NIDRANASHA (INSOMNIA)

🔺 CASE STUDY NO: NIDRANASHA (INSOMNIA)

🔺 NIDANAM (ETIOLOGY / CAUSATIVE FACTORS)

• Vata prakopaka nidana:

  • Excessive physical/mental exertion

  • Anxiety, fasting

  • Intake of ruksha (dry), laghu (light) food

• Manovaha srotodushti: Mental stress, worry, fear, grief

• Ratrijāgaraṇa: Habitual night awakening

• Rajas & Tamas vitiation:

  • Increased Rajas → restlessness

  • Decreased Tamas → disturbed sleep

• Suppression of natural urges (vegadharaṇa)

• Diseases involving pain (śūla), fever (jvara), or mental disorders (mānasa rogas)

🔺 PURVAROOPAM (PREMONITORY SYMPTOMS)

• Restlessness

• Inability to relax the mind

• Disturbed sleep routine

• Anxiety, irritability

Note: No classical purvarupa explicitly mentioned; inferred from early signs.

🔺 LAKSHANA (SYMPTOMS)

• Alpanidratva (reduced sleep), Anidra (complete loss of sleep)

• Dainya (misery), Glāni (fatigue), Shrama (tiredness)

• Angamarda (body ache), Jāḍyata (mental dullness)

• Shirobhrama (giddiness), Jrimbha (yawning), Netraśūla (eye pain)

• Manoavasāda (mental exhaustion, depression)

Reference:

• Charaka Saṃhitā Sūtrasthāna 21/59

🔺 GENERAL EXAMINATION

• Appearance: Tired, anxious, dull

• Vital Signs:

  • BP: May show hypertension

  • Pulse: May be elevated (tachycardia)

  • Temperature: Usually normal

  • Respiratory Rate: Increased in anxious individuals

• Mental State:

  • Mood: Irritable, low

  • Speech: Slow or hurried

  • Orientation: Usually intact, may be distracted

• Eyes: Redness, puffiness, dark circles

🔺 SYSTEMIC EXAMINATION

• CNS:

  • Anxiety, irritability

  • Poor concentration or memory

  • Check for depression, psychosis

• CVS:

  • Palpitations

  • Hypertension or anxiety-related tachycardia

• RS:

  • Rule out Obstructive Sleep Apnea (OSA)

• Endocrine System:

  • Thyroid enlargement (Hyperthyroidism)

  • Weight loss/gain

🔺 LABORATORY INVESTIGATIONS

• Thyroid Function Test (T3, T4, TSH)

• CBC: Rule out anemia/infection

• FBS / HbA1C: Assess glucose levels

• Vitamin D & B12 Levels: Deficiency may impact sleep

• Liver Function Test (LFT)

• Serum Cortisol: Stress-related hormonal disturbance

• Urine Drug Screening: Rule out substance-induced insomnia

• ECG / Holter Monitoring: If palpitations or arrhythmia suspected

• Polysomnography (Sleep Study): In cases of OSA or periodic limb movement disorder

🔺 DIFFERENTIAL DIAGNOSIS (DD) OF NIDRANĀSHA

• Primary Insomnia

• Generalized Anxiety Disorder

• Major Depressive Disorder

• Bipolar Disorder

• Schizophrenia

• Obstructive Sleep Apnea (OSA)

• Restless Legs Syndrome

• Periodic Limb Movement Disorder

• Narcolepsy

• Fibromyalgia / Chronic Pain

• Hyperthyroidism

• GERD

• Substance Abuse / Withdrawal

• PTSD, Nocturia

• Dementia (Alzheimer's)

• Circadian Rhythm Disorders

• Epilepsy

🔺 SAMPRAPTI (PATHOGENESIS)

• Nidana → Vata prakopa

• Disturbance of Vyana Vata → Insomnia

• Imbalance of Rajas (↑) and Tamas (↓)

• Manovaha srotodushti → Vata aggravation → Nidranāsha

Samprapti Ghataka:

• Dosha: Vata, Rajas ↑, Tamas ↓

• Dushya: Mana, Rasa

• Srotas: Manovaha srotas

• Adhisthana: Mastishka, Mana

🔺 SAMANYA CHIKITSA (GENERAL MANAGEMENT)

• Nidana Parivarjana: Avoid stress, irregular food, gadgets

• Vata Shamana Chikitsa:

  • Snigdha ahāra (unctuous diet)

  • Warm milk with ghee at bedtime

  • Snehana (abhyanga) of head and feet

  • Shirodhara with kṣīrabala taila

  • Medhya rasāyana:

    • Brahmi, Mandukaparni, Shankhapuṣpī

• Lifestyle Modifications:

  • Yoga, meditation, prāṇāyāma

  • Dinacharya (routine sleep and food schedule)

  • Reduce screen time before sleep

🔺 UPASHAYA (RELIEVING FACTORS)

• Shirodhara (kṣīrabala taila)

• Ghee, milk, nourishing food at night

• Quiet, dark sleeping environment

• Listening to calm music or chants

🔺 ANUPASHAYA (AGGRAVATING FACTORS)

• Excess gadget/screen exposure

• Light/noisy sleeping conditions

• Skipping meals or spicy/dry food

• Stressful thoughts before bed

• Irregular sleep pattern

🔺 VISHESHA CHIKITSA (SPECIFIC MANAGEMENT)

• Medications:

  • Brahmi Vati

  • Manasāmitra Guṭikā

  • Ashwagandhāriṣṭa

  • Sarasvatāriṣṭa

  • Tagara Chūrṇa

  • Jatāmāṃsī, Vaca, Yastimadhu

  • Kṣīrabala Taila (internal & external use)

• Panchakarma Therapies:

  • Shirodhara – with kṣīrabala taila

  • Nasya: Anu taila or kṣīrabala taila

  • Abhyanga & Swedana – for Vata pacification

  • Basti (Anuvāsana / Matra): With medhya-snehana dravyas

• Yoga & Prāṇāyāma:

  • Śavāsana

  • Bhrāmari

  • Nāḍī Śuddhi

  • Yoga Nidrā