The Western Medicine and Ayurvedic Management of Sleep Disorders

By: Sanghee Chon

Introduction

Everyone sleeps. We, humans devote a third of our lives to sleep.  It looks so easy, and nothing much to it, but why are over 40 million Americans diagnosed with  long term sleep disorders[1]?  The National Sleep Foundation(NSF)[2],  in their 2005 survey indicates 75 percent of adults had at least one symptom of a sleep problem, such as waking a lot during the night or snoring, and 54 percent experienced at least one symptom of insomnia.  Lack of sleep is directly linked to poor health, and it increases the risk of diabetes, heart diseases, obesity, and personality disorders[3].  Sleep deprivation played a role in catastrophes such as the Exxon Valdez oil spill off the coast of Alaska, the space shuttle Challenger disaster, and the nuclear accident at the Three Mile Island[4]. Each year, Americans spend an estimated $2 billion on sleep medications and make almost 2 million overnight visits to sleep laboratories, and it cost Americans an estimated $100 billion annually in lost productivity, medical expenses, sick leave, and property and environmental damage.

The U.S. National Library of Medicine and National Institutes of Health indicate that there are more than 100 different types of sleep and waking disorders[5], it is a group of syndromes characterized by disturbance in a person’s hours of sleep, their quality or timing of sleep, or in behaviors or physiological conditions associated with sleep.  Although sleep is a basic behavior in animals as well as humans, researchers still do not completely understand all of its functions in maintaining health.

So what is Sleep Disorders?

Dr. Marc Halpern defines it as “Sleep disorders are conditions in which a person’s sleep pattern is disturbed, such that a person has a hard time falling asleep, staying asleep, sleeps too much, or sleeps at inappropriate times” [6].

What are the common signs of sleep problems?

I can’t fall asleep.

I can’t stay awake.

I can’t get up in the morning.

I do strange things in my sleep.

I can’t sleep because of my partner.

Western Medical Definition

In our brain there’s a pacemaker like mechanism which regulates the daily routine of sleeping and waking called the biological clock or internal clock.  This pacemaker like mechanism gradually becomes established during the first months of our life, and start to control ups and downs of physiological patterns, such as body temperature, blood pressure, the release of hormones (i.e, melatonin[7], and cortisol[8]), digestive juice secretions, urine production, and the timing of sleep and wakefulness.  Each of these patterns and dozens more have a daily rhythms, and they are called the Circadian Rhythms [9].  The Circadian Rhythm of sleep and wakefulness makes a person’s desire for sleep strongest between midnight and dawn, with a second smaller peak in the middle of the afternoon between 2pm to 3pm[10].

In the 1970s, the location of this internal clock was found to be the SupraChiasmatic Nucleus(SCN)[11].  Although it is largely self-regulating, the clock responses to several types of external clues to keep it set twenty-four hours, and scientists call these cues Zeitgebers – a German word meaning “time givers” – it includes, Light, Time Cues, and Melatonin[7].

For light, because of the connections between the eye and SCN[11], light can directly affect the sleep and wake rhythm.

For Time Cues, a person reads a clock to follow work and transportation schedules, and obey social demands to remain alert for certain tasks and events, and with this, there’s continual pressure to stay on schedule thus help the circadian clock adhere to a twenty-four hour schedule.

For melatonin[7], cells in the SCN[11], when absence of light, melatonin levels begin climbing in the late evening and ebb after dawn.  The melatonin production can be suppressed even in the middle of the night by exposure to light.  This cluster of cells is part of the Hypothalamus[12], the brain center that regulates appetite and other biological states.

In the past 30 years, however, laboratory studies on human volunteers have yielded new information about the different types of sleep. Researchers have learned about the cyclical patterns of different types of sleep and their relationships to breathing, heart rate, brain waves, and other physical functions. These measurements are obtained by a technique called Polysomnography[13], and the use of Electroencephalogram(EEG)[14] recording which capture a recording of electrical activity in the brain.  The EEG measures the waves in cycles per second.  The more active the brain, the more small, fast, chaotic looking wave pattern, the less active the brain, shows a larger, slower, and more regular wave pattern.

Scientist divide sleep into two major types:

• Non-REM(NREM)[15], or quite, sleep
• Rapid Eye Movement (REM)[16], or dreaming, sleep

figure A – http://static.ddmcdn.com/gif/sleep-stages.gif

5 different stages of sleep:

Stage 1: Also called Alpha brainwave pattern sleep.  Once your eyes are closed your nerve cells no longer receive visual input.  The brainwave settle into a steady and rhythmic pattern of about eight to twelve cycle per second.  On the EEG, the predominant brainwave slow to four to seven cycle per second.  General signs are, the body temperature begins to drop, muscles become relaxed, and the eyes often move slowly from side to side, and lose awareness of their surroundings, but they are easily jarred into wakefulness.

Stage 2:  This is the first stage of established sleep, and the very first time it occurs it lasts ten to twenty five minutes before you progress to another stage of sleep.  The stage 2 sleep is commonly seen in the transition between other sleep stages, and overall about half the night is usually spent in stage 2 sleep.  One very interesting aspect of stage 2 sleep is that about every two minutes, EEG tracings show a pattern called a K-complex[17], which scientists think represents a sort of built-in vigilance system that keeps oneself poised to be awakened if necessary since K-complexes can provoked by certain sounds or other external or internal stimuli.

Stage 3 and 4, or Deep Sleep:  Together, stage 3 and 4 are known as deep sleep, or slow-wave stage.  As you progress into this stage, fewer and fewer of the brain’s processing centers stay active and the firing of the remaining brain cells become more and more coordinated.  On the EEG tracings, the resulting waves become bigger, and more distinct and eventually, the large slow brain wave called Delta waves become the major features on the EEG.  General signs are, the breathing becomes slower, and more regular, the blood pressure and pulse drop to about 20 to 30% below ones waking rates, the brain becomes less responsive to external stimuli, making it difficult to awaken.  According to sleep scientists, Deep sleep seems to be a time for ones body to renew and repair itself, because during deep sleep stage, less blood flow is directed toward the brain, which cools the brain measurably as well as at the beginning of this stage the pituitary gland releases a pulse of growth hormone that stimulates tissue growth and muscle repair.

Dreaming sleep stage: Scientists don’t really know if dreams have deep meaning, but just as a deep sleep stage restores our body, dreaming sleep stage restores our mind in part by clearing out the irrelevant information.  This stage has been described as an “Active brain in a paralyzed body”, and the dreaming sleep stage occurs during REM sleep.  A sleeper’s brain races as the eyes dart back and forth rapidly behind closed lids.  Unless the sleeper has circulatory or other physical issues, the body temperature arise, and the penis or clitoris becomes erect, blood pressure increases, heart rate and breathing speed up to daytime levels.  The sympathetic nervous system (fight or flight), is twice as active as when a person is awake, but in spite of all these activities, the body hardly moves except for intermittent twitches, because the muscles not needed for breathing or eye movement are temporally paralyzed.

Three to five times a night, or about every ninety minutes, a sleeper enters REM sleep, and the REM duration progressively increases over the duration of the night, and generally the final period of REM may last about thirty minutes.  All in all the REM sleep make up about 25 percent of total sleep in young adults, and if someone was deprived of REM sleep, the person enters the REM sleep earlier and spends a higher proportion of sleep time in it, and that phenomenon is called REM rebound.

How much of sleep is needed?: 

Our body has a built-in tendency to maintain internal equilibrium by adjusting our physiological process, and one of the critical concepts known is Homeostasis.  Homeostasis influences many of the body functions, and sleep is one of them.  It influences the timing of sleep in two different aspects.

• Elapsed time since last sleep: A typical person sleeps from 11pm to 7am without napping then goes 16 hours between sleep sessions.  Then as consecutive hours of sleeplessness go beyond this point, the drive for sleep steadily increases.
• Cumulative sleep debt: A person with average 8 hours of sleep per day fails to get 8 hours of sleep for 3 nights by 2 hours.  That would have (2+2+2=6 hours) of cumulated sleep debt by the 4th night, and the greater the sleep debt, the stronger the drive for sleep becomes.

Sleep and Age

As we age the sleep trends of adulthood continues, and after reaching age 60,  the sleep latency and the percentage of time spent in stage 1 and 2 increase, while the total sleep time, and percentage of time spent in deep sleep and REM, and sleep efficiency all continue to drop.  Not too surprisingly, the older we get, the more likely we are to supplement nighttime sleep with daytime naps.

Optimal sleep amount in human per day.

Age and Condition	Average amount of sleep per day
New born	up to 18 hrs
1 – 12 months	14 – 18 hrs
1 – 3 years	12 – 15 hours
3 – 5 years	11 – 13 hours
5 – 12 years	9 – 11 hours
Adolescents	9 – 10 hours
Adults, including elderly	7 – 8 hours
Pregnant woman	8(+) hours

figure B – http://en.wikipedia.org/wiki/Sleep#Optimal_amount_in_human

 

The most common sleep disorders include:

Insomnia – Duration of Insomnia can be classified into 3 different categories; Transient being lasting a few days, Short-term being lasting a few weeks, Long-term being more than three weeks [18]. Primary insomnia [19]: Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms.  Secondary insomnia [20]: Often caused by illness or disease, a non sleep condition such as Angina, Heartburn, or Depression or medication taken for a such conditions.  Substances taken for other reasons than sleep or health, such as alcohol, caffeine, or recreational drugs, can lead into insomnia.  Menopausal symptoms caused by hormonal changes can contribute to insomnia.  Typical symptoms are the hot flushes, hot flashes, and night sweats due to estrogen level changes[21].

Sleep related breathing disorders – Sleep apnea, and mostly obstructive sleep apnea[22]: Obstruction of the airway during sleep, causing lack of sufficient deep sleep; often accompanied by snoring. Other forms of sleep apnea[23]are less common. The air is blocked from entering into the lungs, causing the individual to unconsciously gasp for air. The individual will pause for an average of ten seconds in order to breathe. This is commonly found in overweight, middle-aged men but is also found in people who have suffered from stroke.  Simple snoring[24].  Hypopnea syndrome [25]: Abnormally shallow breathing or slow respiratory rate while sleeping.

Disrupted sleep situations – Situational circadian rhythm sleep disorders: Shift work sleep disorder (SWSD)[26] and jet lag.

Movement Disorders – Restless legs syndrome(RLS)[27]: An irresistible urge to move legs. RLS sufferers often also have PLMD. Periodic limb movement disorder(PLMD)[28]: Sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk[29], which is not a sleep disorder.

Narcolepsy – Narcolepsy[30]: Excessive daytime sleepiness[31](EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times. Sleep paralysis[32]: is characterized by temporary paralysis of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations.  Not a disorder unless severe. Often seen as part of narcolepsy.

Parasomnias: Parasonmias[33]is a disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples.  Rapid eye movement behavior disorder (RBD)[34]: Acting out violent or dramatic dreams while in REM sleep (REM sleep disorder or RSD).  Sleepwalking[35]or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.  Night Terror[36]: Pavor nocturnus, sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror[37].  Bruxism [38]: Involuntarily grinding or clenching of the teeth while sleeping.

Disturbances of sleep timing: Delayed sleep phase syndrome (DSPS)[39]: inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms. (Other such disorders are an advanced sleep phase syndrome (ASPS)[40], non 24hour sleep wake syndrome (Non-24)[41], and irregular sleep wake rhythm,[42] all much less common than DSPS, as well as the transient )

Other type of sleep disruption:   Cataplexy[43]: a sudden weakness in the motor muscles that can result in collapse to the floor.  Nocturia[44]: A frequent need to get up and go to the bathroom to urinate at night. It differs from Enuresis[45], or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.  Somniphobia[46]: A cause of sleep deprivation. Somniphobia is a dread/ fear of falling asleep or going to bed. Signs of illness include anxiety and panic attacks during attempts to sleep and before it.

Health conditions that disrupt sleep:

• Cardiovascular disease – Congestive heart failure and Coronary artery disease are the two most common heart problems that affect sleep.
• Endocrine disorders – Diabetes, and Thyroid disease.
• Neurological disorders – Parkinson’s disease, Epilepsy, Alzheimer’s diseases/Dementia, Headaches, and Strokes/Tumors.
• Respiratory disease – Asthma, and Chronic Obstructive Pulmonary Disease (COPD).
• Mental illiness – Anxiety, Depression, Bipolar disorder, Schizophrenia, and Seasonal Affective Disorder (SAD).
• Other Health Problems – Gastoresophageal Reflux Disease(GERD), Kindney disease, and Arthritis.

Medications that disrupt sleep: 

1. Cardiovascular drugs, such as Alpha blockers, Antiarrhythmics, Beta blockers, and Diuretics.
2. Antidepressants.
3. Other drugs – Beta agonists, Corticosteroids, Nicotine patches, Sedating antihistamines, Stimulants, Theophylline, and Thyroid replacement drugs.

Western Medications for Sleep Disorders

A brief history of sleep medications in United States [47]: Sleep and sleep problems may go back to the beginning of the human history, the study of sleep really did not take off until the twentieth century.  In the 1920s, a physiology professor at the University of Chicago name Nathaniel Kleitman, ushered in the era of sleep discovery by studying the effect of sleep deprivation and describing the various internal events that occur during sleep.  In 1964, the first sleep center, the narcolepsy clinic was established at Stanford University under the direction of Dr. William Dement.  In 1970, recognition of other disorders and the practice of sleep medicine began to grow, and the first specialty exam for sleep specialists was given in 1978. Finally in 2005, with an extensive body of scientific knowledge, more than eighty recognized sleep disorders, and more than twenty six hundred sleep specialists in the United States, sleep medicine was recognized as an official medical subspecialty.

Common choices of Over The Counter Medications and side effects[48]:

Drug	What’s in it	Side effects
Benadryl, Unisom sleep gels, Nytol Quickcaps, Simple sleep, Sleepinal Maximum strength softgels, Sominex Maximum strength caplets, Tylenol PM	Diphenhydramine (Antihistamine)	Diphenhydramine is a sedating. Side effects might include daytime drowsiness, dry mouth, dizziness and memory problems, gastric distress, and nausea.  Rare cases: fast or irregular heartbeat, blurred vision, delirium, sensitivity to sunlight.
Unisom SleepTabs	Doxylamine (Antihistamine)	Side effects are similar to diphenhydramine, include daytime drowsiness, dry mouth, dizziness and memory problems, gastric distress, and nausea.  Rare cases: fast or irregular heartbeat, blurred vision, delirium, sensitivity to sunlight.
Melatonin	The hormone melatonin helps control your natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild.	The most common melatonin side effects include daytime sleepiness, dizziness and headaches. Other, less common melatonin side effects might include abdominal discomfort, mild anxiety, irritability, confusion and short-lasting feelings of depression.
Valerian	Supplements made from this plant might reduce the amount of time it takes to fall asleep as well as promote better sleep overall. However, the active ingredient isn’t clear and potency can vary.	Side effects of valerian supplements might include headache, abdominal discomfort, excitability or uneasiness, and heart disturbances.

Prescription medications and their side effects[49]:

There are different types of prescription medications.  One pill that helps you fall asleep, the other pill that helps you stay asleep, and one pill does both.

General Side effects associated with prescription sleep medicine include:

1. Dizziness
2. Headache
3. Gastrointestinal problems, such as diarrhea and nausea
4. Prolonged drowsiness, more so with drugs that help you stay asleep
5. Severe allergic reaction
6. Sleep behaviors, such as sleep-driving and sleep-eating
7. Daytime memory and performance problems

Prescription Sleep Medicine

Drug	May not be safe if	Things to know
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	May be used for a longer period of time than zolpidem or zaleplon.  High-fat meals may slow your absorption of the drug and make it less effective.  Stopping the drug suddenly may cause symptoms of withdrawal, such as anxiety, unusual dreams, nausea and vomiting.
Ramelteon (Rozerem)	Are pregnant or breast-feeding.  Have a history of kidney or respiratory problems, sleep apnea, or depression.  Have a liver disease.	May interact with alcohol.  High-fat meals may slow your absorption of the drug and make it less effective.  A manufactured drug similar to melatonin. Not likely to be habit-forming.
Triazolam (Halcion)	Are pregnant or breast-feeding.  Have a history of drug abuse, depression or respiratory conditions.	May interact with grapefruit juice, alcohol and many medications.  Can be habit-forming. Seldom prescribed by sleep specialists.   Drug must be stopped gradually.
Zaleplon (Sonata)	Have severe liver problems.  Are pregnant or breast feeding.  Have a history of depression, liver or kidney disease, or respiratory conditions.	May interact with other medications.  High-fat meals may slow your absorption of the drug and make it less effective.  Can be habit-forming.  Very short acting, so can be taken in the middle of the night following precautions from your doctor.
Zolpidem (Ambien, Edluar)	Have a history of depression, liver or kidney disease, or respiratory conditions.	May become less effective over time.  Sleep behaviors, such as sleep-driving and sleep-eating may occur.

Prescription pills help you stay asleep:

Drug	May not be safe if	Things to know
Estazolam	Are pregnant, breast-feeding, or are an older adult.	May interact with many other medications.  Can be habit forming.
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	May be used for a longer period of time than zolpidem or zaleplon.  High-fat meals may slow your absorption of the drug and make it less effective.  Stopping the drug suddenly may cause symptoms of withdrawal, such as anxiety, unusual dreams, nausea and vomiting.
Zolpidem (Ambien, CR)	Have a history of depression, liver or kidney disease, or respiratory conditions.  Are pregnant or breastfeeding.	This extended release formula may be used for a longer period of time than regular zolpidem or zaleplon.
Temazepam (Restoril)	Have a history of severe depression, substance abuse, lung disease, or kidney or liver problems.  Are pregnant or breast-feeding.	May interact with alcohol and many medications.  Can be habit-forming.
Doxepin (Silenor)	Have a history of glaucoma, trouble urinating (urinary retention) or heart disease.	May cause weight gain.

Alternative treatments:

• Relaxation technics: Progressive muscle relaxation[50], Deep breathing, Meditation, Visualization (a form of meditation), Biofeedback[51], Cognitive Therapy[52].
• Exercise: Walking, Swimming, Running, Cycling, Aerobic workouts, and any physical activities.
• Herbal supplements – Valerian, Lavender, Chamomile, Passionflower.
• Synthetic Melatonin.
• Acupuncture.
• Hot Baths.

Alternative things people take to stay awake:

• People with sleep deprived often relay on Energy drinks[53] and/or Stay awake over the counter pills[54] to perform their daily activities.
• The very latest in 2012, there’s a Caffeinated Potato Chips made by Arma Energy Snx foods are made with Caffeine, salt, Vitamin B, Taurine, and other spices.  Caffeine and Taurine are two ingredients commonly found in energy drinks to boot your daily wakefulness and performance.

Emerging New Sleep Theory.

Biphasic sleep[55]

“The dominant pattern of sleep, arguably since time immemorial, was biphasic,” Roger Ekirch, a sleep historian at Virginia Tech University and author of “At Day’s Close: Night in Times Past” (Norton 2005), told Life’s Little Mysteries. “Humans slept in two four-hour blocks, which were separated by a period of wakefulness in the middle of the night lasting an hour or more. During this time some might stay in bed, pray, think about their dreams, or talk with their spouses. Others might get up and do tasks or even visit neighbors before going back to sleep.”

References to “first sleep” or “deep sleep” and “second sleep” or “morning sleep” abound in legal depositions, literature and other archival documents from pre-Industrial European times. Gradually, though, during the 19th century, “language changed and references to segmented sleep fell away,” said Ekirch. “Now people call it insomnia.”  Ekirch further explained that in the past, and especially during winter, darkness spanned up to 14 hours each night. Except for those affluent enough to burn candles for hours, folks were left with little to do but go to bed early, and this gave a great deal of flexibility to their nightly sleep requirements. Segmented or biphasic sleep patterns evolved to fill the long stretch of nighttime, and as observed by anthropologists, segmented sleep continues to be the norm for many people in undeveloped parts of the world, such as the Tiv group in Central Nigeria.

In places with electricity, though, artificial lighting has prolonged our experience of daylight, allowing us to be productive for longer. At the same time, it has cut nighttime short, and so to get enough sleep we now have to do it all in one go. Now, “normal” sleep requires forgoing the periods of wakefulness that used to break up the night; we simply don’t have time for a midnight chat with the neighbor any longer. “But it has been hypothesized that people with particularly strong circadian rhythms continue to [wake up in the night],” said Ekirch.

In the 1990s, a sleep scientist named Thomas Wehr discovered that everyone sleeps biphasically when subjected to natural patterns of light and dark. In Wehr’s well-known study, he subjected participants to 14 hours of darkness per night, and found that they gradually shifted to a routine of taking two hours to fall asleep, then sleeping in two four-hour phases separated by about an hour of wakefulness—a pattern that exactly matched Ekirch’s historical findings.

An Interactive Illustration of a historic timeline on sleep:

This interactive illustration shows written history on for the mankind going back to 800 B.C.

http://healthysleep.med.harvard.edu/interactive/timeline [56]

 

Ayurveda Definition

Introduction to Sankhya Philosophy

According to Sankhya’s philosophy, the system of enumeration, at the beginning, there was nothing but pure potential consciousness and pure potential for matter.  The pure consciousness is called Purusha.  The pure potential is called Prakruti.  Purusha is choice less, passive awareness, when Prakruti is creative potential and primordial matter with three Maha Gunas (Sattva – clarity, Rajas – action, Tamas – inertia).  Purusha deeply desired to know itself and by merging with Prakruti, the universe unfolded with the soundless sound OM, and from this sound five basic (Pancha Maha Bhutus) elements are produced (Fire, Water, Ether, Air, Earth).  Further more this five elements are manifested into the three biological organizations known as Vata, Pitta, and Kapha.

Through the creation of the Mahat (intelligence of the universe), the cosmic laws and rules of nature, both gross (physic, and chemistry…) and subtle (karma, and the laws governs health…), the three biological organizations was to be governed by it.  From this three indivisible unique individual biological organizations, a phenomena called Ahamkara (self-identity) or ego materialized, and for Purusha to truly experience itself, as for human beings, the potential for sensory experiences on the subtlest level would have to occur through Tanmatras (Sound, Touch, Sight, Taste, and Smell).  For each sensory potential, sense organs were matched with Tanmatras, and it’s called Pancha Jnanedriyani, or Buddhi (Ear, Hand, Eyes, Tongue, and Nose), and through Pancha Jnanedriyani, the biological organizations gain knowledge of the world.

In order for human beings to be able to take action in the world, there was need for organs to perform specific functions, and it’s called Pancha Karmendryani.  These action organs are the expressive organs of our human nature which would allow us to Procreate, Excrete, Walk, Talk, and Hold things.

After all the physical capability to experience and act within the world, a mind was needed to process the experience.  This mind is called Manas, and it is limited mind projected by Ahamkara, because it does not allow for awareness greater than the physical world, thus it is self-identity, ego, and sensory.  Although Ahamkara is processing the experiences within this world, there’s a component within each creation which directly connected to Purusha called Atman, or Soul.

“It is always connected to Purusha and it could even be argued that it is Purusha.  Hence, through our soul, Purusha experiences its own nature.”

– Dr. Halpern, Principles of Ayurvedic Medicine, Chapter 1: Philosophy, page 18 –

Sleep and Dreams in Ayurveda

“Sleep and its virtues ;—Sleep is the illusive energy of God.  It — the all-pervading deity – naturally has its sway over all created beings. The kind of sleep which sets in when the sensation-carrying channels Sndyu of the body are choked by Sleshma, which abounds in the quality of Tamas, is known as Tatmasi-nidrai.”

“Sleep overcomes a man whenever the heart is enveloped in the illusive effects of Tamas. Sleep is the offspring of Tamas and it is the quality of Sattvam that brings on awakening. This is the fundamental law of Nature.“

– Caraka Samhita – Chap. IV.] SARIRA STHANAM. vs, 149 and 150 –

This whole world is the dream of Purusha.  Purusha doesn’t need any sleep, because it is the full awakening of awareness.  In that pure awareness, we are not aware that we are aware.  The moment you become aware that you are aware, that is the beginning of the dream, which is the creative bed of Prakruti.

Within Ahamkara (self identity), the three maha gunas are present in an un-manifested form as Sattva, Rajas, and Tamas, and these are the mind.  These forms are equal and balanced in pure form called mahat (intelligence).  Sattva creates the concept of an observer, which is Rajas.  Rajas then creates the concept of observations, and Tamas creates the objective world.

Our mind is the pure essence of Sattva, split from Ahamkara, and the mind has three states:

Jagrat –  (Wakeful state), this state is associated with Sattva.  This wakeful state functions with more of Sattva quality such as Clarity and Purity.  It creates individualconsciousness and the concept of an observer.

Svapna –  (Dream state), this state is associated with Rajas.  In this state, the moment we become conscious of consciousness, it creates a center and projects outside of itself, because of its Rajasic quality.  The movement of observations is Rajas, which relates to the Dream state.

Shshupt – (Deep sleep state), this state is associated with Tamas.  When awareness flows from one point to another, it becomes attention, and that flow of attention is perception.  Perception is the process of Rajas carrying awareness through the doors of perception – the senses – to meet with the objective world which is Tamas. The visual world is an expression of Tamas, which is inertia, and matter.  Tamas relates to the state of Deep sleep.

– Dr. Vasant Lad, Ayurveda Today – Sleep and Dreams –

 Sleep can be defined as a state of consciousness that moves from wakefulness to a lose of critical activity and response to the events in the environment, accompanied by profound alternation in the function of the brain.  Sleep is not a continuous uniform phenomenon.  There are ups and downs, fluctuations, and variations in the nature and depth of sleep.  Even in the same person, the depth and nature of sleep will vary.

Between Jagrat(wakeful state), and Shushupti(deep sleep), there is a transitional period, in which we are neither awake nor asleep.  We enter into a subjective world at this junction between wakefulness and deep sleep is dreaming.  Sleep is not a constant process, rather it fluctuates from wakeful to deep sleep to dreaming, to light sleep, back to dreaming and then to deep sleep, and so on.

Passing through several lighter stages of sleep, one enters into a dark timeless zone called deep sleep, where the mind becomes relatively unconscious and inactive.  We are cut off from the sensory world, and in this deep, dreamless sleep, there is no color, no light, and no form.  At that stage, Tarpaka Kapha, Prana Vata, and Sadhaka Pitta are still active, but the mind does not think or feel about anything.  In this stage of deep sleep, the person is close to his own being.  Deep sleep is not possible with dreams.  Dreams are due to Rajas, which represents movement.

The nature of sleep varies according to a person’s prakruti and vikruti doshas.

• Vata person, sleep is light and easily get interrupted, can’t sleep well in cold condition and noisy condition.
• Pitta people find it difficult to go to sleep, but once they fall asleep, they have relatively sound sleep.  Cant’ sleep well during hot weather or lighted room.  They are intermediate sleepers.
• Kapha people have most deep prolonged sleep.  Kapha can sleep comfortably in almost any room, cool or warm, lighted, or dark.

The rhythm of sleep also varies according to the individual’s age and one’s Prakruti, Vikruti, diet, habits, environment, season, work responsibilities, stress, and daytime sleep.

Etiology (Nidana)

In Ayurveda, sleep is considered one of the three great pillars of health and life, and through sleep, we build ojas, the essence that gives the tissues strength and endurance and the force that keeps the tissues healthy. On the physical level, biochemical manifestation, an intracellular force.  On the mind level, it stabilizes the mind and provides the container for thought and emotion.

The causes of the sleep disorders is primarily Vata dosha vitiation, but Pitta and Kapha doshas vitiation can play roles.  There many likely factors in sleep disorders such as Neurological problems, Mental illness, Medical conditions, Tension, Stress, Work overload, Emotional problems, Pain affecting parts of the body, Anxiety, Worry, Fear, Restlessness, and Excess intake of alcohol and coffee, but there are deeper fundamental causes.

 “Cause of disorders are perverted, negative and excessive use of time, intelligence and sense objects.”

– Sutrasthana Chapter1 Sutra#54 –

 

Within Vedic teaching there are Three Causes Of Disease which are linked to the Four Fundamental Goals, the Three Pursuits of Life, and the Three Pillars of Life, illustrating the root of the causes.  Every human being is motivated to achieve, and have the deepest natural attachment to the Goals, Desires, and to Pillars of life.  While achieving these seem almost birth rights, a person could develop extremely unhealthy motivations and attachments while trying to achieve the goals, fulfill the desires, and have accomplishing the pillars of life, which then through these actions illness manifests in a person.

 

The Four Fundamental Goals

Kama: It means pleasure, which is dominated by ego, and its goal is the pursuit of pleasure and ecstasy.  Kama is preservation of life through attraction to what is pleasurable.  When Kama is kept in check by the Soul, Kama brings joy to the incarnation, but when it is overindulge, it brings waves of ecstasy that ultimately lead to disease.

Artha: Artha means prosperity, which is the pursuit of what is needed to support life.  When a person is motivated by his higher pursuit of Artha, no excess accumulation of physical things, and there’s no waste and no indulgence.  When a person is only motivated by lower pursuit of Artha, accumulation becomes the primary motivating goal, and the prosperity lead to greed, excess and waste without ever getting the satisfaction and contentment of what one already owns, and has.

Dharma: It means duty, job, right livelihood, and contributing one’s God’s given gift or service to society.  People motivated by ego pursues status, power, and put greater importances on self importance.  People motivated by spiritual aspiration pursues to serve with their highest contribution to society and be able to recognize that they are servant of God, and they are the vehicle through which the service can occur.

Moksha:  It means liberation, and the highest goal or higher nature of the goal is to free the soul from the cycle of life and death, and it is only achieved by complete devotion to God and spiritual awareness. There are a couple of lower symptoms of Moksha when motivated by lower expression.  One is a simple desire to be just “Be Good, and Do Good”, although it is nobel, it still is motivated by Ahamkara (ego).  The other symptom is the “Spiritual Egoist or Holier than Thou”.  This person may appear very spiritual by his and her actions, and may even desire liberation, but still this person is motivated by ego.

 

Three Pursuits Of Life

When the Four Goals In Life and Three Pursuits Of Life over-laps in some areas, there are distinctions.

• The desire to live: The most fundamental and basic instinct of all life.  The motivation to take care of oneself, and live longer, and later in life take actions on a higher meaning of living that is harmonious with purpose to fulfill the higher goals of the four goals in life, and become liberated.
• The desire to earn: Earning money through the right livelihood and service to humanity is the higher goal, but when the desire is misplaced, a person places too much emphasis on money, and may become greedy.
• The desire to perform virtuous acts: This equates to the same desire as Moksha, and is one of human’s deep desires within which wanting to make the world a better place for all people.

 

The Three Pillars Of Life

Ayurveda is built upon The Three Pillars Of Life, and what considered to be proper lifestyle have also built around this.

– First Pillar (Proper management of Food and Digestion): If intake of food is constitutionally correct with good digestion a person extracts the nutritions and life energy(Prana) of the food, and build Ojas which is a subtle energy that protects the body and the mind from disease.

– Second Pillar (Proper management of Sleep): When a person is not rested properly due to either too much or too little sleep, the body can not repair the damage caused by stress and strain.  Too much sleep disturbs Kapha, too little sleep disturbs Vata, and if not properly managed, becomes a cause of illness.

– Third Pillar (Proper management of Sexual Energy):  Sexual energy is called Shukra, and whenever Shukra is released, Ojas, the energy provides vitality and stability to the body and the mind becomes depleted.  Excessive sexual activities and indulgence can leave a person with exhaustion and weaken state, thus becoming prone to illness.  Proper management of sexual restriction can rebuild health, and practical path for the Yogi who seeks enlightenment.

Three Causes of Diseases:

– Unwholesome conjunction of the senses with the objects of their affection: Forgetting our true nature as a spirit, we exist as its senses, body, and mind, and the meaning of life becomes pursing the pleasures in life, and more than likely taking in too much disharmonious energetic and physical impressions doesn’t match with their constitution.

– Prajnaparadhs – Intellectual blasphemy, the failure of the intellect or crimes against wisdom:

We have innate and intuitive ways to make decisions by looking deep within ourselves to find how to act in ways that would bring us toward health and peace of mind.  By ignoring the voice of the wisdom, we behave in such ways  – eating the wrong type of foods, eating too much, staying up too late, watching too much television, movies, playing video games, and all other unhealthy, and unbalanced activities against one’s own wisdom – that we hurt our health, and destroy or lose peace of mind.

– Parinama – Transformation or decay due to the time and motion:

As we age, our body breaks down, and become weaker, and frail.  In this sense, time is a cause of disease.   There are two different types of time.   When the linear time is static, the biological time is dynamic.  As the biological time changes with the motion, the faster we move, the faster the body ages, vice versa, the slower we move, the slower it ages.  This logic applies to the mind.  The faster thoughts pass through the mind, the faster biological time moves, and when the mind is focused and in the present, biological time slows down.  As in meditation when the mind is perfectly still, there’s no passage of biological time.

Caraka Samhita added that Vata, Pitta, Kapha, Rajas, and Tamas as the other Five Causes of Disease, and specifies the Endogenous, Exogenous, and Psychic as three important classifications even if they are not the causes of disease.

Dr. Halpern further explains that the primordial cause of disorders is when we forget the true nature of ourselves as spirit, and by losing that awareness, we forget that part of God resides with each of us.  When we forget that truth, we tend to live just as a sensory being, and craving only the sensory pleasures in life.

Symptoms (Rupa)

Ayurveda interprets the sleep disorders as a Nervous system disorder and it is called Vatavyadhi.  It means Vata diseases in Sanskrit.  In Ayurveda, nervous system disorders are linked with mental disorders since the mind and nerves are connected together by a system of special channels.  Symptoms of sleep disorders varies from Vata, Pitta, and Kapha dosha [58].

– Vata: Frequent insomnia, nervousness, anxiety, ungroundedness, hypersensitivity, excess thought and worry, difficulty falling asleep, easily disturbed sleep, difficulty falling back into sleep once awakened.  Dreams may be filled with flying, falling, nightmares, freightening, encounters with ghosts, other disturbing experiences.

– Pitta: Involves turbulent emotions with anger, jealous, resentment, irritability, and hatred from unresolved emotions, excessive willfulness, over-eating hot and stimulating food, over exposure to sun and heat, after a stressful life events, work related, or due to febrile disease or infectious condition are causatives for Pitta people.   Sleep is often agitated and broken, but be able to fall back to sleep Dreams may be filled with dramatic events, and sleep disturbing.

– Kapha: In a very rare circumstances Kapha becomes vitiated with a sleep disorder, by either sleeps excessively or experience insomnia.  It’s often temporary situation due to excessive Kapha blocking channel to the mind preventing sleep from occurring or sleeps too much.

In Ayurveda, there are clear indicative prodromal symptoms at the very beginning of diseases materialization, and the stages of its development in

The disease development stages:

• Accumulation stage: there are only mild disturbance, and the site of the disturbance is the home of each Dosha.
• Aggravation stage: it is considered as a second phase, and the disturbed symptoms may worsen, but still remain at the site of a dosha.
• Alleviation stage:  although this stage isn’t in the disease development stages, worth mentioning that this stage is where all prodromal disease signs and symptoms should have resolved and going back to be in a good healthy condition.  It will get harder and harder as the stage proceeds.
• Over-flow stage: Improperly managed symptoms leaves the home site of a dosha, and over-flows in the the circulatory system (Rasa and Rakta dhatu [59]) with mild and transient symptoms.

Dosha	Over-flow Symptoms
Vata	Mild and Transient: generalized dryness and cold, dry skin, dry cough, scanty urine and sweat.
Pitta	Mild and Transient: generalized warmth, intensity and burning membranes, ruddy skin, yellow phlegm, dark yellow or burning urine, increased sweat.
Kapha	Mild and Transient: generalized water retention, and lethargy, difficulty breathing, mucousy cough, increased sweat and urine.

• Dr. Halpern Principle of Ayurveda Medicine Chapter 4: pathology Table 20 – Symptoms of overflow –
• Relocation stage: this is where the weakest part (organs or tissues) of within the body, and this is where disorder settles in.

Dosha	Key Dhatus	Key Organs and Systems
Vata	Majja, Ashthi	Nervous system, Kidney, Skeleton
Pitta	Rakta	Liver, Spleen, Eyes, Blood
Kapha	Rasa, Medas, Mamsa, Shukra	Respiratory system

 

Dr. Halpern Principle of Ayurveda Medicine Chapter 4: pathology Table 21 – Dhatus and Organs as Sites of Relocation –

• Manifestation stage: the symptoms of the disease of the tissue or organ become deepen, and complexity of the disease gets its name from Allopathic medicine stand point.
• Diversification stage:  it is the final stage in the unfolding of the disease, and the symptoms become very specific to the affected site with severe symptoms, and depends on the disease, one may face a death at this stage.

Pathology (Samprapati) and Ayurvedic Treatment (Chikitsa)

Classical Ayurveda sees sleep disorders as primarily Vata disturbances, but any dosha can disturb sleep when any dosha increases the Majja dhatu [59] and Manovaha srota [60]high.  For Pitta, Sadhaka subdosha[58] is present in the cerebral cortical area, for Kapha, Tarpaka subdosha is in the medulla area of the brain, for Vata, Pranavayu governs the sensory stimuli and motor responses.  When any of the above are vitiated or increased, the person’s sleep rhythm and pattern becomes disturbed, and if untreated or alleviated, through the diseases development, the vitiations starts to take its place.

Ayurvedic Treatment for sleep disorders varies according to the individual, and the actual causes of the conditions, and the treatments will be done through balancing and bringing the disharmonized dosha(s) back into its natural state of harmony.  Treatments for sleep disorders includes Panchakarma therapies, Internal medicines, Rasayana therapies, Yoga and Meditation, Aroma therapy, Color therapy, Meditation, Breath, Pranayama, plus other yogic practices, and Life Style change management including diet regime all form part of Ayurveda treatments for sleep disorders.

Etiology, Pathology and Treatment for Insomnia.

Vata Insomnia:

Nidana – the cause and conditions precipitated by a Vata disturbing life style along with its natural qualities of cold, dry, light, rough and mobile.   When combined with irregular sleep routines, stress, worry, anxiety, intake of too much sensory stimulants, too much caffeine and restlessness easily disturbs sleep.  Also general feeling of being overwhelmed would further manifests into the Five Diseases Development stages.

Pathology – Vata accumulates and aggravated in the Purishavaha srota, then over-flow into the rasa and rakta dhatus, after that it relocates to the manovaha srota and majjavaha srota causing anxiety and restlessness.

Treatment – Vata often presents with excess motion in the mind and nervous system, and normalizing them can be difficult.  For Vata, having routines around their life style is very important to stabilize the mind and the body.

• Standard mealtimes, bedtime, and wakeup time.
• Limit sensory input in the evening (TV, Video game, stimulating music).
• Not getting overly excited especially before bedtime.
• Soothing bedtime rituals (warm milk with nutmeg, warm bath, daily warm oil massage(self abhyanga)[61], deep relaxation exercises).
• Long term tonifications (Shirodhara[62], abhyanga, yoga and meditation)
• Time in nature
• Sleep rhythm adjustment with sun.
• Mantra chanting (bija mantra of Lum)

– Intake of sedative herbs (Jatamasi, Shank Pushpi, Ashwagandha, with/without sesame oil, or buttermilk). These herbs reduce the flow of prana through the nerves and nadi[63] of the physical and subtle body.

Ayurvedic Classical text on how to induce sleep

“Therapies to Induce Sleep:

Massage, anointing, bath, meat-soup of domestic, marshy and aquatic animals, rice with curd, milk, fat, wine, mental ease, pleasant smell and sound, gentle rubbing,

saturating drops and paste on eyes, head and face, well-covered bed, comfortable room and proper time [including establishing the same time each night]– these bring shortly the sleep which is disturbed by some factor.”

– Caraka Samhita Sutrasthana21#52-54 –

Pitta Insomnia:

Nidana – Usually Pitta experiences sleep disorder symptoms due to the lifestyle of consuming hot and spicy foods, overly intense, overly competitive, working late, work pressure, and often a nickname “workaholic” associated with Pitta people.  Warm nighttime temperature, too many nights laying in bed thinking about work, setting goals, planning or trying to solve work related problems would cause insomnia.

Pathology – Pitta accumulates and aggravated in the annavaha srota, then over-flows into the rasa and rakta dhatu. after that it relocates to the manovaha srota where the mind becomes overheated, increases focus, and may become obsessed with problem solving.

Treatment – Majority of the treatments for Vata insomnia are applicable for Pitta along with cooling oil (Brahmi oil prepared in coconut/sunflower oil) massages to the scalp in the evenings.  Also a purgative (remove heat) may help to reduce pitta from its root.

For the cases of too warm weather related insomnia, it can be alleviated by use of bitter, and alterative herbs to cool the body.  If work related obsessive planning and problem solving insomnia, take time before bed to write down their thoughts, and if the thought arise again while in bed, instead of thinking excessively in bed, get up, write it down, and go back to bed.  Also take time out for vacations, and participated in non-competitive, playful, and light on the mind type of activities.

Kapha Insomnia: Kapha is Water and Earth, thus sleeps well and seldom have sleep disorders having such qualities as heavy, dull, and moist, getting too much sleep may arise as a disorder.

Classical text indications on how to Reduce Sleep:

“Purgation, evacuation of head, emesis, fear, anxiety, anger, smoking, exercise, blood-letting, fasting, uncomfortable bed, predominance of Sattwa and subduing tamas–these check the unwholesome and excessive occurrence of sleep.”

– Caraka Samhita Sutrasthana21#55-57 –

 

Etiology, Pathology, and Treatment for Restless Legs Syndrome

Nidana – The Western medicine still does not know an exactly Etiology for this condition. Restless legs syndrome may be due to an internal itching sensation or intolerable creeping sensation in the lower extremity.  This sensation can be so strong that there is an irresistible urge to move the leg.  This condition seems to occur during the Vata time (at the dawn and at the dusk), or at the end of the day when a person goes to bed exhausted, and fatigued.  This condition may get worse when it is cold or at a cold climate.

“Restless leg syndrome is a neurological condition that is characterized by an uncontrollable desire to move the legs while resting or trying to fall asleep. The condition has no known cause and no known cure and often gets worse as a person ages. It is also not known how many people suffer from the condition though most Medical Doctors report having seen between 1-10 cases. As the condition has been receiving recent publicity, more patients can be expected to report symptoms to their doctors and practitioners.”

• Dr. Halpern, Clinical Article: Restless Leg Syndrome: An Ayurvedic and Personal Perspective –

Pathology – From an Ayurvedic perspective, the pathology of the condition includes a disturbance of vata dosha in the majjavaha srota. Vata dosha is responsible for excessive motion and disturbances in the movement of prana. In my condition, it was clear from the agitation to the solar plexus that pitta also played an important role. Hence, it can be said that vata may be pushing pitta out of balance.

• Dr. Halpern, Clinical Article: Restless Leg Syndrome: An Ayurvedic and Personal Perspective –

In line with the etiology factors described above, there may be the Vata qualities of  excessively active, mobile and irregular attributes in mamsa and majja dhatus contributing to restless leg syndrome.

Vata dosha accumulates, and aggravates in the digestive system, then over-flows into the circulatory system, after that, relocates in the mamsa and majja dhatus, then manifest and diversifies.

Treatment – Dr. Halpern lists extensive list of treatments base on his own personal dealings with the disorder and his own recovery from the disorder.

In considering treatment for the condition, the Ayurvedic practitioner should consider a vata or vata-pitta pacifying program of diet, herbs and lifestyle. Herbs that may be beneficial are those with the following actions.

1. Nervine Sedatives: These help reduce the flow of prana through the nerves and nadi of the physical and subtle body. skullcap and jatamamsi are good examples of nervine sedatives.
2. Nervine Tonics: These herbs help to stabilize the flow of prana through the nerves and nadi of the physical and subtle body while improving the ability of the nervous system to manage stress. Ashwaganda and shankha pushpi are examples.
3. Rasayanas: These are herbs that restore the strength and endurance of the body. Many herbs are considered to be rasayanas including ashwaganda and amalaki.
4. Cool Dipanas: These herbs have a regulating action on agni and on the flow through the manipura chakra. Fennel, dill and aloe vera are examples.

Dr. Halpern also indicates below as additional treatments from his patients.   Each patient has their own unique experience and each person’s path toward healing is often equally unique. Below are additional suggestions on how to manage Restless Leg Syndrome.

1. The condition may improve if the patient goes to bed earlier, prior to the rise in pitta that naturally occurs after 10:00pm .
2. If the condition is active, consider having the patient get out of bed and perform yoga poses that work the thigh muscles and also those that flex and extend the solar plexus and pelvis. I have found that forward bends, backward bends and spinal twists are all beneficial as well as specific poses that contract the thighs such as the chair pose and the warrior pose series. I would not recommend any poses be performed in a manner that is too active. All poses should be performed very slowly with great attention to the body and breath.
3. Have the patient perform alternate nostril breathing before bed.
4. If your patient has found that sexual release alleviates the condition encourage a period of abstinence to build the shukra and the ojas.
5. Avoid the use of stimulants such as caffeine and nicotine.
6. Avoid the use of white sugar

Etiology, Pathology, and Treatment of Chronic Fatigue Syndrome (CFS)

Nidana – According to the Center for Disease Control there are approximately 500,000 adults who suffers from this syndrome, and when chronic viral infection such as Epstein Barr Virus, Allergic mechanisms, and Faulty immune function have been suggested the cause is not known.  In Ayurvedic point of view, this disorder is predominantly a Pitta disorder, but Vata and Pitta in combination can cause the disorder as well.  Chronic Fatigue Syndrome and sleep disorders can go side by side, since poor sleep depletes Ojas, and lowers the body’s immune responses to any diseases.  With continued poor sleep, the body can not repair itself, further more can not build the ojas, therefore people with compromised immune system, and low ojas can become susceptible to this disease, for any diseases for that matter.

Pathology – An infectious mononucleosis virus[64], can infect the rasa dhatu (both stable and unstable) by clogging up the channels especially the lymph nodes in the area of the neck, then it becomes inflamed and swells up.  Low grade fever, sore throat, aches and pain are common symptoms, and the person may feel like “dead on his/her feet with feeling of extreme fatigue.  Usually Pitta increases the rakta dhatu, resulting in burning out the dhatu and causing fatigue.

Pitta dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the circulatory system (Rakta dhatu), then manifest and diversifies.

Treatment – Restore Ojas and building the rakta dhatu is the upmost important regiments, and followed by below lifestyle recommendation.

• Don’t over exert oneself
• Have enough restful sleep
• Eat home-cooked meals,
• Don’t eat foods with additives or preservatives, or canned food.
• Take multi-vitamins.
• Take care of allergies: food intolerances and seasonal and all allergies.
• Intake of herbs:
  • Amalaki, Turmeric. These herbs are blood tonic and rebuild Rakta dhatu.
  • Licorice, Ashwagandha, Bala.  These herbs are Rasayana herbs.

Etiology, Pathology, and Treatment for Depression

Nidana – In Ayurvedic perspective, depression is a sign of low Ojas and weak immune function.  Depression is most commonly a Kapha psychological disorder.  Kapha struggles with low energy/ojas, reduced functioning, slow metabolism and obesity, attachments, and have very restrictive world views, and the struggles could lead to depression.  Vata people tend to be melancholic and sensitive, and having lower body mess with poor stamina makes them easily get hurt.  Vata depression is associated with abandonment, lack of love and nurturing in life, and in a long run easily become unhappy, depressed, and on severe situation, they may become suicidal.  Pitta depression often follows some failure in life from not being able to achieve the level of success one wanted and become depressed, and the depression often accompany by anger.

The Western medicine defines the depression in two different types.  Healthy depression means when a person is feeling realistic feelings of pain, sadness, disappointment, guilt, anger, anxiety, or physical or psychological trauma.  Unhealthy depression means suppressing the realistic feelings for a prolonged time period so starts to effect sleeplessness and insomnia, and eventually leading into a serious depression.  The effect becomes cause and cause becomes effect.

People feel depression one time or more throughout their lives, and the nature of depression is that it comes and goes.  Most of people are capable of functioning normally in relationship and in life in general in this state, and go about with their lives.

Some people may be unable to function in one or more areas of life, and when healthy depression is prolonged,  with this persistent bad feelings, sad feelings, and unrealistic suppression of these feelings, will produce chemical changes in the brain, which then turns into a unhealthy depression.  A person with unhealthy depression may suffer from insomnia, passive, less active, sleeping abnormal amounts of hours, sleeping during the day, and insomnia at night and gets into a vicious circle of not getting proper sleep, moving further into unhealthy depression.

Pathology

Vata type of depression shows, fear, anxiety, internalization and self blame of cause for problems, and insomnia.

Vata dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the mind (Manovaha srota), then manifest and diversifies.

Pitta type of depression shows, failure, anger, hatred, envy/jealousy, competitiveness, and outwardly blaming for failure.

Pitta dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the mind (Manovaha srota), then manifest and diversifies.

Kapha type of depression shows, greed, possessiveness, hypersomnia, emotional eating, and deep attachment.

Kapha dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the mind (manovaha srota), then manifest and diversifies.

Treatment 

Changing lifestyle can beneficial in both cases of healthy and unhealthy depression.  Vata and Kapha type depressions are some what easier to treat than the Pitta, since Pitta type of depression can become serious and may need medical help.

These are type of treatment one can easily do to get out of short-term and long-term depression.

– Routinize the lifestyle by sticking to a daily routines

• Wake up early and watch the sunrise
• Go for a morning walk
• Increased periods of activity are better than prolonged periods of passivity.
• Cultivate friendships and enjoy a social life
• Try not to take things personally
• Watch your life objectively and know yourself as you are
• Eat fresh food (steamed vegetables, basmati rice, mung dal, fruit, wholesome foods, etc)
• Don’t eat leftovers, canned goods, frozen food.
• Daily yoga, Pranayama, meditation or relaxation.

Vata type specific treatments

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Depression.

• Dashmula 500mg, Ashwagandha 400mg, Vidari 300mg, Jatamansi 200mg – three times a day.  Triphala 1/2 tsp nightly.
• Basti made from a tea containing Dashmula, Gaducchi, and Brahmi, 1tsp each.
• Whole body Abhyanga with warm sesame oil follow by a hot shower.
• Gentle yoga asana follow by calming Pranayama.
• Vacha[65] oil nasya[66]

Pitta specific treatments

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Depression.

– Shatavari 500mg, Gulvel sattva 300mg, Kama dudha 200mg, Shankha pushpi 200mg – three times a day.  Bhumyamalaki 1/2 tsp nightly.

• Basti made from a tea containing Gaducchi, Shankaha pushpi, and Jatamamsi, 1tsp each.
• Brahmi ghee nasya
• Whole body Abhyanga with sunflower oil follow by a hot shower
• Yoga asana followed by cooling pranayama

Kapha specific treatments

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Depression.

– Punarnava 500mg, Chitrack 200mg, Kutki 200mg, Sarasvati 200mg – three times a day.  Bibhitaki 1/2 tsp nightly.

• Whole body Abhyanga with sesame oil follow by a hot shower
• Vigorous yoga asana followed by heating pranayama
• Basti made from a tea containing Punarnava and Brahmi – 1tsp each.
• Anu tailam nasya or vacha powder nasya
• Abhyanga (sesame oil massage of the whole body) followed by hot shower.

Etiology, Pathology, and Treatment of Sleep Apnea

Nidana – Loud snoring, noisy breathing, gurgling, and harrumphing during sleep can all be associated with sleep apnea.  People who are obese, have nasal congestion or stuffy nose, deviated nasal septum or other such conditions often has sleep apnea.  Other sleep apnea cause could be some food intolerances or food allergies, and induced by cold medicines and other drugs.

Pathology – Sleep apnea can be seen as Kapha dominant disorder since it is highly associated with obesity as a main symptom, but also Vata and Pitta could have this disorder.

Kapha dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the Medas (Medovaha srota), then manifest and diversifies.

Treatment (Lifestyle recommendations)

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Sleep Apnea.

• Punarnava 500mg, Sitopaladi 400mg, Talisadi 300mg, Abhrak Bhasma 200mg, Trikatu 100mg, three times a day. Before going to bed, inhale steam with 2 drops of eucalyptus oil to open up the air passage in the nose.
• Lose weight with proper diet and exercise
• Use of nasal spray that relieves nasal congestion
• Nasya with vacha oil before going to bed
• Avoid drinking alcohol since it can increase sleep apnea
• No smoking
• Avoid allergic foods
• Avoid eating late at night
• Yoga asana and pranayama – alternating nose breathing, and fire breathing.

 

Etiology, Pathology, and Treatment of  Snoring

Nidana – When a person sleeps on the back, gravity acts on the loose tissue in the upper respiratory passage and the tongue falls backward into the throat, and that creates snoring.  Snoring is particularly common in men since they have a more oval vocal cord because the physiology of the Adam’s apple, and frequently occur in obese people and those with  upper respiratory congestion.  Snoring can be not only a stressful thing for the partner to endure nightly base due to being waken up by the noise, but also lose of sleep can become serious problem in many aspects including their health.

Causative factors:

• sleeping on the back
• obesity
• upper respiratory congestion
• heavy consumption of alcohol in the evening prior to sleep
• sleeping pills and tranquilizers
• insufficient sleep
• stress
• a soft, and saggy mattress
• a pillow that is too low/high

Treatment (Lifestyle recommendations)

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends the below herbal formulation and Lifestyle changes for treating Snoring.

• Sitopaladi 500mg, Talisadi 400mg, Mahasudarshan 300mg, Abhrak Bhasma 200mg, three times a day.  T

– Take 1tsp of bhymamalaki before bedtime will help this condition

• sleep on the side (especially the left side as this promotes better digestion)
• ensure sufficient sound sleep always
• sleep on a firm mattress
• use an appropriate pillow (size, firmness, etc)
• elevate the head end of the bed if possible
• inhale steam with eucalyptus oil
• no smoking
• avoid drinking alcohol in the late evenings

 

Etiology, Pathology, and Treatment of Migraine

Nidana – Ayurvedic interpretation of migraine are due to Vata and Pitta type vitiation due to lack of sleep, overwork, stress, poor digestion or muscular tension.  Pitta constitution who are perfectionist, compulsive types, or type A personalities with success oriented and live more in the head than the heart may be with frequent migraine.

Vata type is characterized by irregular pattern of onset reoccurrence accompany by throbbing pulsating pain, Cluster headaches, Constipation, and Gas and bloating.  Pitta type is characterized by burns in the eyes, red eyes, facial sweating accompany by Excessive sweating, Nausea, Photosensitivity, Flashes of light (ophthalmic migraine).

Common causative factors are:

• disturbed sleep
• emotional factors
• food allergies and intolerances
• coffee
• chocolate
• soft drinks (Cola and such)
• citrus fruits
• sour foods

 

Pathology – There are two main theories to its pathology.

1 – The blood vessels (rakta) contact, due to the cold attribute of Vata, blocking flow to part of the brain(majja).

Vata dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the Manovaha, Raktavaha, and Majjavaha srota, then manifest and diversifies.

2 – The blood vessels (rakta) expand due to the hot quality of Pitta, exerting pressure on the nerve fibers(majja), causing pain.

Pitta dosha accumulates, and aggravated in the digestive system, then over-flows into the circulatory system, after that, relocates into the Manovaha, Rasavaha, Raktavaha and Majjavaha srota, then manifest and diversifies.

Treatment – In classical Ayurveda, Headaches are called Shirah Shula, Shiro Roga, or Shiro Tapa, and Shula, Roga, and Tapa, they all referencing the meaning Pain.  All headaches are conditions of pain, and pain is one of signs of Vata vitiation, thus pacifying Vata is the first crucial step.  Pain in the head is understood as excessive upward movements(Prana vayu, Udana vayu), therefore restoring downward movement (Apana vayu) using laxatives or purgatives would alleviate the excessive upward movements as well as Anuvasana basti (added benefit of nourishing the patient and an essential treatment as a long term care for Migraine and Headaches).

Chronic Migraine and Headaches can further benefit from tonifying therapies to the head such as Shirodhara and Shirobasti.

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Chronic Migraine Headaches.

• Dashmula 500mg, Shatavari 300mg, Kama dudha 200mg, Tagar 200mg, and Jatamamsi 200mg, three times a day.
• Half a teaspoon of Bhymamalaki nightly with warm water
• Do nasya daily with vacha oil nasya for vata.  Brahmi ghee nasya for pitta.
• Rub Bhringaraj oil and Brahmi oil on the scalp and soles of feet before bedtime.

(Lifestyle recommendations)

• Sufficient sound sleep
• Avoid artificial sweeteners and MSG
• Avoid prolonged exposure to sunlight, or wear a hat and sunglasses
• No smoking or drinking alcohol
• Avoid excessive sexual activity
• Take time to relax
• Munch on magnesium: green-leafy vegetables, pumpkin seeds, oats, barley, and soy beans.
• Drink enough water
• Avoid foods to which you are allergic
• Cool the scalp by applying coconut oil medicated with brahmi oil
• Take a brisk walk or do other aerobic exercise in the early morning during Kapha time
• Rest, read, and relax during the middle of the day (during Pitta time).

Etiology, Pathology, and Treatment of Bedwetting in Children

It is important for a child who wets his or her bed not be punished or shamed since it can strongly affect the child’s self esteem, and affects the stress level thus worsen the issue.  Deal this situation as delicately as possible, and keeping the matter discrete is a must, again not to undermine the child’s self esteem.

Common Causatives for bedwetting:

• A family history of bedwetting may contributing factor
• A small bladder
• Overactive Prana Vayu
• Respiratory allergies, which can cause insufficient sleep
• Psychological factors, such as stress, fear, or anxiety
• Scary stories or horror movies should be avoided since it can aggravate bedwetting by increasing Vata dosha.

Treatment – Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad recommends below herbal formulation and Lifestyle changes for treating Bedwetting.

• Externally apply Vacha paste to the belly button.  Internally give (Tila-guda Rasayan) sesame-jaggery candy, made from: Ground Sesame seeds, and Raw sugar or Jaggery – 1/2 tsp mixed well together.
• Boil 1 cup of milk, 1/2 cup of water, 5 whole pippali together.  Cook until water evaporates and the mixture reduces to one cup in total.  Give this to the child an hour before the bedtime. (1 cup of warm licorice milk is an alternative to this).
• Gulpa marma is a set of Marma points that can be gently massaged with vacha oil before bed.  Connected to the Kidneys, Ureter, and Bladder, and gentle massage will calm down undue stimulation of Apana Vayu.
• Brahmi 200mg, Jatamamsi 200mg, and Shanka pushpi 200mg as tranquilizing effect to minimize bedwetting.
• There are cases that a child wets the bed because of the worms.  Therefore deworm the child by giving Vidanga 200mg, Palash 200mg, Kamila 200mg, and Krumi Kathar 200mg, and clean the perineal area before bed with a cotton swab dabbed in need oil.

Etiology, Pathology, and Treatment of Sleepwalking

Through Ayurveda Today article Volume XXIV. Number 2, Dr. Vasant Lad interpretation, recommends below herbal formulation and Lifestyle changes for treating Sleepwalking.

Nidana – The exact cause of Sleepwalking is unknown.  In Western medicine, this is called Somnambulism, meaning Sleeping Ambulance.   It is surprisingly common in children, and rare in adults.  Some children who are oversensitive can have overactive autonomic nervous system and experience sleepwalking or other sleep disorders.

It is more common in male children and female adults. Women can suffer from this condition during the menarche age as hormonal changes may trigger the hypothalamus which governs autonomic actions.  There is real danger of physical trauma to the patient or to others.The person has little or no recollection of his or her sleep walking the following day.

It is an autonomic action performed during sleep due to high Vata in Majja dhatu.  Sleep is induced by Tarpaka Kapha, Sadhaka Pitta, and Prana vayu, Vata.  When Tarpaka suppresses Prana, it can get disturbed and stimulate the autonomic nervous system.  The person appears to awaken partially with open eyes, but a blank facial expression.  He or she may sit up, sit on the edge of the bed, walk around in the bedroom, or leave the room.

Treatment 

-Ashvagandha 500mg, Brahmi 400mg, Shankhapushpi 300mg, Jatamamsi 300mg – three times a day.

• Nasya with Brahmi ghee or vacha oil
• Place a silk bag (4×4 inches) of Jatamamsi root under the pillow
• Massage Murdhni, Sthapani, Oshtha, Jatru, and Kshipra marma points with nutmeg oil
• Mantra, yantra, homa, and havaha therapy can be beneficial if under expert guidance
• Rub Bhringaraj oil on the scalp and soles of feet at bedtime.

Lifestyle recommendations:

• Lock the door and windows in the room
• Place a safety gate at the top of any staircase
• Don’t keep any fire or water hazards
• Hide the car keys
• Keep the patient under observation
• Avoid horror movies or scary stories before bedtime
• When appropriate, another person should sleep on the side of the room closest to the door

Ayurvedic Disease Management: Panchakarma 

Panchakarma is an individualized, per patient specific, most complete and effective, and powerful healing therapy utilized in Ayurveda for cleansing the body and eliminating the root causes therefore evacuating the diseases from its root.  Panchakarma care consists of selecting a proper therapy for the patient, by an  Ayurvedic practitioner, who would need to decide on which type of treatment is the most optimal and best for the patient base on the patient’s health(ojas) level and excess or decreased dosha.  There are tonifications therapy (Brimhana Chikitsa) and there are two different types of reduction therapies, one is Langhana chikitsa, the other is Shamana Chikitsa.

Brimhana Chikita is to increase the internal strength of the patient who are weak or debilitated, weight lose, mental instability, the old and very young, postpartum, and the patient should be free from ama (toxins in the body).  The individually (Vata, Pitta, and Kapha) adjusted to emphasize Brimhana Chikita procedure is through five sensory therapies increases and builds the tissues (dhatus) of the body, and during and after the process, the patient often gains strength and improves the endurance.

Langhana Chikitsa is to either decrease the quantity of a dhatu or purify it, and often through this process the patient may lose weight and the strength thus the body diminishes.  This Langhana chikitsa therapy is recommended for very specific patients who are strong, have excess tissues/dhatus and/or ama/toxins, to reduce the excesses, and this is also done through specifically individualized five sensory therapies.

Shamana Chikitsa is called palliation, a mild reduction therapy.  This therapy is generally recommended for a patient who is not strong enough for panchakarma procedures, and its overall effect is a gentle cleanse.  Main emphasis on watching the patient during this mild cleansing process so the patient doesn’t become more aggravated and/or reduced of Vata imbalances.

For sleep disorders patients, they may have depleted health(ojas), and other weaknesses in their body.  For that circumstances, a Palliation (reduces the vitiated dosha, but does not expel it, and it is a gradual purification process to the body) would likely be selected and performed by the practitioner.  There are three phases in Panchakarma process.  The first phase is Purva Karma (preparation), the second phase is Pradhan Karma (Elimination of the dosha/ama), and the third phase is Praschat Karma (Post care/rebuilding healthy dhatus/ojas).

Palliation for Vata patient –  The program should not exceed 5 to 10 days.  The palliation program includes some tonifying therapies with purifying therapies to ensure Vata imbalance does not arise.

Summary of Vata Palliation Therapy

Therapy	Details
Diet	Kitcheree, Takra, Cooked Vegetables
Herbs	Pachanas – ginger, asafoetida hingwastika
Exercise	Mild Vata pacifying yoga asanas – such as virabhadrasana, Padangusthasana, Tadasana, Basic Virasana, and etc.Walking
Heat	Moist heat – baths and steam 15-20mins
Color therapy	Warm colors
Aroma therapy	Spicy and sweet aromas
Subtle therapies	Alternating nostril pranayama, Chanting “Ram”, Chanting of Gayatri mantra, and Mahamritunjaya mantra, Meditation
Tonic balancing therapies	Daily light oil application – Sesame oil with Ashwagandha, Bala, and Shatavari.Small amount of tonic herbs taken orally – Ashvangandha, Bala, Shatavari, and any demulcent herbs.
Duration	5 to 10 days.

– Dr. Halpern Principle of Ayurvedic Medicine, Chapter 11: Principles of Pancha Karma-

Palliation for Pitta patient –  The program should not exceed 7 to 14 days.  The palliation program includes some tonifying therapies with purifying therapies to ensure Vata imbalance does not arise.

Summary of Pitta Palliation Therapy

Therapy	Details
Diet	Kitcheree, Takra, Sunflower seeds, Cooked Vegetables
Herbs	Cool dipanas – coriander, fennel, cuminBitter tonics – Kutki, dandelion root, milk thistleCool diaphoretics – peppermint, chrysanthemum
Exercise	Mild Pitta pacifying yoga asanas – such as Cat stretch, Ardha Matsyendrasana Padottanasana, Child’s pose, Upavistha Konasana, and etc.Walking
Heat	Mild- only 5 to 10 mins
Color therapy	Cool colors
Aroma therapy	Cooling sweet aromas
Subtle therapies	Lunar pranayama, sheetali pranayam, chanting “Om”, “Ksham”, “Ham”, “Yam”, Mahamritunjaya mantra.  Meditation
Tonic balancing therapies	Daily light oil application – coconut, sunflower oil with bala, brahmi, and shatavariSmall amount of tonic herbs taken orally – Brahmi, Bala, Shatavari, and Licorice.
Duration	7 to 14 days.

• Dr. Halpern Principle of Ayurvedic Medicine, Chapter 11: Principles of Pancha Karma-

Palliation for Kapha patient –  The program should not exceed 7 to 14 days.  The palliation program includes some tonifying therapies with purifying therapies to ensure Vata imbalance does not arise.

Summary of Kapha Palliation Therapy

Therapy	Details
Diet	Kitcheree, Cooked Vegetables
Herbs	Lekhanas – guggul, chitrakDry expectorants – elechampane, cloveWarm diaphoretics – clove, bayleafDiuretics and Dipanas – dry ginger, clove, formula of trikatu
Exercise	Strong Kapha pacifying yoga asanas – such as Vrksasana, Jathara Parivartanasana, Marichyasana, Virabhadrasana, Surya namaskar, etcStrong aerobic exercise
Heat	Strong – 30 to 60 minutes
Color therapy	Heating colors
Aroma therapy	Warm pungent aromas
Subtle therapies	Solar pranayama, Kapalabhati pranayama, chanting “Om”, “Kshum”, “Hum”, “Ram”, Mahamritunjaya mantraDevotional singing and chanting
Tonic balancing therapies	None
Other therapies	Minimal sleep, give things away.
Duration	Approximately 30 days

 – Dr. Halpern Principle of Ayurvedic Medicine, Chapter 11: Principles of Pancha Karma-

According to Dr. Halpern, the whole procedure process, if properly done, could take up to  2 months from the beginning when a type of therapy has been choose to tonify or purify, and thereon going through the Purva Karma, Pradhan Karma, and Praschat Karma.

Purva Karma, the preparatory phase is where such therapies as internal and external oleations, other additional oil therapies, and fomentation therapy would be performed based on the specific patient to move the excess dosha into the digestive tract.

Pradhan Karma is  the removal of excess dosha from the digestive tract by procedures such as Vamana – therapeutic vomiting, Virechana – purgation, Basti – Enema, Nasya – Nasal purgation, Rakta Mokshana – bloodletting.  Both Vamana and Rakta Mokshana aren’t performed due to legality in the United States of America.

Praschat Karma is also called Rasayana, and it means rejuvenation.  A form of specialized tonifications which follows purification.  The very first goal of this phase is to rebuild the agni to prevent rebuild up of ama (toxins).  Ayurveda also puts an importance in the mind, thus after a purification through Panchakarma, rejuvenate the mind along with the body.  There are therapies specific for this:

• extended periods of silence to support the clearing of the mind
• Calming mantra (Sham, Om) to also support the clearing of the mind
• Long periods of sitting in a yoga postures to support the clearing of the mind
• Sexual abstinence to allow shukra to accumulate to support the producing of ojas in physical and mental level
• Sattvic diet to support rebuilding of the mind and increase ojas
• Avoidance of stimulants to avoid decreasing mental and physical ojas
• Sattvic aroma therapy supports the clearing of the mind
• Herbs to take is brahmi/ashwagondha as powder or medicated ghee to clear the mind
• Nature retreats to support the clearing of the mind
• Meditation during 4:00am (the time of brahma) especially when the prana is most available.  This is to clear the mind
• Minimal exertion to support the rebuilding of the mind
• Minimal sleep, only as much as is needed to maintain strength and clarity.

Conclusion

Sleep disorders have multi-faceted causes, symptoms, and types of Relocated, Modified, and Diversified disease conditions.  The Western medicine provides great number of medications in the form of over the counter medications or prescription base medications.  These readily available medications treat similar symptoms with a single type of medication, rather than specifically individualized medication.  Whether it is over the counter medication or prescription medication, they have numerous side-effects, which within itself could become a causative of a disease or an unintended addictions.  Although the western medicinal practice started to included alternative herbal medications and relaxation technics, and even adopted some meditation practices into their treatments.  However the cure for sleep disorders seem to be targeting the symptoms, not the causes at best for now.

Both western medicine and Ayurvedic understanding of sleep have very similar definition in terms of sleep patterns being cyclical.  In western there are 5 stages of sleep, in Ayurveda there are 3 stages of sleep, and both practices emphasize strong rhythms in sleep.  Also, both strongly associates good quality of sleep as essential to one’s over all good health.

Dr. David Frawley, Dr. Marc Halpern, and Dr. Vasant Lad,  all see the sleep disorders having their root in Vata as the cause, with high Vata in the mind, and low ojas, which has relocated into the nervous system, and they put emphasis in a holistic approach of an Ayurvedic regimen for the proper use of senses, and specifically individualized treatments base on tonifications or palliation, reduced stressors, developed routines, lifestyle changes, the right diet, the use of specific herbs, the state of mind, exercise, meditation, all those that are the best for the specific individual.  These types of life changes support the healing of sleep disorders and the nervous system bringing them back in balance and harmony.

Furthermore, when a patient is back in harmony with his/her health state, this individual would have the knowledge to properly manage senses for mental, physical, as well as the subtle consciousness level aspect of his/her own health.

Finally some classical text description of how sleep comes to us for a restful night.

 Yadá Tu Manasi Klánte Karmátmanah Klamán Vitáh

Vishayebhyo nirvartante tadá svapiti mánavah 

Translation – Our body, mind, and senses become tired of being consciously active because of our daily activities, thoughts, feelings, and emotions.  Then the mind withdraws from the sensory world and enters the Sushumna nadi, which is the central canal of the spinal cord.

-Caraka Samhita, Sutrasthana, ch. 21, vs, 25-

 As a falcon or an eagle, having flown through the sky and grown weary, spreads its wings and glides down to its nest, even so this person hastens to that state of sleep where he desires no desires and dreams no dreams.

– Brihadaranyaka Upanishad, 4.3.19 –

References:

[1] Book: The Harvard Medical School Guide to A Good Night’s Sleep – Lawrence J. Epstein, M.D and Steven Mardon

[2] http://www.sleepfoundation.org/sites/default/files/2005_summary_of_findings.pdf (page 18)

[3] Health risk and lack of sleep – http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/10-surprising-results

Lack of sleep and personality disorders – http://psychology.about.com/od/psychotherapy/tp/list-of-psychological-disorders.01.htm

[5] Sleep Disorders overview: http://www.nlm.nih.gov/medlineplus/ency/article/000800.htm

[6] Dr. Marc Halpern: Clinic Ayurvedic Medicine, Chapter 7: The Nervous System.

[7] Melatonin – http://www.webmd.com/sleep-disorders/tc/melatonin-overview

[8] Cortisol – http://en.wikipedia.org/wiki/Cortisol

[9] Circadian Rhythms – http://www.sciencedaily.com/articles/c/circadian_rhythm.htm

[10] A person’s desire for sleep – Source: M.M Mitler, et al, “Methods of Testing for Sleepiness,” Behavioral Medicine 21, 1996:171-83

[11] SupraChiasmatic Nucleus(SCN) – http://www.nature.com/nature/journal/v417/n6887/abs/417405a.html  Article

Nature 417, 405-410 (23 May 2002) | doi:10.1038/417405a; Received 4 January 2002; Accepted 15 April 2002 Prokineticin 2 transmits the behavioural circadian rhythm of the suprachiasmatic nucleus Michelle Y. Cheng1^,2, Clayton M. Bullock1^,2, Chuanyu Li1, Alex G. Lee1, Jason C. Bermak1, James Belluzzi1, David R. Weaver3, Frances M. Leslie1 & Qun-Yong Zhou1

1. Department of Pharmacology, University of California, Irvine, California 92697, USA
2. Department of Neurobiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
3. These authors contributed equally to this work

Correspondence to: Qun-Yong Zhou1 Correspondence and requests for materials should be addressed to Q.-Y.Z. (e-mail: Email: qzhou@uci.edu).

Suprachiasmatic Nucleus: The Mind’s Clock – By David C. Klein, Robert Y. Moore, Steven M. Reppert http://www.multichannelsystems.com/content/suprachiasmatic-nucleus-scn

[12] Hypothalamus – http://biology.about.com/od/anatomy/p/Hypothalamus.htm

[13] Polysomnography: http://medical-dictionary.thefreedictionary.com/Polysomnography

[14] Electroencephalogram (EEG) http://www.nlm.nih.gov/medlineplus/ency/article/003931.htm

[14] NREM – http://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep

[16] REM – http://en.wikipedia.org/wiki/Rapid_eye_movement_sleep

[17] K-complex http://www.sleepnet.com/definition.html

K complex – sharp, negative, high-voltage EEG wave, followed by a slower, positive component. K complex, occurring spontaneously during NREM sleep, beginning in (and defining) stage 2. K complexes can be elicited during sleep by external (particularly auditory) stimuli as well.

[19] Primary insomnia – http://en.wikipedia.org/wiki/Insomnia

[38] Bruxism – http://en.wikipedia.org/wiki/Bruxism

[39] Delayed sleep phase syndrome – http://en.wikipedia.org/wiki/Delayed_sleep_phase_syndrome

[40] Advanced sleep phase syndrome ASPS – http://en.wikipedia.org/wiki/Advanced_sleep_phase_syndrome

[41] Non 24hour sleep wake syndrome  – http://en.wikipedia.org/wiki/Non-24-hour_sleep-wake_syndrome

[42] Irregular sleep wake rhythm – http://en.wikipedia.org/wiki/Irregular_sleep_wake_rhythm

[25] Hypopnea – http://en.wikipedia.org/wiki/Hypopnea

[30] Narcolepsy – http://en.wikipedia.org/wiki/Narcolepsy

[31] Excessive daytime sleepiness –  http://en.wikipedia.org/wiki/Excessive_daytime_sleepiness

[43] Cataplexy – http://en.wikipedia.org/wiki/Cataplexy

[36] Night terror – http://en.wikipedia.org/wiki/Night_terror

[37] Terror – http://en.wikipedia.org/wiki/Fear

[33] Parasomnia – http://en.wikipedia.org/wiki/Parasomnia

[28] Periodic limb movement disorder –  http://en.wikipedia.org/wiki/Periodic_limb_movement_disorder

[29] hypnic jerk – http://en.wikipedia.org/wiki/Hypnic_jerk

[34] Rapid eye movement behavior disorder – http://en.wikipedia.org/wiki/Rapid_eye_movement_behavior_disorder

[27] Restless legs syndrome – http://en.wikipedia.org/wiki/Restless_legs_syndrome

[26] Shift work sleep disorder – http://en.wikipedia.org/wiki/Shift_work_sleep_disorder

[22] Obstructive sleep apnea – http://en.wikipedia.org/wiki/Obstructive_sleep_apnea

[23] Sleep apnea – http://en.wikipedia.org/wiki/Sleep_apnea

[32] Sleep paralysis – http://en.wikipedia.org/wiki/Sleep_paralysis

[35] Sleepwalking – http://en.wikipedia.org/wiki/Sleepwalking

[44] Nocturia – http://en.wikipedia.org/wiki/Nocturia

[45] Enuresis – http://en.wikipedia.org/wiki/Enuresis

[46] Somniphobia – http://en.wikipedia.org/wiki/Somniphobia

[24] Simple snoring – http://www.swedish.org/Services/Swedish-Otolaryngology/Snoring-and-Sleep-Apnea/Simple-Snoring#axzz1rm2fE1Sh

[18] Categories of insomnia duration – The Harvard Medical School Guide to A Good Night’s sleep by Lawrence J. Epstein, M.D. and Steven Mardon.

[20] Secondary insomnia – http://www.thirdage.com/sleep/secondary-insomnia-causes-triggers

[21] Menopause and Insomnia – http://www.sleepfoundation.org/article/ask-the-expert/menopause-and-insomnia

[48] Common choice of over the counter sleep aids/side effects – http://www.mayoclinic.com/health/sleep-aids/SL00016/NSECTIONGROUP=2

[49] Prescription sleeping pills –  http://www.mayoclinic.com/health/sleeping-pills/SL00010

[47] A brief history of sleep medicine – http://www.stanford.edu/~dement/history.html

[50] Progressive muscle relaxation – http://en.wikipedia.org/wiki/Progressive_muscle_relaxation

[51] Biofeedback – http://www.umm.edu/altmed/articles/biofeedback-000349.htm

[52] Cognitive Therapy – http://en.wikipedia.org/wiki/Cognitive_therapy

[4] The Harvard Medical School Guide to A Good Night’s Sleep Page 6, Paragraph 3.

[53] List of energy drinks – http://en.wikipedia.org/wiki/List_of_energy_drinks

[54] Amazon.com search from “caffeine pills” – http://www.amazon.com/s?ie=UTF8&keywords=caffeine%20pills&rh=n%3A3760901%2Ck%3Acaffeine%20pills&page=1

[55]  Biphasic sleep and historical data – http://www.history.vt.edu/Ekirch/sleepcommentary.html  and http://www.lifeslittlemysteries.com/1109-bustin-the-8-hour-sleep-myth.html

[56] A historic perspective on sleep and the timeline:  http://healthysleep.med.harvard.edu/interactive/timeline

Dosha: [57] is the constitution which determines the physical and structural characteristics that define our bodies.

Vata dosha: responsible for all motion, and made up of air and ether with qualities of light, dry, cold, mobile, subtle, and rough.  Its most important residence in the body is the large intestine as well as pelvic cavity, pores of the bones, skin, ears, and thighs.  Its disturbance is any excess of motion, such as twitching, rapid breathing, rapid heart rate, and its primary symptom is pain.  Its subdoshas are, prana vayu – draws in prana(life energy/force), samana vayu – abortion of prana, udana vayu – action, expression, liberation, speech, and memory, vyana vayu – circulation of prana and blood, apana vayu – elimination of waste such as feces, urine, and menses, ejaculation and parturition.

Pitta dosha: responsible for digestion and metabolism, and made up with fire and some water.  Its qualities are light, slightly oily, unstable and sharp.  Its most important residence is small intestine (digestive fire), as well as blood, eyes, skin, sweat glands, liver and spleen.  Its disturbance is fever with reddening of the eyes or skin, heat build up in Liver or spleen. Its subdoshas are, Pachaka – digestion of food, body temperature, Sadhaka – digestion of sensory, impressions, ideas/thoughts, Alochaka – digestion of visual impression and higher truth, Bhrajaka – digestion of touch, sunlight and oil, Ranjaka – formation of blood.

Kapha dosha: responsible for structure and stability of the body, and made up of water and earth, with the qualities of heavy, cold, moist, static, smooth, and soft.  Its most important residence in the body is the production of mucous and located in the chest, head, plasma, and in all of the liquids of the body, including the synovial membranes of the joints.  Its disturbance is swelling, and more importantly weight gain, and excessive mucous production.  Its subdoshas are, Kledaka – lubricates and protects the stomach from acids, Avalambaka – lubricates and protects the respiratory system/storehouse of mucous, Tarpaka – lubricates and protects the nerves, brain and mind, Bodhaka – lubricates and protects the mouth and throat, provides taste, Sleshaka – lubricates and protects the joints, provides stability.

 

Seven Dhatus:[58] Dhatu means Tissue, and response to doshas.  The seven dhatus are the seven types of tissues that make up the human body

1. Rasa – Plasma, lymph, Chyle, Breast milk, and Menses
2. Rakta – Blood, Liver, Spleen, blood vessels.
3. Mamsa – Muscles
4. Medas – Fat, Omentum, Peritoneum
5. Asthi – Bones, Nails, Teeth, Hair
6. Majja – Nervous system, Marrow and Sclera
7. Shukra – Sperm, semen, Prostatic fluids, Seminal vesicles, Prostate glands, Ovum and Ovaries

Ojas:[59]  Primarily composed with water and earth.  It’s called the Eighth tissue, but not considered as a dhatu.  It is the essence that gives the tissues strength and endurance and the force that keeps the tissues healthy. On the physical level, biochemical manifestation, an intracellular force.  On the mind level, it stabilizes the mind and provides the container for thought and emotion.

Srotas:[60] means flow, a channel that supplies the various tissues of the body with nourishment as well as keeping them clean by removing wastes.  The word Srota is also used synonymously with organ systems.  It is considered a Vein, Artery, Lymphatic, Capillary, Duct, Passage, and many other names of both visible and subtle spaces inside the tissue elements of the body.  Structured such as gross channels are made of the dhatus, and almost all srotas have a thin lining of mucous membrane.

Annavaha – Mouth, Stomach, Small intestine.

Pranavaha – Respiratory system; lungs, bronchi, sinus.  Heart.

Sevedavaha – Sebaceous system, hair follicles, skin pores

Purishavaha – Excretory system; colon, rectum

Mutravaha – Urinary system; kidney, ureter, bladder, urethra

Artavavaha – Menstrual system; ovaries, fallopian tubes, uterus, vaginal canal

Stanyavaha – Lactation ducts

Ambuvaha – Water metabolism system; pituitary gland, pancreas, palate and others

Manovaha – Mind

Rasavaha – Lymphatic system

Raktavaha – Blood vessels, red blood cell

Mamsavaha – Muscular system

Medovaha – kidneys, omentum

Asthivaha – skeletal system

Majjavaha – brain, nervous system, bone marrow

Shukravaha – the pathway of sperm and ovum

Abhyanga[61]: The purpose of abhyanga is the application of herbal oil to the body and its subsequent absorption into the body.  Techniques have been developed to apply the oil and they varies and may be applied as a one person, or two person massage, or as self abhyanga.  Strokes applied also vary greatly and sometimes designed to affect the five vayus.  The massage is not meant to be a deep tissue massage, but administration of superficial friction which aids the absorption of oil.

Shirodhara[62]: Shirdhara is the application of warm medicated oil to the forehead over the sixth chakra for relaxation and aiding treatment for chronic headaches, insomnia, anxiety, and nervousness.

Nadi[63]: Nadi is the field of energy in subtle body whose from is more fluid than the physical body.  Energy flows through subtle channels, and the channels permeate the entire subtle body.

Mononucleosis Virus[64]: http://www.med.umich.edu/digitallab/m2pathlabs/hemepath/PDF%20files/2004%20concise%20review%20mononucleosis.pdf

Vacha oil[65]: http://en.wikipedia.org/wiki/Vacha

Nasya[66]: It introduces medicated oils and powders into the nose, the nearest access and outlet to the organs of the head.  It removes ama (toxins) from the nose, larynx, pharynx, mouth, para-nasal sinuses, ears and eyes.  Ayurveda describes the nose as the doorway to the brian since it cleanses and opens the channels of the head and improves oxygenation, the flow of prana.

Herbs[67]:

* Please note – the herbs and compounds hat are given here for the formulation are traditional combinations and used in Ayurveda and the ancient texts.  Some of these are unavailable or very difficult to obtain for a variety of reasons.  Some have problems with contamination of heavy metals other are endangered species.  Some are prevented from export by the government of india .  Others are not approved by FDA for consumption and some are simply not available in USA.

 

Herb	Energetics	Tissues	Systems	Actions
JatamasiNardostachys Jatamansi – Valerianaceae	VPK =BitterAstringent SweetCooling	NerveBlood	NervousMuscularCirculatory	Brain tonicSedativeAntispasmodicAnalgesicAnti-inflammatory

EmmenagogueShank PushpiEvoluvus AlsinodesVPK =Astringent,WarmSweetNerveNervousCirculatoryNervineSedativeBrain tonicAshwagandhaWithania Somnifera SolanaceaVK – P+ ama in excessBitterAstringentSweet

HeatingNerveMuscleFatBone-marrowRe-productiveReproductiveNervousRespiratoryTonicRejuvenativeAphrodisiacNervineSedative

AstringentVidari-kandaIpomoea digitata convolulaceaeVP – KoNerveRe-productiveNervousReproductiveAphrodisiacNutritive tonicDiuretic*mahasudarshan    *Dashmula    Shatavari Asparagus racemosus: liliaceaeVP – K ama in excessSweetBitterCooling sweetWorks on all tissues elementsCirculatoryReproductiveRespiratoryDigestive General tonic for reproductivenervineNutritiveRejuvenativeDemulcent

Anti-acid

*Kama dudha    *Tagar    Bhymamalaki    Brahmi (Manduka Parni)Hydrocotyle asiatica: Umbellifera Bacopa monniera: ScrophulariaceaeVPK =BitterAstringent SweetCooling sweetNerveBloodNervousMuscularCirculatoryReproductive Brain tonicSedativeAntispasmodicAlterativeDiuretic

Bhringaraj oilEclipta alba, etc, ; CompositaeVK-P+ only in excessBitterPungent

Heating-pungentPlasmaBloodBoneMarrowRe-productiveCirculatoryNervousDigestive TonicRejuvenativeAlterativeHemostaticAntipyretic

Nervine

Laxative

VulneraryGuducchi  (Amrit) Tinospora cordifolia: MenispermaceaeVPK=BitterAstringentSweetHot-sweetBloodFatRe-productiveCirculatoryReproductiveDigestiveBitter tonicFebrifugeAlterativeDiureticAphrodisiac

Rejuvenative

Anti-rheumatic*ChitrackVP +K -BitterColdDry

FatTissueDigestionBitter tonicAnti-pyreticKutki (Picrorrhiza Kurroa)   anti-inflammatory, antidysbiosis, antasthmatic, laxative, immunoenhancer, antiarthritic, hepatoprotective, anti-allergic, immunostimulant (all aspects of immunity; T lymphocytes, B lymphocytes and phagocytes) , bitter tonic, choleretic, antioxidant, cathartic; cholagogue, laxative, digestive, alterative, and Liver Protectant against chemical hepatotoxins, hepatic.*Sarasavati

 

Classical texts references and Books:

• Caraka Samhita – Chap. IV.] SARIRA STHANAM. vs, 149 and 150 –
• Caraka Samhita Sutrasthana Chapter 1 Sutra#54 –
• Caraka Samhita, Sutrasthana, chapter 21, vs, 25
• Caraka Samhita Sutrasthana chapter 21#52-54 –
• Caraka Samhita Sutrasthana chapter 21#55-57 –
• Brihadaranyaka Upanishad, 4.3.19 –

The Harvard Medical School Guide to A Good Night’s Sleep – Lawrence J. Epstein, M.D Past president, American Academy of Sleep Medicine

Ayurveda and the Mind (the healing of consciousness) – Dr. David Frawley

Ayurveda and Panchakarma – Sunil V. Joshi M.D.(Ayu)

Dhanwantari – Harish Johari

Ayurvedic Healing – Dr. David Frawley

Yoga for your type – Dr. David Frawley & Sandara Summerfield Kozak, M.S

The Yoga of Herbs – Dr. David Frawley, Dr. Vasant Lad

Planetary Herbology – Michael Tierra, C.A., N.D.

Prakriti – Dr. Robert E. Svoboda

Ayurveda Nature’s Medicine – Dr. David Frawley & Dr. Subhash Ranade

Principles of Ayurvedic Medicine / Textbook Clinical Ayurvedic Medicine Part 2 – Dr. Marc Halpern