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Introduction

According to Ayurveda, getting good sleep at a proper time is one of the characteristics of a healthy man. Nidra is the leading disorder in the new Era. At present Nidra related disorder are increasing day by day due to the working tendencies at night time has increased and hence excessive stress has increased. Sleep is an important physiological process and basic need for the body just like food, water and air. Sleeping has a crucial role in maintaining the normal motor and cognitive functions of the body. Our body’s natural circadian rhythm or biological clock plays an important role in regulating sleep. Vata and Pitta are the Pradhan Doshas contributing to Anidra. Aswapna(Anidra) is included in Vata Nanatmaja Vikaras, hence Vatashamaka treatment should be given for maintaining and promoting health. The Moordhani Tailam i.e. Shirodhara has been considered as an important procedure in management of Anidra. In this study, one group were assigned Shirodhara using Brahmi Taila while another group given  Shirodhara using Bala Hatadi Taila for a period of 45 min for 7 days.

Objectives:

1. To study the efficacy of Brahmi Taila Shirodhara in the management of Anidra.
2. To study the efficacy of Bala Hatadi Taila Shirodhara in the management of Anidra.
3. To compare the efficacy of Brahmi Taila Shirodhara and Bala Hatadi Taila. Shirodhara in the management of Anidra.

In this study, 10[50%] patients were male and 10[50%] patients were female in Group-A while 13[65%] patients were male and 7[35%] patients were female in Group-B.   Totally 17[42.5%] were female and 23[57.5%] were male while more male was recruited in study it may be due random selection of patients.

In Group-A percentage of relief noted in Jrumbha was 77.3%, while in other symptoms like Tandra  percentage of relief was noted as 57.1%, 73.5% in Shiro Gaurava  and 89.7% in Netra Gaurava. Average relief in all symptoms in Group A was 74.4%.

               In Group-B, the  percentage of relief noted in Jrumbha was 59.5%, while in other symptoms like Tandra  percentage of relief was noted as 63.3%, 82.9% in Shiro Gaurava  followed by 83.3% in Netra Gaurava. Average relief in all symptoms in Group A was 65.8%.

Comparison between Two Group w.r.t Symptoms Score:

The Difference between before treatment and after treatment score of both groups compared by ‘Mann-Whitney U Test’. It was found that the sum of rank of Group-A  for the symptom Jrumbha  Test statistic (U’) was 252.5 and U was 147.5, where the test statistic U was not lies between Population Mean ±1.96 SD which was not significant at 5% level of significance as p =0.156(p>0.05) Therefore the difference between Symptom Score of Jrumbha of Group-A and Group-B is statistically not significant, so therefore we can conclude that in the symptom Jrumbha  both drugs are equally effective statistically.

Likewise, in other symptoms viz. Tandra, Shiro Gaurava and Netra Gaurava the test statistics U was not lies between Population Mean ±1.96 SD which was not significant at 5% level of significance as p > 0.05. So therefore, we can conclude that in these symptoms, trial Group-A and Group B intervention  are equally effective statistically. So, from this we can conclude both groups are equally effective statistically for the symptoms of Anidra  viz. Jrumbha, Tandra, Shiro Gaurava and Netra Gaurava.

Comparison between Two Group w.r.t Pittsburgh Sleep Quality Index  :

The Difference between before treatment and after treatment for PSQI score of both groups compared by ‘Mann-Whitney U Test’. It was found that the sum of rank of Group-A  for the criteria Sleep quality, Test statistic (U’) was 240.5 and U was 159.5, where the test statistic U was not lies between Population Mean ±1.96 SD which was not significant at 5% level of significance as p =0.27 (p>0.05) Therefore the difference between Sleep quality Score of Group-A and Group-B is statistically not significant, so therefore we can conclude that in the criteria  Sleep quality both drugs are equally effective statistically.

Similarly, in the parameters Sleep latency, Sleep duration, Sleep efficiency, Sleep disturbance, use of sleep medication and Day time Dysfunction Test statistic (U’) were and the test statistic U was not lies between Population Mean ±1.96 SD which was not significant at 5% level of significance as (p>0.05).

Discussion

Gender: In this study, totally 17[42.5%] were female and 23[57.5%] were male while more male was recruited in study it may be due random selection of patients.

Age: As per inclusion criteria of patients were selected having age between 18 years to 60 yrs. and distributed it in four-sub age groups. Out of 40 patients’ number of patients found in age group 18-29 were 13[32.5%], in age group 30 to 39 yrs. were 22[55%], in 40 to 49 yrs. age group were 04[10%], and 01[2.5%] patient from age group 50-60 yrs. of Anidra was observed.

Clinical findings : In Group-A, regarding symptom Jrumbha,  Tandra,  Shiro Gaurava,  Netra Gaurava,  p value was <0.001 which  was statistically considerably highly significant (p<0.001). In Group-B, regarding symptom Jrumbha,  Tandra,  Shiro Gaurava,  Netra Gaurava,  p value was <0.001 which  was statistically considerably highly significant (p<0.001).

It was found that the difference between Symptom Score of Jrumbha, Tandra,  Shiro Gaurava,  Netra Gaurava of Group-A and Group-B is statistically not significant, so therefore we can conclude that in these symptoms of Anidra both drugs are equally effective statistically. So, from this we can conclude both groups are equally effective statistically for the symptoms of Anidra  viz. Jrumbha, Tandra, Shiro Gaurava and Netra Gaurava.

It was found that criteria Sleep quality, Sleep latency, Sleep duration, Sleep efficiency, Sleep disturbance, use of sleep medication and Day time Dysfunction, the difference between Score of Group-A and Group-B is statistically not significant, so therefore we can conclude that in the criteria of PSQI score  both drugs are equally effective statistically.

Mode of action of Shirodhara:

Imbalance of prana, udana and vyana vayu, sadhaka pitta and kalpha can produce stress and tension which are the usual triggering factors of the Insomnia. Shirodhara re-establishes the functional integrity between these three subtypes of doshas through its mechanical effect. Agnya chakra (the space between the two eyebrows) is the seat of pituitary and pineal gland. As we know the pituitary gland is one of the main glands of the endocrine system and exhibits its action on human body for various functions, etc. Shirodhara stimulates it by its penetrating effect, which decreases the brain cortisones and adrenalin level, Synchronizes the brain wave (alpha wave) and strengthens the mind which is usually disturbed in Insomnia.  By Shirodhara, patient feels relaxation, both physically and mentally. Relaxation of the frontalis muscle tends to normalize the entire body activity and achieves a decrease  activity of sympathetic nervous system with lowering of heart rate, respiration, oxygen consumption, blood pressure, brain cortisones and adrenalin levels, muscle tension and probably increase in alpha brain waves. It strengthens the mind and spirit and this continues even after the relaxation. Special stimulation of different nerve plexus, glands and brain cells accompanies mental functions of different levels. Shirodhara which contain many drugs like Brhami and Bala hatadi tail  drugs may stimulate the endocrine, nervous and immune system and thereby it may reduce Anidra. Further large study can be done on more sample to generalized the results. Theses drug can also be studied for their pharmacokinetic studies. Study can also be done with other procedure of Panchakarma to obtain more efficacy of drug. The limited size of sample was not sufficient to conclude the efficacy of the intervention.

Conclusion

Sleep is one of the basic needs of life and requirement for  Health and longevity. Mutual relationship between Vata and Rajas causes Rajo Guna Vruddhi, which intern cause suppression of effect of Tamas at the psychological level leading to loss of sleep. In Group A regarding symptom Jrumbha,  Tandra,  Shiro Gaurava,  Netra Gaurava,  Shirodhara using Brahmi Taila  intervention having considerably highly significant results. In Group B regarding symptom Jrumbha,  Tandra,  Shiro Gaurava,  Netra Gaurava,  Shirodhara using Bala Hatadi Taila intervention having considerably highly significant results. It was found that the difference between Symptom Score of Jrumbha, Tandra,  Shiro Gaurava,  Netra Gaurava of Group-A and Group-B is statistically not significant, so therefore we can conclude that in these symptoms of Anidra both drugs are equally effective statistically.  In  the Pittsburgh Sleep Quality Index both drugs are equally effective statistically. Percentage of Relief in Each Patient of 40 Patients of Anidra  in Group A  was 76.3% while 69.8% in Group B. Average relief in both groups was 73.0% in each patient of Anidra. Overall, it is concluded that Brahmi Taila Shirodhara and Bala Hatadi Taila are equally effective in if Shirodhara adopted in Insomnia.