Introduction

One of life's greatest elixirs and tonics is sleep. It is a natural revivified for all earth's living things. The numerous sleep disorders are influenced by any changes in the sleep's patterns, quality, or amount. Numerous psychiatric conditions have sleep disruptions as a symptom, and some disorders' diagnostic criteria include it as well. The National Institutes of Health estimate that roughly 14.71% of Americans suffer from sleep disturbances. An urban Indian population was found to have a higher prevalence of sleep problems that affect getting to sleep and staying asleep (28%) than other populations. The most prevalent clinical manifestation of these sleep problems, insomnia, is 40% more prevalent in women than in males. Severe insomnia is sleeping less than 3.5 hours in females and 4.5 hours in males, may lead to a reduced life span. Insomnia is in fact, both a symptom as well as a disorder. Chronic insomnia is more prevalent than heart disease, cancer, AIDS, diabetes and several other most prevalent disorders.If left untreated, insomnia increases the risk of developing diseases like depression, diabetes, hypertension and possibly even death in older individuals as per reported studies. Therefore it is very much essential to identify and treat the condition of insomnia at the earliest.1

Ayurvedic approach : In Ayurveda, Sleep or Nidra have been explained as one of the triads for sustaining life. The alteration of the same as well as etiopathogenesis along with the management is being explained in the classics in the terminology “Nidranasa.” Among the three doshas controlling the human physiology, such a condition results from the aggravation of the doshas – Vata and Pitta, and also depletion of the dosha – Kapha. Also the sleep is regulated by the performance of the dosha in relation with the functioning of manas ie. Rajas Hence it may be manifested both in physical as well as psychiatric disorders. The initiation of sleep is promoted by Vata and the maintenance of sleep is enhanced by Pitta. Fundamental functions of Vata, in connection with mental business are activation (pravarttaka), controlling (niyanta) and motivation (preraka). These basic functions are impaired, while the aggravation of Vata takes place due to specific causes in any conditions, including sleep. The clarity of the sense organs also is contributing to a normal physiologic sleep. Consequently, manoniv?tti, a relaxed state of mind is very much for a sound sleep to get ensued. In nidranasa, the aggravation of  Vata occurs which will further vitiate the other doshas, Pitta as well as Kapha as per the etiology. Vata and manas are very much related in their functioning. Hathayoga Pradeepika highlighted the inter-relationship of Vata and Manas by saying that mind gets active on the light of Vata. Vata kopa also results in dhatukshaya which in fact may lead to depletion of the ojas and hence results in physical as well as somatic ailments. Hence it is of ultimate importance to regulate Vata, in the management of Anidra.1,2 Now a days modern medicine doctors prescribe different types of transquillizers for treatment of insomnia. In initial days of treatment these medication gives considerable relief but continuous and long term use of these medicine results into adverse effects.3 In such era there is need of efficient management of insomnia in natural way without any adverse effect and eradication of root cause of insomnia. In Ayurveda insomnia can be correlated with Anidra. Ayurvedic treatment modalities for the treatment of Anidra (Insomnia) which could be safe, effective, readily available, cost effective without any side effects. Ayurveda has a potent approach towards the treatment of Anidra by both internal and external medications. Here we treated patient of Anidra with is Vataghna Chikitsa. It includes  Shirodhara with Shamana Chikitsa.4

A CASE REPORT :

A Female patient aged about 35 yrs cames in OPD of Kayachikitsa presented with difficulty in initiation and maintenance of sleep since  6 months. During sleep sometimes she used to get dreams which disturbed her sleep. She used to go to bed at 9.30 pm daily but she had to struggle for 1 hour to fall asleep. In between 2 or 3 times she used to awaken and later she had to wait for half an hour to fall asleep again. Because of disturbed sleep she was getting irritation during day time, feeling of low energy and sometimes she used to get headache. She visited allopathic hospital and started anti-psychotic and sedatives drug. Patient took medication regularly for 6 months but the symptoms didn’t get subsided. Hence patient came for  treatment she was admitted in Pakwasa Samanvay Ragnalay Nagpur.

1. Ashtavidha pariksha :

1. Dashavidh pariksha :

1. Systemic examination :

1. General examination :

Methods & Results:

INVESTIGATION :

Haematological investigation was within normal limits. The case was diagnosed as Anidra (insomnia ) on the basis of signs and symptoms.

INTERVENTION :

On admission, patient treated with Shirodhara along with the Shamana Chikitsa . Shirodhara is a type of Murdhani Taila that involves gentle pouring of warm liquids over the forehead. It is the process in which medicated oil is poured in a continuous stream of drip on the forehead in a specific manner and height.  Shiroshara therapy is extensively used for alleviation of psychic and psycho-somatic ailments. In this study Brahmi Taila was used for the Shirodhara procedure. The patient received appropriate counselling regarding the procedure. The patient's vital signs were recorded before to the surgery. The procedure was carried out in the morning. Dharapatra housed Brahmi Taila. To stop the flow of oil into the patient's eyes, cotton plugs and bandages were used to cover the patient's eyes. Dhara was continuously applied to the forehead, neither quickly nor slowly. The oil was kept at a lukewarm temperature throughout the process. While the oil was being poured, Dharapatra was moved like a pendulum, going from one lateral side to the other. The 45-minute procedure lasted for 14 days. Every seventh day, the oil was replaced. 2 litres of Brahmi Taila in total were utilised for the procedure. Shamana Chikitsa was given continuously 14 days during the procedure and after the procedure to till follow up.

Table No. 1: Intervention

Follow up of the patient was done after 15th day of completion of procedure.

ASSESSMENT CRITERIA  & OBSERVATION:

Assessment was done after the completion of procedure and after the follow up. Both subjective as well as clinical improvements were employed for the impact of the procedure. All symptoms which were selected for assessment, their improvements were thoroughly examined and severity of each of them was rated before and after the trial of the procedure. Grading was done for the assessment. Patient was assessed from subjective criteria and also from PSQI scale. Krodha and chinta of the patient was markedly reduced.5

Table no. 2 : Assessment before & after treatment and follow up 

1. Gradation of sleeplessness :

No sleeplessness                    - 0

Occasionally                           - 1

Mild                                          -2

Moderate                               - 3

Severe , require medicine – 4

1. Quality of sleep (Is sleep continuous/disturbed)

Continuous sleep                                                                  - 0

Mild disturbed sleep (disturbed at 1-2 hrs)                   - 1

Moderate disturbed sleep (disturbed at 3-4 hrs)          -2

Severely disturbed sleep (disturbed at 4-5 hrs)           - 3

Table no. 3 : Sleep quality index (PSQI Scale)

Component of PSQI scale-

Global PSQI scale is the sum of all the seven components of PSQI.

RESULT:

Shiroshara with Brahmi Taila along with Shamana Chikitsa gave excellent result by improving the quality of sleep. Significant relief was observed in Subjective parameters of patient. Reduction in PSQI score from 20 to 12 within 20 days of treatment was observed.

Discussion

Insomnia is a sleep disorder in which people have trouble to sleep. Physiologically it can be defined as the state of decrease functioning of thalamus and basal fore brain. Numerous neurotransmitters may be involved in the disruption of sleep, according to pharmacological investigations. The crucial function that serotonin and catecholamine levels play in promoting sleep cannot be overstated. Applying oil externally to the forehead is known as shirodhara, and it is primarily used to nourish and calm the neuromuscular system. Shirodhara is a form of relaxation that calms an agitated Vata Dosha and reduces mental weariness. Through nervous system relaxation, It helps to balance the blood flow in the brain and restore normal central nervous system function. Shirodhara has anti-anxiety and stress-relaxing properties, and these benefits are mediated via brain wave coherence, alpha waves, and a reduction in sympathetic outflow. 6 The continual pouring of Brahmi Taila may also absorb and stimulate the cerebral cortex, repair the lack of neurotransmitter, and produce a calming effect similar to how local ointment after application travels through stratum corneum and reaches the target organ. Shirodhara also promotes mental wellness by calming the agitated manasika bhava, such as krodha, chinta, and bhaya. Shirodhara has a calming impact after treatment because it relaxes the patient and encourages sleep, which may be caused by increased.7

In Andira (insomnia) the main vitiated dosha is Vata , so balances of Vata Dosha is an important thing to treat in insomnia. Brahmi Taila is used for Shirodhara. Taila itself is having the Vatahara, Sukshma and Snigdhatva properties which helps Tarpaka Kapha in proper facilitation and sound connection of Indriyas and Vishaya which was deranged earlier by aggravated Vata Dosha.8 Due to its Sukshma guna it easily penetrates in the deep channels inside the body. Active components of Taila penetrate into the circulation via forehead and produces Vatahara effect and it also produces lubrication and nutrition. Brahmi is a medhya drug which have rasayana (rejuvenative), medohara (anti-dyslipedimic), nidrajanana (sleep promoting), shothahara (antiinflammatory), chittowegahara (anxiolytic) and hrudya (cardiotrophic) properties along with anti hypertensive effects.9 It also balances the vata and kapha dosha. Hence, Shirodhara facilitates for better working by its Medhya effect and the continuous pouring of liquid in relaxed and comfortable position has an additional benifits.10 Cap .stresscom( Ashwagandha) in a dose of  2 capsules, each capsule of 500 mg is administered two times in a day before food. Ashwagandha is said to be rasayana and possesses ushna veerya and vatakaphahara property.11 Saraswatarista is explained to be sarvadoshahara and it promotes chitta santhosha. Sarswatarista are  some of the widely indicated formulation for psychiatric illness like unmada, atatvaabhinivesha etc.  Saraswatarista having Tridoshara , Rasayana , Ojaskara and Medhya properties which provide proper nutrition to the brain and stimulate its function. Brahmi is a proven brain tonic, act as neuro – activator and helps to improve mental & intellectual activity. Triphala and musta churna were given to correct the Agni and improve digestion. All these together helps to improve brain functioning and provides nourishment to brain which is responsible for the suppression of aggravated Vata Dosha thereby overcomes stress & anxiety . calm down the mind and in turns improves quality and duration of sleep.

Conclusion

Ayurvedic treatment modalities for the treatment of Anidra (Insomnia) which could be safe, effective, readily available, cost effective without any side effects. The medicine selected which are vatahara in nature and promoting mental calmness helped in rectifying the pathogenesis of Anidra by reducing the signs and symptoms. In overall assessment it was found that Shirodhara with Brahmi Taila along with Shamana Chikitsa have beneficial role for the management of Anidra.