INSOMNIA

 

Insomnia is inadequate or poor quality of sleep because of difficulty in falling asleep, difficulty in maintaining sleep or waking too early in the morning

It is the most common sleep disorder in elderly.

Chronic Insomnia can lead to severe fatigue, anxiety, depression and lack of concentration.

Insomnia comes under Vata nanatmaja vikara and called as Anidra or Nidranasa in Ayurveda.

Is more common in persons aged more than 65 years and mainly in women than men

TYPES

·         Transient insomnia- lasting from a night to a week and is usually caused  by  traveling or sleeping in an unusual environment.

·         Short term Insomnia- lasts about two to three weeks and is usually attributed to emotional factors such as worry or stress.

·         Chronic Insomnia- occurs most nights and lasts a month or more

ETIOLOGY

• caused by stress Or life style changes
• medical or psychological condition
• About half of Insomnia cases have no identifiable cause.

Ayurveda believes that usually it is the vitiated vata which disturbs the natural body physiology and results in various types of sleep disturbances.  In Ayurveda  causes of  insomnias are pointed out by Caraka. REFER (Ca.su 21/55-57)

FACTORS AFFECTING SLEEP PATTERN

·    Smoking,  caffeine, alcohol

·     Disruption of circadian rhythms; such as shift work, change in work schedule.

·    Uncomfortable and unusual sleeping environment.

·    Psychiatric and neurological conditions

·     Biological factors- By advancement of aging

·     Sleep disordered breathing-sleep apnea

·      Chronic medical illness

·          Excessive computer work or watching T.V.

PATHOGENESIS

Sleep disorders are associated with an impairment of melatonin production. Melatonin produced by the pineal gland at night, plays a role in regulation of sleep-wake cycle and diminished-melatonin Secretion may cause insomnia.

CLINICAL FEATURES

·         Not feeling refreshed
·         Inability to sleep 
·         Drowsiness ,iritability
·     Difficulty in concentrating
·         Impaired ability to perform normal activities
·         Body-ache and heaviness of the body

INVESTIGATIONS

·         Polysomnography

·          Multiple sleep latency test (MSLT)

·         Thyroid function test

·         EEG

MANAGEMENT

Prevention :

·      Daily time table and proper sleeping environment.

·         Application of  ointment to the eyes (like ghee)

·         Head massage, comfortable bed, home and proper time.

·       Decrease use of  coffee and tea, especially in the late evening hours and avoiding alcohol

·         Taking a light and timely dinner, avoiding late night awakening.

·         Following an exercise schedule to reduce stress and help bring sound sleep.

 Medical management :

 Avoidance of aetiological factors

chronic medical illness should be treated first and smoking, excessive consumption of caffeine, alcohol, excessive computer work or T.V, watching should be avoided.

Pancakama procedures followed by Samana chikitsa

·         virecana with Eranda taila

·         Abhyanga , Padabhyanga

·         Siroabhyanga with medicated oils.

·         Sirodhara with medicated liquids (milk/water/oils(Narayana taila)  

·         Picu with Candanabala taila/ Himasagara taila

·         Takradhara

Drug therapy :

·         Single drugs : Asvagandha curna, Jatamansi curna, Bramhi  , Mandakaparni are effective in the management of insomnia.

·         Compound Formulations : Asvagandharista ,Sarasvatarista, Bramhi vați

Yogic Practices :

·         Practice of Pranayama and meditation

·         Suryanamaskara, Tadasana, Matsyasana, Makrasana, Bhujangasana, Padmasana, Pascimottanasana and Svasana

       Counseling : Advice the patient to;

·         Drink Warm milk.before going to bed

·         Do some light physical activities before going to bed

·         Take warm bath before bedtime

·         Sleep on comfortable bed

·         Use the bed and bedroom only for sleep

·         Maintain a regular sleep /wake up schedule

·         Practice yoga and meditation

·         Avoid stressful conditions