Study of Nidra As Adharinya Vega and Its Management With Bhramar Pranayam, Dr. Bhati PDF

“STUDY OF NIDRA AS ADHARNIYA VEGA & ITS MANAGEMENT WITH
BHRAMARI PRANAYAM”
A THESIS SUBMITTED TO
BHARATI VIDYAPEETH UNIVERSITY, PUNE
FOR AWARD OF DEGREE OF
DOCTOR OF PHILOSOPHY IN SWASTHAVRITTA
UNDER THE FACULTY OF AYURVED
SUBMITTED BY
DR MRS. KIRTI RAJENDRA BHATI
UNDER THE GUIDANCE OF

PROF.DR. VIJAY V. BHALSING
RESEARCH CENTRE
BHARATI VIDYAPEETH DEEMED UNIVERSITY
COLLEGE OF AYURVED, PUNE. 411043.
MARCH 2016
CERTIFICATE
This is to certify that the work incorporated in the thesis entitled

“Study Of Nidra As Adharniya Vega & Its Management With Bhramari Pranayam” for
the degree of „Doctor of Philosophy‟ in the subject of Swasthavritta under the faculty of
Ayurved has been carried out by Dr Mrs Kirti Rajendra Bhati in the Department of Swas-
thavritta at Bharati Vidyapeeth Deemed University College of Ayurved Pune during the
period from November 2012 to March 2016 under the guidance of Prof. Dr. Vijay V.
Bhalsing
Place: Pune Dr. Abhijeet Patil

Date: / /2016 Principal
Bharati Vidyapeeth University,
College of Ayurved,
Pune
CERTIFICATION OF GUIDE
This is to certify that the work incorporated in the thesis entitled “Study of
Nidra As Adharniya Vega & Its Management with Bhramari Pranayam” Sub-
mitted by Dr Mrs Kirti Rajendra Bhati for the degree of „Doctor of Philosophy‟ in
the subject of Swasthavritta under the faculty of Ayurved has been carried out in
the Department of Swasthavritta Bharati Vidyapeeth College of Ayurved Pune
during the period from November 2012 to March 2016, under my direct supervi-
sion/ guidance.
Place: Pune
Date: / /2016 Dr. Vijay V. Bhalsing

Prof. HOD Dept of Swasthavritta
Bharati Vidyapeeth University,
College of Ayurved,
Pune
DECLARATION BY THE CANDIDATE
I hereby declare that the thesis entitled “Study Of Nidra As Adharniya Vega & Its
Management With Bhramari Pranayam” submitted by me to the Bharati Vidyapeeth
University, Pune for the degree of Doctor of Philosophy (Ph.D.) in Swasthavritta under
the Faculty of Ayurved is original piece of work carried out by me under the supervision
of Prof. Dr. V. V. Bhalsing.
I further declare that it has not been submitted to this or any other university or Institution
for the award of any degree or Diploma.
I also confirm that all the material which I have borrowed from other sources and incor-
porated in this thesis is duly acknowledged. If any material is not duly acknowledged
and found incorporated in this thesis, it is entirely my responsibility. I am fully aware of
the implications of any such act which might have been committed by me advertently or
inadvertently.
Place : Pune Dr Mrs. Kirti Rajendra Bhati

Date / /2016 Research Student
AKNOWLEDGEMENT
I have a great pleasure while keeping this thesis work in front of reputed personalities in
the research. I take this opportunity as a deep sense of gratitude to those people & institu-
tions, which helped me in this research work.
While going through all stages of this substantial work, from the hardships of collection
of data to the final writing, I had a humble feeling that I am just a tool at the hands of the
almighty God without whose mercy anything was possible for me. I am grateful to Lord
Dhanavantari.
I owe my gratitude to Hon. Dr. Patangraoji Kadam, Founder & Chancellor of Bharati
Vidyapeeth University, Hon. Dr. Shivajirao Kadam, Vice Chancellor of Bharati Vidya-
peeth University, Pune Hon. Dr. Vishwajeet Kadam, Secretary of Bharati Vidyapeeth,
Pune for giving me a chance to work in the institution & for encouragement and timely
regulation & motivation.
I am presenting this thesis with a deep sincere feeling of esteem to the respected
Principal Dr. Abhijeet Patil for insight, encouragement and timely guidance & motiva-
tion.
I have deep sense of gratitude for my Research guide, Head of the Swasthavritta Dept.
and Vice Principal Prof. Dr. Vijay Bhalsing for providing esteem cooperation and with
helping nature and whose constant inspiration, encouragement during presenting this re-
search work.
I express my deep sense of admiration to Dean Prof Dr. Asmita Wele, Bharati Vidya-
peeth, Ayurved faculty Pune for her esteem assistance and constant inspiration, encou-
ragement throughout presenting this research work.
I am gratified to Prof Dr. Narendra Bhatt for whose time to time incessant encourage-
ment, support and spiritual guidance with cheerful manner and deep knowledge in the
subject gave me great boost during my research work.
I express my gratitude to Prof Dr.Manasi Deshpande ,PhD Coodinator for her timely
advice and encouragement in every step of this work.
I am obliged to Mrs. Ashwini Manglekar (Statistician) for extending valuable co-

operation in Statistical Analysis of the said research work.
I am thankful to all College staff, Library staff, BVMF‟s Āyurvedic Hospital‟s staff and
all my students and friends for extending valuable co-operation during this research work
for their enormous help directly or indirectly, in completing this research work.
I appreciate a colossal assistance by Dr Ketki Wagh and Dr Manisha Thakare to accom-

plish this research work.
This acknowledgement would be inadequate without expressing deep gratitude which

cannot be stated in words towards my spouse Dr Rajendra Bhati, my daughter Miss
Poorti Bhati and my father Mr Eknath Shinde for the initiation, instigation, inspiration,
continuous encouragement and moral support. I appreciate a colossal assistance by Dr
Ketki Wagh in accomplishment of this research work.
Dr Mrs Kirti Bhati

Index
Chapter Content Pages
1 Introduction 1-4
2 Literary Review 5-77
3 Aim and Objectives 78
4 Materials and Methodology 79-93
5 Observation & Results 94-119
6 Discussion 120-138
7 Summary 139-141
8 Conclusion 142
9 Bibliography 143-148
10 Annexure - Research Proforma 1-8

Table Index
Sr Table Pg No.
No-
1 Symptoms and Chikitsa of Vegas 17-22
No Stages of sleep in the NREM
2
No 40
3 Synonyms of Anidra 41
4 Anidra Ahara Nidana 49
5 Anidra Vihara Nidana 51
6 Chikitsa Atiyogajanya Nidana of Anidra 52
7 Anidra Manasika Nidana 52
8 Symptoms of Anidra 52
9 Anidra - Samprapti ghataka 53
10 Bahya Upacharas for Anidraa 55
11 Aahara Upacharas for Anidraa 57
12 Manasika Upacharas for Anidraa 58
13 Anya upachara for Anidraa 58
14 Single drugs useful for Anidraa 59
15 Causative factors of Insomnia 60
16 Age wise distribution 64
17 Gender wise distribution 94
18 Prakruti wise distribution 94
19 Dietary Habitat wise distribution 95
20 Occupation wise distribution 95
21 Vyasan wise distribution 96
22 Marital status wise distribution 96
23 Educational status wise distribution 97
24 Habitat wise distribution 97
25 Socio economic status wise distribution 98
26 Result in Group I : Effect on Insomnia 98
27 Result in Group I : Effect on Manasa Bhavas 99
28 Result in Group I : Effect on Brief Psychiatric Rating 100
Scale (BPRS)
29 Result in Group II : Effect on Insomnia 101
30 Result in Group II : Effect on Manasa Bhavas 102
31 Result in Group II : Effect on : Effect on Brief Psychia- 103
tric Rating Scale (BPRS)
32 Result in Group III : Effect on Insomnia 104
33 Result in Group III : Effect on Manasa Bhavas 105
34 Result in Group III : : Effect on Brief Psychiatric Rat- 106
ing Scale (BPRS)
35 Result of Kruskal-Wallis Test 108-11

36 Result on comparison of the effects on sleep quality 112
37 Result on comparison of the effects on Vijnanam 113
38 Result on comparison of the effects on Medha 114
39 Result on comparison of the effects on Vashyata 115
40 Result on comparison of the effects on Emotional with- 116
drawal
Over all effect of the therapies on Effect on Insomnia
41 117
control)
42 Over all effect of the therapies on MANASA BHAVAS 118
43 Over all effect of the therapies on BRIEF PSYCHIA- 119
TRIC RATING SCALE (BPRS)
Sr No. Figures Pg No
1 Schematic representation of Vegotpatti 14
2 Schematic representation of Vegotpatti hetu 15
3 Schematic representation of Vegadharan nidan 16
4 Sleep Wake Cycle 39
5 Wake System 43
6 Sleep System 43
7 Schematic diagram of Samprapti of Anidra 54
ABBREVIATIONS
A. H. - Ashtanga Hridaya
• A. S. - Ashtanga Sangraha
• B.P. - Bhava Prakasha
• B.P. Ni. - Bhava Prakasha Nighantu
• Bhe. Sam. - Bhela Samhita
• Ch. - Charak Samhita
• Chakra. - Chakrapani
• Chi. - Chikitsasthana
• Dal. - Dalhana
• Ha. Sam. - Harita Samhita
• In. - Indriyasthana
• Ka. - Kalpasthana
• Ka. Sam. - Kashyapa Samhita
• Ma. Ni. - Madhava Nidana
• Ni. - Nidanasthana
• Sha. - Sharirasthana
• Si. - Siddhisthana
• Sha. Sam. - Sharangadhara Samhita
• Su. - Sushruta Samhita
• Su. - Sutrasthana
• Ut. - Uttartantra
• Vi. - Vimanasthana
• Y.R. - Yogaratnakara
INTRODUCTION
Aahara (food), Nidra (Sleep) and Bramhacharya (Abstinence) are illustrated as the Three
supportive pillars. Importance of Nidra, its role in maintenance of life is discussed3.
Nidra is also considered under Adharniya vega. It has been rightly stated by Charak that
happiness & misery, proper & improper growth, good strength & weakness, potency &
sterility, knowledge & ignorance and life & demise of an individual depend on appropri-
ate and inappropriate sleep4. Hence, Nidra (Sleep) is one of the important factors to lead
a healthy life.
Suppression of natural urges (Adharniya vega) related to urine, faeces, hunger thirst, fla-
tus, hiccup, sneezing, yawning, vomiting, sleep etc; either willful or forced has been con-
sidered to be harmful in Ayurveda and is likely to induce vitiation of dosas, causing sev-
eral diseases.
The dharana of Nidraavega may cause moha, gaurava of sirah and akshi, aalasya,
jrmbha and Angamarda. Nidraanaasa may cause Angamarda, sirogurutva, Jrmbha,
jaadya, glaani,bhrama, Apakti, tandraa and other rogas caused by vaata Dosha2.
Diseases caused due to Adharniya vega have been categorized as prajnaparadha because
in pathogenesis of such diseases primary fault begins with psyche (Prajna) and later on
somatic involvement occurs. Hence, these diseases may be recognised as psychosomatic
diseases also and the situation leading to these diseases may be considered as stressful
situations because in aetiology of psychosomatic diseases stress plays a major role1. Yo-
ga has a mental as much as a physical aspect. Pranayam help to make the most of the
different breathing techniques which can calm the mind and rest the brain from the end-
less chain of thoughts, offering inner peace and an antidote to the stress of modern day
life.
“Study Of Nidra As Adharniya Vega & Its Management With Bhramari Pranayam”
Uniting both these aspects is the philosophy of yoga. It is a practical philosophy that
complements Ayurveda medicine and aims at uniting the body, mind and spirit enabling
each individual to enjoy healing from within.
In Indian culture, yoga has traditionally been a part of daily routine which is meant for
attaining healthy life. The Sanskrit word pranayam is translated as “the science of
breath” in some circles, and in others it has a broader meaning, “expansion, manifestation
of energy.” Pra (first unit) na (energy) is the vital and primal energy of the universe. As
the breath and prana affects consciousness, the mind and emotions, it also affects our be-
liefs and Karma, just as our judgments, beliefs, and Karma effect the mind, emotions,
prana, breath, and physical body.
Need of the study:
In today‟s era contemporary therapeutic variety of tranquilizers are prescribed for the
managing insomnia. These tranquilizers initially give substantial aid in insomnia but
permanent and extensive use may stimulate various lethal effects including drug addic-
tion6.
In such a circumstances there is a gradual need for the proficient supervision of sleep-
lessness in a normal manner by proper analysis, subsequently following apt life style
and getting rid of the troubles as of source itself. Need has always been there to build up
certain modalities for the Management of Anidra (Insomnia)which could be secure, valu-
able, cost efficient with no adverse reaction, as compared to the remedial measures of
various method of medicine. In the midst of such background an attempt is prepared to
estimate the efficacy of Bhramari Pranayam in a series of patients suffering from insom-
nia.
Ayurveda offers a wide range of therapies and tools to restore balance from dietary rec-
ommendation and yogic treatments which together can help a great deal in treating Ani-
dra. Charak cite Bahya Upacharas such as Abhyanga, Utsadana, Samvahana, Akshitar-
pana, Moordhni Taila, Gramya mamsa rasa,Anupa mamsa rasa,Jaleeya mamsa rasa,
Manasika Upacharas as Mahisha ksheera,Peeyusha,Morata, Manasika Upacharas as
Page 14
Manonukula vishaya grahana,Manonukula sabda granaha,Manonukula gandha grana-

ha, 5 .
References
1 Mehra B, Dwivedi K. PA01.33. Mode of action of medhya drugs: A review. An-

cient Sci Life. 2012;32(5):83.
2 Murthy S. Astanga Hridaya. 9th ed. Varanasi: Chaukhambha Krishnadas Academy;

2013, Sutra, 7/65, pg 121.
3 Sharma R. Caraka Samhita Cakrapani Ayurveda Deepika. vol-1, Sutra 11/35, 1st ed.
Varanasi: Choukhambha Sanskrit Samsthan;2012,pg 219.
4 Sharma R. Caraka Samhita Cakrapani Ayurveda Deepika. vol-1, Sutra 21/36, 1st ed.
Varanasi: Choukhambha Sanskrit Samsthan;2012,pg 381.
5 Sharma R. Caraka Samhita Cakrapani Ayurveda Deepika. Vol-1, Sutra 21/52-3, 1st
ed. Varanasi: Choukhambha Sanskrit Samsthan;2012,pg 384.
6 Tripathi K. Essentials of Medical Pharmacology, 6th ed, Jaypee publications;2013 pg.

392.
Page 15
REVIEW
1) REVIEW OF PREVIOUS WORK
2) REVIEW OF LITERATURE
a) Adharaniya Vega
b) Nidra-Anidra
c) Sleep-Insomnia
d) Bhramari Pranayam
Page 16
REVIEW OF PREVIOUS WORK DONE
AU- N SUB- FORM OF TREAT- MAIN OUTCOMES

THORS JECTS MENT
Waters et 53 Chronic Progressive relaxation Results signify that PMR/CD
al (2003) insomnia + cognitive distraction had a better effect on sleep
(PMR/CD), sleep re- onset than did SR/SC and
striction + Stimulus SHE. SR/SC had a better ef-
control (SR/SC) fect on sleep maintenance than
furazepam or a sleep did PMR/CD while MED was
hygiene (SHE) better than the other treat-
ments.
Lichstein et 89 Older Relaxation, sleep com- All treatments enhanced self
al (2003) adults with pression or placebo de- reported sleep but objective
insomnia sensitization sleep was unaffected. Sleep
compression was most valu-
able.
Pallesen et 55 Older Sleep hygiene + stimu- No noteworthy changes were
al (2003) adults with lus control or sleep hy- observed during the waiting
insomnia giene + relaxation tape list period. Effects of treat-
(after a period of non- ment were better for noctural
intervention for half of measures as compared to day-
the sample) time measures and nontar-
geted behavior (medication
use). There were no diversity
in treatment effects for the two
interventions
Manjunath 120 Geriatric Yoga, ayurvedic herbal The yoga group showed con-
and Telles population preparation, or waiting siderable decline in time taken
(2005) list group to fall asleep, a boost in total
number of hours slept and in
the feeling of being rested in
the morning after six months.
Other groups: No noteworthy
change
Page 17
Morgan et 209 extensive CBT treated sleep At followup, patients with

al (2004) hypnotic clinic group or control CBT reported significant re-
medicine group ductions in sleep latency, pro-
consumer gress in sleep competence and
reduction in hypnotic drug
use.
Suri J.C. et 89 BPO Cohart study It was found that Circadian
al. (2007) rhythm sleep disorders
(CRSD) are not infrequently
seen amongst shift workers
Suri J.C., et 1240 Elderly Epidemiological study A study by was done to inves-
al.(2007) popula- tigate the epidemiology of
tion. sleep disorders
Seetha M 20 Insomnia Ayurvedic herbal Their life style became well

et al.(2007) preparation organized and there was an
urge with in themselves for
active involvement in their
day to day activities
Meshram 278 resident A questionnaire-based Assessed the behavior, atti-
S. doctors tude and knowledge of sleep
et al.(2007) medicine
Devi V et 107 a melato- Ramelteon. Treatment showed no evi-

al nin recep- dence of cognitive impair-
(2008) tor , in- ment, rebound insomnia,
somnia. withdrawal effects or abuse
potential.
Irwin et al 112 Older Tai Chih Chih or health Tai Chi Chih condition
(2008) adults with education showed significant improve-
moderate ments in Pittsburgh Sleep
sleep Quality Index, habitual sleep
complaints efficiency, sleep duration, and
sleep disturbance.
Page 18
Harmat et 94 Students Classical music, audio Music statistically signifi-

al (2008) with sleep book, or no interven- cantly improved sleep quality
complaints tion as measured by PSQI and de-
pressive symptoms. Other
groups did not improve in
these parameters.
Soeffing et 47 Insomniac Cognitive –behavioral CBI showed significant im-
al (2008) hypnotic- intervention (relaxa- provement compared to pla-
dependent tion, stimulus control cebo for sleep onset latency,
older or sleep hygiene) or wake time after sleep onset
adults placebo and sleep efficacy and clini-
cally meaningful improvement
Phadke S 100 extensive Eszopiclone Treatment was effective and
et al hypnotic comparable to other treatment
(2008) drug users in improving the sleep para-
meters in patients suffering
from insomnia with a better
safety profile
Bhat T. et 1 18-month- Zolpidem Treatment was effective and
al.(2008) old child successful
,primary
insomnia
Iyer S et Elderly Sleep and ageing- inte- This study described sleep
al. (2008) popula- ractions and conse- patterns changing subjectively
tion. quences. and polysomnographically
with ageing
Krishna P 67 medical a questionnaire-based, This study shows the high
et al. students Pittsburgh Sleep Quali- prevalence of poor quality of
(2008) ty Index sleep and underlining the rela-
tion of sleep with BP, BMI
and educational performance
among students of medice.
Vincent 118 chronic Online treatment (psy- Treatment produced im-
and Le- insomnia choeducation, sleep provement in the primary end
weky hygiene, and stimulus points of sleep quality, insom-
(2009) control, etc) or waiting nia severity, daytime fatigue,
list dysfunctional beliefs about
sleep
Page 19
Suri J.C., et 120 uncompli- a questionnaire survey. A definite correlation was

al.(2009) cated sta- found between EDS with the
ble adult severity of asthma and the
asthmatics level of control but not with
the mode of diagnosis of
asthma.
Ranawat R 30 Insomnia Bhastrika Yogic Kriya , Treatment improves various
et al.(2011) ,Jatamansi Ghana mental faculties to produce
significant improvement in
sleep pattern of all the pa-
tients.
Bhaduri T 30 Chronic Yoga therapy, shirod- The treatment lessen stress,
at el. Insomnia hara insomnia,anxiety,anger
(2013)
Though modern psychiatry acquired a revolutionary growth in understanding of mental

faculties and related things. Still lacuna persists in the field of psychopharmacology– es-
pecially when we think about its untoward secondary complications in the human sys-
tems.
No studies have been reported to confirm the concept of dharana of Nidra as Anidra,
however similar concept of Circadian rhythm sleep disorders include disorders in which
sleep-wake cycle disturbance, inadequate or poor quality of sleep leads to insomnia, With
this conditions an attempt is made to evaluate the effectiveness of Bhramari Pranayam in
a series of patients suffering from Anidra.
Page 20
References
 Bhaduri T, Chowdhury K, Biswas s, Panja A, . E. Clinical Evaluation of
Sirodhara And Yoga Therapy In Management of Chronic Insomnia. In-
ternational Research Journal of Pharmacy. 2013;4(6):78-80.
 Bhat T, Pallikaleth SJ, Shah N. Primary insomnia treated with Zolpidem

in an 18-month-old child. Indian J Psychiatry 2008;50:59-60.
Devi V, Shankar P. Ramelteon: A melatonin receptor agonist for the

treatment of insomnia. Journal of Postgraduate Medicine. 2008;54(1):45.
 Harmat L, Takács J, Bódizs R. Music improves sleep quality in students.

J Adv Nurs. 2008;2(3):327-35.
 Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older

adults with moderate sleep complaints: a randomized controlled trial of
Tai Chi Chih. Sleep. 2008;31(7):1001-8.
 Iyer SR, Iyer RR. Sleep and ageing - interactions and consequences. In-
dian J Sleep Med 2008;3:ISSN 0973-340X.
 Krishna P, Shwetha S. Sleep quality and correlates of sleep among medi-

cal students. 2008;3:0973-340X. Indian J Sleep Med. 2008;3:0973-340X.
 Lichstein KL, Riedel BW, Wilson NM. Relaxation and Sleep Compres-
sion for Late- Life Insomnia: A Placebo-Controlled Trial. J Consult Clin
Psychol. 2001;69(2):227-39.
 Manjunath N, Telles S. Influence of Yoga & Ayurveda on self-rated sleep

in a geriatric population. Indian J Med Res. 2005;121(5):683-90.
 Meshram S, Meshram C, Mishra G, Wakode S, Maheshwar V, Sontakke

A. Behavior, Attitude, And Knowledge Of Sleep Medicine Among Resi-
Page 21
dent Doctors In University Hospitals Of Central India: A Questionnaire

Based Study.Chest.2007;132(4_MeetingAbstracts).
 Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M. Psychological

treatment for insomnia in the regulation of long-term hypnotic drug use.
Health Technol Assess. 2004;8(8)iii-iv, 1-68.
 Pallesen S, Nordhus IH, Kvale G, Nielsen GH, Havik OE, Johnsen BH,
Skjotskift S. Behavioral treatment of insomnia in older adults: an open
clinical trial comparing two interventions. Behav Res Ther.
2003;41(1):31-48.
 Pathak N, Raut A, Vaidya A. Acute Cervical Pain Syndrome Resulting

from Suppressed Sneezing. Journal of The Association of Physicians of
India. 2008;56:728.
 Ranawat, R. Chundawat N. AYUSH Sectoral Innovation Council Consti-

tuted. Journal of Ayurveda and Integrative Medicine. 2011; 5(4).
 Seetha M, Sharma O. AYUSH Sectoral Innovation Council Constituted.

Journal of Ayurveda and Integrative Medicine. 2007;1(3).
 Soeffing JP, Lichstein KL, Nau SD, McCrae CS, Wilson NM, Aguillard
RN, Lester KW, Bush AJ. Psychological treatment of insomnia in hypnot-
ic-dependant older adults. Sleep Med. 2008;9(2):165-71
 Suri J, et al Indian J Sleep Med (2007a; 2007b; 2009):ISSN 0973-340X
 Vincent N, Lewycky S. Logging on for better sleep RCT of the effective-

ness of online treatment for sleep. Sleep. 2009;32(6):807-15.
 Waters WF, Hurry MJ, Binks PG, Carney CE, Lajos LE, Fuller KH, Betz
B, Johnson J, Anderson T, Tucci JM. Behavioral and hypnotic treatments
for insomnia subtypes. Behav Sleep Med. 2003;1(2):81-101.
Page 22
 Bhaduri T, Chowdhury K, Biswas s, Panja A, . E. Clinical Evaluation of Sirodhara

And Yoga Therapy In Management of Chronic Insomnia. International Research
Journal of Pharmacy. 2013;4(6):78-80.
 Bhat T, Pallikaleth SJ, Shah N. Primary insomnia treated with Zolpidem in an 18-
month-old child. Indian J Psychiatry 2008;50:59-60.
 Devi V, Shankar P. Ramelteon: A melatonin receptor agonist for the treatment of in-
somnia. Journal of Postgraduate Medicine. 2008;54(1):45.
 Harmat L, Takács J, Bódizs R. Music improves sleep quality in students. J Adv Nurs.
2008;2(3):327-35.
 Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older adults with
moderate sleep complaints: a randomized controlled trial of Tai Chi Chih. Sleep.
2008;31(7):1001-8.
 Iyer SR, Iyer RR. Sleep and ageing - interactions and consequences. Indian J Sleep
Med 2008;3:ISSN 0973-340X.
 Krishna P, Shwetha S. Sleep quality and correlates of sleep among medical students.
2008;3:0973-340X. Indian J Sleep Med. 2008;3:0973-340X.
 Lichstein KL, Riedel BW, Wilson NM. Relaxation and Sleep Compression for Late-
Life Insomnia: A Placebo-Controlled Trial. J Consult Clin Psychol. 2001;69(2):227-
39.
 Manjunath N, Telles S. Influence of Yoga & Ayurveda on self-rated sleep in a geria-
tric population. Indian J Med Res. 2005;121(5):683-90.
 Meshram S, Meshram C, Mishra G, Wakode S, Maheshwar V, Sontakke A. Behavior,
Attitude, And Knowledge Of Sleep Medicine Among Resident Doctors In University
Hospitals Of Central India: A Questionnaire Based
Study.Chest.2007;132(4_MeetingAbstracts).
 Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M. Psychological treatment
for insomnia in the regulation of long-term hypnotic drug use. Health Technol Assess.
2004;8(8)iii-iv, 1-68.
Page 23
 Pallesen S, Nordhus IH, Kvale G, Nielsen GH, Havik OE, Johnsen BH, Skjotskift S.
Behavioral treatment of insomnia in older adults: an open clinical trial comparing two
interventions. Behav Res Ther. 2003;41(1):31-48.
 Pathak N, Raut A, Vaidya A. Acute Cervical Pain Syndrome Resulting from Sup-
pressed Sneezing. Journal of The Association of Physicians of India. 2008;56:728.
 Ranawat, R. Chundawat N. AYUSH Sectoral Innovation Council Constituted. Journal
of Ayurveda and Integrative Medicine. 2011; 5(4).
 Seetha M, Sharma O. AYUSH Sectoral Innovation Council Constituted. Journal of
Ayurveda and Integrative Medicine. 2007;1(3).
 Soeffing JP, Lichstein KL, Nau SD, McCrae CS, Wilson NM, Aguillard RN, Lester
KW, Bush AJ. Psychological treatment of insomnia in hypnotic-dependant older
adults. Sleep Med. 2008;9(2):165-71
 Suri J, et al Indian J Sleep Med (2007a; 2007b; 2009):ISSN 0973-340X
 Vincent N, Lewycky S. Logging on for better sleep RCT of the effectiveness of on-
line treatment for sleep. Sleep. 2009;32(6):807-15.
 Waters WF, Hurry MJ, Binks PG, Carney CE, Lajos LE, Fuller KH, Betz B, Johnson
J, Anderson T, Tucci JM. Behavioral and hypnotic treatments for insomnia subtypes.
Behav Sleep Med. 2003;1(2):81-101.
Page 24
REVIEW OF LITERATURE
Adharaniya Vega
Vega is a very fundamental and imperative concept of ayurveda. It is vital for our good
health not to suppress urges from body, but, suppress the urges which are concerned with
the mind.
Vegas are natural urges in reaction to the biological (including psychic) functions of the
organism, adjusting the balance of the system. Some of them are purely physiological
and some are protective biological reflexes.
Total thirteen vega are mentioned by Charak. The probability of restraint of urge (vega)
is more recurrent as a result of in daily routine or profession. Therefore Charak empha-
sized this through applied physiology in Swasthacatuska.
Studies such as the one by Namyata Pathak et al in 2008 have proved acute cervical pain
syndrome resulting from suppressed sneezing3.
VEGA:
Human being is best and supreme in the serial of progress of other living thing. The su-
premacy of the man rest in his quality to work after thinking. But because of hesitation,
pre-occupation, sitting in front of the master, or attending meetings of gentlemen or in the
midst of women, or while travelling in high or low vehicles. One can say most of the oc-
cupational hazards are listed.
Page 25
The meaning of Vega is closely related to that of "Gati Gandhanayo" of Vata. So among
Tridosas, Vatadosa has the unique property for Vega Utpatti. The intensity of the Vega
differs according to the subdivision of Vata.
In Ayurvedic classics, there is no any direct reference regarding the process of Vega Ut-
patti, but in paniniya Siksha, a beautiful description regarding the Sabdotpatti has been
given in the Sixth chapter. On the basis of that, one can understand the formation of vega
i.e Vegotpatti 4.
Figure1: Schematic representation of Vegotpatti
Atma (Buddhi) + Artha

(Purisadi Sancaya: prdnyaparadha
Mana
(Rajas Guna Vrddhi)
Agni(Ahanana kriya)+ Anil(Chala guna of Apana)
Vegotpatti
(Viksepana Kriya of Apana)
Atma along with intelligence i.e. Buddhitatva and Purisadi subjects, produces Rajas Guna
Vriddhi at Manas level. It leads to Ahanan of Kayagni, by doing this it initiates the Cala
Guna Vata (Maruta Tatva). This inspired or motiveted Vata controls all the body func-
tions including micturation and defecation too. For proper rhythmic and on time vegot-
patti of Apana Vata, there should be:
(1) A wish at Atma (Buddhiukta).
(2) Raja dominanting Vaisamya at Manas level.
(3) Cala Guna Vrddhi of Vata for Praspandana and,
Page 26
(4) Last and important is the presence of Vegavisaya i.e. Malamutradi in their respective
organs on respective time.
If the Vegavisaya are not available or at weak level, then there will be no Vegotpatti na-
turally. In the absence of Vegavisaya, if one tries to produces the Vega or in the Vega-
vastha it tries to hold its Visaya, then these two situations may be disturb the Vegotpatti
sequence and it may affect Manas and Agni too. So for the proper Vegotpatti with Apana
Vata, there should be proper presence of Apana Visaya in the Apana Sthana on proper
time.
Figure 2; Schematic representation of Vegotpatti hetu
Manas
Vegotpatti
Hetu
Apana Agni
The common man due to irregular habits of Ahara and Vihara with the suppression of
natural urges routinely is trapped by the evolution and the dissolution of the Apavaigu-
nyata. But when he acquires the extreme Hetus of Apanavaigunyata then he reaches the
stage of Atyantika Apanavaigunyata.
Page 27
Figure 3: Schematic representation of Vegadharan nidan
Vegadharan
(Nidan)
Sharirik Manasik
Anulomana , Sthambhana Agnivaigunyata , Mana vaigunya-

ta
The word „vegadharan‟ has two mechanism Vega + Dharan; Vega means natural urge &
Dharan is suppression, thus Vegadharan means suppression of natural urges. Instigation
of vega are normal body activities through which unwanted body materials are excreted
,which is timely carried out by body at regular intervals & controlled by nervous system,
suppression of which not only stops the elimination of waste products but also brings
strain and disorders of nervous system triggering many diseases. This develops in those
who have regular habit of suppressing urges over long periods so it is very important to
respond to these urges and not to suppress them, its suppression may outcome in instigat-
ing a range of diseases distressing the body.
Ayurveda explains that there are different natural urges exerted by human body and for
well-being of the human body some urges are to be suppressed and the rest should never
be suppressed. Granthakaras describe thirteen urges which should never be suppressed.
Here we shall know about these 13 Adharniya vegas (non-suppressable urges).1 Follow-
ing chart explains the references of Vega in Charak Samhita and Asthang Hridaya along
with the diferrent symptoms mentioned for particular vega by the archaryas and their
specific treatments.
Page 28
Table 1:. Symptoms and Chikitsa of Vegas
Vega Symptoms CS SS AH Cikitsa CS SS AH
Mutra Bastisula    Sweda   

Mehanasula    Avagaha   
Mutrakrcchra    Abhyanga   
Siroruja    Avapidakaghrta   
Vinama    Anuvasana   
Vanskhanashula    Niruha   
Asmari    Matrabasti   
Angabhanga    Madyapaan   
Purisa Pakwasayasula    Avagaha   
Sirahsula    Varti   
Vatarpravartana    BastiKarma   
Varcapravartana    Pramathianna   
Pindikodwestana    Vitbhediannapana   
AdhMana   
Urdwavayu   
Parikartika   
Hrdayasyoparodhana   
Mukhenavitpravrtti   
Retas/ Medhrasula    Abhyanga   
Shukra Vrsnanasula    Madira   
Page 29
Angamarda    Avagaha   
Hrdivyatha    Caranayudha   
Mutravibaddhata    Sali   
Jwara    Niruha   
Vrddhi    Maithuna   
Asmari   
Sandhata   
Vata Vitsanga    Sneha   
Mutrasanga    Sweda   
Vatasanga    Varti   
AdhMana    VatanuloMana   
Vedana   - Anna   
Klama    Pana   
Jathararoga    Basti   
Gulma   
Udavarta   
Drstivadha   
Agnivadha -  
Hrdgada   
Chardi/ Kandu    Pracchardana   
Hikka Kotha    Dhumapna   
Aruci    Langhana   
Vyanga    Raktamoksana   
Page 30
Sotha    Ruksannapana   
Pandvamaya    Vyayama   
Jwara    Virecana   
Kustha    Sharkara   
Hrllasa    Lavana taila Abhyanga   
Visarpa    Gandusha   
Kasa    VaMana   
Swasa  
Kampa   
Ksavathu Manyastambha    Abhyanga   
Sirasula    Sweda   
Ardita    Dhumapana   
Ardhavabhedaka    Nasya   
Indriyadaurbalya    Vataghna Anna   
Urdhvajatru roga    Ghrta Uttarabhastika   
Kujan    Anjana   
Aghrana   
Arkavilokana   
Udgara Hikka    Tikshan Dhoompana   
Swasa    Tikshna Anna  
Aruci    Swedana   
Kampa    Abhyanga   
Vibandhorasa    Vataghana bhojan   
Page 31
Vibaddha Hrdaya   
AdhMana   
Kasa   
Jrmbha Vinama    Vataghnamausada   
Aksepa    Snehan   
Sankoca    swedan   
Supti    Ashrumokshan   
Kampa   
Pravepana   
Manyastambha   
Suryavartak   
Urdhvajatru roga   
Bhrama   
Ksudha Karsya    Snigdha   
Daurbalya    Usna   
Vaivarnya    Laghubhojana   
Angamarda    Alpabhojana   
Aruci   
Bhrama   
Glani   
Sula   
Pipasa/ Kanthasosa    Sita   
trushna Asyasosa    Tarpana   
Page 32
Badhirya    Mantha   
Srama    Yavagu   
Angasada   
Hrdivyatha   
Bhrama   
Sammoha   
Baspa/ Pratisyaya    Swapna   
Ashru Aksiroga    Madhya   
Hrdroga   
Aruci   
Bhrama   
Siroroga   
Manyastambha   
Nidra Jrmbha    Swapna   
Angamarda    Samvahana   
Tandra   
Sirogourava   
Aksigourava   
Moha   
Alasya   
Srama/ Gulma    Visrama   
Swasa Hrdroga    Vataghnakriya   
Sammoha   
Page 33
Kasa Kasavrddhi    Kasahara   

Swasa   
Aruci   
Hrdayamaya   
Page 34
References
1 Dube S, Paṇḍeya S. Śambhavi-anuśruti vyakhya saṃvalita Paṇiniya -śiksha.

Jodhapura: Rajasthani Granthagara; 2004. pg 6
2 Murthy S. Astanga Hridaya. 9th ed. Varanasi: Chaukhambha Krishnadas Acad-
emy; 2013. Sutra 5/2, pg 53
3 Pathak N, Raut A, Vaidya A. Acute Cervical Pain Syndrome Resulting from
Suppressed Sneezing. Journal of The Association of Physicians of India.
2008;56:728.
4 Shastri A. Astanga Sangraha, Varanasi: Choukhambha Sanskrit Pratishthan;
2010. Ni.16/21, pg 383.
Page 35
SLEEP
For the living creature in the world, it is an indispensable incident for maintenance
and re-establishment of both - body and mind.
Since the dawn of the evolution the philosopher of the world tried to study the sleep, its
nature and causes. In India, from the Vedic and Upanishad period, the Yogic phenomena
pertaining to a range of stages interrelated with Atma have been studied by the Yogis.
They have articulated these stages as Jagritavastha (waking state), Svapnavastha
(dream state), Sushuptavastha (sleep state) and Samadhi Avastha (the conscious sleep
phase having Detachment from the external world in different degrees).
SIGNIFICANCE OF SLEEP
Ahara, Nidra and Brahmacharya are the three dynamics, which play vital role for main-
tainance of health in human. In the Ayurvedic literature, these factors i.e. Ahara, Nidra
and Brahmacharya are compared with the thripod of sub-support and are termed as the
three Upastambhas. 33
The enclosure of Nidra in the three Upastambha establishes its importance.
While discussing about Nidra, the ancient Acharyas stated that happiness and sorrow,
growth and wasting, strength and weakness, virility and impotence, the knowledge and
ignorance as well as the survival of life and its termination depend on the sleep 36.
As stated by Kashyapa, getting good sleep at an appropriate time is one of the uni-
29
queness of a healthy man . The magnitude of sleep for health and revival from dis-
eases has been acknowledged spontaneously if not scientifically in the modern texts;
almost all doctors recommend that their patients should get plenty of rest and their ad-
vice is followed because that is just what patients want to do whether such sleep does
have any adoptive value is, however, unknown. Many disorders are linked with ano-
malous model of sleep. Some significant findings of sleep are listed below: Sleep is
Page 36
one of the factor responsible for the pattern of GH secretion. (Factors are stage of
growth, nutritional stage, sleep stage, stress and exercise.).
Secretion is enhanced by sleep while the levels are highest during slow-wave sleep
and lowest during REM sleep. Oxygen consumption is lower during sleep, assist an
anabolic process. Physiological activities (e.g. exercise) and pathological disorders (e.g.
hyperthyroidism), which lead to enhanced catabolism are allied with amplified slow-
wave sleep. Reduced activity and metabolic turnover (e.g. paraplegia and hypothyroid-
ism) are linked with decreased slow-wave sleep. Hormones that obstruct anabolic
processes (e.g.corticosteroids, adrenaline and noradrenaline) are inhibited during sleep.
Etymological derivation of Nidra

The word Nidra is feminine, formed by the prefix ni+dra+rak+ta. This is a state of
nature which causes encapsulation to the consciousness of a person 31.
Definition
Ever since modern people are unable to define it precisely and from the time it is a
question in every mind that what is sleep? How it occurs and what is its role in health ?
But the great sages of India had the perfect knowledge regarding the sleep. The defi-
nitions given in ancient texts are as follows –
1. Sleep is the mental operation having the absence of cognition for its grasp. Vyas
while commenting Patanjali Yoga darshana made a statement as - “sleep is a state
of unconsciousness, but the consciousness remains about his own unconsciousness 3.
2. As stated by Mandukya Upanishad Nidra is a condition in which „Atma‟ does not
have any dream or desire for anything and that state is called „susupti‟ 43.
3. Chhandogya upanaishad states that “the state in which the mind is unaware about
surroundings or will not have any dream is termed as supta or Nidra 42.
4. Nidra is defined as the temporary loss of contact with Jnanendriya and Karmendriya
to the Manas 12.
Page 37
5. Charak 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 36.
6. Susruta described the sleep occurs when the Hridaya the seat of chetana is covered
by Tamas 12.
7. Dalhana the commentator of Susruta states that Nidra is the state of combination of
mind and intellectual in which the person feels happy 10.
8. Astanga Sangraha Vagbhata stated that - the manovaha Srotas become accumu-
lated with sleshma and mind is devoid of sense organs because of fatigue, when indi-
vidual fell asleep 48.
9. Sharangadhara mentions that Nidra is a state where predominance of Kapha
and Tamas is witnessed 45.
10. Adhamalla defines that the Nidra is a state in which the tamoguna combines with
Kapha where mohavastha of indriya and Mana is observed 45.
Phenomenon of Nidra
There is a natural relation between sleeping and awakening throughout 24 hrs. The
sleep comes naturally during the night but it is not necessary magnitude of darkness,
as it is proved by those persons who have to work in night sleeps in the day and readily
adopt themselves to this condition.
Authors of ancient Hindu literature gave crystal clear explanations regarding the phy-
siology of sleep by explaining it in different ways according to their working field and
conceptualized. The theories stated regarding the phenomena of Nidra can be summed
and classified under four groups -
1. Theories of Upanishad
2. Theories of Yoga
3. Theories of Ayurveda
4. Developed contemporary concepts
Page 38
1) Theories of Upanishad
45
a) Ancient seers of Chandyogyopanishad stated that the Atma moves from Hridaya
through the nadis and gets lodged inside the membranous sac around the Hridaya,
then the sleep is induced.
b) Brihadaranyakopanishad40 explains that the Nidra occurs when Atma goes into rest
in space in side the Hridaya
2) Theories of Yoga
The yogic philosophers have made a clear explanation regarding sleep resembles as
Samadhi state which is entirely different from it. They studied „Yoga Nidra‟ pertain-
ing to various states associated with Atma. They have termed these stages as
Jagratavastha – waking consciousness
Svapnavastha – dreaming
Susuptavastha - dreamless sleep
Turiyavastha - conscious dreamless sleep
Maharshi Patanjali3 affirms that the Sleep is a state in which all actions of thought and
sentiment come to an end. In sleep the senses of insight rest in the mind, the mind in the
consciousness and unconsciousness in the being. In deep sleep, the senses of perception
cease to function, because their king, the mind, is at rest.
3) Theories of Ayurved
a) Tamo prabhava theory
According Susruta 19, the sleep is induced by the increase of the inert universal attribute
called Tamas. The term Tamas factually means darkness. Satva, Rajas and Tamas
are the three major or universal attributes that pervade the universe. These three
attributes or dimensions play an important role in the functioning of the mind and even
body, among them Rajas and Tamas are capable to vitiate mind (Manas). Because of
their predominance‟s afflicts the mind the mental diseases are resulting. On the other
Page 39
hand the surging of satva can cause the conductive to mental health and Rajas which
represents in action.
Onset of sleep is related to the surging of Tamas always. These said principles
affect inertia in general. Sleep usually occurs at night as the surrounding is dark and is
predominated by Tamas. This dark environment naturally increases the Tamas in hu-
21
man beings according to the theory of generality . Apart from this the bioelectrical
cells, which are in the body, sustain the energy for activity in the day light by getting
charged through Sun light.
Human is proficient to generate bioelectricity through digestion (JatharAgni). At the

night the person reserves the energy and desires to give up work as the activities
are restricted and energy levels are reserved.
b) Klama (Fatigue) Theory 36

During day sensory and motor power are drained. The drained powers become fati-
gue in their work and lose their activity. They gradually withdraw from their objects.
The mind functions are also uncreative by the enhance and influence of Tamas. Mind
gets isolated from the power and its action of enjoying the power come to an end.
This stage is labeled as sleep. As mind is “Ubhayendriya” - dualistic organ, sustains its
association with the soul in the sleep.
c) Swabhava Nidra Theory11

Sleep is a natural function of Tamas. Apart from sleep Tamas causes fear, ignorance,
depression and laziness also. Satva represents cognition and enlightenment. It is the
cause of awakening: Hence sleep is included in any natural diseases. As Satva is in
opposition to the unaware and inert sleep. Rajas on par with satva correspond to ac-
tion and thus, it is also a factor against to sleep induction, as the physical and mental ac-
tivities are passive or restrained.
Page 40
d) Kapha Dosha theory12

Kapha is supposed to be the potency of the living being. When obliterates the channels
because of the over activity of the body and the mind withdraws from the sensory ac-
tivities and the sleep is induced as physical rest to the body. Such Nidra is associates
with the Tamas to fulfill the sound sleep.
4) Contemporary Concepts of Sleep

Sleep is the great mystery for modern neuroscience. Nearly one-third of our lives we
asleep, but its function is still unknown. Fortunately, in the last few years‟ researchers
have made great development in understanding some of the brain circuitry that reins
wake-sleep situation, but no clarification can be conventional than the physiology of
sleep 4.
The observations concerning the phenomenon of the sleep enlighten the incident happen-
ing during the rest and revitalizing outcome.
1) Vascular Theory:
Sleep is induced by a decrease in the blood supply to the brain or the cognizant core is
known as Ischemic or Vascular theory.
2) Pavlov’s Theory:
Pavlov states that sleep is supported bt the cortical reticence due to the repetitive elici-
tation of a conditional response without fortification. Sleep is caused by the condi-
tional inhibition slowly reaching the entire cortex.
3) Chemical Theory:
According to this theory some chemicals, like lactic acid, acetylcholine, bromide or
specific fatigue toxins were believed to accumulate for the duration of the wake hours
which annoy the nerve cells of brain and as a result causes sleep.
Page 41
4) Kleitman’s Theory:
When the cerebral cortex is inactive muscle, tone is reduced and discharge of afferent
impulses is reduced.Thus sleep is produced.
5) Oxygen Theory:
Sleep depends on the consumption of oxygen. Whenever less oxygen utilized brain
sleep is induced.
6) Hypothalamus Theory:
This theory affirms that there is a sleep center in the hypothalamus. The stimulation
of which is responsible for sleep. To explain this some experiment were conducted.
7) Parasympathetic Theory (Acetylcholine Theory - Dixit):

The dejection of the sympathetic center is stated to be responsible to inducing the
sleep and as such sleep is regarded as a parasympathetic role.
8) Lactic Acid Theory:

Sleep is caused due to accumulation of lactic acid in the nervous tissues.
9) Serotonin Theory:
The most noticeable stimulus to induce nearly natural sleep is the raphe nuclei in the
lower half of pons and in the medulla. Nerve fibers from these nuclei spread widely in
the reticular formation and upward into the thalamus, neocortex, hypothalamus and
most areas of the limbic system. These nerve fibers Ending secrete serotonin. It has
been assumed by the experiment that serotonin is a major transmitter related to pro-
ducting sleep8.
Page 42
10) Neuronal Centers theory 27

Sleep is endorsed due to the Stimulation of some areas in the nucleus of tractus solita-
rius (the sensory region of the medulla and pons). These regions perhaps act by excit-
ing the raphe nuclei and serotonin system. Stimulation of several regions in the dien-
cephalon can also help promote sleep, including -
a) The rostrum part of the hypothalamus, mainly in suprachiasmal area
b) An occasional area in the diffuse nuclei of the thalamus.
Classification of Nidra
Ayurved has different view concerning the types of sleep. Basically Nidra can be
classified into type‟s viz. Svabhavika (natural) and Asvabhavika (abnormal). Former
Svabhavika Nidra is regularly every night, offering favorable property for the living
beings, whereas Asvabhavika is due to diverse causes of pathology.
1) Charak classification of Nidra 37

Charak classifies the sleep condition into seven folds. He concur with the ancient au-
thors who well thought-out that the sleep is Bhutadhatri. Sleep comes at night, spon-
taneously and regularly as a natural instinct and that the other categories were either
due to sin or the disease. The seven types described by Charak run as under
1. Tamobhava Nidra
2. Sleshma Samudbhava Nidra
3. Manah Shrama Sambhava Nidra
4. Sharira Shrama Sambhava Nidra
5. Agantuki Nidra
6. Vyadhyanuvartini Nidra
7. Ratri Svabhava Prabhava Nidra
Page 43
Brief descriptions types of Nidra are elaborated is as follows -

According Charak classification of Nidra
a) Tamobhava Nidra:
Normally the sleep is due to the effect of Tamas, but the Tamobhava Nidra as particu-
larly due to the excessive Tamas causing sleep. When Satva and Rajasa are dimi-
nished in excess and the seat of Atma and Mana i.e. Hridaya is covered by the vitiated
Tamas, then the organization become inert or inactive.
According to some intellectuals, the Tamodbhava Nidra resembles with Sanyasa condi-
tion described by Charak, which is the comatose state. The sleep caused by Tamas is
also the root cause for all sinful acts.Tamas always causes excessive sleep. Thus, the in-
dividual is unable to perform the virtuous files and so he subjects himself to sinful beha-
vior.
b) Sleshma Samudbhava Nidra:

Sleshma is the material state of Tamas having identical properties. When the Sleshma
increases in the body the sleep ensues. Therefore, it is called Sleshma Samudbhava Ni-
dra
c) Manah Shrama Sambhava Nidra:

Due to excessive mental stress and strain, the mind gets tired and unable to perform its
activities; as a result the animal gets sleep.
d) Sharira Shrama Sambhava Nidra:

When a person indulged in excess physical activities he feels too much tired. The
body and mind desire to take rest and agitate to work further and the person gets sleep.
e) Agantuki Nidra:
Sometimes the cause of sleep remains obscure and the cause is not explainable. Howev-
er, the sleep is followed by the death and as such Chakrapani has termed this sleep as a
death signal (Arishta) 37.
Page 44
f) Vyadhyanuvartini Nidra:
Vyadhyanuvartini Nidra. is a situation similar to coma due to Some diseases like San-
nipata Jwara.
g) Ratri Svabhava Prabhava Nidra:

As has been stated earlier the sleep is a natural phenomenon and it comes at a particular
time cyclically in the night. There is no specific or particular reason for this kind sleep
and it is termed as Bhutadhatri36. It has been observed that even the individual who
has slept during the daytime would also feel sleepiness in the night, which is quite a
natural phenomenon.
2) According Susruta classification of Nidra

Susruta 14 described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi and
Vaikariki Nidra.
a) Vaishnavi or Svabhaviki Nidra:

Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the
power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached from the
worldly sensory objects on account of the tiredness of Manasa; and the seat of Manasa
and the Sleshma and Tamas cover Atman. This mostly happens in the night and indi-
vidual gets sleep. The Tamoguna dominant persons may go to sleep at any time i.e.
day or night. But a person having Rajoguna in excess may get sleep sometimes in the
day or in the night, because of Chalatva of Rajasa.
The person having qualities dominated by Satva Guna sleeps at the midnight, be-
cause, at this time Tamas is excess and Satva will be decreased (Dalhana). The term
Papma has been used to describe the Tamobhava of Nidra and also to mention the sinful
activities.
Page 45
b) Tamasi Nidra:
It is the lack of consciousness preceding the death. Tama dominant Kapha induces
this due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individu-
al.
c) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of
Vata and also due to mental and physical pain, distress etc. the person doesn‟t enjoy the
11,38
sufficient and sound sleep in quantity and quality . Disturbed sleep is also a type or
Vaikarika Nidra.
3) According Vagbhata classification of Nidra

Astanga Sangraha51 Vagbhata followed the Charak‟s view with a slight change in the
names. He also mentioned seven types. The commentator Indu opined that the Ta-
mobhva is Antya i.e. comes at the time of death and Agantuka means Shastra Prahara-
dina (due to injury) and considered these are due to Vyadhis.
Astanga Hridaya21 Vagbhata considered only four types of Nidra and included the all
seven types in this viz. Akala sevitha, Ati prasangath sevitha, Nacha sevitha and
Nishevitha. The commentator Hemadri considered them as - The properly taken sleep
brings happiness, nourishment, strength, virility, knowledge and life to the individual.
The improperly taken other three types may kill the individual like the Kalaratri, who
killed all demons.
Instead of above seven fold classification we can make three types of classifications in
terms of Tamas. As we seen that sleep is due to manoDosha Tamas, but here Tamas
means not alone, the other Manasika Doshas are there i.e. according to Charak39 vi-
mansthana Dosha anubhandhya anubhandha concept the Nidra can be made into mainly
three types.
Page 46
 Tamasika Nidra
 Rajayukta Tamasika Nidra
 Satvayukta Tamasika Nidra
According to Susruta11 another sets of Nidra viz. Tamasika Nidra is sleeps both day &
night, Rajayukta Tamasika Nidra get sleeps either in the day or night and Satvayukta
Tamasika Nidra sleep at midnight.
Sleep and immunity

There is much confirmation to support the theory that sleep is a stage of growth and
anabolic activity but little about the role of sleep in recovery from illness. Excessive
sleep, sleepiness fatigue and fever are symptoms of nearly all infections diseases
and chronic inflammatory disorders. Fever probably protects during illness, but the
effects of sleep are more difficult to measure. Many processes could contribute to the
link be in sleep and immune response. For example, the circadian release of melano-
tonin during the night is thought to counteract the immuno-suppression association
with glucocentricoids, melatonin is known to regulate both the release of uptokines and
cell mediated immunity.
A number of molecules play a part in the regulation of sleep and immune

processes muranyl peptides that are produced by macrophages from phagocytosed
bacterial cell walls and certain viral products also increase the length of sleep and the
production of modifiers of the immune response, one class of that is called cytokines.
Cytokines are concerned with the amplification, coordination and regulation of the
immune response. Specific cytokines known to effect sleep include interleukin L-
alpha, interleukin l-beta, tunor necrasis factor and interferon - alpha.
Though the studies regarding the close association between sleep and immune
regulation are carried out, further elucidation is required to prove this any how rest is
part of the host‟s defense against infection5.
Page 47
Nidra as Rasayana
In Shakespeare‟s words the sleep is - indeed a positive thing, a reactive process, a
winding up of the imperative clock, a recharging of life‟s battery and “Chief nourish-
er at life‟s feast”. Rasayana39 (Achara) gives rise regularized sound sleep and vice versa
the regularized sleep patterns induce Rasayana effect. Health is a first muse and sleep
is the condition to produce it.
The goal of the Ayurvedic approach is to create more potent individuals through in-
creased Ojas (immunity), which is the finest end product of digestion & metabolism
that provides energy, enthusiasm, happiness, clarity of thinking, better coordination
between the body and mind52. Only the sound most restful (stage IV) sleep gene-
rates Ojas. A sound quality sleep provides ultimate rest to the mind and senses, with
enhanced capacities of mental and physical work ability for the next day. On the other
hand, lack of sleep vitiates & initiates Vata, Ama (endotoxins), etc. in the body.
Total Body Restoration:
The hypothesis is that sleep is a course by which the whole body is restored. This
theory is based on an accumulation of evidences. The consumption of oxygen is lowest
during slow wave sleep. Though the process of catabolism and anabolism are conti-
nuous, the relative rates vary according to whether the subject is awake or asleep, and it
has been shown that the rate of anabolism is at its peak during sleep.
Growth hormone is released mainly at night, also in association with slow wave sleep
and also treatment of short stature by growth hormone is more effective if given at
night. Further more, cell mitosis is at a climax during sleep7.
It has been postulated that slow wave sleep being more vital for macromolecular synthe-
sis and REM sleep for removing the synthetic products of slow wave sleep to maintain
Page 48
synaptic connections is necessary to maintain cognitive function (ABC of Sleep Dis-

orders)5.
Brain Restoration: 53
Some research workers have postulated that it is the brain not the body that recuperates
during sleep and that sleep counteracts the effects of the metabolism of the brain during
the day. They also claim that the exercise included increases in slow wave sleep can be
explained by an increase in brain temperature and metabolism and alter sleep depriva-
tion it is psychological rather than physiological deficits that are most apparent. This
emphasizes that restorative function is central rather than general.
No one hypothesis completely explains the complexities and vagaries of sleep, but tak-
en together may form the foundation of the explanation for the indisputable need for
sleep.
Nidra and Prakriti

Individuals vary sleep with the Prakriti i.e. personality and vayah (age factor). The
sleep requirement differs with relation to either psychological or somatic personalities.
The sleep according to Prakriti is classified into two groups -
a) According to Deha Prakriti and
b) According to Manasa Prakriti .
a) Nidra - Deha Prakriti

The sleep is produced by tamoguna and sleshma so according to the Prakriti of a
person the quality and quantity of sleep varies. An individual of Kapha Prakriti gets
more sleep which is sound also, while a person of Vata Prakriti gets less sleep is re-
lated to the age or vayah. In balyavastha, Kapha is predominant, so child sleeps more
time than the youth. In vriddhavastha, Vata is predominant, so the old aged gets very
less sleep. Apart from the deha Prakriti some naturally get less sleep.37
Page 49
b) Nidra - Manasa Prakriti :

Susruta11 described only three types of Nidra viz. Vaishnavi or Svabhaviki, Tamasi and
Vaikariki Nidra.
1) Svabhaviki Nidra:
Svabhaviki Nidra is caused due to the Maaya or illusionary effect attached to the
power of Vishnu Maaya. Here, Maaya is a desire of the Manasa to get detached
from the worldly sensory objects on account of the tiredness of Manasa; and the seat of
Manasa and the Sleshma and Tamas cover Atman. This mostly happens in the night and
individual gets sleep. The Tamoguna dominant persons may go to sleep at any time i.e.
day or night. But a person having Rajoguna in excess may get sleep sometimes in the
day or in the night, because of Chalatva of Rajasa. The person having qualities
dominated by Satva Guna sleeps at the midnight. Because, at this time Tamas is
excess and Satva will be decreased (Dalhana).
The term Papma has been used to describe the Tamobhava of Nidra and also to
mention the sinful activities.
2) Tamasi Nidra:
It is the lack of consciousness preceding the death. Tama dominant Kapha induces this
due to the blockage of Sanjnavaha Srotasa, and this Nidra cannot awaken individual.
3) Vaikariki Nidra:
This is a condition of insufficient sleep due to the decrease of Kapha and increase of
Vayu and also due to mental and physical pain, distress etc. the person doesn‟t enjoy
42,15
the sufficient and sound sleep in quantity and quality . Disturbed sleep is also
a type or Vaikarikanidra.
Page 50
Nidra and Kala

Manu23 the great law maker has described the divisions of time, and then has re-
marked that the thirty muhurta period (24hours) is divided by the sun into day and night,
the day being intended for the activities and the night designed for the rest and repose.
Naturally the night is described as a proper time for sleep. The person should not
awake at night and should not sleep in day time because both are Dosha prakopaka.
It is advised to take sleep avoiding at the first and last parts of night. As the sleep is
one among five varjyas of sandhya Kala, if taken the person becomes needy or
sparse30. As it is well known concept that early morning awakjening is good for health
and also to get Bramhajnana.
Figure 4 :Sleep Wake Cycle
Sleep Wake Cycle

___________________________
13
Page 51
Relationship between the Nidra and Dosha - Dhatu - Malas

By the previous descriptions regarding sleep it is very clear that sleep is having
important role in the maintenance of equilibrium of body. As Nidra is said to be
Kapha dominant process, it also maintains the equilibrium between three humors. In
Ayurvedic classics, it is mentioned that in the Kaphaja vikaras, Nidra and tandra are
commonly seen and in Vataja vikaras sleeplessness occurs and in Pittaja vikaras
lack of sleep is one of the symptoms 44.
The equilibrium of the Dhatus also depends upon the sleep. Charak36 and Susruta22
have stated that by means of proper sleep the Dhatusamya, the nourishment of the
body, the increase of strength and the stability of life are achieved. When the decrease
of Rasa Dhatu occurs, the sleep is diminished and the Dhatus get proper nourishment
again only when the proper sleep is enjoyed. By the proper sleep the digestion power is
properly mentioned and the Agni functions remain normal. The evacuation of the
bowel and the emptying of the urinary bladder take place properly, if a person has slept
well.The bad habits of waking at night and sleeping at day time have been stated
to provoke all the three Doshas.
Table – 2 ;Karma of Nidra at different Dhatu level

• Rasa pushti and varnaprada
• Rakta varna, Agnidipti
• Mamsa pushti and Bala
• Meda attractiveness (shriman)
• Asthi Bala
• Majja varna, utsaha
• Ojas Jivana
• Manasa gyana, and sukha
Page 52
STAGES OF SLEEP
During each night, a person goes through stages of two types of sleep that alternate
with each other. The EEG (Electro encephalogram), EOG (Electro occulogram),
EMG (Electro myogram) can be conveniently record during the sleep by fixing
small silver electrodes to the scalp and to the face before the subject goes to sleep.
EOG reveals the eyeball movements while EMG indicates the tension of the muscles.
Based on these records two kinds of sleep classified are -
1) Non Rapid Eye Movement Sleep (NREM)
2) Rapid Eye Movement Sleep (REM)
Non Rapid Eye Movement Sleep (NREM):

In NREM type of sleep the brain waves are very slow, so it is also called slow-wave
sleep. This sleep is exceedingly restful and is associated with decrease in peripheral
vascular tone and many other vegetative functions of the body
Characteristics of NREM Sleep:

Most sleep during each night is of slow-wave variety and it is deep, restful type of
sleep. NREM sleep is composed of four stages (75 percent in young).
Table – 3 Stages of sleep in the NREM
Stage I Stage II Stage III Stage IV
5% 45% 12% 13%
NREM sleep is a peaceful state relative to waking as the decrease of pulse rate, respira-
tory rate, blood pressure, basal metabolic rate is seen in this state. The deepest portion
of NREM sleep (stage III & IV) is sometimes associated with unusual arousal charac-
teristics. The organization during arousal during stage III or IV may result in specific
problems including enuresis, somnambulism and stage IV nightmares or night ter-
rors.
Page 53
NREM sleep is frequently called „dreamless sleep‟, but dreams do occur during it.
These dreams are not usually remembered whereas those of REM sleep are likely to be
remembered 8.
REM sleep (Paradoxical Sleep, Desynchronized Sleep):9

REM sleep is a qualitatively different kind of sleep characterized by a high level of
brain activity and physiological activity levels similar to those in wakefulness. In a
normal night of sleep, bouts of REM sleep lasting 5 to 30 minutes usually appear on
the average every 90 minutes, the first such period occurring 80 to 100 minutes after
the person falls asleep. When the person is extremely sleepy, the duration of each bout
of REM sleep is short and even may be absent.
Characteristics of REM Sleep

It is usually associated with active dreaming. The person is even more difficult to
arouse by sensory stimuli than during deep slow-wave sleep and yet people usually
awaken in the morning during an episode of REM sleep, not from slow-wave sleep.
The muscle tone throughout the body is exceedingly depressed, indicating strong
inhibition of the spinal projections from the excitatory areas of the brain stem. Probably
the most distinctive feature of REM sleep is dreaming. The heart rate and the respiratory
rate usually become irregular, which is characteristic of the dream state. Despite the ex-
treme inhibition of peripheral muscles, a few irregular muscle movements occur.
These include, in particular, rapid movements of the eyes.
The brain is highly active in REM sleep and the overall brain metabolism may be
increased as much as 20%. This type of sleep is also called paradoxical sleep because it
is a paradox that a person can still be asleep despite marked activity in the brain.
However, the brain activity is not channeled in the proper direction for people to be ful-
ly aware of their surroundings and therefore to be awake.
Page 54
EEG Changes in Different Stages of Wakefulness & Sleep:

Alert wakefulness is characterized by high frequency β waves, whereas quiet wakeful-
ness is usually associated with α waves. Slow-wave sleep is divided into four stages.
In the first stage of slow-wave sleep, the voltage of the EEG waves becomes very low;
this is broken by “sleep spindles”, that is, short spindle-shaped bursts of α waves
that occur periodically. In stages II, III and IV of slow-wave sleep, the frequency of
the EEG becomes progressive slower until it reaches a frequency of only 1 to 3 waves
per second in stage IV, these are typical δ waves 9.
It is often difficult to a difference between REM sleep brain wave pattern and that of
alert awake person. The waves are irregular high frequency β waves which are sugges-
tive of excess but desynchronized nervous activity as found in the awaken state.
Therefore, REM sleep is frequently called desynchronized sleep.
Figure 5 Wake System Figure 6 Sleep System
Page 55
PHYSIOLOGY OF SLEEP
When Manas is exhausted then sleep occurs this phenomenon can be understood in
this manner. According to Howell, sleep is due to cerebral ischaemia. Cerebral cortex
is the seat of higher centers like pre and post central gyrus, association area etc., which
have the correlation with mental activities described in Ayurveda. So due to the reduc-
tion in cerebral blood supply Manas becomes Klanta that causes sleep 4, 36.
Further, during sleep, Indriyas (both Jnanendriya and Karmendriya) become inactive
by the detachment from their sense organs or from their work. Kleitman explains that
due to reduction of muscle tone and discharge of less afferent impulses, the cerebral
cortex remains inactive. This can be interpreted in the terms of „Guru‟ and „Varanaka‟
properties (according to Sankhya theory) of Tamas. Fatigue of the muscles with con-
sequent reduction of transmission of afferent impulses to the cerebral cortex and thereby
keeping it inactive seems to be a possible factor in the production of sleep 4,12.
HOW SLEEP IS REGULATED

During wakefulness, the brain is kept in an alert state by the interactions of two major
systems of nerve cells, in the upper part of the pons and in the midbrain, which
makes acetylcholine as their neurotransmitter, sends inputs to the thalamus, to activate
it. It in turn activates the cerebral cortex, and produces a waking EEG pattern. How-
ever, during REM sleep the cholinergic nerve cells and the thalamus and the cortex are
in a condition similar to wakefulness but the brain is in REM sleep. The difference is
supplied by three sets of nerve cells in the upper part of the brain stem: nerve cells
that contain the neurotransmitter a) norepinephrine b) serotonin and c) histamine.
These monoamine neurons fire most rapidly during wakefulness, but they slow down
during slow wave sleep, and they stop during REM sleep.
The brain stem cell groups that control arousal are in turn regulated by two groups of
nerve cells in the hypothalamus. One group of nerve cells, in the ventrolateral
preoptic nucleus, contains inhibitory NT (neurotransmitter), galanin and GABA.
Page 56
When the venterolateral pre-optic neurons fire, they are thought to turn off the arousal
system, causing sleep, damage to the ventrolateral preoptic nucleus produces irreversible
insomnia (Anidra). A second group in the lateral hypothalamus acts as an activating
switch. They contain the NT orexin and dynorphin, which provide an excitatory signal
to the arousal system, particularly to the monoamine neurons. Recent studies show that
in humans with narcolepsy, the orexin levels in the brain and spinal fluids are ab-
normally low. Two main signals control this circuitry. First, there is homeostasis.
There is an intrinsic need for a certain amount of sleep each day. Some people think
that a chemical called adenosine may accumulate in the brain during prolonged wake-
fulness, and that it may drive sleep homeostasis. The other major influence on sleep
cycle is the body‟s circadian clock, the suprachiasmatic nucleus. These nerve cells in
the hypothalamus contain clock genes, which go through a biochemical cycle of almost
exactly 24 hours, sleep, hormones and other bodily functions. The suprachiasmatic nuc-
leus provides a signal to the ventrolateral preoptic nucleus and probably the orexin
neurons 6.
The Depth of Sleep:

The depth of sleep is not constant throughout the sleeping period, but varies from hour to
hour. Experiments upon man in which auditory stimuli were employed to arouse the sub-
ject at different time or in the movements of the sleeper were recorded indicate that the
depth of sleep follows a characteristic curve. In most adults sleep deepens rapidly to the
end of the first hour, after which it lessens sharply for a time, and then more slowly till
the time of waking. Generally, sleep taken during the daytime is lighter than that du r-
ing the night. Deep sleep is dreamless, dreams occur only during light sleep and chiefly
in the period, which just precede waking. In sleep, unconsciousness is not uniform for
all senses; the depth of sleep is greatest for the sensations of smell and least for
those of pain, hearing and touch. The sleep requirement of different persons va-
ries widely; it also alters with age. The following are average figures for the hours of
sleep required at different periods of life:
Page 57
• Newborn (infant) 18 - 20 hours

• Growing children 12 - 24 hours
• Adults 7 - 9 hours
• Aged (old) persons 5 - 7 hours
Physiological Changes Accompanying Sleep: 5

During sleep most bodily functions are reduced their basal levels. The blood pressure is
lower, the systolic pressure showing a decline of from 10 to 30 mmHg. If the sleep is
disturbed by exciting dreams the blood pressure might be elevated well about the
normal waking level. The pulse rate is slowed by from10 to 30 beats. The metabolic
rate is reduced by from 10 to 15% below the basal level and the rectal temperature by a
fraction of a degree Fahrenheit. The heat regulating mechanisms are depressed. The
respirations are slowed as a rule they also tend to become irregular or periodic.Muscle
tone is minimal, the knee jerk is abolished and a positive Bebinski may be present.
The thresholds for most somatic reflexes are definitely raised. Vasomotor reflexes,
however, are more active. The pupils are usually constricted, the light reflect is re-
tained. The eyeballs are turned upwards and outwards. Urine volume is reduced and the
specific gravity is raised. The secretion of sweat gland is considerably increased. Gas-
tric secretion is increased or little altered during sleep. Lacrimal and salivary secretions
are reduced.
PHYSIOLOGICAL EFFECTS OF SLEEP

Charak explains that in the night, the Hridaya (heart) gets contracted and the Srotasa
(the channels of circulation) as well as the Koshtha (the gastro-intestinal tract) are con-
tracted, the body elements get softened16.
According to modern view, sleep causes two major types of physiological effects.
1) Effects on the Nervous System itself.
Page 58
2) Effects on the other structures of the body
The first one seems more important because lack of sleep wakefulness cycle in the
nervous system at any point below the brain cause neither harms to the body organs
nor any deranged function.
On the other hand, lack of sleep certainly does affect the functions of the central
nervous system. Prolonged wakefulness is often associated with progressive malfun c-
tion of the mind and sometimes even causes abnormal behavioral activities of the nerv-
ous system. So, in the absence of any definitely demonstrated functional value of
sleep, we might postulate that the principle value of sleep is to restore the natural Bal-
ance among the neuronal centers6.
Sleep does have moderate physiological effects on the peripheral body. For instance,
during wakefulness, there is enhanced sympathetic activity and hence increases the
muscle tone. Conversely, during slow-wave sleep, sympathetic activity decreases
while parasympathetic activity increases. Therefore, a „restful‟ sleep ensues - fall in
blood pressure, respiratory rate and pulse rate, and skin vessels dilate, activity of GIT
sometimes increases, muscles fall into a mainly relaxed state, and the overall basal me-
tabolic rate of the body falls by 10 to 30 percent.
FUNCTIONS OF SLEEP – 23,49

Sleep at the night time makes for the Balance of the body constituents (Dhatusamya),
alertness, good vision, and good complexion and fired digestive power.
Susruta described that, those who takes proper sleep in proper time will not suffer
from disease, the mind of them will be peaceful, they gain strength and good complex-
ion, good virility, their body will be attractive, they won‟t be lean or fatty and they
live good hundred years 15
Page 59
Despite the wealth of information that is accumulating about the biochemistry and
physiology of sleep, its precise nature and functions are not exactly known to the
modern physiology. A number of theories have been proposed, which include the hy-
pothesis that sleep is needed; for consolidation of memory, for binocular vision, or
as part of thermoregulatory evolution, for conservation of energy. The most widely
held theory about the function of sleep is that its senses as a period of recuperation or
restoration. There are two ways in which this hypothesis is interpreted; total body res-
toration and neurological restoration.
DISEASE REVIEW
By going through the previous description, it is quite evident that Nidra is not only an
important but an essential phenomenon of life, which affects the body and mind equally
in a favorable way when it is enjoyed in a rightful manner. Otherwise the inade-
quate Nidra (Anidra) leads to various problems like dukha, karshya, abala, klibata,
ajnana at last leads to death also 36.
35
Charak explains Nidra and Nidranasha in context of ninditi purusha at sutra sthana
which is included in 80 nanAtmaja Vata vikaras34. But has no explanation of Manage-
ment at either in Chikitsa sthana or else where.
Susruta12 describes it under the chapter of garbha vyakarana shariram might be - of

Nidra plays a role in nutrition and development of the body. He also describes vaikarika
Nidra (sleep disorders) in the same chapter along with Chikitsa.
48
Vruddha Vagbhata of Astanga Sangraha mentions Nidra and Nidra vikara along with
22
Chikitsa in viruddha annavijnaniya adhyaya and in Vagbhata of Astanga Hridaya di-
cuss the same in annaraksha adhyaya, while affirming trayopastambha.
Page 60
Sarangadhara 44 resolute the Anidra in Vataja nanAtmaj vikara, Alpa Nidra in Pittaja
nanAtmaja vikara and atiNidra under Kaphaja nanAtmaja vikara.
Deprivation of Anidra
It is composed of two words „A‟+‟Nidra‟. The suffix „A‟ provides negative meaning
to the act of Nidra2. Anidra means less or no sleep. Ayurveda Vishwakosha part I
2
explains Anidra as Nidranasha. In Ayurvedic texts the term „Anidra‟ is used indicat-
ing a pathological condition in which A+ is devoid of sleep.
Synonyms of Anidra
Table – 3 Synonyms of Anidra
Sr Synonyms CS SS AH AS YR MN HS BS DN RN
1
No Anidra          
2 Alpa Nidra          
3 Aswapna          
4 Jagarana          
5 Nidranasha          
6 Nidra vighata          
7 Nasta Nidra          
8 Nidra dourbalya          
9 Nidra bhramsha          
10 Nidra kshaya          
11 Nidra bhanga          
12 Nidra vinasha          
13 Nidra cheda          
14 Nishi Jagarana          
15 Nidra viparyaya          
16 Prajagarana          
Sr Synonyms CS SS AH AS YR MN HS BS DN RN
No Page 61
Alpa Nidra::Alpa means small minute19 which refers to reduction in sleep time,
18 18
Jagarana::Jagarana means awake or waking Nidra rahita, Nidra abhava which
refers to the loss of sleep or no sleep.
19
Nidra kshaya:: Kshaya means harsa, adarshana, bhanga so, this term refers to dis-
turbances in sleep reduction in sleep time.
Nidra bhanga:The word bhanga 19 means breaking splitting, dividing, this shows dis-
turbances of sleep.
19
Nidra chheda: Chheda means cutting off, a section, apiece which shows disturbances
during sleep,
Nidra bhramsha::The term „bhramsha‟19 means to drop, fall down, cessation, loss
which refers to reduction in sleep time.
Vigata Nidra:The term „Vigata‟19 means gone, disappear, ceased which can be corre-
lated with loss of sleep or reduction in sleep time.
19
Nasta Nidra:Nasta means lost, disappeared deprived which convey the meaning of
loss of sleep. By seeing all these synonyms Nidranasha can be considered as difficulty
in initiation of sleep reduction in sleep time and disturbances during sleep either one or
more 8
NidanaPanchaka
Nidana
Charak mentions the causes for Anidra as - eva eva cha vigneyo Nidranashasya he-
tavaha 37 the factors are Atiyoga of vamana, Atiyoga of virechana, Atiyoga of nasyakar-
ma, Atiyoga of rakta mokshana and Atiyoga of dhoomapana. Due to the excess use
of these factors makes the Vata vitiation and Anidra is inducted.
 Ati vyayama, Ati upavasa and Asukha shayaa are the causatives of Vata vitia-
tion, thus the Anidra is induced.
 Ati chinta, Ati krodha and Ati bhaya are the Manasika karana leading to Tama
kshaya and rajo vruddi induces the Anidra.
Page 62

Along with these, some others Chikitsa procedures of AtiNidra advised by Charak can
also are considered as causative factors for Anidra, which are as follows: Satva audarya
(increased satwa), Tamojayee (conqueror of Tama), Karya (engaged in work), Kala
(old age), Vikara (disease), Prakriti (personalities such as Vata) and Vayu (Vata Dosha)
are the causes of Anidra 36.
Further Susruta has mentioned some extra Nidana factors which may cause Anidra;
these factors are: Vata vridhi, Pita vridhi, MaNastapa, Kshaya and Abhighata 13.
Bhavamishra considers Atiyoga of nasya, upavasa, vyayama, chinta, dukha, bhaya,

Kapha kshaya as the causative factors of Anidra/Nidranasha 20.
Astanga Sangraha Vagbhata mentions Nidana which may cause the Anidra are as
follows: Lobha, Harsha, Vyatha, Atimaithuna, Ati kshudha, Rukshanna sevana, Ya-
vanna sevana and Anjana are said to cause Anidra with their individualized qualities em-
bedded 49.
At consideration of all these Nidana factors, the sharirika Doshas such as Vata, Pitta,
and Manasika Dosha raja are the principal causative factors for Anidra/Nidranasha.
Table – 4 Anidra Ahara Nidana
Ahara CS SS AS AH BS HS BP
Rookshanna       
Yavaanna       
Page 63
Table – 5 Anidra Vihara Nidana
Vihara CS SS AS AH BS HS BP
Vyayama       
Upavasa       
Asukhasaiyya       
Kshudha       
Atimaithuna       
Table -6 Chikitsa Atiyogajanya Nidana of Anidra
Nidana CS SS AS AH BS HS BP
VaMana       
Virechana       
Nasya       
Rakta mokshana       
Dhoomapana       
Sveda       
Anjana       
Langhana       
Table -7 Anidra Manasika Nidana
Nidana CS SS AS AH BS HS BP
Bhaya       
Chinta       
Krodha       
MaNastapa       
Shoka       
Vyatha       
Harsha       
Lobha       
Page 64
In addition to above discussed causative factors, Susruta has mentioned abhighata and
kshaya as Nidana of Anidra 12.
Purvarupa: Purvarupa is not mentioned for Anidra in any Ayurvedic classics.
Rupa: In Ayurvedic classics some symptoms are mentioned due to holding up of

sleep schedule. They are in the following table.
Table – 8 Symptoms of Anidra
Rupa CS 89 SS 90 AH 91 AS 92
Jrumbha    
Angamarda    
Tandra    
Shiroroga    
Shirogourava    
Akshigaurava    
Jadya    
Glani    
Bhrama    
Apakti    
Vataroga    
Charak has described the symptoms on suppression of sleep; yawning, body ache,
drowsiness, head disorders and heaviness in eyes are caused. Susruta has described fol-
lowing symptoms due to restraint of sleep. Yawning, body aches, stiffness in the body,
head and eyes drowsiness are the symptoms caused by restraint of sleep. Vagbhata has
mentioned that due to Anidra - malaise, heaviness in head, yawning, laziness, languor,
giddiness, indigestion, stupor and Vatajanya rogas will be manifested.
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Anidra Samprapti
Anidra is not explained as a separate disease in Ayurveda, Depending upon the
Dosha, dushya contribution Anidra is emphasized. Anidra is talk about as Vata vikara
with Pita vriddhi associated with some other disease states or symptoms which is com-
mon in aged people.
Figure –7 Schematic diagram of Samprapti of Anidra
As described, Kapha, Tamas, Hridaya and sanjavaha Srotas are responsible for Nidra
34
. But yogic concept defines Nidra as - when Atma having contact with manomaya ko-
sha then susupti avastha (sleep) occurs. Consequently, when changes appear in this
physiological process or path it causes the Anidra 3. Hence it is evidential that the Vata
Pitta, raja, Hridaya and sanjnavaha Srotas play an important role in the Samprapti of
Page 66
Anidra. Thus it is accomplished that the vitiation of involved factors leads to the condi-
tion of Anidra/Nidranasha.
Types of Samprapti
Sankhya: According to Ayurveda, Asvapna/ Anidra is of two types viz., either due
to Vataprakopa or Pittaprakopa 46.
Vikalpa: In Anidra, mainly Vata Prakopa occurs and it‟s Chala and Laghu Guna vi-
tiates, keeping the mind active, causing Anidra. Thus the Dosha amshamsha kAl-
pana is essential.
Pradhanya: In Pradhanya Samprapti of Anidra, the predominance of morbid humors

are described in terms of the comparative and superlative degrees. As Anidra is of
Vataja Nanatmaja Vyadhi, vitiation of Vata takes place, and Pitta dominance is not
ruled out. Thus the validation of the Dosha Pradhanyata is essential.
Bala: Bala of Anidra i.e. Vyadhi can be illustrious by the strength of manifestation of
symptoms, severity, duration etc, act as a prognostic tool.
Kala: Kala is an vital factor, while considering Nidra as well Anidra. Charak37
point out the Nishi Kala causes Nidra naturally. Sleeping at day time is contraindicated.
Not sleeping at night indicates that Kala interferences to cause the Anidra - thus the
time factor have an influential effect on Anidra/Nidra.
Table – 9 Anidra - Samprapti ghataka
Dosha Vata & Pitta (Vriddhi), Kapha

(Kshaya)
Dushya Rasa
Srotas Manovaha, Rasavaha
Srotodushti Prakara Atipravritti (Over indulgence)
Adhisthana Hridaya
Agni Jatharagn
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Dosha: Dosha association in Anidra is Vata, Pitta and Kapha. Vata and Pitta are in
Vruddhi state, while in case of Kapha, the Kshaya is usually observed.
Dushya : Anidra is a psycho-somatic condition, so initially no dushya is drawn in. Lat-
er in due course the Dhatu involvement associates symptoms and conditions of Anidra
viz. Glani, Aruchi, Apakti etc, the symptoms of Annavaha Srotas and Rasa Dhatu, as
their role in Samprapti of Anidra, as they provide Tushti, Preenana for the entire body.
Srotas: The role of Manovaha Srotasa is implicit without any debate in Anidra as the
mind psychologically and body physically takes rest voiding the external stimu-
li.Hence Rasavaha Srotas has a pivotal role in the pathogenesis of Anidra. Seat of
Manovaha and Rasavaha is Hridaya where the functions of different levels originate
from the same. Moreover, the etiological factors responsible for Rasa Dushti are said
to be psycho disturbing, such as Chintyanam Chatichintanat, where the chetana and sta-
wa are disturbed.
Srotodushti Prakara: Over lenience of Manas is a common feature of Anidra, en-
dorsed to the Manovaha sroto Atipravritti along with Rasavaha sroto dusti. Adhistha-
na: Hridaya is the abode for Rasa and Mana. It is the platform where the whole
Samprapti process is observed. Hridaya is the base for Mana and its role in Anidra is
well defined.
15.
Agni: Nidra boost the Agni Apakti and Aruchi are the symptoms of Anidra, indicates
the vitiation of Agni.
UPADRAVA
Ashtanga Sangraha, states that amplified Vata is due to Anidra produces Kapha
kshaya. The decreased and dried Kapha causes Srotorodha resulting in overtiredness
that eyes of the patient remain wide open and watery secrets from eyes. This danger-
ous exhaustion is Sadhya up to three days then becomes Asadhya 50.
Upashaya and Anupashaya
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Mamsa sevana, madya, ksheera and ksheera vikaras, abhyanga, utsadana, tarpana and
sneha sevana, etc., can be well thought-out as upashaya of Anidra, while rukshanna,
yavanna, dhoomapana, krodha, shoka etc., can be measured as its anupashaya.
Chikitsa in general
No specific treatment is mentioned for Anidra in our texts. Depending upon the Chi-
kitsa mentioned is in different contexts, for Anidra it can be broadly divided into 2
types:
1. Bahya Chikitsa
2. Abhyantara Chikitsa.
Abhyantara Chikitsa can be again sub divided into:
(a) ahara pradhana Chikitsa
(b) aushadha pradhana Chikitsa
Table – 10 Bahya Upacharas for Nidranasha
Bahyupachara CS SS AH AS YR BP KS HS BS BR
Abhyanga          
Utsadana          
Samvahana          
Shitarpana          
Moordhni Tai-          
Udvartana
la          
Shirobasti          
Shirastarpana          
Karnapoorana          
Padabhyanga          
Angamardha-          
Mardana
na          
Shirolepa          
Vadana lepa          
Page 69
Table No. – 11 Aahara Upacharas for Anidra

Ahara Upacharas CS SS AH YR BP KS HS BR RV DN RN
Gramya mamsa ra-           
sa
Anupa mamsa rasa           
Jaleeya mamsa rasa           
Mahisha ksheera           
Peeyusha           
Morata           
Goodhooma           
Varahamamsa           
Guda           
Matsya           
Dadhi           
Koorchika           
Masha           
Sita           
Yoosha           
Sneha           
Kilata           
Madhya           
Table No. – 12 Manasika Upacharas for Anidra
Manasika Upachara CS SS AH AS HS BP
Manonukula Vishaya grahana      
Manonukula Sabda grahana      
Manonukula Gandha grahana      
Mrudu shayya      
Sukha shayya      
Sukha sparsh      
Nischinta      
Nityatrupti      
Bhaya tyaga      
Chintatyaga      
Lobha tyaga      
Swasteerna Sayana      
Sukhavartalapa      
Santosha      
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Table No. – 13 Anya upachara for Nidranasha
Anya Upacharas CS AH AS BP KS HS YR
Snana       
Shirolepa       
Varsa sevana in Varsa Ritu       
Lehana Karma       
Vastra kruta vayu sevana       
Kamsya patrakruta vayu sevana       
Talapatra kruta vayu sevana       
Kadali patrakruta vayu sevana       
Viewing dance and hearing humor-       
ous voice
Some basic measures, which can be recommended to the patient of Ani-
dra/Nidranasha, are:
• regular schedule for sleep.
• let alone seeing excited pictures at night.
• Smoking, tea, coffee or alcohol at night hampers sleep.
• thoughts tensions should be released before going to bed.
• sleep is induced by soft music or favorite songs.
 Mediating before r sleep
• praying before sleep.
• before goes to sleep rinse hand, feet and face
• Avoiding excess coitus
• Avoiding sleep in day
• Evacuation of stool and urine
• Mosquito bites are avoided
• Adequate privacy has to be given
Basic therapies of Anidra :
Page 71
a) Single drug therapy: Ayurved has described many drugs which gives relief from
Anidra. These single drugs are:
Table No. – 14 Single drugs useful for Anidra
Single Drug BP KS HS DN RN BR
Palandu      
Ikshurasa      
Potaki      
Tila      
Trikatu      
Ketaki      
Vartaka      
Kakamachi      
Asuri      
Single drugs are as follows:

• Brahmi, Kusmanda,Katu tumbi,Aswagandha ,Yamini , Jatiphala, Drakshya, Pippali
moola,Apamarga moola,Bhanga , Sarpagandha , Khas khas,Shankapuspi, Punarna-
va, Kupilu, JaTamamsi,Karpura, Tagara,Ahiphena, Parasika yavani, Raja sarshapa, etc.
b) Compound drug
o SarasVata choorna
o Nidrakara choorna
o Ashvagandharista
o Shankhapushpyarista
o Chandravaleha
Page 72
o ChinTamani Chaturmukha Rasa

o Vatakulantaka rasa
o Nidrodaya rasa
o Sarpagandha ghana vati
o Agasti Sutaraja Vati
o Indumarichadi vati 17
o Swarna Makshika Bhasma 47
o Yashada Bhasma 1
o Tungadrumadi Taila 47
o Dhanyamla
o Kantakaryadi kwatha 26
o Kakajanghadi Kwatha 25
o Ghrita Bharjita Nagara 1
o Mukta Bhasma - mainly for Pittavridhi JanyAnidranasha
c) Amayika Prayoga
 Ghrita Bharjita Bhanga + Madhu 20
 Pippalimoola + Guda 18
 Aswagandha Choorna + Pippalimoola Choorna + Parasika Yavani Choorna with
milk.
 Sarpagandha powder - 1gm + Rasasindura ¼gm with milk
 Sarpagandha powder (50gm) + Jaharamohara Pisti 6 gms + Pravala Pisti (6
gm) + Amrita Satva (6 gms) Dose - ½ - 1 gm BID or TID with Gulab Arka (mainly
for Insomnia due to HTN)
 Amalaki - 2 parts + Pippalimoola - 1 part + JaTamansi - 1 part Dose - 1 tsf twice
daily.
 Aswagandha Choorna + Pippalimoola Choorna with milk
 Kakajangha Twak Kwatha + Madhu 20
 Shalmali Niryasa + Kiratatikta 26
Page 73
 Ghrita + Taila Yamaka Yusha 29

 Mahisha Ksheera + Khas Khas
 RohiTamatsya Kambalika + Kutajaveeja Choorna + Guda 25
Contemporary concepts of Anidra vis-à-vis Insomnia8

In the early 1970‟s Interests on sleep disorders developed when obstructive sleep apnea
becomes recognized as a common and life threatening situation. Many countries sur-
veyed different sleep related complaints. The disturbances of sleep are also very com-
mon complaints in psychiatry. Sleep is disturbed in several ways in its pattern, quality
and duration. An average sleeping time decreases as age advances is normal phe-
nomenon. Insomnia may differ in some pathological problems like mania,.
Delay in falling asleep (early insomnia) occurs in anxiety, depression is characterized

by early waking up (late insomnia) and the sleep is usually non-refreshing.. In certain
organic conditions delirium and dementia, The sleep wake pattern is disturbed. As
sleep is constant in quite a lot of conditions, it has imperative significance in proper ap-
preciation and considerate of sleep related symptoms.
Classification of Sleep Disorders:

A. Association of Sleep The classified sleep disorders in 1979
Disorders Centers (ASDC) which are widely accepted consists of 4 major types of
sleep disorders:
1. DIMS (Disorders of initiating and maintaining sleep)

2. DOES (Disorder of Excessive somnolence)
3. DOSWS (Disorder of sleep wake schedule)
4. Parasomnias
B. Sleep disorders according to ICSD (International Classification of Sleep Disorders)

1. Dyssomnias
Page 74
2. Sleep disorders associated with medical or psychiatric illness

3. Parasomnias
4. Proposed sleep disorders (Sleep related laryngeal spasm)
C. Sleep disorders according to DSM-IV

1. Dyssomnias
2. Parasomnias
3. Sleep disorders related to another mental disorders
4. Others sleep disorders
Dyssomnias:
Dyssomnias are described under headings, viz. Hypersomnia (DOES), Disorders of
Sleep-wake schedule (DOSWS) and Insomnia (DIMS). Out of insomnia (DIMS) are
discussed here elaborately.
Insomnia (DIMS) –
During classification of sleep disorders Insomnia is mentioned under Dyssomnia. A

synonym also gives for insomnia which shows its clinical features i.e. DIMS (Disorders
of Initiation and Maintenance of Sleep).
Two unique disorders, which produce DIMS, include periodic leg movements and
restless leg syndrome.
Page 75
Table 15 Causative factors of Insomnia

Symptoms Medical conditions Psychiatric
/environmental
Conditions
Difficulty in fall- Any painful or uncomfortable Anxiety, common
ing asleep condition Anxiety, chronic neurotic
CNS lesions Anxiey, prepsychotic
Tension anxiety
Environmental changes
Conditioned (habit)
insomnia sleep
Sleep wake schedule
Disorders
Difficulty in re- Sleep apnea syndromes Depression
maining asleep Nocturnal myclonus & Environmental changes
restless legs syndrome Sleep wake schedule
Dietary factors disorders
Episodic events(parasomnias) Dream interruption
Direct drug effect(including Alco- Insomnia
hol)
Diagnosis of Insomnia:
People are consistent in their quantity of sleep they require and some of those who
grumble of insomnia may be having enough sleep without realizing it.
Usually the diagnosis of Insomnia can be based on the account given by the patient.
EEG recordings are occasionally supportive whether there is lifelong doubt about the
level and nature of the insomnia. Hence diagnosis of insomnia made on the basis of fol-
lowing points:
Page 76
 Disturbances of sleep -
 Dilemma in initiation of sleep
 Trouble to sustain sleep (may be frequent awakening or early morning awakening)
 Non restorative sleep (i.e. despite adequate period of sleep, sensitivity of not having
proper sleep) (Poor quality of sleep)
 It causes either marked distress or interferes with social and occupational function-
ing.
 Above sleep conflict (either one or more) if take place at least thrice a week for at
least one month can be diagnosed as Insomnia.
Types of Insomnia:
Mainly Insomnia is classified in 2 types
I. Primary - No apparent cause for insomnia
II. Secondary - It is due to one of several medical conditions that have an effect on
sleep.
I. Primary Insomnia:
Of all the insomnia about 15% is of primary source. In childhood and adolescences
it is atypical but become more customary as age advances. Females are more af-
fected.
Symptoms of primary insomnia are
Difficulty in initiating of sleep (more common in younger adults)
Difficulty in maintaining of sleep (common in elderly)
Not related to any mental disorders or physical conditions
Individual shows excessive worry during the day about not being able to fall asleep.
In evening the person shows intense efforts to fall asleep but becomes unsuccessful.
Person complaining of lethargy, fatigue, lack of concentration, easily irritable.
He may resort to hypnotics or alcohol to reduce tension or cups of coffee or other sti-
mulants to overcome the tired feelings.
Page 77
II. Secondary Insomnia

Secondary to other disorders
Several psychiatric disorders are associated with insomnia
Also occur secondary to substance abuse like alcohol, amphetamine, steroids and sev-
eral others
After a course of progressive worsening a chronic stable stage is reached which contin-
ue for several years
Sometimes the course is episodic with short periods of improvement and worsening.
Investigative tools 28
The investigations are not only for Insomnia but also can be applied for other sleep
disorders. These are as follows:
1) Clinical evaluation:
A detailed sleep history is the most informative diagnostic tool. A thorough sleep
history can help for deciding whether the sleepiness or sleeplessness is normal or
pathological.
2) Multiple Sleep Latency Test (MSLT):
Objective conformation of hypersomnolence and determining its severity are manda-
tory in a patient before using long term treatment with CNS stimulants initiated. MSLT
is widely used for evaluation of hyper somnolence.
3) Polysomnography:
Most patients with sleep-wake disorder require monitoring of various physiologic
parameters during sleep (polysomnography). The basic parameters in polysomnography
are:
 Several changes of EEG to distinguish wakefulness from sleep and for sleep
staging.
 Eye movements
 Electro cardiogram
 Electro myogram of chin muscles, tibialis anterior muscle.
Page 78

 Oral and nasal air flow by thermistor or a mask.
 Respiratory effort of the chest and abdomen by impedance pneumography.
 Oxygen saturation by ear oximeter.
Page 79
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hambha Subharati, 1994. Shareera 4/33-5, pg 277.
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Chaukhambha Subharati, 1994. Shareera 24/88, pg 398.
16 Kushwaha H, Charak Samhita, Part II, 2009, Chaukhambha Orientalia,
Varanasi Chikitsa 15/241, pg- 420.
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Bhavan,; 2006. 15/162-66, pg 861.
18 Mishra B. Bhaisajya Ratnavali, vol 2. Varanasi: Chaukhambha Sanskrit
Bhavan,; 2006. 21/9,pg 74.
19 Monier-Williams M. English-Sanskrit dictionary. New Delhi: Munshiram
Manoharlal Publishers; 1993, pg 60.95,327,407,417,532,957.
20 Murthy K. Bhavaprakasha, madhyama khanda,. Varanasi: Krishnadas
Academy; 2002. 1/324-7, pg 45.
21 Murthy S. Astanga Hridaya. 9th ed. Varanasi: Chaukhambha Krishnadas
Academy; 2013 Sutra, 7/54, pg 119.
22 Murthy S. Astanga Hridaya. 9th ed. Varanasi: Chaukhambha Krishnadas
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talia,; 2010 ,Chikitsa 24/88, pg 234.
24 Nene G. Manusmruti. 7th ed. Varanasi: Chaukhambha Sanskrit Sams-
than; 2003.1 /65, pg 21-22.
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management-guest-article#.VvVAhNJ97IU.
26 Pandey J. Harita Samhita,. Varanasi: Chaukshambha Visvabharati; 2010,
Truteeya 15/5 pg 346
27 Razran G. Extinction re-examined and re-analyzed: a new theory. Psycho-
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Page 83
PRANAYAM:
Pranayam is generally defined as breath control. Although this interpretation may seem
correct in view of the practices involved, it does not convey the full meaning of the term.
The word Pranayam is comprised of two roots: 'prana' plus 'ayama'.
Prana means 'vital energy' or 'life force'. It is the force which exists in all things, whether
animate or inanimate. Although closely related to the air we breathe, it is more subtle
than air or oxygen. Therefore, Pranayama should not be considered as breathing exer-
cises aimed at introducing extra oxygen into the lungs. Pranayama utilizes breathing to
influence the flow of prana in the nadis or energy channels of the pranamaya kosha or
energy body.
The word yama means 'control' and is used to denote various rules or codes of conduct.
However, this is not the word which is joined to prana to form Pranayama; the correct
word is 'ayama' which has far more implications. Ayama is defined as 'extension' or
'expansion'. Thus, the word Pranayama means' extension or expansion of the dimension
of prana'. The techniques of Pranayama provide the method whereby the life force can
be activated and regulated in order to go beyond one's normal boundaries or limitations
and attain a higher state of vibratory energy and awareness.
Pranayama practices establish a healthy body by removing blockages in the pranamaya

kosha, enabling increased absorption and retention of prana. The spiritual seeker re-
quires tranquillity of mind as an essential prelude to spiritual practice. To this end, many
pranayanya techniques utilize kumbhaka, breath retention, to establish control over the
flow of prana, calming the mind and controlling the thought process. Once the mind has
been stilled and prana flows freely in the nadis and chakras, the doorway to the evolution
of consciousness opens, leading the aspirant into higher dimensions of spiritual expe-
rience. In The Science of Pranayama, Swami Sivananda writes, "There is an intimate
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connection between the breath, nerve currents and control of the inner prana or vital
forces. Prana becomes visible on the physical plane as motion and action, and on the
mental plane as thought. Pranayama is the means by which a yogi tries to realize within
his individual body the whole cosmic nature, and attempts to attain perfection by attain-
ing all the powers of the universe."
Bhrāmari Prānāyāma
Information about Pranayama in general and Bhramari Pranayama in specific can be

found in the two yogic texts of reference, viz. Hath Yoga Pradipika and Patanjali Yoga
Sutra. These texts describe in detail the procedures, effects, and uses of various
Pranayamas, the various steps involved in performing a particular Pranayama.
According to Upanisads, prana is the principle of life and consciousness. It is equated

with real self (Atma). Prana is the breath of life of all beings in the universe. Prana is
usually translated as breath. If breathing stops, so does life. Ancient Indian sages knew
that all functions of the body were performed by five types of vital energy (prana-vayus).
Bhramari relieves stress and cerebral tension, and so helps in alleviating anger, anxiety
and insomnia, increasing the healing capacity of the body. It strengthens and improves
the voice. Bhramari induces a meditative state by harmonizing the mind and directing
the awareness inward. The vibration of the humming sound creates a soothing effect on
the mind and nervous system1.
The word Bhrāmarī means “Bee”. The practice is so called because a sound is made
which imitates the sound of a humming bee. Inhale swiftly, creating the sound of a male
bee. It is a method of harmonizing the mind and directing awareness inwards. Breath out
slowly while softly making the sound of a female black bee. This is followed by kumb-
haka. This is Bhramari Pranayam for which there are many reasons, the most profound
Whether or not we imitate a bee successfully is of that one is engrossing impressive con
Page 85
crete that express itself in the resonance dissolving its significance. Humming sound is
important which goes along with intense inward visualization. When nadis are pure
muscle are relaxed, the humming breathing carry with it the sense. Kumbhaka is fol-
lowed, go along with an astonishing, perched, potentially filled peace. Exhalation fol-
lows the best ever route timewise thus humming turn out to be an incident. The vibra-
tions turn out to be a rushing noise that fills the entire ambiance.
A deep relationship between pattern of respiration and status of mind is present. It is a

common experience that in angry status of mind, rate and rhythm of respiration is in-
creased. Similarly in depressed mood again change in rate & rhythm of respiration is ob-
served. This shows that status of mind changes the respiration.This relationship principle
can be used in opposite direction too, that is by changing rate and rhythm of respiration,
status of mind can be changed. By practicing Prānāyām the ability to perceive, to know
the reality, is intensified.The mind is trained and made capable for the process of
Dhāranā.
So long as breathing is continued and the air is moving in and out of the body, the mind
remains unstable. When the breath is stopped, the activity of the mind is also controlled
and it becomes standstill. Thus, by Prānāyām a practitioner attains a complete motionless
state of Citta (concentration). Since the mind becomes steady and peaceful after the prac-
tice of Prānāyāma, it becomes suitable and capable to be concentrated on one object at a
time. Such „one pointed ness‟ is a pre-requisite of Dhāranā while helps in good grasping
and ultimately good retention capacity.
By Bhrāmari, Ājñā Cakra is activated, which help in activation of all the other Cakras.
The movement of Nādis is regulated so, the prāna helps in controlling the Mānasa
Vikāras like Krodha, Bhaya, Cintā etc. also maintains the normal function of Buddhi.
During the practice of Bhrāmari all the sensory organs (except skin) are to be closed with
the fingers. This leads the detachment between Indriyas to its yasu is which further di-
Page 86
verts the Manas towards Indriya yas (Cintya) a Visnirapeks. This is a very important
stage in the process of memory i.e. Medhā.
The „M‟ recitation in Bhrāmari activates the Manas and its function of Cintya, Vicārya,
Uhya, kalpa. Dhyeya and Sam It helps in controlling the functions of the Indriyas and
help in Tarka and Hitahita Vicāra which is the function of Buddhi2.
Bhramari Pranayama relieves stress and cerebral tension, alleviating anger, anxiety and
insomnia, and reducing blood pressure. Bhramari causes the whole brain to vibrate. Vi-
bration of the cerebral cortex sends impulses to the hypothalamus which has the capacity
to control the pituitary gland (the master of all glands). The hypothalamus also sends im-
pulses to the sympathetic and parasympathetic nervous systems. This helps tune the
whole neuroendocrinal system to function in a harmonious and synchronized way. Pa-
roxysmal Gamma waves produced in brain during the Bhramari Pranayama which is
connected with positive feelings, approach of contentment and acts as a natural antide-
pressant (Vialatte et al., 2009)5. With Bhramari Pranayam, the parasympathetic nervous
system are activated by the pressing of eyeballs due to vagus stimulus. Parasympathetic
nervous system is linked with a peaceful and composed status of body and mind.
Compression of Ocular nerve in Bhramari pranayam has been clarified in the application
of vagus nerve stimulus and the limbic system. Combination extract of Ginkgo biloba and
Bhramari Pranayam have affirmative effects on tinnitus (Pandey et al., 2010)3.Bhramari
pranayam facilities a self-induced sound remedy and is a treatment for tinnitus and ocu-
lar compression.
Slow, deep and more normal breathing is related with parasympathetic activaty in fact
leads to a condition explained as calm and tranquil. Pranayama can produce favorable
modifications in emotional condition . Bhramari Pranayam offer a mixture of acoustic
cure to create a drop in central nervous system proficient by motivating the auditory co
Page 87
tex for tinnitus aid, and to also stimulate parasympathetic nervous system, thus support-
ing a less negative emotional reaction.
Bhramari Pranayam produce Paroxysmal Gamma brain waves which is related with con-
structive thoughts, outlook of contentment and acts as a natural antidepressant(Vialatte et
al., 2009)5.
Bhramari pranayam has been able to confirm as a combined therapy for tinnitus along
with other therapies.6
Page 88
References
1. Asana Pranayama Mudra Bandha. [s.l.]: Satyananda Yoga-Zentrum; 2010, pg

369.
2. Counter Insomnia with Brahmari pranayama [Internet]. Wellnessyoga.cz. 2012

[cited 20 December 2012].]. Available from:
http://www.wellnessyoga.cz/articles/139-counter-insomnia-with-brahmari-
pranayama
3. Pandey S, Mahato N, Navale R. Role of self-induced sound therapy: Bhramari

Pranayama in Tinnitus. Audiological Medicine. 2010;8(3):137-141.
4. Svatmaram, Rieker H. The Yoga of light: Hatha Yoga Pradipika. [New York]:
Herder and Herder; 1971, Ch 4, pg55.
5. Vialatte F, Bakardjian H, Prasad R, Cichocki A. EEG paroxysmal gamma waves

during Bhramari Pranayama: A yoga breathing technique. Consciousness and
Cognition. 2009;18(4):977-988.
6. Zabara J. Inhibition of Experimental Seizures in Canines by Repetitive Vagal

Stimulation. Epilepsia. 1992;33(6):1005-1012.
Page 89
AIM AND OBJECTIVES
Aim:
To Study of Nidra as Adharniya Vega & its Management with Bhramari Pranayam.
Objectives-
 To evaluate effects of Bhramari Pranayam in a series of patients suffering from

symptoms of Anidra on various scientific parameters.
 To evaluate effects of Sleep Hygeine in a patients suffering from symptoms of
Anidra on various scientific parameters.
 To compare the efficacy of Bhramari Pranayam against those of Sleep Hygiene
Page 90
MATERIAL AND METHODOLOGY
Methodology:
Approval from ethical committee BVDUCOA-EC for the project Ph.D./ SW 01, was taken
on 22nd March 2013.The clinical trials were conducted as per the study.
Study design: Open randomized control clinical study.

 Yoga module adopted:Bhramari Pranayam (Standard operative procedure) 25
Pre procedure:
 Pranayam training was given under expert guidance and after consultation from
physician.
Main Procedure:
 Lying down. With erect Spine, closed eyes.

 Shanmukhi Mudra: the ears plugged with the respective index fingers or thumb.
 Inhalation and exhalation done forcibly with a humming or buzzing sound.
 Enjoying the sound and vibrations produced during these breathing techniques.
 Awareness: Physical – within the head & on making the breath steady & even
Spiritual – on Agyna chakra
 Trail was started by doing it 5-6 times which was gradually increased to 10-15
times depending on the capacity of breathing.
 Subjects performed Pranayam for 15 days under expert‟s guidance.
 This daily practice of Pranayam was performed for 6 days a week and continued
for 3 months.
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Time of the practice:
 Before sleeping
 Sleep Hygiene6
Patients were educated about Sleep Hygeine which comprised the following
 Taking a light exercise between 4 pm and 7 pm and never after 7 pm

 Going to bed when drowsy and at a proper time
 Removing the clock from the bedroom
 Switching off the (T.V.) and room light, etc.
 Avoiding more than six caffeinated drinks (coffee, tea, cola drinks) in a day and
strictly avoiding these beverages and alcohol at bedtime.
 Taking a light snack and/or milky drink before bedtime
 Ensuring quiet ambience in the bedroom and a comfortable bed and mattress.
 Avoiding large volumes of fluid or heavy and sugary/fatty meals near bedtime
 Sleep Diary Assessment:3
After the registration for the trial a sleep diary was given to each Individuals.
Individual had to fill the diary and get it with him during the follow up.
Sleep diary included 11 situations:
i. Time into bed,
ii. Time of lights out,
iii. Time to fall asleep,
iv. Number of Awakenings,
v. Time out of bed,
vi. Naps- Day time,
vii. Rate how you felt today,
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viii. Irritability,
ix. Total time of sleep,
x. Sleep Quality,
xi. Feeling after Awakening.
Inclusion criteria:
 Individuals between the age group of 16 to 60 years having Anidra of minimum

one month duration were selected for the study.
 Individuals with Anidra as Nidra Vegadharan were included for the present study.
 Individuals of Anidra with mild hypertension, mild depression and anxiety dis-
orders without any complications of any other diseases were included for the
present study.
Exclusion criteria:
 Individuals below 16 years and above 60 years of age.

 Individuals with major psychiatric illness like schizophrenia, depressive psycho-
sis, epilepsy etc, will be not registered.
 Individuals with alcohol dependence or drug dependence were excluded from the
study.
 Individuals having chronic illness like asthma, malignancies, liver cirrhosis,
chronic renal failure, diabetes etc. were excluded.
 Individuals with acute illness like Cardio Vascular Accident, Congestive Cardiac
Failure, Myocardial Infarction, Chronic Obstructive Pulmonary Disorders, me-
ningitis, and acute pain conditions and similar other disorders will be excluded.
Procedure for data collection:
 Subjects were randomly enrolled from Bharati Medical Foundation‟s Ayurved

Hospital.
 Special Performa of case paper was prepared for this study.
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
 Written informed consent of patients was taken prior to commencement of clin-
ical trials.
 Total 100 known cases of Aharaniya vega Nidra (Anidra) were selected.
 Findings were recorded before and after the clinical trials.
 Pranayam training was given for 15 days.
Sample Size: Since Prevalence of insomnia was about 6.5% 4

Total 100 patients were taken for the studies which were divided in three groups consi-
dering dropouts.
Group-I: Bhramari Pranayam was advised to 31 patients of Anidra (Insomnia)
Group-II: Sleep Hygiene was advised to 31 patients of Anidra (Insomnia).
Group-III: Bhramari Pranayam and Sleep Hygiene. Combined was advised to 31

patients of Anidra (Insomnia)
Duration-
 Total duration of study – 3 months.
 Each patient was given practice of Bhramari Pranayam for15 days.
 Each patient did the Bhramari Pranayam for next 2 months & 15 days.
Withdrawal/dropout: When the patient did not continue the treatment for more
than 7 days or more, did not come for the follow up after 15 days, he was withdrawn
from the research and was considered as dropout.
Follow up:-
Follow up was done periodically for total duration of 2 months & 15 days.
 1st Follow up - on 15th day
 2nd Follow up - on 30th day
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 3rd Follow up - on 45th day

 4th Follow up - on 60th day
 5th Follow up - on 90th day
Criteria for assessment -
 Symptoms taken for the assessment of clinical development were systematically

inspected and the severity of each symptom and poinst of sleep diary was rated
before and after the trial for scientific evaluation.
 Visual Analogue Scale technique was used with an effort by giving numerical
values to all symptoms depending upon their severity before and after the treat-
ment where „0‟ indicated no symptoms and increased the score according to the
severity of the symptoms to quantify for analysis.
1. GRADATION OF INSOMNIA
 Sleeplessness
No complaint 0
Patient gets sleep at night or awakens early in the morning 1
Sleep is full of dreams or sleep disturbs due to any other reason during 2
night
Sleep disturbs at midnight due to any reason and does not get sleep af- 3
terwards
Patient doesn‟t get sleep after resting in day time/gets sleep late at night 4
and awakens early in the morning
Gets sleep after taking sedatives 5
Doesn‟t get sleep at all 6
 Disorders Of Sleep-Wake (S-W) Schedule
Normal (s w) pattern 0
Transient change 1
Frequently changing 2
Delayed sleep phase 3
Irregular (s w) pattern 4
Non24 hours (s w) syndrome 5
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 Shirahshula, Angamarda etc.
No symptoms 0
Mild degree (Occasionally complaints) 1
Moderate degree (once or twice in 2 – 3 days) 2
Severe degree (daily complaints) 3
 Sleep Quality
Enjoyable sleep 0
Anxious or agitated before and during sleep 1
Feeling unfreshed and unrest after sleep 2
Sleep experience negative and not enjoyable 3
 Sleep Time
Adequate sleep (6 – 8 hours) 0

Inadequate night sleep (4 – 5 hours) with ½ to 1 hour day nap 1
Inadequate night sleep (4 – 5 hours) without day nap 2
Inadequate night sleep (2 – 3 hours) 3
Gets 1 – 2 hours night sleep with or without day nap 4
No sleep at night but gets 1 – 2 hours day nap 5
No sleep at all 6
 After Awakening
Fresh (Sukhavabodhana) 0
Sleepy or fatigued 1
Poor concentration 2
Poor problem solving 3
Tense, irritable 4
2. GRADATION OF MANASA BHAVAS28
In Charak Samhita, 22 Manasika Bhavas and their methods of examination is men-

tioned. Here, in this study an attempt is made to provide the objectivity by scoring each
Bhavas as follows –
Page 96
1) Manasa – Arthesu Avyabhicharanena
No deviations 3
Getting deviated very rarely 2
Deviation oftenly and knowledge perception impairs 1
Deviation and Perception frequently disturbed 0
2) Vijnanam – Vyavasayena i.e. “Vyavasayah Pravritih” (Chakrapani)
Normal functioning in routine 3

Gradual hampered performance in functions 2
Impaired motivation towards functioning oftenly 1
Loss of pace and motivation in functioning 0
3)HarshaAmodenai.e“Nrityagitavaditradutsavakaranama” (Chakrapani)
Totally cheerful on all occasion 3

Cheerful and initiative with good circumstances 2
Cheerful and active in that, only at occasion 1
No feeling of cheerfulness 0
4) Priti – Tosena i.e. "Mukhanayanprasadadih” (Chakrapani)
Always happy and pleased 3

Happy and pleased occasionally 2
Express happy mood oftenly 1
No feeling of happiness at all 0
5) Dhairyam-Avishadena i.e. "Manaso Adeinyam” (Chakrapani)
No fear or sorrow at any cause 3

Fearful only at reasonable at any cause 2
Fearful occasionally 1
Always in fearful and depressed emotions 0
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6) Viryam – Utthanena i.e. “Kriyarambhena” (Chakrapani)
Starts and works very quickly 3

Works with less interest 2
Delayed and decreased in working capacity 1
Not able to start any work 0
7) Avasthan – Avibhramena i.e. “Sthiramatitvam” (Chakrapani)
Always confident and stable in perception 3

Rarely confident and stable in perception 2
Oftenly stable in knowledge perception 1
Not stability or confidence in perception 0
8) Shraddha – Abhiprayena i.e. “Abhyarthanena”(Chakrapani)
Always very good in attitude and interest 3

Occasionally good in attitude and interest 2
Impaired attitude and interest 1
Totally loss of attitude and interest 0
9) Medha – Grahanena i.e. “Granthadidharanena”(Chakrapani)
Always grasps the events at an instance 3

Grasps the event but confused 2
Delayed in grasping the events with confusion 1
Unable to grasp or understand 0
10) Samjna – Naagrahanenan
Completely attentive in all occasions 3

Attentive rarely 2
Attentive only occasion 1
Absolutely no attentiveness 0
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11) Smriti – Smaranena i.e. “Tatkaranam Samskaroanumiyate” (Chakrapani)
Very good in recalling and remembering 3

Recalls and remembers with difficulty 2
Delayed recall and remembrance with confusion 1
Unable to recall and remember 0
12) Hriya – Apatarpanena i.e. “Lajjitakaranena”(Chakrapani)
Shyness intact always completely 3

Feeling of shyness only in front of some known persons 2
Feeling of shyness in unknown atmosphere 1
No shyness at all 0
13) Shila – Anushilanena i.e. “Anusilanam Samtatasilanam” (Chakrapani)
Very good conduct at all instances 3

Impaired conduct only at occasions 2
Impaired conduct recurrently 1
Totally abnormal conduct 0
14) Dhriti – Alaulyena

Not greedy for anything (Good controlling power) 3
Greedy and willing for few objects (Mild) 2
Greedy but not strongly willing (Moderate) 1
Greedy for all objects (Cannot control) 0
15) Vashyata - Videyataya i.e. “Vidheyaprakarena”(Chakrapani)
Always accepts, obeys and under control 3

Obeys and accepts oftenly 2
Obeys and under control only on strong commands 1
Does not obey at all 0
16) Rajah–Sangena i.e. “Naryadisangena Tatkaranam Rajoanumiyate” (Chakrapani)

Frequently and totally loss of affection 3
Loss of affection occasionally 2
Gradual decreased affection 1
Normal affection 0
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17) Moha – Avijnanena
Totally involvement and affliction with objects 3

Increased affliction, oftenly towards objects 2
Gradual affliction towards objects 1
Normal functioning capacity 0
18) Krodha – Abhidrohena i.e. “Parapidartha Pravrittih” (Chakrapani)
Frequent thoughts and functions of violence and sadistic 3

Violent, Sadistic functions oftenly 2
Violent thoughts very rarely 1
No violent tendencies 0
19) Shoka Dainyena i.e. “Rodanadi” (Chakrapani)
Weeps and feels inferior very frequently 3

Inferiority complexes and greedy oftenly 2
Feels inferiority and sorrow at occasion 1
No feeling of Sorrowness 0
20) Bhayam – Vishadena
Always in depressed and fearful emotions 3

Depressed mood even in reasonable cause 2
Depressed mood only in reasonable cause 1
No depressed mood 0
21) Dvesha – Pratishedhena i.e. “Vyavrutya”(Chakrapani)
Always thoughts and acts of revenge 3

Thoughts and acts of revenge oftenly 2
Thoughts of revenge only at few events 1
No revenging tendency at all 0
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22) Upadhi – Anubandhanena i.e. “Uttar Kalinaphalena”(Chakrapani)

Even other cannot help in resolving the impact of concerned problem 3
Impact can only be solved by the perseverance effort and counseling by 2
others
Prolonged, disturbing impact but able to solve by self efforts. 1
Normally short impact that can be solved by the person himself. 0
3. BRIEF PSYCHIATRIC RATING SCALE (BPRS)29

 Somatic Concern
Not present 0
Mild : occasional complaint or expression of concern 1-2
Moderate : frequent expressions of concern or exaggerations of existing ills 3-4
Severe : preoccupied with physical complaints or somatic delusions 5-6
 Anxiety

Not present 0
Mild : mentions or acknowledges being worried or fearful on direct ques- 1-2
tioning only
Moderate : volunteers he/she is anxious or fearful and may ask for reassur- 3-4
ance
Severe : feels in a panic, insists on anxious talk and may speak of impending 5-6
death
 Emotional Withdrawal

Not present 0
Mild : tends not to get involved with other people but will respond if ap- 1-2
proached
Moderate : seems to avoid emotional contact with others for much or most of 3-4
the time; this may be expressed as a passive withdrawal
Severe : actively avoids participation, unresponsive, and may leave an area 5-6
when spoken to or just not respond at all when approached
Page 101
 Conceptual Disorganization
Not present 0
Mild : peculiar use of words, rambling speech, and speech a bit hard to under- 1-2
stand or make sense of
Moderate : associations loose, apparent topic shift without readily apparent 3-4
reason, and sentences may be incomplete or peculiarly constructed. Blocking
interrupts talk
Severe : often completely incoherent, uses made up words,grammar incompre- 5-6
hensible or severe blocking
 Guilt Feelings

Not present 0
Mild : worries about having failed someone or something,and wishes to have 1-2
done things differently
Moderate : preoccupied about having done wrong or injured others by doing, or 3-4
failing to do, something
Severe : delusional guilt and an obviously unreasonable self reproach 5-6
 Tension

Not present 0
Mild : seems anxious, tense posture an nervous Mannerisms 1-2
Moderate : clearly very tense, fearful expression, trembling,and restless 3-4
Severe : continually agitated, pacing and hand wringing 5-6
 Mannerisms And Posturing
Not present 0
Mild : eccentric or odd mannerisms, or activity that ordinary individuals 1-2
would have difficulty explaining, for example, grimacing or picking
Moderate: does things or has mannerisms in a way that most people would 3-4
regard as „crazy‟. Behavior serving no apparent constructive purpose
Severe: posturing, smearing, intense rocking and „fetal‟positioning and 5-6
strange rituals that dominate the patient‟s attention and behavior.
Page 102
 Suspiciousness
Not present 0
Mild : seems on guard, unresponsive to „personal‟questions, and describes in- 1-2
cidents where other have harmed or wanted to harm him/her that sound plausi-
ble
Moderate: does not trust others and says others are talking about him/her and 3-4
intend harm. Says or implies that he/she expects other patients or staff to cause
hurt/harm
Severe: delusional paranoia. Speaks of Mafia plots, or the Federal Bureau of 5-6
Investigation (FBI), hosPital staff or others poisoning his food
 Grandiosity
Not present 0
Mild : says he/she is feeling great and has no problems 1-2
Moderate : says he/she is enthusiastically ready to take over the ward, or the 3-4
Management of others
Severe : delusional, Patient says he/she is appointed by God or is uniquely 5-6
qualified to run the world
 Hostility

Not present 0
Mild: snappish or grumpy manner or talk, mild irrita- 1-2
bility, or sour expression
Moderate: angry, sarcastic, or argumentative. May slam about or be 3-4

noisy, but no actual physical aggression toward people or objects
Severe: threatens or assaults people, or throws objects.May be severe if clear- 5-6
ly furious and just barely controlling Anger
Page 103
 Hallucinatory Behavior
Not present 0
Mild: patient sees, smells or feels something but knows it isn‟t real. 1-2
Knowledge of the patient/experience suggests that the patients has
occasional hallucinatory behavior
Moderate: talks about, or to, voices or other hallucinated experiences. Fre- 3-4
quent gestures suggestive of active ongoing hallucinations for a sustained pe-
riod
Severe: pervasive involvement in hallucinated experience during at least 5-6
some of the rating period. Little or no evidence that the patient rejects them
as „different‟ to normal
Page 104
References
1. Iyengar BKS , Light on Pranayama, Pranayama Dipika . 26th Ed [New Delhi]:

Harper Collins; 2012. Ch 21 ,pg 152-3.
2. Sleep Hygiene [Internet]. Sleepfoundation.org. 2012 [cited 20 December 2012].
Available from: http://www.sleepfoundation.org/article/ask-the-expert/sleep-
hygiene
3. [Internet]. 2012 [cited 20 December 2012]. Available from:
http://www.nhs.uk/livewell/insomnia/documents/sleepdiary.pdf
4. [Internet]. 2012 [cited 20 December 2012]. Available from:
http://www.dna.com/report global sleeplessness epidemic affect 150 millions
adults in developing world_1773194
5. Sharma R. Caraka Samhita Cakrapani Ayurveda Deepika Vol-II,. Varanasi:
Choukhambha Sanskrit Samsthan; 2009. Vimana 4/8, pg 166.
6. [Internet]. Wikipedia. 2012 [cited 20 December 2012]. Available from:
https://en.wikipedia.org/wiki/Special:Search?search=30.%09BRIEF+PSYCHIA
TRIC+RATING+SCALE+%28BPRS%29&go=Go
Page 105
OBSERVATIONS & RESULTS
In this "Study of Nidra as Adharniya Vega & its Management with Bhramari Pranayam"
was studied on 93 patients suffering from Anidra. During the study, some of the observa-
tions were made before (Day-0) and after (Day-90) the treatment and after the follow up.
 Age wise distribution

Table 16
AGE No of patients
16-25 20
26-35 36
36-45 23
46-55 11
56-60 3
Grand Total 93
There were maximum no. of patients i.e.39 % in age group 26-35 and 26% in age group
36-45 and a minimum of 3% in the age group of 56-60.
 Gender wise distribution

Table 17
Gender No of patients
Male 61
Female 32
Grand Total 93
Maximum no. of patients i.e. 66% were males and 34 % were females.
Page 106
 Prakruti wise distribution
Table 18
PRAKRUTI No of patients
KP 9
KV 11
PK 5
PV 13
VK 17
VP 38
Grand Total 93
Maximum no. of patients i.e. 41% belonged to Vata-Pitta Prakriti , and minimum no.
of patients i.e. 5% belonged to Pitta -Kapha Prakriti.
 Dietary Habitat wise distribution

Table 19
Dietary Habitat No of patients
Non-Veg 55
Veg 38
Grand Total 93
This shows, dietary habit of Patients, among them, 59% were non vegetarian, while 41%
were vegetarian.
Page 107
 Occupation wise distribution

Table 20
Occupation No of patients
STUDENT 30
HOUSE WIFE 12
IT PROFES-
41
SIONAL
LABOUR 10
Grand Total 93
Considering the nature of occupation, it was found that maximum i.e. 44% of patients
were IT professional, while 32% were student and 11% were labou, and 13% were
housewives.
 Vyasan wise distribution

Table 21
Vyasan No. of patients

ALCOHOL 11
SMOKING 48
TOBACCO 22
None(
12
tea,coffee)
Grand Total 93
This showed that maximum i.e. 51% patients were having smoking vyasan and mimi-
mum no. of patients i.e.12% having alcohol vyasan.
Page 108
 Marital status wise distribution

Table 22
Marital status No. of patients
MARRIED 32
UNMARRIED 61
Grand Total 93
It was found that maximum number of patients i.e 66 % were unmarried, while 34% were
married.
 Educational status wise distribution

Table 23
No. of
Educational status
patients
Illiterate 2
Primary 9
Secondary 11
H. Secondary 9
Graduate 21
Post Graduate 41
Grand Total 93
It was found that maximum number of patients i.e 44 % were post graduate, while mini-
mum i.e. 2% were illiterate.
Page 109
 Habitat wise distribution

Table 24
Habitat wise No. of patients

URBAN 32
RURAL 61
Grand Total 93
It was found that maximum number of patients i.e 66 % were urban, while 34% were ru-
ral.
 Socio economic status wise distribution

Table 25
Socio economic No. of pa-

status tients
Poor 9
Lower middle 11
Middle 19
Upper middle 13
Rich 41
Grand Total 93
It was found that maximum number of patients i.e 44% were rich, while minimum i.e.
10% were poor.
Page 110
RESULT
Group I : Effect on Insomnia (Table 25)
Posi- Nega- P
Ti Z val- Interpreta-
Parameter N tive tive val-
e ue tion
rank rank ue
Sleeplessness 31 0 31 0 -4.88 0 S
Disorders Of Sleep-
31 0 31 0 -4.88 0 S
Wake (S-W) Schedule
Sleep Quality 31 3 26 2 -4.366 0 S
Sleep Time 31 0 31 0 -4.892 0 S
After Awakening 31 0 31 0 -4.914 0 S
Shirahshula, Angamar- -
31 0 31 0 0 S
da etc. 4.909
After the completion of the course, its effect on the associated complaints was observed
as presented in table – highly significant relief were observed in Sleeplessness and Dis-
orders of Sleep-Wake (S-W) Schedule Sleep Quality, Sleep Time, After Awakening, Shi-
rahshula, Angamarda by Bhramari Pranayam.
Page 111
Group I : Effect on Manasa Bhavas
Posi- Nega- P
Interpre-
Parameter N tive tive Tie Z value val-
tation
rank rank ue
Manasa – Arthesu
31 0 26 5 -4.523 0 S
Avyabhicharanena
Vijnanam – Vyava-
31 10 9 12 -0.434 0.665 NS
sayena
HarshaAmodenai 31 2 15 14 -3.326 0.001 S
Priti – Tosena 31 6 15 10 -2.64 0.008 S
Dhairyam-
31 3 15 13 -2.946 0.003 S
Avishadena
Viryam – Utthanena 31 1 13 17 -3.082 0.002 S
Avasthan – Avibhra-
31 8 11 12 -1.326 0.185 NS
mena
Shraddha – Abhi-
31 10 8 13 -0.471 0.637 NS
prayena
Medha – Grahanena 31 7 12 12 -1.797 0.072 NS
Samjna – Naagraha-
31 7 15 9 -2.087 0.037 S
nenan
Smriti – Smaranena 31 3 16 12 -3.137 0.002 S
Hriya – Apatarpane-
31 6 17 8 -2.763 0.006 S
na
Shila – Anushilanena 31 4 17 10 -3.094 0.002 S
Dhriti – Alaulyena 31 4 15 12 -2.751 0.006 S
Vashyata – Videya-
31 5 16 10 -2.683 0.007 S
taya
Rajah–Sangena 31 1 24 6 -4.33 0 S
Moha – Avijnanena 31 2 29 0 -4.676 0 S
Krodha – Abhidrohe-
31 2 25 4 -4.452 0 S
na
Shoka Dainyena 31 2 23 6 -4.159 0 S
Bhayam – Vishadena 31 3 28 0 -4.45 0 S
Dvesha – Pratished-
31 0 27 4 -4.64 0 S
hena
Upadhi – Anuband-
31 0 26 5 -4.524 0 S
hanena
Page 112
After the completion of the course, its effect on the associated complaints of Manasa
Bhavas, was observed– no significant relief on Vijnanam – Vyavasayena, Avasthan –
Avibhramena, Shraddha – Abhiprayena, Medha – Grahanena were observed were as In
other Manasa Bhavas significant results were observed.
Group I : Effect on BRIEF PSYCHIATRIC RATING SCALE (BPRS)
Nega-
Positive Z val- P Interpre-
Parameter N tive Tie
rank ue value tation
rank
Somatic Concern 31 0 31 0 -4.894 0 S
Anxiety 31 0 31 0 -4.906 0 S
Emotional withdraw- 31 0 29 2 -4.756 0 S
al
Conceptual disorga- 31 0 31 0 -4.905 0 S
nization
Guilt Feelings 31 0 31 0 -4.894 0 S
Tension 31 0 31 0 -4.923 0 S
Mannerisms And 31 0 31 0 -4.931 0 S
Posturing
Suspiciousness 31 0 31 0 -4.931 0 S
Grandiosity 31 0 31 0 -4.894 0 S
Hostility 31 0 31 0 -4.892 0 S
Hallucinatory beha- 31 0 31 0 -4.925 0 S
vior
The present study suggests that statistically highly significant result was found in all
symptoms of Brief Psychiatric Rating Scale.
Page 113
Group II : Effect on Insomnia
Posi- Nega- P
Ti Z Interpre-
e value tation
rank rank ue
Sleeplessness 31 0 31 0 -5 0 S
Disorders Of Sleep-
Wake (S-W) Sche- 31 0 28 3 -5 0 S
dule
Sleep Quality 31 0 29 2 -5 0 S
Sleep Time 31 0 31 0 -5 0 S
After Awakening 31 0 0 0 -5 0 S
Shirahshula, Anga-
31 2 29 0 -4.909 0 S
marda etc.
The present study depicts that highly significant improvement was observed in Sleepless-
ness and Disorders of Sleep-Wake (S-W) Schedule Sleep Quality, Sleep Time, After
Awakening Shirahshula, Angamarda
Page 114
Group II : Effect on MANASA PARIKSHA Bhavas
Posi- Nega- Inter-

Ti Z P
Parameter N tive tive preta-
e value value
rank rank tion
Manasa – Arthesu
31 0 28 3 -5 0 S
Avyabhicharanena
Vijnanam – Vyava-
31 2 13 16 -3 0 S
sayena
HarshaAmodenai 31 11 10 10 -1 0.2 NS
Priti – Tosena 31 6 11 14 -2 0 S
Dhairyam-Avishadena 31 0 14 17 -3 0 S
Viryam – Utthanena 31 4 8 19 -1 0.2 NS
Avasthan – Avibhrame-
31 0 13 18 -3 0 S
na
Shraddha – Abhipraye-
31 7 13 11 -2 0 S
na
Medha – Grahanena 31 9 14 8 -1 0.3 NS
Samjna – Naagrahane-
31 0 19 12 -4 0 S
nan
Smriti – Smaranena 31 0 17 14 -4 0 S
Hriya – Apatarpanena 31 0 22 9 -4 0 S
Shila – Anushilanena 31 0 25 6 -5 0 S
Dhriti – Alaulyena 31 4 8 19 -2 0.1 NS
Vashyata – Videyataya 31 3 16 12 -3 0 S
Rajah–Sangena 31 0 20 11 -4 0 S
Moha – Avijnanena 31 2 23 6 -4 0 S
Krodha – Abhidrohena 31 0 26 5 -5 0 S
Shoka Dainyena 31 0 28 3 -5 0 S
Bhayam – Vishadena 31 0 31 0 -5 0 S
Dvesha – Pratishedhe-
31 0 29 2 -5 0 S
na
Upadhi – Anubandha-
31 2 29 0 -4 0 S
nena
After the completion of the course, its effect on the associated complaints of Manasa
Bhavas, was observed in Group II – no significant relief on Harsha,Amodenai, Viryam –
Utthanena, Medha – Grahanena and Dhriti – Alaulyena were observed were as in other
Manasa Bhavas significant results were observed.
Page 115
Group II : Effect on Brief Psychiatric Rating Scale (BPRS)
Positive Negative Z P
Parameter N Tie Interpretation
rank rank value value
Somatic Concern 31 0 25 6 -5 0 S
Anxiety 31 0 31 0 -5 0 S
Emotional with-
31 0 31 0 -5 0 S
drawal
Conceptual disorga-
31 0 31 0 -5 0 S
nization
Guilt Feelings 31 0 31 0 -5 0 S
Tension 31 0 31 0 -5 0 S
Mannerisms And
31 0 31 0 -5 0 S
Posturing
Suspiciousness 31 0 29 2 -5 0 S
Grandiosity 31 0 31 0 -5 0 S
Hostility 31 0 31 0 -5 0 S
Hallucinatory beha-
31 0 31 0 -5 0 S
vior
The present study denotes that statistically significant result was found in: all symptoms
of Brief Psychiatric Rating Scale.
Page 116
Group III : Effect on Insomnia
Posi- Nega- P
Ti Z val- Interpreta-
e ue tion
rank rank ue
Sleeplessness 31 0 31 0 -4.889 0 S
Disorders Of Sleep-
Wake (S-W) Sche- 31 0 31 0 -4.894 0 S
dule
Sleep Quality 31 0 31 0 -4.595 0 S
Sleep Time 31 0 31 0 -4.927 0 S
After Awakening 31 0 31 0 -4.927 0 S

Shirahshula, Anga-
31 0 31 0 -4.904 0 S
marda etc
The present study depicts that highly significant improvement was observed in Sleepless-
ness and Disorders of Sleep-Wake (S-W) Schedule Sleep Quality, Sleep Time, After
Awakening Shirahshula, Angamarda in Group III.
Page 117
Group III : Effect on MANASA PARIKSHA BHAVAS
Posi- Nega- Inter-

Ti Z P
Parameter N tive tive preta-
e value value
rank rank tion
Manasa – Arthesu Avyab-
31 0 29 2 -4.772 0 S
hicharanena
Vijnanam – Vyavasayena 31 2 18 11 -3.623 0 S
HarshaAmodenai 31 8 19 4 -2.737 0.006 S
Priti – Tosena 31 0 16 15 -3.585 0 S
Dhairyam-Avishadena 31 7 15 9 -2.712 0.007 S
Viryam – Utthanena 31 0 18 13 -4.146 0 S
Avasthan – Avibhramena 31 1 14 16 -3.218 0.001 S
Shraddha – Abhiprayena 31 9 6 16 -0.357 0.721 NS
Medha – Grahanena 31 5 12 14 -2.284 0.022 S
Samjna – Naagrahanenan 31 6 16 9 -2.492 0.013 S
Smriti – Smaranena 31 0 20 1 -4.089 0 S
Hriya – Apatarpanena 31 4 21 6 -3.73 0 S
Shila – Anushilanena 31 2 16 13 -3.4 0.001 S
Dhriti – Alaulyena 31 4 16 11 -2.826 0.005 S
Vashyata – Videyataya 31 5 24 2 -4.025 0 S
Rajah–Sangena 31 0 27 4 -4.652 0 S
Moha – Avijnanena 31 2 27 2 -4.569 0 S
Krodha – Abhidrohena 31 2 27 2 -4.489 0 S
Shoka Dainyena 31 0 27 4 -4.612 0 S
Bhayam – Vishadena 31 2 27 2 -4.536 0 S
Dvesha – Pratishedhena 31 0 27 4 -4.667 0 S
Upadhi – Anubandhanena 31 0 27 4 -4.668 0 S
After the completion of the course, its effect on the associated symptoms of Manasa
Bhavas, was observed in Group II –relief on Shraddha – Abhiprayena was not significant
but others were significant
Page 118
Group III : Effect on Brief Psychiatric Rating Scale (BPRS)
Inter-
Positive Nega- Z val- P
Parameter N Tie preta-
rank tive rank ue value
tion
Somatic Concern 31 0 31 0 -4.903 0 S
Anxiety 31 0 31 0 -4.907 0 S
Emotional withdrawal 31 0 31 0 -4.933 0 S
Conceptual disorganiza-
31 0 31 0 -4.891 0 S
tion
Guilt Feelings 31 2 29 0 -4.857 0 S
Tension 31 0 31 0 -4.898 0 S
Mannerisms And Post-
31 0 31 0 -4.998 0 S
uring
Suspiciousness 31 0 31 0 -4.907 0 S
Grandiosity 31 0 31 0 -4.89 0 S
Hostility 31 0 31 0 -4.913 0 S
Hallucinatory behavior 31 0 31 0 -4.913 0 S
The present study indicates that statistically highly significant result was found in all
symptoms of Brief Psychiatric Rating Scale.
Page 119
Kruskal-Wallis Test was applied to test if there were statistically significant differences
between three groups of an independent nonparametric parameter. Following results
were found.
Result of Kruskal-Wallis Test
mean chi p
Parameter Group N df
rank sq value
Group I 31 49.24 2
0.44
Sleeplessness Group II 31 44.82 2 0.799
8
Group III 31 46.94 2
Group I 31 49.05 2
0.71
Disorders Of Sleep Wake Group II 31 44.24 2 0.698
9
Group I 31 56.42 2
8.43
Sleep Quality Group II 31 45.24 2 0.015
3
Group I 31 47.89 2
0.36
Shirahshula, Angamarda etc. Group II 31 44.97 2 0.832
8
Group I 31 46.77 2
Sleep Time Group II 31 43.65 2 2.38 0.304
Group I 31 50.95 2
1.44
After Awakening Group II 31 45.95 2 0.486
3
Group III 31 44.1 2
Group I 31 46.44 2
Manasa – Arthesu Avyabhi- 0.59
Group II 31 44.82 2 0.744
charanena(Deviation) 2
Group I 31 51.68 2
Vijnanam – Vyavasayena( Per- 7.37
Group II 31 37.15 2 0.025
formance) 5
Group I 31 44.74 2
Harsha – Amodena( Cheerful-
Group II 31 42.68 2 0.32 0.202
ness)
Page 120
Group I 31 47.81 2
1.58
Priti – Tosena( Happiness) Group II 31 50.68 2 0.452
7
Group I 31 43.08 2
Dhairyam-Avishadena( Fear-
Group II 31 46.1 2 2.07 0.355
fulness)
Group I 31 45.53 2
Viryam – Utthanena( working 3.00
Group II 31 42.44 2 0.222
capacity) 6
Group I 31 47.87 2
Avasthan – Avibhrame- 0.05
Group II 31 46.52 2 0.973
na(Confidence in perception) 6
Group I 31 44.74 2
Shraddha – Abhiprayena( At- 0.49
Group II 31 49.15 2 0.779
titude and interest) 9
Group I 31 53 2
Medha – Grahanena( grasp or 7.84
Group II 31 51.19 2 0.02
understand) 3
Group I 31 50.42 2
Samjna – Naagrahanenan(
Group II 31 50.56 2 3.48 0.175
Attentive)
Group I 31 53.87 2
Smriti – Smaranena( Recall
Group II 31 46.05 2 4.06 0.131
and remember)
1.51
Group I 31 51.35 2 0.469
Hriya – Apatarpanena( Shy- 6
ness) Group II 31 46.06 2
0.87
Group I 31 48.63 2 0.646
Shila – Anushilanena( Con- 4
duct) Group II 31 43.53 2
Group I 31 48.56 2
Dhriti – Alaulyena( control- 0.21
Group II 31 46.84 2 0.897
ling will power) 8
Group III 31 45.6 2
Group I 31 57.26 2
Vashyata – Videyataya( ob- 8.27
Group II 31 38.58 2 0.84
idence and control) 1
Page 121
Group I 31 49.03 2
8.27
Rajah Group II 31 45.31 2 0.16
1
Group I 31 40.97 2
Moha Group II 31 45.35 2 5 0.082
Group I 31 44.29 2
Krodha Group II 31 43.34 2 3.03 0.22
Group I 31 52.42 2
2.35
Shoka Group II 31 45.02 2 0.308
4
Group I 31 49.26 2
0.53
Bhaya Group II 31 46.73 2 0.765
5
Group I 31 47.31 2
Dvesha Group II 31 51.32 2 3.2 0.201
Group I 31 42.39 2
Upadhi Group II 31 45.82 2 2.95 0.228
Group I 31 47.26 2
1.80
Somatic concern Group II 31 42.68 2 0.406
1
Group I 31 47.03 2
Anxiety Group II 31 50.4 2 1.2 0.549
Group I 31 41.58 2
13.2
Emotional withdrawal Group II 31 40.89 2 0.001
6
Group I 31 46.48 2
Conceptual disorganization Group II 31 43.95 2 1.06 0.58
Group I 31 48.05 2
0.15
Tension Group II 31 47.21 2 0.927
3
Group I 31 48.77 2 0.25
Manneurism and posturing 0.882
Group II 31 46.19 2 1
Page 122

Group I 31 44.13 2
1.11
Suspiciousness Group II 31 50.79 2 0.572
6
Group I 31 41.19 2
2.47
Hostility Group II 31 50.15 2 0.29
6
Group I 31 40.97 2
4.12
Hallucinatory behavior Group II 31 46.44 2 0.127
3
Group III 31 53.6 2
Group I 31 45.27 2
0.36
Motor retardation Group II 31 46.71 2 0.835
1
Group I 31 46.27 2
0.04
Uncooperativeness Group II 31 47.1 2 0.976
8
Group I 31 50.21 2
Unusual thought content Group II 31 47.13 2 1.08 0.58
Group I 31 50.95 2
2.05
Blunted effect Group II 31 47.94 2 0.358
3
Group I 31 50.31 2
1.11
Excitement Group II 31 47.03 2 0.573
5
Further, Mann Whitney test was applied to compare those parameters which were found
to be significant in each group and to test their intergroup result.
Page 123
COMPARISON OF THE EFFECTS
Comparison of sleep quality, Vijnanam – Vyavasayena (Performance), Medha – Graha-

nena (grasp or understand), Vashyata – Videyataya (obedience and control), Emotional
withdrawal showed variation so Mann Whitney U test was applied.
Result on comparison of the effects on sleep quality (Table 36)
Mann
Mean sum Wilcoxon P val-
N Whitney Z
rank rank W ue
u
Gr
31 35.34 1095.5
I
361.5 857.5 -2 0.45
Gr
31 27.66 857.5
II
Gr
31 37.08 1149.5
I
307.5 803.5 -2.7 0.0006
Gr
31 25.92 803.5
III
Gr
31 33.58 1041
III -
416 912 0.301
Gr 1.03
31 29.42 912
II
By using Mann Whitney U test for Comparison of sleep quality it was found that there
was statistically significant difference in improvement on sleep quality in Group I and
Group III whereas effect of Group I was same as effect of Group II on sleep quality. Si-
milarly effect of Group II was same as effect of Group III on sleep quality.
Page 124
Result on comparison of the effects on Vijnanam ( Performance)
(Table 37)
Mann
Mean sum Wilcoxon P
N whitney Z
rank rank W value
u
Gr I 31 36.65 1136
321 817 -2.4 0.016
Gr II 31 26.35 817
Gr I 31 31.03 962
-
466 962 0.813
0.237
GrIII 31 31.97 991
GrIII 31 26.78 830.5

334.5 830.5 -2.21 0.027
Gr II 31 36.21 1122.5
By using Mann Whitney U test for Comparison of Vijnanam – Vyavasayena it was found
that there was statistically significant difference in improvement on Vijnanam – Vyava-
sayena (Performance) in Group I and Group II Also in Group II and Group III whereas
effect of Group I was same as effect of Group III on Vijnanam – Vyavasayena (Perfor-
mance).
Page 125
Result on comparison of the effects on Medha (grasp or understand) (Table 38)
Mann
Mean sum Wilcoxon P
N Whitney Z
rank rank W value
u
Gr I 31 32.16 997 -
460 956 0.751
Gr II 31 30.84 956 0.317
Gr I 31 36.84 1142
315 811 -2.5 0.012
GrIII 31 26.16 811
Gr
31 36.25 1127 -
III 330 826 0.022
2.291
Gr II 31 26.65 826
By using Mann Whitney U test for Comparison of Medha – Grahanena it was found that
there was statistically significant difference in improvement on Medha – Grahanena
(grasp or understand) in Group I and Group III. Also in Group II and Group III whereas
effect of Group I was same as effect of Group II on Medha – Grahanena (grasp or under-
stand).
Page 126
Result on comparison of the effects on Vashyata (obedience and control)
(Table 39)
Mann
Mean sum wilcoxon P
N whitney Z
rank rank W value
u
Gr I 31 37.65 1158
299 795 -2.65 0.008
Gr II 31 25.65 795
Gr I 31 35.9 1113
344 840 -2.01 0.043
GrIII 31 27.1 840
Gr
31 28.94 897
III -
401 897 0.242
1.169
GrII 31 34.06 1056
By using Mann Whitney U test for Comparison of Vashyata – Videyataya it was found
that there was statistically significant difference in improvement on Vashyata – Videya-
taya( obedience and control) all groups.
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Result on comparison of the effects on Emotional withdrawal
(Table40)
Mann
Mean sum wilcoxon P
N whitney Z
rank rank W value
u
Gr I 31 31.35 972
-
476 972 0.929
0.089
GrII 31 31.65 981
Gr I 31 26.23 813
317 813 -2.66 0.008
Gr
31 36.77 1140
III
GrIII 31 25.24 782.5

286.5 782.5 -3.41 0.001
Gr
31 37.76 1170.5
II
By using Mann Whitney U test for Comparison of Vashyata Emotional withdrawal it was
found that there was statistically significant difference in improvement on Emotional
withdrawal in Group I and Group III Also in Group II and Group III whereas effect of
Group I was same as effect of Group II on Emotional withdrawal.
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Over all effect of the therapies on Effect on Insomnia
(Table 41)
ASSESSMENT
BhPr SH CT
PARAMETER
Sleeplessness 92.88% 93.56% 98.26%
Disorders of
Sleep Wake 76.53% 74.56% 75.26%
(SW) Schedule
Sleep Quality 93.68% 92.56% 95.12%
Sleep Time 61.08% 59.97% 65.28%
After Awaken-
76.63% 78.36% 77.14%
ing
Shirahshula,
89.00% 90.00% 93.00%
Angamarda etc.
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Over all effect of the therapies on Manasa Bhavas
(Table 42)
ASSESSMENT
BhPr SH CT
PARAMETER
Manasa Arthe-
76.67% 77.91% 78%
su
Vijnanam 55% 65.67% 83.33%
Harsha 65% 60.17% 63.33%
Priti 91.90% 90.09% 92.33%
Dhairyam 76% 78% 77.04%
Viryam 97.39% 98.67% 99.33%
Avasthan 45% 45.67% 43.33%
Shraddha 71% 55.61% 54.86%
Medha 66.67% 71% 81.43%
Samjna 65.44% 54.32% 54%
Smriti 71.11% 69.22% 71%
Hriya 39.87% 41.19% 43%
Shila 56.17% 55% 57%
Dhriti 41.39% 43.21% 39.33%
Vashyata 57.01% 65.67% 81.97%
Rajah 85.26% 85% 81.47%
Moha 65.17% 66.21% 68.01%
Krodha 96.33% 98% 97.77%
Shoka 74.25% 70% 75.41%
Bhaya 68.32% 69.77% 69%
Dvesha 75.15% 79.39% 80.14%
Upadhi 85.67% 85.91% 86.60%
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Over all effect of the therapies on Brief Psychiatric Rating Scale (BPRS)
( Table 43)
ASSESSMENT
BhPr SH CT
PARAMETER
Somatic concern 95.67% 95% 94.23%
Anxiety 85.31% 82.67% 87.21%
Emotional with-
90.01% 91.21% 92.05%
drawal
Conceptual disor-
71.22% 70.04% 72.84%
ganization
Tension 94.42% 93.38% 95.55%
Mannerism and
67.16% 65.21% 68.84%
posturing
Suspiciousness 75.39% 77.85% 79.31%
Grandiosity 59.36% 59.84% 61.65%
Hostility 64.71% 62.42% 66%
Hallucinatory be-
83.61% 80% 82.29%
haviour
Motor retardation 78.43% 75% 79.52%
Uncooperativeness 74% 72.40% 73.10%
Unusual thought
81.17% 80% 79.30%
content
Blunted affect 95% 93.63% 94.27%
Excitement 95.67% 95% 93.33%
It was observed throughout the different assessment criteria that all parameters related to
activities of daily living for example, anxiety, tension, somatic concerns, affect, emotion-
al withdrawal, these showed a highly significant response (Approx 90%). This could be
due to the fact that these parameters directly correlate with quality of life, and Bhramari
Pranayam due to its action on manovaha Srotas, has a considerable impact in controlling
and improving these symptoms.
Page 131
DISCUSSION
DISCUSSION ON LITERATURE
Ayurveda considered Nidra as natural urge Adharniya vega, the suppression of this urge
leads to many complications considered as Adharniya vega. Nidra is one of the tripods
for the maintenance of the living organism While discussing about Nidra and anidra in
the perspective of Astaunindaniya, Carak has affirmed that happiness & sorrow, growth
& wasting, strength &weakness, virility & impotence, the knowledge & lack of know-
ledge as well as survival of life and its termination depend on the sleep. Moreover, Nidra
is Pushtida and Jagarana or anidra does the Karshana of the body. Untimely extreme
sleep and expanded vigil take away both contentment and endurance, like the night of
destructions. Carak has included the Asvapna(Insomnia) in Nanatmaja Vata Vikaras.
Sushrut enlightened this in Garbha Vyakarana Shariram, as Nidra has a responsibility

nourishment and growth of the body. He further explained the Vaikariki Nidra which can
be associated to sleep disorders.
Vagbhatta in Ashtanga Sangraha mentioned this in Viruddhanna-vigyaniya Adhyaya,

where he explained the Trayopastambhas. Here he considered Manda Nidra due to Vata,
but used Asvapna term in Vataja Nanatmaja Vikaras. In Ashtanga Hridaya – Nidra, its
Vikaras and Chikitsa are revealed under Anna-rakshadhyaya where Trayopastambhas are
explicated. Sharangadhara, concerted the Anidra ,Alpa nidra Atinidra in Vataja ,Pittaja
,Kaphaja Nanatmaja Vikara.
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Hence it can be concluded that all Acharyas considered the importance of Nidra, hence
Anidra, is explained along with physiology of Nidra only. Anidra or Alpa Nidra is seen
as a Lakshana in many diseases and it may be Upadrava or Lakshana of Arishta. there-
fore, the Nidana, Samprapti and Chikitsa are enlightened concerning Anidra.
Sleep is one of the most important physiological functions that influence the daytime ac-
tivity,vigilance, concentration and performance. Hence maintaining good quality sleep
would be crucial to health. Insomnia is a common sleep disorder and is often associated
with significant medical, psychological and pharmacological approaches; however, long-
term use of frequently prescribed medications can lead to habituation and problematic
withdrawal symptoms.
Stress is one of the commonest causes attributed to Insomnia. Sleep disturbance asso-
ciated with stress has not been well-documented, predominately due to its transient‟s na-
ture. It must be further emphasized that those who do respond with insomnia may later
develop chronic psychophysiological insomnia as result of the initial stress. Vata and
Manasa are interdependent and if one becomes vitiated, it vitiates the other Thus both
seems to be vitiated in Anidra. Carak has given importance to Vata in the management of
Anidra Treating this psychic disorder is a difficult task, however proper counseling and
relaxation techniques along with other therapies are supportive in the management.
Hence, Manaha -sukham, Manonukula-vishaya etc. are mentioned in the management of
Anidra.
DISCUSSION ON PREVIOUS RESEARCH
 Kozasa EH et al.2010 observed Sleep hygiene is the most frequently cited inter-
vention along with other interventions like CBT or an active control. Considering
that many insomniacs present “bad” habits before sleep, these instructions can
change the quality of sleep.
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 Irwin et al (2008) focused on therapies such as music, Yoga, Tai Chi Chi (a wes-
ternized and standardized version of Tai Chi, consisting of 20 simple and separate
movements), relaxation and sleep hygiene
 Vincent N et al (2009) Used specific questionnaires for insomnia, such as insom-
nia severity or the PSQI, online treatment, psychoeducation, stimulus control in-
struction, sleep restriction, relaxation training and Harmat L et al (2008) reports
classical music were all found to lead to improvements in these two measures.
 A reduction in sleep latency, an increase in sleep efficiency (calculated using
questionnaire responses) and a significant reduction in the frequency of hypnotic
drug use in the CBT group were observed by Morgan K et al (2004)
 Edinger J at el. (2001) claims, cognitive changes was correlated with improve-
ments noted on both objective (PSG) and subjective measures of insomnia symp-
toms, particularly within the CBT group.
 Cognitive changes were correlated with improvements noted on both objective
(PSG) and subjective measures of insomnia symptoms, particularly within the
CBT group by Lichstein K at el. (2001)
 Yoga led to an increase in the number of hours of sleep and in the feeling of being
rested in the morning, but the waiting-list control group (no intervention) and the
ayurveda (a herbal preparation) group did not show increased hours of sleep.in a
study by Manjunath N at el. (2005)
 A sleep diary was used evaluate a group exposed to sleep hygiene with a stimulus
control, and it was compared to that of a group exposed to sleep hygiene and a re-
laxation tape. Pallesen S at el. (2003)to observed that the effects of both treat-
ments were greater for nocturnal measures as compared to daytime measures.
However, there were no differences in treatment interventions when compared
one to another.
 Waters W et al.(2003), states that, flurazepam was superior to progressive muscle
relaxation plus cognitive distraction (PMR/ CD), sleep restriction and stimulus
control (SR/SC) or sleep hygiene education.
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 Vincent N et al.(2009)Online treatment produced improvements in the primary

end points of sleep quality, insomnia severity and daytime fatigue. This online
treatment also produced significant changes in pre-sleep cognitive arousal and
dysfunctional beliefs about sleep.
 Suri J.C., et al. using the Chervin and the Stanford Sleep Clinic questionnaire had
conducted a study on a sample of adult population of Delhi which reflected that
the impact of sleep disorders on the morbidity profile on this strata of society, the
phenomenal burden of undiagnosed sleep disorders and its impact on social, men-
tal, physical and economic health of the society.
 Krishna Pushpa, Shwetha S et al. aimed to analyze the quality of sleep in 67 med-
ical students using the Pittsburgh Sleep Quality Index and to relate sleep with
blood pressure (BP), body mass index (BMI) and academic performance. This
study showed the high prevalence of poor sleep quality and underlined the close
relationship of sleep with BP, BMI and academic performance among medical
students.
 The pattern of sleep, prevalence of anxiety and depression and the overall impact
of the nature of their employment on their lifestyle were studied in a segment of
BPO workers employed in the call centers around New Delhi by Suri J.C. et al. in
2007. It was found that Circadian rhythm sleep disorders (CRSD) are frequently
seen amongst shift workers who, in turn, comprise a large segment of the popula-
tion employed in the BPO industry
 Meshram Sushant H et al. after having conducted a questionnaire-based study to
assess the behavior, attitude and knowledge of sleep medicine among resident
doctors had concluded that there was an intense need for including sleep medicine
in their curriculum.
 In an unusual study, Ambar Chakravarthy describes his personal experience of
systemic effects of late night sleep deprivation and non-restorative sleep - A
common experience amongst doctors. Results of some simple self-
Page 135
experimentations have been mentioned to highlight the possible pathogenetic me-

chanisms.
 Seetha M et al. observed in 20 patients treated with dashmoola siddha ksheera de-
veloped more confidence. Their life style became well organized and there was
an urge with in themselves for active involvement in their day to day activities.
 Ranawat R at el. states that Bhastrika Yogic Kriya and Jatamansi Ghana vati
showed significant results in the Management of Insomnia in 34 patients of Ani-
dra (primary insomnia).
 Bhaduri T. at el states that Sirodhara and Yoga are very helpfull in the manage-
ment of chronic insomnia along with Lifestyle modification like Diet.
 Mahendra S. at el (2012) observed that Early treatments for insomnia(anidra) fo-
cused on therapeutic approaches with interventions such as systematic desensiti-
zation, relaxation, hypnosis, biofeedback, and paradoxical intention which tar-
geted hyperarousal associated with insomnia.
Though modern psychiatry acquired a revolutionary growth in understanding of mental

faculties and related things. Still lacuna persists in the field of psychopharmacology –
especially when we think about its untoward secondary complications in the human sys-
tems.
No studies have been reported to confirm the concept of dharana of Nidra as Anidra,
however similar concept of Circadian rhythm sleep disorders include disorders in which
sleep-wake cycle disturbance, inadequate or poor quality of sleep leads to insomnia.
With this backdrop an attempt is made to estimate the efficacy of Bhramari Pranayam in
a series of patients suffering from Anidra.
Present study was carried out with the hypothesis there should be influence of Nidra vega
on the body and it may be within physiological limits or may be pathological. But Nidra
is one among a many factors which will have the influence on the physiology and patho-
logical process. So in the analysis of observational data limitations like influence of vega
Page 136
dharan, was taken into consideration. As it is primary work on the Nidra vega dharan ,
chronic disorders or patients suffering from chronic illness are not selected. So in the
analysis illness and medicine which is continuing are also considered as limitations.
In this study the efforts are made to provide a practical base to the concept of vega dha-
ran and its effect on health at physical and mental level. When a person stays awake for a
extend, the it is that he will be unable to remain awake, and the more possible he is to
start to feel drowsy. This growing sleepiness is recognized as the homeostatic sleep drive.
The purpose of sleep restraint is to regulate the sleep-wake cycle by tailoring the moment
spent in bed to the individual's right sleep need.
Vata and Mana are interdependent and if one becomes vitiated, it vitiates the other. In
this disorder, both are seem to be vitiated. Hence, Acharya Charak gave importance to
Vata in the Managementof Anidra. Treating this psychic disorder is a difficult task.
Proper counseling, relaxation techniques along with other therapies are considerable in
the Management. Hence, Manaha Sukham, Manonukula Vishaya etc. are mentioned in
sleeplessness, which are indicative of psychic Management.
Hence a treatment consisting of Bhramari Pranayam and Sleep Hygiene was planned for
the study. 93 patients of Anidra were registered for this study and the significant data
pertaining to their Nidanatmaka aspects are being discussed as under:
DISCUSSION ON OBSERVATION
Age: Out of the 93 patients of Anidra studied in this series, maximum 40% patients be-
longed to the age group of 26 –35 years. Minimum patients (3%) were found from the
age group 56 to 60. This age group denotes the initial stage of Vata predominance. Ra-
jas is mainly related with Vata. Vitiation of these both plays an active role in the patho-
genesis of Anidra.
Page 137
Sex: In this series maximum number of patients i.e. 66% patients were males whereas
34% patients were females. Though, generally insomnia is seen on higher side in females
than males, this observation may be due to more availability of the patients in particular
sex. Also Dharana of Nidra Vega is done more by the male sex due to lifestyle.
Prakriti : All the patients of this study were having Dvandvaja Prakriti with highest
number of patients i.e. 41% patients having Vata-Pitta Prakriti . This gives evidence that
Vata-Pitta Prakriti patients are more at risk for developing Anidra because, generally
Vata and Pitta Prakriti people have disturbed or less sleep. 63% patients were having
Rajas Predominant Manasa Prakriti followed by 25% patients, who were having Tamas
predominant Manasa Prakriti . Rajas is the main causative factor in Anidra as it has
Pravartaka property, which keeps mind active leading to Anidra.
Education, Socio-economic Status, Occupation & Marital Status: Maximum number

of patients i.e. 44% were having post graduate level education and 2% patients were illi-
terate. 44% patients were from rich class and 10% patients were from a poor socioeco-
nomic background. 44% patients were IT professionals followed by 32% were students.
Maximum 66% patients were married. The above data signifies that as majority of the
patients were postgraduate level educated, they were from upper class and were IT pro-
fessionals and unmarried too. The research work reported that there is no relationship of
education with sleeplessness.
Upper class may have more struggle in life, hence the mental problems are also more. IT
professionals suffer from excessive mental tension and worry, which may lead to disease
manifestation. In the married may be because of commitments, targets, problems related
to the lifestyle the prevalence of disease is more common. But, to say this with confirma-
tion a survey is necessary.
Page 138
Diet Habitat: Maximum 59% patients were having Non-vegetarian type of food. Non
vegetarian food is Rajas and Tamas in nature that affects Vata Dosha, and thus might be
enhancing the disease manifestation.
Vyasana: 51% patients had the addiction of smoking, 12% each alcohol and 24% tobac-
co or pan chewing addiction. Caffeine, an alkaloid drug in coffee and tea has a stimulant
action on CNS and increased mental activity. Researchers reported that alcohol can alter
sleep. Though it initially produce sleep, but fall in blood concentration leads increased
arousal due to cortical stimulation. Nicotine, a poisonous alkaloid content of tobacco and
pan is responsible for dependence and leads to CNS stimulation. All these contents have
CNS stimulant activity. They aggravate the disease condition further.
Habitat: Maximum 66%patients were urban dwellers, while 34% were rural dwellers.
The living style is much changed in urban areas than rural. The environmental factors,
the working atmosphere, living condition – all contribute for this. Still Indian life style is
having its root in rural areas, which is best for living healthily.
Family History & Present Status: 14.28% patients each had positive family history for
psychic and physical disturbance. 7.14% patients had family history of Alcohol addic-
tion. 32.14% patients had negative relationships in family and in 14.28% patients, family
had a negative attitude and insight toward the patients, which might act as a stressor and
may be enhancing the psychic symptoms found in insomnia.
Agni: In this study, majority of the patients i.e. 63% had MandAgni. As Nidra is stated
to enhance Agni (Su. Chi. 24/88), sleeplessness may produce MandAgni by hampering it.
Koshtha: 60% of patients were having Madhyama Koshtha followed by 24% patients
having Krura Koshtha. Madhyama and Krura Kostha are suggestive of Pitta and Vata
Page 139
Dosha dominancy respectively, may be because of majority of the patients were having
Vata-Pitta Sharirika Prakriti in this study.
Sleep: All the patients i.e. 100% reported disturbed sleep, as disturbed sleep is one of the
chief symptoms of insomnia.
Dreams: In this study, 60% patients had occasional dreams, while 12% patients had reg-
ular dreams in their sleep. Dream is the pre-state of deep sleep. In deep sleep, nobody
sees the dreams. Sometimes, dreams are also indicative of underlying disorders, which
disturb the sleep and may cause Anidra.
Mala Pravritti: 67% patients were having regular Mala Pravritti and 13% patients had
complaint of constipation.
Mutra Pravritti: Maximum number of patients i.e. 75% had normal micturation. 15%
patients had polyuria. Frequent micturation is commonly seen in Anidra patients.
Satmya, Satva, Appetite, Exercise Tolerance: 6 0% patients were having Madhyama

Satmya followed by 22.00% patients Pravara and 12% Avara Satmya. Charak has men-
tioned that a person having Madhyama and Avara Satva are more vulnerable to diseases,
which is supported in this study. Maximum number of patients i.e. 60% were having
moderate appetite, 30% were having poor appetite, and 10% had normal appetite. Proper
sleep helps in the digestion, improves AgniBala etc. Maximum number of patients
i.e.25% patients were having good exercise tolerance, though maximum number of pa-
tients i.e. 68% patients belonged to moderate exercise category, which indicates that their
working capacity is decreased because of sleeplessness. Nidana: Maximum number of
patients i.e. 82.14% patients were having Manasika Nidanas, followed by 71.43% having
Aharaja Nidana, 46.43% having Viharaja Nidana and 28.57% having Anya Nidanas.
This gives evidence that Manasika Nidanas have great role in disease manifestation
Page 140
– Anidra. Aharaja and Viharaja Nidanas also having importance as they are having
mainly VataPitta Prakopaka effect.
Chief Complaints: All the patients had complaint of sleeplessness, followed by 95% pa-
tients having difficulty in falling asleep and 60% patients having difficulty in maintaining
sleep. 80% were having distress in their working area, 39% had impaired sleep wake
schedule. As sleeplessness – Anidra is due to Dushti of Vata and Rajas – sleeplessness,
disturbed sleep might be seen due to their Chala and Pravartaka Guna respectively.
Associated Complaints: These associated complaints are due to Vata, Pitta and Rajasa.
Though some of the symptoms like Akshi Gaurava, Shiro Gaurava etc. are seen in Kapha
Prakopa, in Anidra also they are seen, due to Vata only.
Effect On Insomnia:
Effect On Sleeplessness: Bhramari Pranayam provided 92.88% relief, Combined Ther-

apy provided 98.26% relief followed by 93.56% relief in Sleep Hygiene group. Hence it
was statistically highly significant in all the three groups. Thus, Combined is better than
other two groups in sleeplessness, though the difference in percentage of Bhramari Pra-
nayam and Combined Therapy was not very significant.
Effect On Disorders of Sleep wake (SW) schedule:- 76.53% relief was provided by
Bhramari Pranayam which was statistically significant. Though, 75.26% relief was ob-
served also in combined group, which was insignificant followed by 74.56% relief in
Sleep Hygiene administered group having insignificant relief. Thus, Bhramari Pranayam
is better in. Disorders of Sleep wake (SW) schedule.
Page 141
Effect on Sleep Quality:- Sleep quality was improved 95.12% in combined therapy,
93.68% in Bhramari Pranayam and 92.56% in Sleep Hygiene group. All the results were
significant. But, combined therapy showed better result in sleep quality.
Effect on Sleep time:- In Combined therapy group 65.28% improvement in sleep time
was observed whereas 61.08% and 59.97% increase in sleep time were noted in Bhrama-
ri Pranayam and Sleep Hygiene treated groups. Though, all were statistically significant,
combined therapy is comparatively better than other two groups.
Effect On After awakening:- 77.14% improvement was provided by combined therapy

in mood after awakening followed by 76.63% and 78.36% improvement by Bhramari
Pranayam and Sleep Hygiene respectively. All the results were statistically significant.
Here better relief was obtained by Sleep Hygiene.
Effect On Associated Symptoms like Shirahshula, Angamarda etc:- 89% relief was
provided by Bhramari Pranayam which was statistically significant. 93% relief was ob-
served also in combined group, which was significant followed by 90% relief in Sleep
Hygiene administered group having significant relief. Thus, Combined Therapy is better
in Shirashuladi Associated Symptoms.
Effect on Manasa Bhavas:
Manasa – Arthesu Avyabhicharanena (Deviation): Statistically significant with

78.00% relief in Manasa was observed in Combined therapy followed by 76.67% relief
in Bhramari Pranayam group and 77.91% relief in Sleep Hygiene group. Both were
found statistically insignificant. Hence, Combined therapy provided better relief than
both group.
Page 142
Vijnanam – Vyavasayena (Performance): Combined therapy provided significant of

83.33% relief, whereas Sleep Hygiene provided significant with 65.67% relief and Bhra-
mari Pranayam provided insignificant of 55% relief in Vijnanam.
Harsha – Amodena (Cheerfulness): Combined therapy provided significant of 63.33%

relief, whereas Sleep Hygiene provided insignificant with 60.17% relief and Bhramari
Pranayam provided significant of 65% relief in Harsha.
Priti – Tosena (Happiness): Combined therapy group provided 92.33% relief which
was statistically significant followed by 91.9% relief by Bhramari Pranayam and 90.09%
relief by Sleep Hygiene was observed. Thus, combined therapy showed better results in
relief of Priti.
Dhairyam-Avishadena (Fearfulness): Bhramari Pranayam provided 76% relief, com-

bined therapy provided 77.04% relief followed by 78% relief in Sleep hygiene group,
which was statistically highly significant in all the three groups. The difference in per-
centage of Bhramari Pranayam, Sleep hygiene and combined therapy was very minor.
Viryam – Utthanena (working capacity): Combined therapy provided significant of

99.33% relief, whereas Sleep Hygiene provided insignificant with 98.67% relief and
Bhramari Pranayam provided significant of 97.39% relief in Viryam.
Avasthan – Avibhramena (Confidence in perception): Combined therapy provided

significant of 43.33% relief, whereas Sleep Hygiene provided significant with 45.67%
relief and Bhramari Pranayam provided insignificant of 45% relief in Avasthan.
Shraddha – Abhiprayena (Attitude and interest): Combined therapy provided signifi-

cant of 54.86% relief, whereas Sleep Hygiene provided significant with 55.61% relief
and Bhramari Pranayam provided insignificant of 71% relief in Shraddha
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Medha – Grahanena(grasp or understand): Combined therapy provided significant of

81.43% relief, whereas Sleep Hygiene provided insignificant with 71% relief and Bhra-
mari Pranayam provided insignificant of 66.67% relief in Dwesha
Samjna – Naagrahanenan (Attentive): Combined therapy group provided 54% relief

which was statistically significant followed by 65.44% relief by Bhramari Pranayam and
54.32% relief by Sleep Hygiene was observed. Thus, combined therapy showed better
results in relief of Samjna – Naagrahanenan (Attentive).
Smriti – Smaranena (Recall and remember): Combined therapy group provided 71%
relief which was statistically significant followed by 71.11% relief by Bhramari Pra-
nayam and 69.22% relief by Sleep Hygiene was observed. Thus, combined therapy
showed better results in relief of Smriti – Smaranena (Recall and remember).
Hriya – Apatarpanena (Shyness): Combined therapy group provided 43% relief which
was statistically significant followed by 39.87% relief by Bhramari Pranayam and
results in relief of Hriya – Apatarpanena (Shyness).
Shila – Anushilanena (Conduct): Combined therapy group provided 57% relief which
was statistically significant followed by 56.17% relief by Bhramari Pranayam and 55%
relief of Shila – Anushilanena (Conduct).
Dhriti – Alaulyena (controlling will power): Combined therapy provided significant of

39.33% relief, whereas Sleep Hygiene provided insignificant with 43.21% relief and
Bhramari Pranayam provided significant of 41.39% relief in Viryam.
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Vashyata – Videyataya (obidence and control): Combined therapy provided significant

of 81.97% relief, whereas Sleep Hygiene provided significant with 65.67% relief and
Bhramari Pranayam provided significant of 57.01% relief in Vashyata.
Rajah: Combined therapy group provided 81.47% relief which was statistically signifi-
cant followed by 85.26% relief by Bhramari Pranayam and 85% relief by Sleep Hygiene
was observed. Thus, combined therapy showed better results in relief of Rajah.
Moha: Combined therapy group provided 68.01% relief which was statistically signifi-
cant followed by 65.17% relief by Bhramari Pranayam and 66.21% relief by Sleep Hy-
giene was observed. Thus, combined therapy showed better results in relief of Moha
Krodha: Combined therapy group provided 97.77% relief which was statistically signifi-
was observed. Thus, combined therapy showed better results in relief of Krodha
Shoka: Combined therapy group provided 74.25% relief which was statistically signifi-
was observed. Thus, combined therapy showed better results in relief of Shoka
Bhaya: Combined therapy group provided 69% relief which was statistically significant
followed by 69.77% relief by Bhramari Pranayam and 68.32% relief by Sleep Hygiene
was observed. Thus, combined therapy showed better results in relief of Bhaya
Dvesha: Combined therapy group provided 80.14% relief which was statistically signifi-
giene was observed. Thus, combined therapy showed better results in relief of Dvesha
Page 145
Upadhi: Combined therapy group provided 86.60% relief which was statistically signifi-
giene was observed.. Thus, combined therapy showed better results in relief of Upadhi.
Effect On Brief Psychiatric Rating Scale (BPRS)
Somatic concern: Combined therapy group provided 94.23% relief which was statisti-
cally significant followed by 95.67% relief by Bhramari Pranayam and 95% relief by
Sleep Hygiene was observed. Thus, combined therapy showed better results in relief of
Somatic concern.
Anxiety: Combined therapy group provided 87.21% relief which was statistically signif-
icant followed by 85.31% relief by Bhramari Pranayam and 82.67% relief by Sleep Hy-
giene was observed. Thus, combined therapy showed better results in relief of Anxiety.
Emotional withdrawal: Significant relief of 91.21% and 90.01% by Sleep Hygiene and
Bhramari Pranayam respectively were provided while Combined therapy provided
92.05% relief which was significant. Here, also Combined therapy provided better result
than Bhramari Pranayam and Sleep Hygiene in Emotional withdrawal
Conceptual disorganization: Combined therapy group provided 72.84% relief which

was statistically significant followed by 71.22% relief by Bhramari Pranayam and
results in relief of Conceptual disorganization.
Tension: Combined therapy group provided 95.55% relief which was statistically signif-
icant followed by 94.42% relief by Bhramari Pranayam and 93.38% relief by Sleep Hy-
giene was observed. Thus, combined therapy showed better results in relief of Tension.
Page 146
Manneurism and posturing: Combined therapy group provided 68.84% relief which was
statistically significant followed by 67.16% relief by Bhramari Pranayam and 65.21%
relief of Manneurism and posturing.
Suspiciousness: Combined therapy group provided 79.31% relief which was statistically
significant followed by 75.39% relief by Bhramari Pranayam and 77.85% relief by Sleep
Hygiene was observed. Thus, combined therapy showed better results in relief of Priti.
Grandiosity: Combined therapy group provided 61.65% relief which was statistically
significant followed by 59.36% relief by Bhramari Pranayam and 59.84% relief by Sleep
Hygiene was observed. Thus, combined therapy showed better results in relief of Priti.
Hostility: Combined therapy group provided 66% relief which was statistically signifi-
giene was observed. Thus, combined therapy showed better results in relief of Hostility.
Hallucinatory behavior: Combined therapy group provided 82.29% relief which was
statistically significant followed by 83.61% relief by Bhramari Pranayam and 80% relief
by Sleep Hygiene was observed. Thus, combined therapy showed better results in relief
of Hallucinatory behavior.
Motor retardation: Combined therapy group provided 79.52% relief which was statisti-
cally significant followed by 78.43% relief by Bhramari Pranayam and 75% relief by
Motor retardation.
Uncooperativeness: Combined therapy group provided 73.1% relief which was statisti-
cally significant followed by 74% relief by Bhramari Pranayam and 72.4% relief by
Page 147
Uncooperativeness.
Unusual thought content: Combined therapy group provided 79.3% relief which was
statistically significant followed by 81.17% relief by Bhramari Pranayam and 80% relief
by Sleep Hygiene was observed. Thus, combined therapy showed better results in relief
of unusual thought content.
Blunted affect: Combined therapy group provided 94.27% relief which was statistically
significant followed by 95% relief by Bhramari Pranayam and 93.63% relief by Sleep
Hygiene was observed. Thus, combined therapy showed better results in relief of
Blunted effect.
Excitement: Combined therapy group provided 93.33% relief which was statistically
significant followed by 95.67% relief by Bhramari Pranayam and 95% relief by Sleep
Hygiene was observed. Thus, combined therapy showed better results in relief of Ex-
citement.
PROBABLE MODE OF ACTION OF BRAMARI PRANAYAM
In Bhramari Pranayam, patients feel relaxation both – physically as well as mentally.

Relaxation of the frontals muscle tends to normalize the entire body and achieve a de-
crease in activity of sympathetic nervous system with lowering of heart rate, respiration,
oxygen consumption, blood pressure, muscle tension. It strengthens the mind and spirit
and this continues even after the relaxation. Corresponding to different levels and powers
of consciousness there are different nerve plexuses and glands in human organisms. Spe-
cial stimulation of different nerve plexus, glands and brain cells accompanies mental
function of different type at different levels. Thus, the Hindu theory of Chakras – center
of consciousness – is based on this fact.
Page 148
According to Ayurveda, the forehead and head are areas of many vital spots – Marma,
which have got very important place in the body. In some cases, even slight stimulation
of such Marma may have beneficial effect on the body, due to their connection with
higher centers. Bhramari Pranayam makes the patient to concentrate on this area, by
which the stability arrives in the mind function and this leads to locate the Mana in „Ni-
rindriya Pradesha‟ and patient may get sleep.
In this way, Bhramari Pranayam can be considered as an adjunct aid among the method
of relaxation through its procedural effect and might be able to break the pathogenesis of
Anidra at different levels.
PROBABLE MODE OF ACTION OF SLEEP HYGEINE
In today's challenging globe no one is getting time to lie down peacefully and relax for a
while. We are constantly open to the elements of stress and pressure. If we lie down in a
comfortable position for a while and meditate we positively feel better. The practices of
Sleep hygiene also bring into being a meditative outcome helping to prevail over the
grievance of insomnia. The method of Sleep hygiene produces almost similar effects as
that of Yog Anidra technique in yogic science.
In Ayurved, there are number of measures explained for relaxation of body and mind. By
these measures like ratricharya and relaxation the mind comes down to a restful state, it
lessen constant worry, facilitates normal and better function of mind. All the yields of
relaxation are achieved by the practice of Sleep hygeine.
LIMITATIONS
Following limitations of the study should be addressed in subsequent trials of yoga for
Adharaniya vega of Nidra. The effects of the intervention, although promising, must be
interpreted with caution. In particular, the beneficial effects of general activation and so-
cial support (i.e., personal participation) are unknown. A subsequent study planned by
Page 149
our group was included an attention-control group to control for these factors. A poten-
tial understanding on quality of life was lacking. Additionally, this study was subject to
the common limitations of research involving self-report. Although back-filling of di-
aries was reduced by collecting these forms after every fortnight, there was still the po-
tential for delayed completion of these forms. Electronic data collection would improve
the accuracy of daily sleep, Actigraphy and symptom reporting.
Few side effects of the intervention occurred, all of which were minor. Safety of the in-
tervention was supported with proper councelling and modifications of yoga to meet such
needs. This baseline knowledge may be important for future studies of yoga for Anidra.
Page 150
SUMMARY
The dissertation “Study of Nidra as Adharniya Vega & its Management with Bhramari
Pranayam” comprises following parts:
1. Introduction
2. Objectives of the dissertation
3. Review of literature
4. Methodology
5. Observation and results
6. Discussion
7. Conclusion
The volume begins with the conceptual part which deals with literary aspects of the study
collection of all subject related topics. Unlike other disorders, this entity has both – physio-
logical and pathological importance. In physiological normalcy, it maintains the health and
in pathological condition it hampers the health. Hence,before going to the disease review, a
detailed description regarding Nidra – from Ayurvedic and modern point of view has been
discussed. Nidra with its physiology, importance, function and its untoward effect– when it
is not taken in proper quality and quantity and by holding up of it have been discussed.
Various phenomena on occurring of sleep from Upanishadik, Yogic, Ayurvedic and modern
point of view has been presented and concluded. As Manasa is playing a key role in Nidra,
relation between Manasa and Vata and its importance in the context of Nidra have been
dealt together. In the disease contrive, Anidra – according to Ayurvedic point of view with
its Nidana, Rupa, Samprapti vis-à-vis pathogenesis, Samprapti Ghataka and Chikitsa with
Page 151
the consideration of psychic level have been critically analyzed and presented. Insomnia
with up to date modern perspective has been discussed after discussing Anidra.
Introduction:
It includes brief knowledge about Adharniya Vega, Nidra, Anidra and Bhramari Pranayam
followed by need of study is described. After that prevalence of Insomnia and Hypothetical
role of Bhramari Pranayam over Anidra is mentioned.
Objectives of the dissertation:
It includes Aim, Objective and literary study of Adharniya Vega, Nidra, Anidra and Bhramari
Pranayam from various text is mentioned.
Review of literature:
This part includes the conceptual part which deals with literary aspects of the study collec-
tion of all subject related topics. Unlike other disorders, this entity has both – physiological
and pathological importance. In physiological normalcy, it maintains the health and in
pathological condition it hampers the health. Hence, before going to the disease review, a
detailed description regarding Nidra – from Ayurvedic and modern point of view has been
discussed. Nidra with its physiology, importance, function and its untoward effect – when it
is not taken in proper quality and quantity and by holding up of it have been discussed.
Various phenomena on occurring of sleep from Upanishadik, Yogic, Ayurvedic and modern
point of view has been presented and concluded. As Manasa is playing a key role in Nidra,
relation between Manasa and Vata and its importance in the context of Nidra have been
dealt together.
Methodology:
This comprises the selection criteria, study design, plan of the study, physiology, subjective
and objective parameters and grading for assessment criterion.
Page 152
Observation and Result:
It includes observation on all demographic data‟s with their graphical representation about the
same, regarding the observation Age, Sex, Prakrutī, and results of individual symptoms
followed overall response of the treatment.
Discussion:
This includes Discussion About Clinical Study, Patients, Disease, Treatment and Lakṣanaa,
Management of Anidra followed by Discussion regarding probable mode of action of Bhrama-
ri Pranayaon Anidra. In the end of Discussion Probable Samprapti Bhang of Anidra and
Mode of Action of Bhramari Pranaya is mentioned.
Conclusion: Thus it can be concluded that Yogic therapies when combined with beha-
vioral therapy like Sleep Hygiene plays a very major role in providing relief to patients
suffering from Anidra especially as an Adharneeya Vega.
Page 153
CONCLUSION
It was found through this study that Nidra as an Adharneeya Vega can be very effectively
Managed with Yogic therapies such as Bhramari Pranayam.
Bhramari Pranayama when used a treatment tool was found to be significant in a majority
of the testing parameters which were assessed from Ayurvedic and Psychiatric scale pa-
rameters.
To further test effect of combined therapies, sleep hygiene was also adminsitered a group
of patients. It was concluded that combined therapy of Bhramari Pranayam and Sleep
Hygiene gave remarkable results and proved statistically highly significant, thus improv-
ing quality of life of patients on a large scale.
Thus it can be concluded that Yogic therapies when combined with behavioral therapy
like Sleep Hygiene plays a very major role in providing relief to patients suffering from
Anidra especially as an Adharneeya Vega.
Such an approach of giving combined therapies can help improve quality of life for pa-
tients suffering from various illnesses and thus provide a big respite from mental illnesses
and life stressors that disrupt the society at large in today‟s day and time.
Page 154
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Page 160
BHARATI VIDYAPEETH DEEMED UNIVERSITY

COLLEGE OF AYURVED
Pune-Satara Road, Pune – 411 043
Research Proforma
Swasthavritta Department
Tittle:Study Of Nidra As Adharniya Vega & Its Manage-

ment With Bhramari Pranayam
Scholar: Dr Shinde Kirtimalini E Guide:Prof. Dr. Bhalsing
Vijay V.
Patient Name:
Address: Ph:
Age: Years Sex: Male /Female Group:

Religion:H/M/C/J/O O.P.D./ I.P.D. NO:
Education: UE/ P /S /HS /G /PG
Occupation: Hw/Srv/B/Lab/Ag/St/Other
Maritalstatus: Um/M / W / D
Socio-eco status: P/Lm/ M / Um
Habitat:Urban/Rural
Diagnosis:
Result:
No. Chief Symptoms Duration BT At
1 Sleeplessness: Difficulty in falling
sleep/maintaining sleep/ Non restorative sleep
2 Distress: Impairment in social, occupational

or other areas of functioning
3 Disorder of sleep wake schedule: Transient jet

leg syndrome/ work shift change Present: Fre-
quently changing S.W. schedule/Advance/ De-
layed sleep phase syndrome/ Non 24 hrs. S.W.
syn/ irregular, S.W. pattern
4 Sleep walking/ Sleep terrors
Page 161
Associated Symptoms
1.Sleep anxiety attack /sleep related epileptic
seizures /sleep related bruxism / head bang-
ing/painful erections /sleep related –asthma
/c.v.sym /gastro esophageal reflux
2 .Other psychiatric/neurological disorder
3 .Other medical disorder
4 .Not otherwise specified
H/O. Present Illness:
H/O. Past Illness:
Physical Stress:
Psychic Stress: Previous social / economic / personal events
FAMILY HISTORY:
Number of Members:
Positive & Negative relationships:
H/O. Physical / Psychological disturbances in family:
H/O. Alcohol / Drug abuse in family:
Family attitude & insight into Pt’s illness:
PERSONAL HISTORY:
Agni : S/ V/ M/ T
Koshtha : Mr./ Madh. /Kr.
Diet :
 Dravyatahara : Veg/ Mixed
 Food habitat : Satvika / Rajasika / Tamasika
 Dominant Rasa : M/ A/ L/ K/ T/ Ks.
 Dietetic Habits : Sam/ Vis/ Adh/ Ana
 Quantity : Alpa/ Madhyama/ Adhika
 Appetite : Poor/ Moderate/ Good
 Addiction : Tobbaco chewing/ Smoking/ Sniffing/ Sleeping pills/
Tea/
 Coffee/ Alcohol/ Cold drinks/ Betal/ Drugs Since…………………
Page 162
Sleep : Sound / Disturbed

 Difficulty in falling asleep/ Unsatisfying sleep/ Fatigue on waking
 Day...……..hrs. / Night…………..hrs.
 Dreams : Occasional / regular
Bowel : Regular /irregular

Constipation/ loose motion ………….times / day
Micturation : Normal/ Polyuria / Dysuria/ Oligouria
Frequency:………….day /…………….night
Menstrual History: Regular/ irregular
Menarche : ………….yrs.
P.M.H. : …………./day associated complaints.
Quantity : S/ M/ H
Menopause : …………..yrs.
Obstetric History : No. of deliveries
Type: Normal/ L.S.C.S./ Forceps/ Miscarriage/ Premature/Any other
Marital Life : Duration
Any other problem
Occupational History: Working hrs…………./day ………….night
Exercise : Regular /irregular /no /less /excess time………..hrs./day
Vital Data : Temp……..F Pulse / min
Respi. /min B.P. mmHg
SCORING ADOPTED FOR INSOMNIA
Chief Symptoms
Sr.No SYMPTOMS RANG B A

. E TT
1. Sleeplessness 0-6
2. Disorders Of Sleep Wake 0-5

(S W) Schedule
3. Sleep Quality 0-3
4. Sleep Time 0-6
5. After Awakening 0-6
6. Akshigaurav / Shirogaurav / Alasya / 0-3

Jrimbha /Shirodaha / Netradaha / An-
gamarda / Glani /Bhrama / Ajirna /
Page 163
Kshudhaman-
dya/Vibandha/Shirahshoola / Keshapa-
tan / Krodha / Bhya /Shoka / Dainyata
/ Udvega / Vishad /Smrithihrasa
GRADATION OF MANASA PARIKSHA BHAVAS
Sr.No SYMPTOMS RANGE BT AT
1. Manasa – Arthesu Avyabhicharanena 0-3

(Deviation)
2. Vijnanam – Vyavasayena( Performance) 0-3
3. Harsha – Amodena( Cheerfulness) 0-3
4. Priti – Tosena( Happiness) 0-3
5. Dhairyam-Avishadena( Fearfulness) 0-3
6. Viryam – Utthanena( working capacity) 0-3
7. Avasthan – Avibhramena(Confidence in percep- 0-3
tion)
8. Shraddha – Abhiprayena( Attitude and interest) 0-3
9. Medha – Grahanena( grasp or understand) 0-3
10. Samjna – Naagrahanenan( Attentive) 0-3
11. Smriti – Smaranena( Recall and remember) 0-3
12. Hriya – Apatarpanena( Shyness) 0-3
13. Shila – Anushilanena( Conduct) 0-3
14. Dhriti – Alaulyena( controlling will power) 0-3
15. Vashyata – Videyataya( obidence and control) 0-3
16. Rajah–Sangena 0-3
17. Moha – Avijnanena 0-3
18. Krodha – Abhidrohena 0-3
19. Shoka Dainyena 0-3
Page 164
20. Bhayam – Vishadena 0-3

21 Dvesha – Pratishedhena 0-3
22 Upadhi – Anubandhanena 0-3
BRIEF PSYCHIATRY RATING SCALE
Sr.No ITEM BT AT Sr.No ITEM BT AT

1. Somatic concern 9 Hostility
2. Anxiety 10 Hallucinatory
behavior
3. Emotional with- 11 Motor retarda-
drawal tion
4. Conceptual disor- 12 Uncooperative-
ganization ness
5. Tension 13 Unusual
thought con-
tent
6. Manneurism and 14 Blunted effect
posturing
7. Suspiciousness 15 Excitement
8. Grandiosity
Scholar’s signature Guide’s

signature
Page 165
INFORMED CONSENT FORM
I confirm that I have read and understood the Participant Information Sheet
1 dated …………………for the above study and have had the opportunity to ask
questions and am satisfied with the responses received.
I understand that my participation in the study is voluntary and that I am free to
2 withdraw at any time from the study without giving any reason and without af-
fecting my medical care or legal rights.
I understand that the researcher /others working on behalf of the researcher,

the Ethics Committee and the regulatory authorities will not need my permis-
sion to look at my records, both in respect of the current study and any further
3
research that may be conducted in relation to it. Even if I withdraw from the
study, I agree to this access. However I understand that my identity will not be
revealed in any information related to third parties or publications.
I agree not to restrict the use of any data or results that arise from this study
4
provided such a use is only for scientific purpose(s).
Page 166
5 I consent voluntarily to participate as a participant in the above research study.
Name of participant: Signature of participant:
Signature of Candidate : Signature of the Guide:
Witness: Date:
saM ma tI p ~
maI KalaI sahI krNaar,
EaI / saaO.
………………………………………………………
…… vaya…………vaYao-
ilahUna dotao / doto kI Da^ ikit-maailanaI, iSaMdo yaaMcyaa AnausaMQaana p`baMQaamaQyao sahBaagaa-
sa maaJaI puNa- tyaarI Aaho. maI yaa saMSaaoQana p`klpamaQyao svat:hUna sahBaagaI haot
Asauna maaJaI tpasaNaI AaiNa ]pcaar krNyaasa prvaanagaI dot Aaho.
Page 167
p`klpamaQyao haoNaa-yaa pirNaamaaMcaI malaa Da^@TraMnaI pUNa- klpnaa idlaI Aaho

AaiNa %yaasaazI maaJaI tyaarI Aaho. maI kaoNa%yaahI AaimaYaalaa ikMvaa dDpNaalaa ba-
LI na pDta, malaa saMSaaoQana Pa`klpat saaimala k$na GaoNyaasa prvaanagaI dot Aaho.
idMnaak : sahI /
AMgaza
saaaxIdar:
Page 168

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“STUDY OF NIDRA AS ADHARNIYA VEGA & ITS MANAGEMENT WITH

UNDER THE FACULTY OF AYURVED

UNDER THE GUIDANCE OF

This is to certify that the work incorporated in the thesis entitled

Place: Pune Dr. Abhijeet Patil

Date: / /2016 Dr. Vijay V. Bhalsing

Place : Pune Dr Mrs. Kirti Rajendra Bhati

I am obliged to Mrs. Ashwini Manglekar (Statistician) for extending valuable co-

I appreciate a colossal assistance by Dr Ketki Wagh and Dr Manisha Thakare to accom-

This acknowledgement would be inadequate without expressing deep gratitude which

Dr Mrs Kirti Bhati

2 Literary Review 5-77

3 Aim and Objectives 78

4 Materials and Methodology 79-93

5 Observation & Results 94-119

10 Annexure - Research Proforma 1-8

35 Result of Kruskal-Wallis Test 108-11

Need of the study:

Manonukula vishaya grahana,Manonukula sabda granaha,Manonukula gandha grana-

1 Mehra B, Dwivedi K. PA01.33. Mode of action of medhya drugs: A review. An-

2 Murthy S. Astanga Hridaya. 9th ed. Varanasi: Chaukhambha Krishnadas Academy;

6 Tripathi K. Essentials of Medical Pharmacology, 6th ed, Jaypee publications;2013 pg.

1) REVIEW OF PREVIOUS WORK

REVIEW OF PREVIOUS WORK DONE

AU- N SUB- FORM OF TREAT- MAIN OUTCOMES

Morgan et 209 extensive CBT treated sleep At followup, patients with

Seetha M 20 Insomnia Ayurvedic herbal Their life style became well

Devi V et 107 a melato- Ramelteon. Treatment showed no evi-

Harmat et 94 Students Classical music, audio Music statistically signifi-

Suri J.C., et 120 uncompli- a questionnaire survey. A definite correlation was

Though modern psychiatry acquired a revolutionary growth in understanding of mental

 Bhat T, Pallikaleth SJ, Shah N. Primary insomnia treated with Zolpidem

Devi V, Shankar P. Ramelteon: A melatonin receptor agonist for the

 Harmat L, Takács J, Bódizs R. Music improves sleep quality in students.

 Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older

 Krishna P, Shwetha S. Sleep quality and correlates of sleep among medi-

 Manjunath N, Telles S. Influence of Yoga & Ayurveda on self-rated sleep

 Meshram S, Meshram C, Mishra G, Wakode S, Maheshwar V, Sontakke

dent Doctors In University Hospitals Of Central India: A Questionnaire

 Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M. Psychological

 Pathak N, Raut A, Vaidya A. Acute Cervical Pain Syndrome Resulting

 Ranawat, R. Chundawat N. AYUSH Sectoral Innovation Council Consti-

 Seetha M, Sharma O. AYUSH Sectoral Innovation Council Constituted.

 Suri J, et al Indian J Sleep Med (2007a; 2007b; 2009):ISSN 0973-340X

 Vincent N, Lewycky S. Logging on for better sleep RCT of the effective-

 Bhaduri T, Chowdhury K, Biswas s, Panja A, . E. Clinical Evaluation of Sirodhara

Figure1: Schematic representation of Vegotpatti

Atma (Buddhi) + Artha

Agni(Ahanana kriya)+ Anil(Chala guna of Apana)

Figure 2; Schematic representation of Vegotpatti hetu

Figure 3: Schematic representation of Vegadharan nidan

Anulomana , Sthambhana Agnivaigunyata , Mana vaigunya-

Table 1:. Symptoms and Chikitsa of Vegas

Vega Symptoms CS SS AH Cikitsa CS SS AH

Mutra Bastisula    Sweda   

Kasa Kasavrddhi    Kasahara   

1 Dube S, Paṇḍeya S. Śambhavi-anuśruti vyakhya saṃvalita Paṇiniya -śiksha.

Etymological derivation of Nidra

Human is proficient to generate bioelectricity through digestion (JatharAgni). At the

b) Klama (Fatigue) Theory 36

c) Swabhava Nidra Theory11

d) Kapha Dosha theory12

4) Contemporary Concepts of Sleep