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Introduction

Nidra or sleep plays an important part in our life. We all know the value of sleeping well and            we have all experienced the feeling of being refreshed after having good night’s sleep. It is a physiological process occurring in every individual. Restful sleep is the foundation for                               your mental and physical wellbeing. Ayurveda has stated sleep as one of the most important pillars of health associated with happiness and good health. The swasthya depends on three upastambha i.e. Ahar, Nidra and                           Brahmacharya1. Ayurveda is not only the system of medicine but also the way of life. It includes physical, mental and spiritual wellbeing. According to Charaka, when the mana including the indriya is exhausted and they dissociate themselves from their objects, then individual sleeps2. The disturbance in Nidra might be related to the faulty life style, mental tension, changed food habits and stress which ultimately                 disturb the Nidra. Acharya Charaka has described Nidra among the primary tripod of life with its merits and demerits, classification and management.

In Charaka Samhita importance of Nidra has been stated as Sukhakar- Happiness, Pushtiker- Nourishment, Balyake - Stength, Vrishya- Aphrodisiac, Dnyanaker- Learning,     Jeevanker- Life giving3.

People aren’t aware of the risk of sleep deficiency. In fact, they may not even realize that they’re sleep deficient. ‘Nidravegdharan’ i.e. suppression of urge of sleep had already been narrated in Brihattrayi. Ayurveda dose not dictate eight hours sleep for every night for everyone, but quality of sleep and quantity of sleep required by an individual is completely different. In today’s life where people put work ahead of sleep and gets affected by many life style disorders, we need to review the literature of ayurvedic text written 5000 years ago in order to improve quality of life because safeguarding the health of youngsters in this new, growing world becomes a big health challenge to public health specialist.

Aim & Objectives:

1. To review literature of Nidra with reference to Brihattrayi.
2. To study of etiopathogenesis of Nidranash from Brihattrayi.
3. To study management of Nidranash from an ayurvedic perspective.

Material & Methods

The classics of Ayurveda Brihattryi designated as Charak Samhita, Sushruta Samhita, Ashtanga Sangraha and Ashtanga Hridaya and their available commentaries.

Review on Nidra:

Vachaspatyam:

It is always used in famine gender. Sleep is a state of unconsciousness of the person. In Upanishad and Ayurvedic literature, Nidra is considered as one of the essential function of living organisms.

Definition of Nidra

1. Charaka affirmed that when the mind as well as soul gets exhausted or becomes inactive and the sensory and motor organs become inactive then the individual gets sleep.
2. Sushruta described the sleep occurs when the Hridaya the seat of Chetana is covered by Tamas4.
3. Ashtanga Sangraha – Vagbhata stated that the Mnovaha Srotas become accumulated with Shleshma and the mind is devoid of sense organs because of fatigue, when individual falls asleep5.

Synonyms of Nidra

In Amarkosha, four synonyms have been mentioned –

1) Shayanam 2) Svapah 3) Svapnah 4) Samvesh

Similarly, in Vaidyak Shabda Sindhu, three synonyms are available.

1) Sambhashah 2) Suptih 3) Swapanam

In Charak Samhita, Bhutadhatri has been used as a synonym and in Sushruta Samhita the word Vaishnavi Maya is used.

Types of Nidra

Acharya Charak has classified Nidra in following manner6:

1. Tamobhava - Caused by tamas
2. Shleshmasamudbhava - Caused by (vitiated) kapha
3. Manah- sharirshrambhava - Caused by mental exertion
4. Agantuki - indicative of bad prognosis leading to imminent death

        5.   Vyadhyanuvartini - Caused as a complication of other diseases like sannipata jwar.

        6.   Ratri-swabhavprabhavaja - Caused by the very nature of the night (physiological sleep)

Acharya Dalhan has classified Nidra into three types7:

1. Tamsik – When sangyavaha srotas is filled with shleshma and dominated by tamoguna.
2. Swabhaviki – This type of Nidra occurs naturally in all living beings.
3. Vaikariki – If there is any disturbance in mana and body, Nidra does not occur. But if Nidra is produced , it is vaikariki.

Acharya Vagbhat has classified Nidra in seven types8:

1. Kala swabhav – Caused by the very nature of night (physiological).
2. Amayaja swabhava- Caused as a complication of other diseases like sannipata jwara.
3. Chitta kheda prabhav - Caused by mental exertion
4. Deha kheda prabhav - Caused by physical exertion
5. Kapha prabhav - Caused by vitiated kapha
6. Agantuka – indicative of bad prognosis leading to imminent death
7. Tamo prabhav - Caused by tamas

Physiology of Nidra

When mana is exhausted and when it dissociates itself from all Vishaya then a person sleeps. According to Dr. Howell, sleep is due to cerebral ischemia. Cerebral cortex is the seat of higher centers like pre and post central gyres, association etc. which have the correlation with mental activities described in Ayurveda. So due to the reduction in cerebral blood supply Mana becomes klanta which causes sleep. Further during sleep Indriyas become inactive by the detachment from their sense organs or from their work.

Importance of Nidra:

Ahar, Nidra and Bramhacharya are the three factors which play an important role in the maintenance of a living being. In the Ayurvedic literature these three factors have been compared with the three legs of sub- supports and have been termed as Trayopstambha.

While describing importance of Nidra Ayurveda illustrates:

• It creates happiness in life.
• It maintains the consistency of body.
• It increases the strength.
• It increases the power of brain and mind.
• Lastly it prevents the life.

Nidranash :

The word Nidranash is composed of two wordi.e. Nidra and Nidranash.

Nidra:

Nidra is state where mind and intellects are rest.

Nasha

Based on the above Nirukti the term Nidranash can be broadly defined as the loss of sleep or the derangement in the quality and quantity of sleep.

Synonyms of Nidranash

1. Anidra
2. Alpanidra
3. Awvapna
4. Jagarana
5. Nidravighata
6. Nidrakshay

Nidana of Nidranash

There is no direct reference regarding the causative factors of Nidranash. In Charaka Samhita, Ashtang Hridaya and Ashtanga Sangraha the acharyas have explained the chikittsa procedure of Atinidra and in this context they mentioned that if any atiyoga occurs to these chikittsa procedure it may lead to Nidranash. So atiyog of following chikittsa procedures can be taken as causative factors of Nidranash9.

• Atiyog of Vaman
• Atiyog of Virechana
• Atiyog of Nasya karma
• Atiyog of Rakta mokshana
• Atiyog of Dhoompana
• Atichinta
• Atikrodha
• Vata Vriddhi
• Pitta Vriddhi
• Mnastapa
• Dhatukshaya
• Abhighata

Some other Nidana factors which may also cause the Nidranash according to Ashtanga Sangraha are as follows10

• Lobha (Grief)
• Harsha (Happiness)
• Vyatha(Sorrow)
• Atimaithuna(Excessive Intercourse)
• Atikshudha (Excessive hunger)
• Rukshanna sevan (intake of dry food)
• Anjana

All these Nidana factors can be classified under following headings:

1. Aharaja Nidana – Rookshanna sevan
2. Viharaja Nidana – Vyayam etc.
3. Manasika Nidana – Bhaya etc.

Purvarupa:

Purvarupa of Nidranash has not been mentioned in Samhitas. Acharya Charak included Nidranash in 80 Nanatmaja Vyadhi.

Table no.1 Samprapti Ghatak

Upadrava11-12-13

In Ashtanga Sangraha, it is mentioned that increased vayu due to nidranash produces kaphakshaya, this decreased and dried kapha sticks in walls of dhamanis and causes srotorodha, This, results in so much exhaustion that eyes of the patient remain wide open and watery secretion starts coming through eyes. This exhaustion is sadhya up to three and half days,  then it is asadhya. Nidranash leads to squeezing pain in the body parts, heaviness of head, to much of yawning, lassitude, giddiness, indigestion, stupor and diseases of Vata origin.

Pathya-Apathya

Pathya is wholesome regimen which does not impair the body system and which is pleasant to the mind. If one follows certain principles and controls the activities and make changes in the regimen as mentioned earlier in the form of Ahara and Vihara management, he can get a sound, normal and good sleep.

Apathya are those which adversely affect the body and mind and are considered to be unwholesome. It may be said that etiological factors of nidranash are apathya in the diseases.

Chikittsa of Nidranash:14-15

The chikittsa of any disease in simple word is giving up of causative factors. In the treatment of Nidranash, one should depend upon measures having vatashamak, roganivaraka effects as well as pacifying effects on mental activities. The treatment described in ayurvedic classic can be classified as:

• Bahya Upachara
• Manasika Upachara
• Ahar Upachara

Bahya Upachara

Abhyanga, Utsadana, Samvahana, Akshi tarpana, Shiro lepa, Karnapurana, Shiro basti, Shiro dhara, Moordhni tailam

Manasika Upachara

Manonukula vishaya graham, Manonukula shabda graham, Manonukulagandha grahan,

Ahar Upachara

Gramya mansa, Anupa mansa, Jaleeya mansa, Mahisha kheera, Piyusha

Anya Upachara

Some other measures, which can be advised to the patient of nidranash, though are not mentioned in Ayurvedic texts are as follows:

• Maintaining regular time for going to bed.
• Avoid smoking, having tea, coffee before bead.
• Do not indulge in ant type of work till late night.
• Should devoid of thoughts tensions before bed.
• Hearing music before bed.
• Offering prayer before bed.
• Avoiding sleeping during daytime.
• Proper evacuation of stool and urine
• Maintaining adequate privacy and being free from any disturbances.
• Avoid mosquito bite.
• Excess coitus is not advised,
• Activities such as washing hands, feet induce sleep.
• Reading books before bed.

Discussion

Sleep restores energy to the body and provides relaxation particularly to the nervous systems. It helps in building and restoring the control of brain and nervous systems over the muscles, glands and other body systems. Anidra and Nidranasha is enumerated as one of the Nanatmaja Vikara of Vaat Dosha. It is also included as one of the symptoms in vaat and pitta dosha vriddhi lakshanas. Kaphadosha, Tamas, Hridaya ans Sangyavaha srotas are responsible for the induction of sleep. There is relation between the age and duration of sleep. Along with this the influence of Tridosha can also disturb the sleep pattern. Increased condition of Vaat Dosha can cause loss of sleep. Increased condition of pitta dosha in relation to its ushna and tikshna guna is also responsible for insomnia. Kshaya can also cause loss of sleep as it is responsible for the deprivation of dhatus from  their normal function. This condition may bring the loss of sleep.

Conclusion

Sleep is one of the basic instincts of life. Health and longevity are conquered by proper sleep. Insomnia is gradually threatening health of an individual, personal and social behavior including occupational life. Hence it has been considered as psychosomatic disorder aggravated by vitiated Vaata-Dosha. Various measures are provided in Ayurveda which can certainly help to overcome this situation. Avoiding causative factors is a must to tackle the condition more precisely with administration of many upachar or treatment regimen as well as herbs in single or compound form, having sedative activity.