made by their respective pathagnosis symptoms.
Even the nidranasha occuring due to the misconduct of panchakarma and abhighata,
has to be differentiated by history of panchakarma treatment done previously and any
history of Abhighata.
Dr Kavitha S 158

Discussion on materials and methods
Present study is a Controlled Clinical Single Blind study with pre and post design
where there are three groups. Group A was treated with 2g Pippalimula choorna along
with 2g of Guda with milk in the evening after meals, along with Diet Chart prepared
as per our classics, for a period of 48days. Group B was treated with 2g Pippalimula
choorna along with 2g of Guda with milk, in the evening after meals, for a period of
48days. For Group C Only diet chart was suggested as per our classics, for a period of
48days. The follow up period was for 48days.
Reason for Selection of Guda Pippalimula Yoga:
Reason for Selection of Guda
Sweetening substances are being used in the Ayurvedic formulations to increase it’s
palatability, for preservation and also to have, tonic effect. They are responsible for
the generation of alcohol in Asavarishtas and serve as base in Avaleha Kalpana.
In our Ayurvedic formulation, various sweetening agents used are Guda, Sita,
Sharkara etc.Guda makes Pippali mula more palatible.
Apart from Palatibility, Guda is having madhura rasa madhura vipaka Guru Snigdha
Guna. It is vata samaka and can increase kapha, both of these properties promote
Nidra.
Jaggery and sugar not only differ in their composition but also in their effect on the
human metabolism. Carbohydrate, which is prominently present in sugar, need B-
vitamins for their proper utilization by the body and the nature has so arranged it that,
in their natural states, both cereals and natural sugar items (like, cane-juice, fruits,
Dr Kavitha S 159

nuts etc.), and also protein foods, have more than enough of the B-vitamins needed
for the assimilation of all the carbohydrate present. If excess of refined sugar is eaten,
it is likely to lead to some degree of B-vitamin deficiency. Symptoms of B-vitamin
deficiency include irritability, nervous exhaustion, sleeplessness, heart trouble,
digestive disorders and mental disturbance.
On the other hand, one hundred gram of jaggery provides 200 calories and so requires
about 0.1 mg of vitamin B and, it contributes many times this amount itself. It
improves digestion, prevents fatigue,purifies blood and provides strength to the
muscles. All these properties help in promoting sleep.
Reason for Selection of Pippalimula: With its Laghu Snigdha and Tikshna gunas
pippalimula acts as an excellent Vata shamaka drug. Vata vriddhi takes place in
nidranasha and vata haratva property might promote sleep in nidranasha.
Reason for Selection of Milk as anupana: Ksheera is said to be the Agryadravya in
generating nidra. In Harita samhita Ksheera is said to be tandra nidra kara. With its
Madhura rasa, Snigdha, guru, mrudu, shlakshna, picchila, manda gunas, sheeta virya,
madhura vipaka, vatapittahara and sleshmakrit properties, milk can act as an excellent
adjuvant to guda and pippalimula for inducing sleep.
Discussion on the Diet chart: A diet chart was prepared for groups A and C by
including all the ahara dravyas which were quoted by several samhitas as nidra janaka
ahara dravyas. Following are the ingridients of the diet chart.
Dr Kavitha S 160

Masha: patients were adviced to use Masha for preparing Idly, Vada, dosa, laddu etc.
Masha with its Madhura rasa, Guru snigdha gunas, Madhura Vipaka, might act
wonderfully in promoting sleep due to its Vatashamaka and Kapha vardhaka
properties
Godhuma: Patients were advised to make Chapati, Puri, Paratha, Upma (broken
wheat semolina), etc. Godhuma with its Madhura rasa , Guru Snigdha Hima Gunas,
Sheeta virya, Madhura Vipaka, helps in promoting sleep due to its Vatapittaghna and
Kaphakara properties
Ghrita: Patients were advised to use ghrita in all the food items they consume. Ghrita
with its Madhura rasa, snigdha, guru and sara Gunas; Sheeta virya and Madhura
vipaka, helps in promoting sleep due to its vata shamaka properties
Ikshu Rasa: Patients were advised to take ikshu rasa and ikshu vikaras like guda.
Ikshu rasa with its Madhura rasa, guru guna, shita veerya, madhura vipaka, and, helps
in promoting sleep due to its vata hara property
Upodika : patients were advised to cook this leafy vegetable which is having
madhura rasa, Guru, snigdha, picchila gunas, shita veerya, madhura vipaka. It helps in
promoting sleep due to its Vatapittaghna and Kaphakara properties.
Shali Dhanya: patients were advised to use Shali Dhanya extensively which is having
Madhura rasa, Sheeta veerya, Madhura Vipaka. It helps in promoting sleep due to its
Vata hara properties.
Dr Kavitha S 161

Dadhi: Patients were advised to eat Dadhi liberally which contains madhuramla rasa,
Guru, abhishyandi and snigdha gunas, and amla vipaka. It promotes sleep by the
virtue of its vata hara and kapha kara, properties.
Draksha: Patients were advised to drink the juice of Draksha as it contains Madhura
rasa, Snigdha, Guru, Mridu, Gunas, Sheeta virya, Madhura vipaka. It helps in
promoting sleep by the virtue of its Vata pitta shamaka properties.
Tila: Patients were advised to eat sweets made out of tila, guda and ghrita as tila
contains Madhura, Kashaya, and Tikta rasas, Snigdha guna and madhura vipaka. It
promotes sleep by the virtue of its vata hara properties.
Gramya Mamsa: Patients were advised to take Gramya mamsa which is vata hara
and promotes sleep.
Anupa Mamsa: Patients were advised to consume mamsa of Anupa animals as it
contains madura rasa, snigdha guru picchila and abhishyandi gunas. As anupa mamsa
helps in promoting sleep by virtue of its Kapha vardhaka Properties.
Inclusion criteria:
Reason for Selecting the age group between 30 – 50 years: Patients above 50 years
may suffer with Jara janya Nidranasha which takes it out of the primary insomnia
category. So patients above 50 years were excluded. Patients in this group (30-50) are
health conscious and usually follow what doctor says by using the medicines and
following diet regulations strictly. Younger patients who are unmarried or college
going or school going might find difficulty in following the diet chart prepared for
Dr Kavitha S 162

nidranasha. More over as primary insomnia is seen to occur more in middle aged
group, and also Charaka has considered 30-60 years as Madhyavastha of life, but as in
the present era of modernisation and lifestyle changes 60years tends to be more
towards oldage. Hence the upper limit of age was taken as 50 years.
Reason for Selecting Primary Insomnia with a history of one to five years:
Chronic insomnia with a history of more than 5 years usually gets associated with
other symptoms and diseases resulting out of insomnia which takes this disease out of
the primary insomnia category. More over the gudapippalimoola yoga is said to bring
sleep to those who have not slept since along duration of time in Bhaishajya Ratnavali
as in the sloka:
“Gudam pippalimoolasya churnennatichiram lihan | Ciradapi cha samnashtaam
nidraamapnoti asamshayam ||” in the context of Murcha roga chikitsa (21st Chapter)
Exclusion criteria:
Reason for excluding Patients suffering from other systemic illnesses and on any
medication: These patients may suffer with insomnia, which might be a complication
of the systemic illness or medication they are using. Unless and until the systemic
illness is cured, or the medication is avoided his/her insomnia cannot be managed. So
such patients were excluded.
Reason for excluding Patients who have underwent surgery within the past 6
months: These patients might suffer from severe pain due to surgery which can cause
insomnia. It becomes impossible to cure such insomnia unless and until such pain is
Dr Kavitha S 163

relieved which happens only after the surgical wounds are healed completely. So such
patients were excluded.
Discussion on Sampling Method and Research Design:
Reason for Purposive Sampling: This sampling method helps us to divide the
patients into three convinient groups which allows us to make three purposeful
categories which can show particular effects on Nidranasha , which can be compared.
Discussion on Statistical Analysis -
Contingency Co-efficient –
It is applied when Categorical Data Analysis is to be done. Then a contingency
table can be used to express the relationship between the variables
Descriptive statistics -
The Descriptives procedure displays univariate summary statistics for several
variables in a single table and calculates standardized values (z scores). Variables can be
ordered by the size of their means (in ascending or descending order), alphabetically, or
by the order in which one select the variables (the default).
t-test: This test is used as the sample size is small and so as to find significance of the
Qualitative data.
Chi-square test:
The Chi-Square Test procedure tabulates a variable into categories and computes
a chi-square statistic. This goodness-of-fit test compares the observed and expected
Dr Kavitha S 164

frequencies in each category to test either that all categories contain the same proportion
of values or that each category contains a user-specified proportion of values.
ANOVA: This test is used as there are multiple variants involved in the study.
Repeated measures ANOVA: This test is used as in the study the same sample is
subjected to statistical analysis repeatedly at different phases of study
Intervention:
Reason for making 3 Groups in the study: This was done so as to get a clear picture
regarding individual efficacies of the interventions and also to know their combined
effects. This design even would help to compare the efficacies of the three Groups.
Discussion on observation and results
AGE–In the present study, 15(33.3%) patients were in the age group of 30-40, 30
patients(66.7%) were in the age group of 30-40. The age in relation with nidranasha is
statistically insignificant. This might be because of smaller sample size.
SEX – In the present study, 14 patients (31.1%)were males & 31 patients(68.9%)
were females. This is statistically significant (p value =0.040) indicating more
prevalence of Nidranasha in females.
MARTIAL STATUS - In the present study, 33 patients (73.3%)were married,5
patients(11.1%) were unmarried & 7 patients(15.6%) were widowers. This is
statistically insignificant (p value =.139) indicating more prevalence of Nidranasha in
married people. Marital troubles might account for stress which might have induced
sleeplessness
Dr Kavitha S 165

RELIGION - In the present study,38 patients (84.5%)were hindu,5 patients(11.1%)
were muslim, 1 patient(2.2%) was Christian & 1 patient(2.2%) was jain. This is
statistically insignificant (p value =.320) indicating more prevalence of Nidranasha in
hindus which might be only because of more hindu population followed by muslims
in and sround mysore area. Larger sample can give an idea about prevalence of
Nidranasha among several religious groups.
HABITAT - In the present study, 11 patients (24.5%) were rural, 34 patients(75.5%)
were urban. This is statistically significant (p value =0.040) indicating more
prevalence of Nidranasha in Urban people which indicates that the effect of urban
living under stressful conditions and pollution causes more prevelance of nidranasha
in urban people when compared with rural people.
OCCUPATION - In the present study, 2 patients (4.4%)were agriculturists, 3
patients (6.7%) were shop-keepers, 30 patients (66.7%) were house–wives, 3 patients
(6.7%) were salesman, 2 patients (4.4%) were govt. officials, 4 patients (8.9%) were
teachers & 1 patient (2.2%) was a mason. This is statistically insignificant (p value
=0.625). More prevalence of Nidranasha in housewives however cannot be attributed
to a specific reason and a study on a larger sample gives a better picture.
SOCIO-ECONOMIC STATUS - In the present study, 16 patients were Poor (35.5%),
25 patients (55.6%) belonged to the Lower Middle Class and 4 patients (8.9%)
belonged to the Upper Middle Class. This is statistically insignificant (p value
=0.748) indicating more prevalence of Nidranasha in lower middle class. A larger
sample study will give better results
Dr Kavitha S 166

EDUCATION - In the present study, 13 patients (28.9%) were Illiterate, 7 patients
(15.5%) had completed their Primary Education, 18 patients (40%) had completed
their Secondary Education, 4 patients (8.9%) were Graduates and 5 patients (6.7%)
were Post Graduates. This is statistically insignificant (p value =0.273) indicating
more prevalence of Nidranasha in people who have completed secondary education.
NATURE OF WORK - In the present study, 25 patients (55.6%) were Active,
whereas 20 patients (44.4%) had sedentary nature of work. This is statistically
insignificant (p value =0.914) indicating more prevalence of Nidranasha in people
who are active .
DIET - In the present study, 18 patients (40%) consumed Vegetarian Diet whereas 27
patients (60.0%) consumed Mixed Diet (both vegetarian and non-vegetarian foods).
This is statistically highly significant (p value =0.000) indicating more prevalence of
Nidranasha in people with mixed diet. But according to ayurveda most of the ahara
suggested for sleeplessness consists of mamsa of various animals. The cooking style
of non vegetarians who add a lot of spices and oil to their foods which might cause
vidaha might result in nidranasha.
CHRONICITY - In the present study, 33 patients (73.3%) reported chronicity ranging
between 12-24 months, while 12 patients reported chronicity ranging between 25-60
months. This observation is statistically insignificant (p value =0.256)
PRAKRUTI - In the present study, 28 patients (62.2%) were of Vata-Pitta Prakruti, 2
patients (4.4%) were of Pitta-Kapha Prakruti and 15 patients (33.4%) were of Kapha-
Vata Prakruti. This is statistically significant (p value =0.046) indicating more
prevalence of Nidranasha in Vata Pitta prakruti people who might have vata pitta
Dr Kavitha S 167

prakopa and kapha kshya which is the basis for nidra nasha.
SARA - In the present study, 2 patients had Pravara Sara (4.4%), 33 patients had
Madhyama Sara (73.4%) and 10 patient had Avara Sara (22.2%). This observation is
statistically insignificant (p value =0.233)
SAMHANANA - In the present study, 6 patient had Pravara Samhanana (13.3%), 30
patients had Madhyama Samhanana (66.7%) and 9 patients had Avara Samhanana
(20%). This is observation statistically insignificant (p value =0.097)
PRAMANA - In the present study, 4 patients were of Pravara Pramana (8.9%), 39
patients were of Madhyama Pramana (86.7%) and 2 patients were of Avara Pramana
(4.4 %). This observation is statistically insignificant (p value =0.827)
SATMYA - In the present study, 21 patients had Madhyama Satmya (46.6%) and 24
patients had Avara Satmya (53.4%). This observation is statistically insignificant (p
value =0.448)
SATTVA - In the present study, 1 patient had Pravara Sattva (2.2%), 14 patients had
Madhyama Sattva (31.1%) and 30 patients had Avara Sattva (66.7%). This
observation is statistically insignificant (p value =0.710)
AGNI - In the present study, 33 patients had Samagni (73.4%), 7 patients had
Mandagni and 5 patients had Vishamagni (11.1%). This observation is statistically
insignificant (p value =0.153)
KOSHTA - In the present study, 30 patients had Madhyama Koshtha (66.7%), 3
patients had Mridu Koshta (6.6%) and 12 patients had Kroora Koshtha (26.7%). This
observation is statistically insignificant (p value =0.249)
Dr Kavitha S 168

VYAMAMA SHAKTI - In the present study, 4 patients had Pravara Vyayama Shakti
(8.9%), 32 patients had Madhyama Vyayama Shakti (71.1%) and 9 patients had
Avara Vyayama Shakti (20%). This observation is statistically insignificant (p value
=0.350)
ONSET OF THE DISEASE - In the present study, 20 patients (44.4%) had Gradual
Onset of the disease whereas 25 (63.6) patients had Sudden Onset of the disease. This
is statistically significant (p value =0.021) indicating that some sudden changes in
diet or area of work or sleeping place is causing an immediate effect on sleep quality
and also causing nidranasha in many.
Dr Kavitha S 169

DISCUSSION ON RESULTS
Pittsburgh Sleep Quality Index (PSQI) is used to assess the results of the study. PSQI
is divided into seven components which indicate seven traits of sleeplessness. They
are as follows
Discussion on C1 Component 1: Subjective sleep quality:
This denotes the rating given by the patient about the quality of his/her sleep dring the
past month. The results obtained shows that in all the three groups the change was
highly significant. However by observing the mean scores we can say that the result is
best in Group A followed by Group B and Group C occupies the third place.
Discussion on Component 2: Sleep latency
This denotes the time taken by the patient to become asleep after lying down on the
bed. The results obtained shows that in all the three groups the change was highly
significant. However by observing the mean scores we can say that the the group in
which time taken to be asleep has reduced significantly is group A followed by
Group B and Group C occupies the third place.
Discussion on Component 3: Sleep duration
It indicates the number of hours patients are experiencing sleep. The results obtained
shows that in all the three groups the change was highly significant. However by
observing the mean scores we can say that the the group in which sleep duration has
increased significantly is group A, followed by Group B, and Group C occupies the
third place.
Dr Kavitha S 170

Discussion on Component 4: Sleep efficiency
Component 4 indicates the sleep efficiency which can be calculated by dividing the
number of actual hours of sleep with number of hours spent in bed multiplied by
hundred. Results obtained shows that there is a significant increase in sleep efficiency
in both the groups A and B which is highly significant. However in group C the
increase is not statistically significant (P value 0.071) . This shows that intake of nidra
janaka ahara itself is not sufficient in bringing a statistically significant increase in
Sleep Efficiency.
Discussion on Component 5: Sleep disturbance
Component 5 indicates Disturbance in sleep during the night in terms of night awakening
with out any reason or getting up for micturition. Results obtained show that there is a
significant decrease in sleep disturbance in group A . It is Statistically highly significant. But
in group B( P value .124) and group C(P value 0.455) the decrease in sleep disturbance is not
significant . However Among B and C groups, the average mean scores show that the
decrease in sleep disturbance is more in Group B. this observation indicates that to bring a
highly significant decrease in sleep disturbance a combination of Guda Pippali Mula ,
Nidrajanaka Ahara is very useful.
Discussion on Component 6: Use of sleep medication
Component 6 represents the patients need for medication to induce sleep. Results obtained
show that in all the three groups there is a significant decrease in the use of sleep medication.
It shows that the present study is highly succuessful in bringing down the need for a sleep
medication. The statistical values in all the three groups are highly significant. However when
Dr Kavitha S 171

we compare the mean scores Group C in which only nidrajanaka ahara was used decrease in
score is a bit less.
Discussion on Component 7: Daytime dysfunction
Component 7 represents Daytime dysfunction which indicates the patients had trouble staying
awake while driving, eating meals, or engaging in social activity during day time or trouble in
keeping up enough enthusiasm to get things done. Results show that in groups A and C there
is a significant decrease in Daytime dysfunction where the result is statistically significant. In
group B the decrease in daytime dysfunction is highly significant statistically.
Discussion on Global PSQI
Global PSQI score is the sum of all the seven components of PSQI . when we
compare the mean values of Group A before Treatment (16.67) After Treatment(5.73)
and After follow up (9.67) we observe significant improvement which indicates Guda
Pippalimula Yoga along with a Nidra janaka Diet regimen, helps in producing highly
significant improvement in nidra nasha. When we compare the mean values of Group
B before Treatment (16.87) After Treatment(6.53) and After follow up (10.73) we
observe significant improvement which indicates Guda Pippalimula Yoga alone is
also capable of producing highly significant improvement in nidra nasha. However
the mean values indicate that Group A (medicine + diet) is still better than Group B
(only medicine). When we compare the mean values of Group C before Treatment
(17.47) After Treatment(10.20) and After follow up (14.73) we observe a moderate
improvement which indicates Nidra janaka Diet regimen helps in producing
moderate improvement in nidra nasha. The change in scores of Global PSQI before
Dr Kavitha S 172

the treatment, after the treatment and after follow up is highly significant both in the
groups(P=0.000). and within the groups (P=0.001).
By comparing the mean values of both the groups, overall effect of group A was
found to be better.
Proposed Mode of action of Guda Pippali Mula Yoga.
Guda Pippali Mula yoga advised in Bhava prakasha and Bhaishajyaratnavali, with
Kseera anupana has shown highly significant improvement in the patients of
Nidranasha. This action may be due to the synergistic effect of the three ingridients
Guda, Pippali Mula and Ksheera. Guda with its Madhura Rasa, Madhura Vipaka,
Guru and Snigdha Gunas exhibits all the useful properties to promote sleep. However
its ushna virya is a debatable property. Though ushna virya acts as vatahara it might
also produce kapha hara properties. But its effect is being cleverly balanced by the
sheeta virya of its anupana ksheera. In the same way Pippalimula with its katu rasa
katu vipaka Laghu and tikshna gunas seems to be against the context of nidra
janakatva but its snigdha guna helps in becoming Vata hara. As vata vitiation is the
most important phase of nidra nasha, Pippali mula might help in the samprapti
vighatana by virtue of its vata hara property. Its anushna sita veerya coupled with the
properties of Milk and Guda also helps in increasing kapha and promoting sleep.
Ksheera with its Madhura rasa, Snigdha, guru, mrudu, shlakshna, picchila, manda
gunas, sheeta virya, madhura vipaka, vatapittahara and sleshmakrit properties milk
can act as an excellent adjuvant to guda and pippalimula for inducing sleep. And more
over mahisha ksheera has been regarded as the Agryadravya in promoting sleep. With
the above insights we can infer that Guda pippali mula yoga with Ksheera anupana is
Dr Kavitha S 173

a wonderful yoga containing three potent yet different drugs chosen by our acharyas
which balance each others’ properties in a synergistic fashion to bring about
successful promotion of Nidra in Nidranasha patients.Pippalimoola has piperine and
piplartine which are known to have sedative effect and are used in epilepsy for its
sedative effect.
Dr Kavitha S 174

RECOMMENDATION FOR FURTHER STUDY
The same study could be done with a larger sample for more accurate results and
conclusions.
For the clinical trail, all types of insomnia should be considered.
A study on Insomnia should be done in collaboration with the Sleep laboratory.
An attempt has to be made on the effect on manasika chikitsa, such as ashwasana etc.,
in Nidranasha.
The Guda Pippalimula Yoga, being non-palatable, could be used in capsule form or
any other palatable form (according to convenience).
Dr Kavitha S 175

CONCLUSION
On the basis of conceptual Analysis and Observations made in this clinical Study, the
following conclusion can be drawn:
Nidranasha effectively represents Insomnia.
Vata Vriddhi along with Kapha kshaya is the main reason for Nidra nasha
It was observed that the primary insomnia is more in Vata-Pitta prakruti patients.
More patients were from urban areas.
Guda Pippalimula Yoga with Ksheera anupana is having vatashamaka and kapha
vardhaka property.
Diet regimen given to the group also helps in pacifying vata and increasing Kapha.
Individual effect of Group A (Guda Pippalimula Yoga and Diet Regimen) is best
during all phases of treatment
Individual effect of Group B (Guda Pippalimula Yoga) is good in all the phases of
treatment.
Individual effect of Group C(Only Diet Regimen) is Not significant during any phase
of treatment and during overall intervention.
Guda pippalimula Yoga with Ksheera anupana along with a Nidrajanaka Diet
Regimen is found to be very effective in Managing Primary insomnia.
Dr Kavitha S 176

SUMMARY
An estimated 30%-50% of the general population are affected by insomnia, and
amoung them 15% are suffering from this condition, where the cause is not known i.e.,
primary insomnia. The whole world is looking towards a safer and more natural way to
overcome insomnia. Ayurveda with its ability to teach people how to lead a healthy life can
help mankind in overcoming insomnia.
Present study concentrates on finding an effective way to treat Insomnia with medicines and
diet regimen. Being a Single Blind comparative study, three groups were made- Group A,
Group B & Group C. Hence the study was designed to compare & understand the effect of the
Guda Pippali Mula Yoga, effect of Diet Regimen comprising of Nidra janaka Ahara and
combined effect of both.
The present dissertation work is divided into 2 parts. The first part deals with the
Introduction, Nirukti, Paribhasha, Concept of Nidra Nasha, Nidana, Poorva Roopa, Roopa,
Upashaya-Anupashaya, Samprapti, Upadrava, Sadhyasadhyata, Arista Lakshana, Chikitsa,
and Pathya- Apathya of Nidranasha. In the same part modern review on Insomnia was also
dealt. Drug review is dealt at the end of first part.
In the second part, Materials & Methods, Observation of clinical trials, Results,
Statistical tables & graphs, Discussion, Summary, and Conclusions are dealt. A total of 45
Patients were selected for the study.
For Group A 2g Pippalimula choorna along with 2g of Guda was administered with
milk, in the evening after meals, along with Diet chart for Nidranasha, for a period of 48 days.
For group B 2g Pippalimula choorna along with 2g of Guda was administered with milk, in
Dr Kavitha S 177

the evening after meals, for a period of 48days. Members of Group C were advised only to
follow Diet chart for Nidranasha created as per our classics, for a period of 48 days. The
followup period was 48 days.
PITTSBURGH SLEEP QUALITY INDEX (PSQI) was used to assess the effect of medicine
and diet on three groups. The Observations and Results were statistically analyzed for better
interpretation.
During the period of overall treatment best result was seen in Group A, followed by Group B
and in Group C though improvement was seen, it is not statistically significant. During the
period of follow up Best result was seen in group A , followed by Group B and Group C.
The conclusion derived on the basis of detailed observation & deep study is submitted
under the chapter on Conclusion. Future perspective of the study is highlighted as an aid for
the future research workers.
Dr Kavitha S 178

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Dr Kavitha S 181

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Dr Kavitha S 182

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Dr Kavitha S 183

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Dr Kavitha S 185

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Dr Kavitha S 187

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Dr Kavitha S 192

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Dr Kavitha S 193

Dr Kavitha S 194

A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMOOLA YOGA IN PRIMARY INSOMNIA
ANNEXURE-I
CASE SHEET
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA
SIDDHANTA
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.
“A CONCEPTUAL STUDY OF NIDRANASHA WITH A
COMPARITIVE STUDY OF DIET AND GUDA PIPPALIMULA YOGA
IN PRIMARY INSOMNIA”
HEAD OF THE DEPARTMENT : DR. SHAKUNTHALA G. N. M.D (AYU)
GUIDE : DR. BALAKRISHNA D.L. M.D (AYU)
RESEARCHER : Dr. KAVITHA S. B.A.M.S
Part A: History taking & Examination-

1) Name of the Sl.No
Patient
2) Gender Male Female OPD No.
3) Age Years 4) Religion I P D No.
5) Marital Status Married Unmarried Others
6) Occupation Sedentary Active Working in shifts
7) Economical Poor Middle Upper Rich

Lower Middle
Status
8) Educational status UE PS MS HS G PG Others
9) Present Address
10) Living since __ Pin

years
11) Schedule Initiation Completion
Dates
12) Result Complete Marked relief Moderate Relief Mild No change

relief Relief
Dr. Kavitha S I
1) Chief complaints
a. Reduction in sleep time
b. Initiation of sleep
c. Sleep interruption
d. Day time naps
e. Others
2) Associated Complaints
a. Shirogaurava e. Bhrama
b. Jadya f. Apakti
c. Glani g. Angamarda
d. Jrumbha h. Others
3) History of present illness

Mode of Onset Sudden Gradual Insidious
Duration of Sleeplessness
Continuous / Intermittent / Change of Place /Bed/Stress/anxiety
4. Occupational History
Nature of work :
Sedentary /active /physical activity/ mental activity /any change of job /change of place due to
work/ whether working in shifts
5. Personal History
Food habits Vegetarian Non-vegetarian Rasa
Preference
Agni Sama Vishama Manda Teekshna
Addictions Tobacco Alcohol Drugs Others
If changed
recently
Bowel Habits Normal Loose Constipated Changed
Dr. Kavitha S II
Menustrual Regular Irregular Amenorrhea

History Menopause
Family history
Other system medications

Treatment
History
Antidepressant Sedatives Tranquilizes Hypnotics
Underwent any Surgery recently

(within 6 months)
History of past illness
6. General examination
Temperature °F Pulse / Respiration /Min

Min Rate
Height Cms Weight Kg B.P /mmHg
7. Systemic Examination
CVS CNS
R.S P/A
8. Asta stana pareeksha:

Naadi: V/P/K/VP/PK/VK/VPK
Mutra: times per day, times at night.
Mala: Drava/ Baddha/ Samyak.
Jihwa: Alipta/Alpa lipta/Lipta.
Shabda: Prakruta / Vikruta.
Sparsha: Prakruta / Vikruta.
Druk: Prakruta / Vikruta.
Aakruti: Pravara/ Madhyama/Avara.
Dr. Kavitha S III
9. Dashavidha pareeksha:
i. Prakruti: V/ P/ K/ VP/ PK/ KV/ VPK.
ii. Vikruti: a) Dosha: V/ P/ K/ VP/ PK/ KV/ VPK.
b) Dushya: R/ RA/ Ma/ Me/ As/ Mj/ Sh/ Others.
iii. Sara: Pravara ( ), Madhyama ( ), Avara ( )
iv. Samhanana: Pravara ( ), Madhyama ( ), Avara ( )
v. Pramana: Pravara ( ), Madhyama ( ), Avara ( )
vi. Sathmya: Pravara ( ), Madhyama ( ), Avara ( )
vii. Sattva: Pravara ( ), Madhyama ( ), Avara ( )
viii. Ahara shakti:
a) Abhyavaharana: Pravara ( ), Madhyama ( ), Avara ( )
b) Jarana: Pravara ( ), Madhyama ( ), Avara ( )
ix. Vyayama shakti: Pravara ( ), Madhyama ( ), Avara ( )
x. Vaya: Bala ( ), Madhyama ( ),Vruddha( )
10. Nidana panchaka
1.Nidana:
Aharaja:
Viharaja:
Manasika:
2. Poorva rupa:
3.Rupa:
4. Upashaya-Anupashaya:
Dr. Kavitha S IV
Samprapti ghataka:
Dosha: Dushya:
Ama: Srotus:
Srotodusti prakara: Udbhavastana:
Sancharastana: Adhishtana:
Roga marga:
5. Samprapti :
11. Vyadhi Viniscaya : Nidranasha
Chikitsa Krama: Intervention
Group A Group B Group C
2g Pippali mula churna with 2g 2g Pippali mula churna with 2g Nidra janaka Ahara.
Guda after dinner along with Guda after dinner.
Nidra janaka Ahara.
Grading of PSQI Q Q Q Q Q5 Q6 Q7 Q8 Q9 Q10 Q 11 GlobalPSQI

1 2 3 4
Before treatment
After treatment
After follow up
Signature of Researcher
Signature of H.O.D Signature of Guide
Dr. Kavitha S V
ANNEXURE-II
PITTSBURGH SLEEP QUALITY INDEX (PSQI)
Name__________________________ Date________ Age___________
1. During the past month, when have you usually gone to bed at night?
USUAL BED TIME_________________________
2. During the past month, how long (in minutes) has it usually taken you to fall asleep each
night?
NUMBER OF MINUTES_____________________
3. During the past month, when have you usually gotten up in the morning?
USUAL GETTING UP TIME__________________
4. During the past month, how many hours of actual sleep did you get at night? (This may be
different than the number of hours you spend in bed.)
HOURS OF SLEEP PER NIGHT________________
For each of the remaining questions, check the one best response.
5. During the past month, how often have you had trouble sleeping because you……..
(a) cannot get to sleep within 30 minutes
Not during the Less than Once or Three or more
past month_____ once a week____ twice a week___ times a week____
(b) Wake up in the middle of the night or early morning

(c) Have to get up to use the bathroom.
(d) Cannot breathe comfortably.
(e) Cough or snore loudly.
Dr. Kavitha S VI
(f) Feel too cold.

past month________ once a week_______ twice a week_______ times a week______
(g) Feel too hot.
(h) Had bad dreams.
(i) Have pain.
(j) Other reason(s), please describe_____________________________________
____________________________________________________________________________
How often during the past month have you had trouble sleeping because of this?
6. During the past month, how would you rate your sleep quality overall?
Very good ___________
Fairly good ___________
Fairly bad ___________
Very bad ___________
7. During the past month, how often have you taken medicine (Prescribed or "over the
counter") to help you sleep?
8. During the past month, how often have you had trouble staying awake while driving, eating
meals, or engaging in social activity?
Dr. Kavitha S VII
9. During the past month, how much of a problem has it been for you to keep up enough
enthusiasm to get things done?
No problem at all _________
Only a very slight problem _________
Somewhat of a problem _________A very big problem _________
10. Do you have a bed partner or share a room?
No bed partner or do not share a room _________
Partner/ flatmate in other room _________
Partner in same room, but not same bed _________
Partner in same bed _________
11. If you have a bed partner or share a room, ask him/her how often in the past month you
have had………
(a) Loud snoring.
(b) Long pauses between breaths while asleep.
(c) Legs twitching or jerking while you sleep.
(d) Episodes of disorientation or confusion during sleep.
(e) Other restlessness while you sleep: please describe_________________________
Dr. Kavitha S VIII
ANNEXURE-III
DIET CHART
Sl. NO. Time Diet
1 6.00 AM One glass of Milk{150 ml} with jaggery.
2 8.00 AM Chapati/poori/Idli/Dosa/UddinVada/Paratha
with ghee/wheat upma with Ghee
3 11.00 AM Sugarcane juice/grape juice
4 1.00 PM Shastika Shali rice with curd and curry prepared
from fish, prawns, chicken, mutton, Beef, Pork,
Basella leaves, onion, Sesamum. Sweet
prepared from milk, jaggery, wheat, black gram
laddu
5 4.00 PM Sweet Lassi /Sugar cane juice/grape juice/
6 7.30 PM Chapati or paratha with ghee and curry
prepared from fish, prawns, chicken, mutton,
Beef, Pork, Basella leaves, onion, Sesamum and
Curd.
7 9.30 PM One glass of milk{150 ml } with jaggery
Dr. Kavitha S IX

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“A CONCEPTUAL STUDY OF NIDRANASHA WITH A COMPARITIVE

STUDY OF DIET AND GUDA PIPPALIMULA YOGA IN

Dissertation submitted to the

In the partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (AYURVEDA)

Under The Guidance of

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA

not have been completed.

I am extremely thankful to Dr. Naseema Akthar, HOD, Department of PG Studies in

Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for her

constant guidance and support.

I sincerely express my indebtedness and profound gratitude to my Guide

Dr. Balakrishna D. L., Professor, Head of the Department of Panchakarma,

encouragement through out my PG studies.

I am grateful to Principal Dr.Ashok D. Satpute, Professor and Head, Department of

Rasashastra and Bhaishajya Kalpana, Government Ayurveda Medical College,

Mysore for his support and encouragement.

I am highly thankful to (Late) Dr.G.N.Shakuntala, former HOD, Department of PG

Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for

I sincerely express my indebtedness and profound gratitude to Dr.N.Anjaneya

Murthy, Joint Director of AYUSH, Professor and former HOD, Department of PG

Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for

his ever lasting support and inspiration.

I owe my deep sense of gratitude to all my teachers Dr. T. D. Ksheera Sagar,

Dr. Shanthala Priyadarshini, Dr.H.M.Chandramouli, Dr. Gopinath,

analysis and interpretations.

I express enormous amount of thanks to my senior Colleague Dr.Soubhagya Bilagi,

my colleague Dr.Aparna.K and My junior colleague Dr.Rekha.A.R for their timely

suggestion, support and encouragement through out my study.

I am thankful to my senior colleagues Dr.Savita Shenoy, Dr. Vijayalakshmi,

Dr.Yogesh and Dr.Kedar Sharma. I owe my special thanks to my classmates

Dr.Annapoorani, Dr.Pankaj Pathak and Dr.Rajesh Bhat.

I also thank our Department employee Annaiahachar.

This acknowledgement would not be complete without paying obeisance to my

guidance propelled me to achieve my goal.

I am especially indebted to my in-laws Sri T. Muralikrishna and Smt. T.

for allowing me to complete my study.

I also thank my sister Jyothi Nandi, brother-in-law Gopal S. Nandi(CA) brother

S. Venkatesh, sister-in-law Dr. Susheela Murthy her husband Commander

I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in a

Background of the Study

Primary insomnia, where the cause of sleeplessness is obscure, is normally treated

chemicals. Other modalities of treatments such as relaxation therapy and psycho-

treated it leads to impaired mental functioning, accidents, headaches, increase in

mortality rates, stress, depression and heart diseases.

Holistic management of Nidranasha is the need of the day and Ayurvedic

professionals need to re evaluate the management of nidranasha. Nidranasha has been

described in detail by all our acharyas. Nidranasha is mentioned in various contexts

aspects of Nidranasha. The present study is aimed at studying concepts of Nidranasha

Objectives of the Study

 To systematically review & study the literature on Nidranasha, available in all

 To review literature on Nidrajanaka Ahara and modifications suggested to

prevent and manage Nidranasha.

 To clinically evaluate the efficacy of Guda Pippalimula yoga in Nidranasha by

comparing with Ayurvedic diet suggested in Nidranasha (Primary Insomnia).

As it is a comparative study, the patients are divided in to three Groups consisting of

15 patients in each Group.

Group A: 2g Pippalimula choorna along with 2g of Guda was administered with

our classics, for a period of 48days.

To systematically review & study the literature on Nidranasha, available in all

To review literature on Nidrajanaka Ahara and modifications suggested to

To clinically evaluate the efficacy of Guda Pippalimula yoga in Nidranasha by

Guda Pippali mula Yoga

Nidra Janaka Ahara